Tuesday, May 24, 2022

It is a natural response to a serious illness in a friend or loved one to make a Mi Shebarach in shul or even, if particularly concerned, to say Tehillim in honor of the patient. These are efforts to enlist the intervention of the Almighty on behalf of the ill person. Almost all religions and cultures have their own rituals and procedures for attempting to achieve the same effect from God. Indeed, in Chapter 16 of II Chronicles, King Asa of Judah develops a foot illness, and while he consults physicians, he does not pray to God and so dies soon after.

Given the usual wide gulf between religion and science, one would think that science would ascribe these processes to the realm of quackery and generally ignore them with a half-smile and bemused shake of the head. And for the most part you would be right. Nonetheless, there does exist a fairly large published literature of studies, some well done, that attempt to determine the impact of prayer on clinical outcomes.

There are some specific issues that would be attendant on such studies. There would need to be an effort to avoid the placebo effect—a patient aware that prayers are being recited for him/her may improve simply on that basis, without a true effect of the prayer itself. A second issue may be which Supreme Being is being called upon to provide assistance—prayers directed to the wrong God may be ineffective for obvious reasons. A third problem may be what we refer to as kavana or emuna, the beliefs of those who are doing the praying. In essence, perhaps they are not doing it right or intensively enough.

Perhaps the best known study on this subject was the MANTRA II study, led by researchers at Duke University, and published in 2005 in the Lancet. It was conducted among cardiac patients and involved nine sites across the United States. Over 700 patients were randomized to have prayer groups throughout the world pray for them or not. The prayer groups were from different denominations, including Jewish, Christian, Muslim and Buddhist. The institutional review board required that the subjects be made aware that someone might be praying for them as part of a study. The subjects were undergoing cardiac stenting procedures or cardiac catheterization that might lead to stenting. The endpoints of the study included acute adverse events, such as a new myocardial infarction (heart attack), new congestive heart failure, the need for cardiac bypass surgery, or even death. It also included a six-month follow-up period with re-hospitalization or death within that time. The study ultimately found no significant differences between those who had prayers recited for them versus those who did not.

Another well-known study was the STEP study (Study of the Therapeutic Effects of Intercessory Prayer), published in 2006 in the American Heart Journal, which focused on patients who were to undergo coronary artery bypass graft surgery at six medical centers in the U.S. There were three arms to this randomized trial with roughly 600 patients in each arm. Group 1 received prayer for 14 days after being told that they may or may not receive prayer; group 2 did not receive prayer after being told that they may or may not receive prayer; and group 3 received prayer after being told they would receive prayer. The prayers were provided by members of three different Christian denominations. The outcomes, significant adverse events after surgery, were mostly similar across groups except that group 3 had slightly more complications.

A colleague of mine at Columbia, Richard Sloan, has written extensively on the subject of religion and medicine. He has reviewed most of the salient studies on the subject and he has basically concluded that it is difficult if not impossible to do a convincing study on the subject. Or, more accurately, that religion and medicine do not have anything to do with each other from an efficacy point of view. Fred Rosner, a well-known Jewish bioethicist, has similarly written that studies of the efficacy of prayer on medicine are probably not appropriate. To quote one of his articles, “Prayer in Judaism is thought to be efficacious if offered by the proper person at the proper time with the proper intent under the proper circumstances.” Obviously, this does not lend itself to testing via a randomized trial.

While I think prayer cannot be bad, I think we should recognize that we also cannot know what a good outcome means and should just pray for the best.

Perhaps we should have the geology/meteorology department do a randomized trial of prayer and rain.

And while we are at it, I would answer the question from two weeks ago as to which yeshiva had an alumnus that was a Nobel laureate aside from the Yeshiva of Flatbush. The answer is RJJ (Rabbi Jacob Joseph School) which was attended by Robert Aumann who won the 2005 Nobel Prize in Economics.

This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.

Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.

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