On a quiet Saturday afternoon, Ming He, a fourth-year medical student in Dallas, came across a man dying in the VA Hospital. Suffering from a rare cancer and hooked up to an oxygen tank, the man, an Orthodox Jew, could barely breathe, let alone speak. There were no friends or relatives by his bed to comfort him. When the young student walked into his room, the man looked at her and said, "Now that I'm dying, I realize that I never really learned how to live." Ming He, 26, had no idea how to respond.
"I thought, 'My God, the chaplain doesn't work on weekends, what do I do?' " She held the man's hand for a few minutes in silence; two days later, he died. And as soon as she could, she signed up for "Spirituality and Medicine" at the University of Texas Southwestern Medical School, a course that teaches students how to talk to patients about faith and illness.
More than half of the med schools in the country now offer such courses--up from just three a decade ago--largely because patients are demanding more spiritual care. According to a NEWSWEEK Poll, 72 percent of Americans say they would welcome a conversation with their physician about faith; the same number say they believe that praying to God can cure someone--even if science says the person doesn't stand a chance. On Beliefnet, a popular interfaith Web site, fully three quarters of more than 35,000 online prayer circles are health related: patients' loved ones--as well as total strangers--can log on and send prayers into the electronic ether, hoping to heal cancers, disabilities, chronic illness and addiction. Popular practices like these, as well as the growing belief in the medical community that what happens in a person's mind (and, possibly, soul) can be as important to health as what happens on the cellular level, are leading many doctors to embrace the God they banished from the clinic long ago in favor of technological and pharmaceutical progress.
All over the medical establishment, legitimate scientists are seeking the most ethical, effective ways to combine patients' spiritual and religious beliefs with high-tech treatment. Former mutual-fund tycoon Sir John Templeton spends as much as $30 million a year funding scientific projects that explore the nature of God (sidebar). "The Anatomy of Hope," a meditation on the effects of optimism and faith on health, by New Yorker medical writer Jerome Groopman, M.D., is coming out early next year. The National Institutes of Health plans to spend $3.5 million over the next several years on "mind/body" medicine. And this weekend Harvard Medical School will hold a conference on spirituality and health, focusing on the healing effects of forgiveness. "There's been a tremendous shift in the medical profession's openness to this topic," says Dr. Andrew Newberg, a neurologist at the University of Pennsylvania who is studying the biological effects of meditation and prayer on the brain. "People like me --are very intrigued by what we're seeing."
Modern medicine, of course, still demands scientific proof on top of anecdotal evidence. So over the past decade, researchers have been conducting hundreds of studies, trying to scientifically measure the effects of faith and spirituality on health. Can religion slow cancer? Reduce depression? Speed recovery from surgery? Lower blood pressure? Can belief in God delay death? While the research results have been mixed (chart), the studies inevitably run up against the difficulty of using scientific methods to answer what are, essentially, existential questions. How do you measure the power of prayer? Can one person's prayer be stronger--and more effective--than another's? How do you separate the health benefits of going to church or synagogue from the fact that people who attend religious services tend to smoke less and be less depressed than those who don't?
For critics of this trend, that's precisely the problem. In 1999, crusading Columbia University professor Richard Sloan wrote a paper in the medical journal The Lancet attacking the faith and healing studies for weak methodologies and soft thinking. Along with a second paper published a year later in The New England Journal of Medicine, the broadside ignited furious letter-writing campaigns in the academic press and divided the medical profession into two camps. Some scientists, like Sloan, believe that religion has no place in medicine and that steering patients toward spiritual practice can do more harm than good. Others, like Duke University's pioneering faith-and-medicine researcher Dr. Harold Koenig, believe that a growing body of evidence points to religion's positive effects on health and that keeping spirituality out of the clinic is irresponsible.
To make sense of the morass of data, the NIH commissioned a series of papers, published earlier this year, in which scientists attempted to definitively assess the state of the faith-and-health research. Lynda H. Powell, an epidemiologist at Rush University Medical Center in Chicago, reviewed about 150 papers, throwing out dozens that had flaws--those that failed to account for age and ethnicity, for example, which usually affect religiosity. In one respect, her findings were not surprising: while faith provides comfort in times of illness, it does not significantly slow cancer growth or improve recovery from acute illness.
One nugget, however, "blew my socks off," Powell says. People who regularly attend church have a 25 percent reduction in mortality--that is, they live longer--than people who are not churchgoers. This is true even after controlling for variables intrinsically linked to Sundays in the pew, like social support and healthy lifestyle. While the data were culled mainly from Christian churchgoers, Powell says the findings should apply to any organized religion. "This is really powerful," she says.
In an effort to understand the health differences between believers and nonbelievers, scientists are beginning to parse the individual components that compose religious experience. Using brain scans, researchers have discovered that meditation can change brain activity and improve immune response; other studies have shown it can lower heart rate and blood pressure, both of which reduce the body's stress response. (Most religions incorporate meditative practices, like chanting or prayer, into their traditions.) Even intangibles, such as the impact of forgiveness, may boost health as well. In a survey of 1,500 people published earlier this year, Neal Krause, a researcher at the University of Michigan's School of Public Health, found that people who forgive easily tend to enjoy greater psychological well-being and have less depression than those who hold grudges. "There's a physiology of forgiveness," says Dr. Herbert Benson, head of the Mind/Body Medical Institute, and a host of the upcoming Harvard conference. "When you do not forgive, it will chew you up."
Using prayer to effect health is perhaps the most controversial subject of research. In the NEWSWEEK Poll, 84 percent of Americans said praying for others can have a positive effect on their recovery, and 74 percent said that would be true even if they didn't know the patient. But what does the science say? At a meeting of the American College of Cardiology last month, Duke researcher Dr. Mitchell Krucoff reported preliminary data on a national trial of 750 patients undergoing heart catheterization or angioplasty. A group of patients who were prayed for (by, among others, Roman Catholics and Sufi Muslims in the United States, Buddhist monks in Nepal and Jews at the Western Wall) did no better than a second group that received standard care or a third, which was given a special program of music, therapeutic touch and guided imagery. But there was one intriguing finding: a fourth "turbocharged" group, which received both prayers and the music program, had death rates 30 percent lower than any of the other patients. "Despite all the attention modern medicine has paid to new technology, it has neglected to ask what happens if you pay attention to the rest of the patient," says Krucoff.
Overall, the prayer studies have not shown clear effects, and even religious proponents are skeptical that it can ever--or should ever--be tested. So many people already pray for the sick that scientists cannot establish a control group; when the prescription is prayer, patients often get it whether doctors want them to or not. This "noise"--the extra prayers of mothers, fathers, sisters, brothers, friends, church members--may taint trial results. And the studies prompt questions that no one, not even the best scientists, will ever be able to answer: Can one extra prayer mean the difference between life and death? Can prayer be dosed, the way medicines are? Does harder praying mean better treatment by God? In the minds of many, especially theologians, those questions border on the sacrilegious. "To think that God would only respond to the group that was prayed for and leave the other group out in the dark is based on total misconceptions of how God responds to prayer," says Cynthia Cohen, a senior research fellow at --the Kennedy Institute of Ethics at Georgetown University. "God is not a machine who responds mechanically."
Still, prayer can be an enormous source of comfort to patients and their families. Anton Imling, 54, was raised Catholic, but he rarely attended church. In 2002, Imling was diagnosed with non-Hodgkin's lymphoma, and one day last spring he wound up in the intensive-care unit at North Shore University Hospital in Manhasset, N.Y., battling a massive infection. His wife, Shirley, later told him he'd been close to death. Throughout his illness, friends and family had formed prayer circles as far away as Maryland and Texas, and Imling had begun exploring his spirituality with the Rev. Jon Overvold, who works for the HealthCare Chaplaincy in New York, an organization that provides chaplains to local hospitals. Imling believes those prayers and a "spiritual being" saved his life. He hasn't beaten the cancer and he hasn't become a zealot, but he now prays several times a week, mostly for others who are sick. "You can be the strongest person in the world, but there's a need for that extra little boost." When patients are in crisis, their religious upbringing often doesn't matter. Rabbis and imams have prayed with Catholics. Overvold's colleague, Sister Maureen Mitchell, recalls the parents of a sick baby saying, "Do your thing. We're Jewish, but whatever will help."
Other experts worry, however, that faith can sometimes interfere with a patient's journey through illness. Dr. Suki Tepperberg, a family physician in Dorchester, Mass., has concerns about those who put too much faith in God's will. One of her patients, a Jehovah's Witness who has diabetes and hypertension, believes her illness is in God's hands and she sometimes eats destructively, harming her health. Tepperberg is worried that, while this woman could take better care of herself, "she believes God really is the ultimate decision-maker." In her review of the literature, Powell found several studies suggesting that praying with a sick person can sometimes impede recovery; one study concluded that the risk of a bad health outcome doubled, perhaps because patients believed God would protect them or that their illness was some kind of divine punishment.
Interpreting disease as retribution for sin has its roots in the Bible--Miriam and King Uzziah were struck with leprosy after offending their God--and it continues to haunt many patients today. Molly Winterich, a nurse at Rainbow Babies and Children's Hospital in Cleveland, often hears parents question God, especially in the dead of the night, when fear runs rampant. They'll ask: "Why would God do this to an innocent child?" and "What did I do wrong?" Those questions, and the belief that their prayers somehow failed their children, can lead to self-reproach, despair and even physical decline. Kenneth Pargament, a psychology professor at Bowling Green State University in Ohio, studied the religious coping methods of almost 600 patients with diseases from gastrointestinal disorders to cancer. Those who thought God was punishing them or abandoning them were up to 30 percent more likely to die over the next two years. "Spiritual struggles are red flags," says Pargament. "We don't want to turn the medical profession into clergy, but to treat these struggles as divorced from the patient's medical problems is shortsighted."
Koenig, director of Duke's Center for the Study of Religion/Spirituality and Health, could not agree more. He is leading the charge for a better understanding of patients' religious and spiritual beliefs in the medical setting. "It just makes too much sense," he says, when patient after patient tells him, "Doctor, religion is the most important thing; it keeps me going." --Koenig advocates that doctors take spiritual histories of any patient they are likely to have an ongoing relationship with, asking questions like: "Is religion a source of comfort or stress? Do you have any religious beliefs that would influence decision-making? Do you have any spiritual needs that someone should address?"
Not asking can have devastating consequences because religion can affect the most pragmatic details of a person's life, says Dr. Susan Stangl, a family-medicine doctor at UCLA. Stangl recalls a Muslim patient who needed medication, but was observing Ramadan and couldn't drink or eat during the day. After taking a spiritual history--routine for all hospitalized patients at UCLA--Stangl chose a once-a-day medication that could be taken after sundown. "If we hadn't talked about it, I would have written him a prescription for four times a day and he would not have taken it," she says. "He might not have wanted to tell me. People don't want to contradict their doctors."
Today, more than 70 of the United States' 125 medical schools--from Harvard to Stanford--offer specific courses in spirituality or incorporate the theme into the curriculum, says Dr. Christina Puchalski, director of the George Washington Institute for Spirituality and Health. Students often shadow hospital chaplains in an effort to acquaint themselves with issues that don't show up in blood tests. "Patients really do want their physicians to connect with them on a deeper level than just their cholesterol," says Dr. Jeffrey Bishop, an M.D. and Episcopal priest who teaches the class Ming He is taking at the University of Texas.
Columbia's Sloan agrees, but says religion shouldn't be the arena for this kind of intimate doctor-patient connection. His main concern is that religion will creep into physicians' domain. Problems range from simple logistical issues, he says--physicians barely have enough time to ask how patients are feeling, let alone inquire about their faith--to ethical blunders. Simply asking about religious beliefs or faith could be a setup for manipulation, making patients feel as if they have to be religious for the benefit of their health and bear responsibility for their illness if they're not.
Just because some studies show that being married can make you live longer, Sloan argues, "we don't expect physicians to say to patients, 'I recommend that you get married'." Doctors should feel free to refer patients to hospital chaplains, he adds, but that's as far as the religious conversation should go. "Nobody disputes that in times of difficulty, religion provides comfort for an enormous number of people," says Sloan. "The question is whether medicine can add to that. My answer is no."
Few would disagree that doctors have to tread carefully. Dr. Jim Martin, head of the American Academy of Family Physicians, teaches residents to take spiritual histories, but "if a patient flinches, we don't go there." And if a patient says faith or spiritual beliefs are not important, " we check that box and move on." Still, Martin says some residents have crossed the line. "My problem is trying to keep them from bringing that evangelical vigor into doctor-patient relationships," he says. Lee Ann Rathbun, a chaplain at Baylor University Medical Center, recalls one incident in which the doctor told his patient that "if she was right with God, she wouldn't be depressed. I felt like he was imposing his spiritual beliefs."
Even advocates of prayer in the clinic are concerned about practitioners like Dr. Darrell Hermann. A pediatric surgeon at Baylor, Hermann says he felt compelled to raise prayer with Tiffany Webb and Jeff Fendley, a young couple whose baby was born with a dangerous abdominal-wall defect, even though he had no idea if they were religious. "I heard them make a comment that they wished she'd get better and I said, 'You could take this a step further. You could pray'." Fendley says he was pleased to make a religious connection with his baby's doctor and that it helped him cope with the severity of her condition. "He quoted the Bible and said we'll need to talk to God. There's no doubt in my mind that we did," says Fendley. "I just knelt down and cried." While Webb and Fendley found comfort in the doctor's intervention, other patients might have seen it as an unacceptable intrusion. And so the debate rages on, from the ivory tower to the bedside of a very sick child.