I’ll give this story the Most Likely Not To Appear In The Sequel To What The Bleep Do We Know Award.
Yesterday, the American Heart Journal released details of a new study that finds that there is no positive effect of prayer for cardiovascular patients receiving surgery. Patients who were prayed for but did not know of the prayer had no fewer negative complications after the surgery than a separate group of patients who simply were not prayed for.
However, patients who were prayed for, and knew that they were being prayed for, actually experienced a statistically significant higher rate of negative complications after surgery. So, this study indicates that patients who are prayed for and know about the prayer actually suffer as a consequence. It seems that the power of prayer is really the power to royally screw things up for people.
What are some possible explanations for this effect? Well, it could be that prayer makes people tense. It could be that many patients resent having people pray for them, and wish the people praying would just mind their own business.
A third, more amusing, explanation was offered by Mitchell W. Krucoff, Suzanne W. Crater, and Kerry L. Lee, the authors of the American Heart Journal article. It’s an explanation so silly that it’s got me wondering whether the entire story is just some kind of April Fools Day joke. They write, “Although for personal or cultural practices assumptions of Divine benevolence may be both relevant and satisfactory, for clinical research, such an assumption could only be considered scientifically naive as in the history of medicine there has never been a healing remedy that was actually effective without having potential side effects or toxicities.”
In plain language, the authors of the study are speculating that maybe there is some kind of divine force called upon by prayer, but that the divine force may have serious unanticipated side effects that counteract the therapeutic effects of prayer. It’s kind of like all those warnings you hear on those TV ads for prescription drugs:
Warning: Prayer may result in erectile disfunction, severe headaches, anal leakage, suicidal tendencies, and complications after surgery. Please talk to your doctor about whether prayer is right for you.
I have a more simple explanation: Prayer was found not to have any therapeutic effects because it doesn’t. Furthermore, telling cardiac patients that a bunch of people are praying for them freaks them out, so that the lack of benefit from the prayer itself is compounded by the anxiety about why a bunch of people are praying about someone they’ve never met.
This study is a welcome first step in putting all that hokum about the power of prayer in its proper place amongst the various discarded snake oil remedies of history. Let the scientific process work. Let the study be replicated. I’m confident that prayer, and other forms of what the alternative medicine folks call “widely practiced therapeutics with no plausible mechanism”, will be established in its proper place as another piece of superstitious garbage.
Perhaps you think I’m being too harsh in my language. Remember, people’s lives are on the line. They deserve to know what works, and what doesn’t, and those people who value adherence to their religious faith over helping people in need are being selfishly cruel. Medical science is one thing we should never allow to become captive to theological dogma.
I think a better test of the efficacy of prayer would be to not tell the patients anything… and have a group that is being prayed for, and one that isn’t…. and see what happens.. This would take any negative thoughts associated with a patient thinking that they need to be prayed for…
Actually, there were two such groups in this study. One group was not told anything about prayer, and was not prayed for. Another group was not told anything about prayer, and was prayed for. Then, a third group was told it was being prayed for, and was prayed for.
What I would have liked to see was a fourth group… a group that was told it was being prayed for, and was not actually prayed for. That would have rounded out the study nicely.
I am an atheist, have been one since early childhood, but I confess myself to have actually aquiesced to prayer. My friend and cousin in law is a methodist minister, and my wife and I were visiting them when I experienced the onset od symptoms of some consequence of Agent Orange exposure. This consists of the rupture of capillaries in muccus membranes and uncontrolled bleeding. It’s no picnic to endure, but worse to see. We all piled into the car and they took me to their local VA where I was put into a cubicle, hooked up to some plasma, and was left alone. My rev’d cuz in law announced herself as my clergy person, and got them to allow herself and my wife in. (her husband is also an atheist, and exceppt for my wife, sons, and their families, he and his wife and their daughter are my closest friends)Anyway, my rev’d cuz in law asked if I minded if she and my wife prayed for me. I asked if they really HAD too, and she said they would respect my wishes…but they were afraid, didn’t understand what was going on, and no one would tell them anything, so they would probably “wind up screaming at me like a pair of harpies.” I admit it, I told them to go ahead if it made them feel better. PLEEEEZE! Didn’t make anything better, but there was a worse alternative.
Nicely documented, J.Clifford, my prayers for you have been answered.
Adriftatsea, studies such as you describe have been done, the one I have read about shows prayer has no effect if the person does not know they are being prayed for.
The comments to the study point out a couple of loose ends. One is that in a similar study two-thirds of the people who had been assigned to a group not being prayed for thought they were being prayed for when they were not. Following up on this group might have shown something about placebo effect.
From the review, “A more straightforward interpretation might have been that patients who were asked to hide a clinical study treatment assignment from their bedside staff and ‘who were certain that intercessors would pray for them had a higher rate of complications,’ that is, that this construct appears to do harm.”
One of the effects of prayer is to mobilize the patient’s social support network. Asking the patient to hide their knowlege that they were being prayed for from their primary caregivers serves to isolate, not link, the patient from social support. So the study does not tell us whether the key detrimental factor was the prayer itself, or the effect of stress from attempting to keep secrets from the primary caregivers.
Sarge, very perceptive that the prayer might make the person praying feel better. So your caregivers could spend more time dealing with your medical needs and not the very real emotional needs of your family.
Finally with regards to…
“Although for personal or cultural practices assumptions of Divine benevolence may be both relevant and satisfactory, for clinical research, such an assumption could only be considered scientifically naive as in the history of medicine there has never been a healing remedy that was actually effective without having potential side effects or toxicities.”
…I am not aware of any adverse effects from placebos. While the mind-body connection in medicine is poorly understood, it is also well known that morphine works much better when caregivers tell patients in advance they will experience pain relief from it.
I haven’t read the article. Serious question:
Did the author’s consider the possibility that those who knew that they were being prayed for had a heightened expectation for recovery due to some divine intervention, and so made less effort themselves (following drug therapies, exercising, appropriate rest…).
Less serious question:
Or maybe those doing the praying just came from the wrong sub-subdivision of Christianity, so God wasn’t paying attention; or maybe those doing the praying didn’t believe sincerely enough, so God wasn’t listening.
Or (now here’s a catch22 that no researcher is going to like)…
God wants us to believe on faith, not on evidence, Right?
Just like when God planted the fossil history when He created the world…
God manipulated the data as a test of faith….
Booyeah!
The complete study can be accessed for $30 unless you have a subscription, and I’m not quite that curious.
Although the name of someone I know was on the prayer list at church today. So, do I pray for him and just not tell him? or tell him after he is out of danger? Do I tell his wife I’m not going to pray for him and ‘have a nice day’? Actually, I ususally just ask how someone is. That conveys concern without appearing to meddle with God’s will. And what if someone is praying for their own death?
If Jerry Falwell was praying for me, I would get out of Dodge in a hurry.
Personally, I wouldn’t belong to a church if I couldn’t believe in dinosaurs.
There’s supposedly a scene in some Britcom, the restaurant at the end of the universe, I think, where God actually physically appears. When confronted with the inconsistency between his appearance and the faith argument for his non-existence, he disappears in a poof of smoke, having been eliminated by a stroke of logic.
I think Scott is actually on to something when he asked, “Did the authors consider the possibility that those who knew that they were being prayed for had a heightened expectation for recovery due to some divine intervention, and so made less effort themselves (following drug therapies, exercising, appropriate rest…).” The power of the mind to heal the body can be a strong force. I’m currently working on a study where we are finding that individuals who score high on a depression/anxiety questionnaire are more likely to suffer cardiovascular disease or death during the 9-year follow-up period. The people in the prayer study who knew they were being prayed for may have relaxed their own emotional efforts at healing precicely at a time when they needed to redouble and concentrate their their own efforts. However, this doesn’t explain why those who (falsely) thought they were being prayed for didn’t suffer the same effects. I think it more likely that the statistically significant detrimental outcome was simply a fluke and that in reality there were no differences between the groups.
A statistically significant fluke? Do you know the meaning of statistically significant? Sigh.
Listen, Mark, you’ve obviously not paid attention to this article. When you write “However, this doesn’t explain why those who (falsely) thought they were being prayed for didn’t suffer the same effects”, you are failing to understand that there WAS NO SUCH GROUP in this study. That explains why that group didn’t suffer the same effects. A group of people that does not exist cannot suffer from any effects.
OK, so I misspoke a little. There was a group who were told that they might or might not have been prayed for, but were not actually prayed for. Most of these people probably did believe they were being prayed for.
As for not understanding statistics, I’m a statistician conducting medical research for a major medical university. I read the original article and they state that the results they observed were were significant at the 95% probability. Their analysis was just barely significant at this level. Their test of significance resulted in a value of 1.02 (anything less than 1.0 would have been non-significant). It would not have been significant at the 96% level of significance. This means that the likelihood of observing these results by pure chance is 5%. This is a low probability, but still high enough that it could be expected to happen every so often (1 time in 20). Hence my observation that this could simply be a “statistical fluke”. There was a not inconsiderable number of people who dropped out of the study who were counted as having complications. This assumption may have swayed the statistics across the “statistically significant line”. I would argue that a majority of these drop-outs got better and went home without any complications.
Jclifford said, “Listen, Mark, you’ve obviously not paid attention to this article.” Jcliff, why be so mean? This is an example of the ‘argumentum ad hominem’ fallacy. Do I have to pray for you again?
The discussion of the study clearly states similar studies have shown there is a sub-group who believes they are being prayed for when they are not. Attention to this group might produce insights about placebo effect. This study did not attempt to identify such a group, but that does not mean the group does not exist.
It is not clear from reading the summary whether the researchers attempted to control for compliance with medical regimes. This is clearly a possible dependent variable that would explain the higher rate of negative complications for the group that knew they were being prayed for.
The researchers themselves dismissed the statistically significant finding as a fluke, which the reviewers find fault with. However, it is equally clear that prayer itself has not been isloated as a cause of these significant findings and other variables may be involved. It is certainly counterintuitive, given what we know about ‘self-fulfilling prophecy’ and ‘placebo effect’.
If people are being counted as having complications when it is not known whether they had complications, this would seem to be a problem with the design of the study.
Mark and Layla,
There were three groups in the study.
1. Patients who were prayed for but did not know of the prayer
2. Patients who simply were not prayed for.
3. Patients who were prayed for, and knew that they were being prayed for
It’s very, very simple – and pointing out a misstatement, along with explaining why a misstatement is incorrect, is not an ad hominem argument. Saying, “You can’t believe my opponent because he’s an idiot” is an ad hominem argument.
Layla, differences in observable complications are a perfectly valid measure. You seem determined to find some reason to dismiss the study.
And no, that’s not an ad hominem argument either. You… seem… determined…
I think that we could all agree that this is a pretty poor study and it’s getting a lot more press than it really deserves. The only thing it clearly shows is that praying for people who are in the hospital and recovering from surgery has no positive effect when measured by the rate of complications. The hullabaloo about whether people have negative effects from knowing that others are praying for them is, I believe, overblown.
jclifford,
these are not “observable” complications.
look at mark’s #9 post again: “There was a not inconsiderable number of people who dropped out of the study who were counted as having complications. This assumption may have swayed the statistics across the “statistically significant lineâ€. I would argue that a majority of these drop-outs got better and went home without any complications”
When people drop out of a study, it means they disappear and you don’t see them anymore, so you don’t know if they had complications or not. According to Mark, who is a researcher, (and I have had a second level graduate research course, so i can really appreciate what he does) and Mark has read the full text that you can’t read without a subsciption, the people who dropped out of the study were coded as having complications. no one knows if they had complications or not because they dropped out of the study, but the study assumed they had complications. Now, if i had complications, I would be back in doctor’s office looking for a nice script for something. If I had no complications, but instead just got well, I would save a $95 office visit by staying home and forgeting about the stupid followup appointment and the stupid study. mark thinks they dropped out of the study becasue they didn’t have complications, and so do I.
jclifford,
look again at the design of the study.
“The primary analytic plan also represents some fundamental trade-offs, as is almost always the case in clinical trial planning. As the authors carefully explain, their prospective plan compared Group 1 (prayer but uncertain) versus Group 2 (no prayer but uncertain) and independently compared Group 1 (prayer but uncertain) with Group 3 (prayer and certain). This structure allows a single feature to be assessed for efficacy in each comparison: the effect of adding prayer in a double-blind (Group 1 vs Group 2) and the effect of certainty versus uncertainty in patients receiving intercessory prayer (Group 1 vs Group 3). The trade-offs of adopting this analytic plan, however, especially in light of the data, are relatively unexplored in discussion by the authors, and although rethinking the analysis plan after the data have been examined may be fatally biased, some discussion of the absence of even secondary analyses of all exposure to prayer versus placebo or a 3-way comparison model across the studied groups might have been helpful to readers.”
“Defining other features of the study cohort might also have been revealing. Patients enrolled in the double-blinded arms might still be inclined to guess or even believe they know what their treatment assignment actually was. In elective percutaneous coronary intervention patients enrolled in a double-blinded prayer study, about two thirds of patients not actually assigned prayer believed that they were.8 In STEP, documentation of what patients were actually assigned versus what they believed they were assigned in Groups 1 and 2 (uncertain prayer and uncertain no prayer, respectively) might have provided insight into the possible role of a placebo effect.”
Group 2 in particular did not receive prayer, but they were in a double-blind group, meaning neither they nor the researchers knew whether they were assigned to a prayer or non-prayer group. Many in this group may have believed that they were being prayed for.
jclifford,
You seem…so…worried that I might pray for you.
“Personally, I wouldn’t belong to a church if I couldn’t believe in dinosaurs.” Layla
I like that quote!
Having passed my Psychology AS and A2, a large chunk of which is the validity of experiments, I say it’s a well planned experiment, though in need of follow-up studies.
The experiment needs to be repeated by an entirely different group, and I’d prefer to see some reference to the religious beliefs of the patients to see if they change results at all.
The interpretivist within me would also like an interview with each patient separately to find out THEIR views on the praying when they’re told about it, or their views on the experiment when it’s over.
If you are a student or former student, you may be able to read the full text online if your university library subscribes to this journal.
A few interesting tidbits emerged from the complete text of the study that didn’t come out in the review:
-The study was open to patients with any or no religious faith.
-The 3 groups. Group 1: 597 people did not receive intercessionary prayer after being informed that they may or may not receive prayer. Group 2: 601 people received prayer after being informed they may or may not receive prayer Group 3: 604 people were told they would definitely receive prayer.
-The intercessionary prayers were performed by 2 catholic monasteries and 1 protestant group who prayed a specific prayer for 14 days at specific times.
-Out of 3295 eligible patients, 1493 did not wish to participate. This was a 45% refusal rate. Everyone in the study signed an informed consent form. The people who would be freaked out by someone praying for them had a chance to remove themselves from the study.
-Almost all subjects believed that friends, relatives, and/or members of their religious institutions would be praying for them.
-All three groups showed a similar strong belief in spiritual healing.
-Although patients lost to follow-up were assumed to have had a complication, a modified analysis removing the patients with missing data showed similar results.
-Patients in the 3rd group had more extensive procedures performed. The percentage with 3 vessels bypassed (instead of 1 or 2) was 61% of group 3 but only 58% and 60% for groups 1 and 2.
-Preexisting health conditions like hypertension, COPD, and myocardial infarction were higher predictors of complications than whether the subject knew they were being prayed for.
-Postoperative atrial fibrillation/flutter was responsible for excess of complications in group 3
-While Group 3 had a significantly higher complication rate, the group had slightly lower readmission and mortality rates.
The researchers conclude, and I agree, that 1) the study doesn’t test the effect of prayer (since participants believed someone was already praying for them), but only the effect of a certain type of prayer 2) further study is needed to determine the reasons for group 3 having higher complication rates.
What does this tell us about the placebo effect?
Sugar pills tend to have a statistically measurable positive effect if you tell the patient they’re medication.
You would expect to at least see that here, but apparently we don’t.
What’s up with that?
There are at least some praying cardioligists and doctors who
believe in prayer enough to pray daily, but who feel there are too many
variables in prayer to allow studies to meaningfully study/evaluate.
Like this opinioin:
Newstimeslive.com Prayer study comes under fire
http://news.newstimeslive.com/story.php?id=81953&category=Local
Wednesday, April 05, 2006 1:45:58 AM GMT-7
Dr. Michael Frymus, chief of cardiothoractic surgery at Danbury Hospital, said he’s not sure why people would spend money on a study that measures the power of prayer, even though he prays daily and believes in its power. “There are just too many variables and unknowns,” Frymus said.
We’re open to all discussions. But any meeting will have to be on the basis of withdrawing the First Job Contract. There have been five one-day public sector strikes in which millions of workers and students took part. An employers group has warned the protests are starting to hurt the economy. No Pasaran!
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