The debate over the role of spirituality in medicine is centuries old.
But with the recent publication of a major Newsweek cover story on the subject, it's clear that the debate rages on. And one of the most outspoken critics of recent research, Columbia Presbyterian's Richard Sloan, remains at the forefront of the controversy.
In 1999, Sloan, the director of the behavioral medicine program at Columbia Presbyterian Medical Center, published "Religion, Spirituality, and Medicine" in the esteemed British medical journal The Lancet. The paper denounced the media's excitement about the role of faith in healing the sick, making Sloan a lone voice of dissent against growing interest in alternative healing methods.
Critiquing a number of recent medical studies and popular media reports celebrating religion's role in everything from reducing blood pressure to increasing longevity, Sloan's paper identified several basic methodological errors. The Lancet paper concluded: "Even in the best studies, the evidence of an association between religion, spirituality and health is weak and inconsistent ... [and] it is therefore premature to promote faith and religion as adjunctive medical treatments."
"This [paper] is going to be a little bit of a bombshell," said Tom Mayo, a medical ethicist at the University of Texas Southwestern Medical Center, following its publication. Mayo was right. Sloan's attack provoked furious letter-writing campaigns in the academic press, and the medical profession was split in two over the issue of faith and healing research.
Four years later, Sloan continues to write papers opposing the introduction of religion into medical practice, and is working on a book on the subject. But while he hasn't given up the fight, Sloan sees little room for optimism. "I think it's worse now than it was then," he said. Despite recent inconclusive studies on the subject, he cited "an even broader interest within medicine and among the general public in pursuing what I continue to think is the wrong direction."
The Nov. 10 article published in Newsweek describes a national trial of 750 patients undergoing heart catheterization. Some members of the group were prayed for by Roman Catholics and Sufi Muslims in the United States, Buddhist monks in Nepal, and Jews at the Western Wall, while others had nobody praying for them. The purpose of the test was to see if the prayers affected quicker recovery--if, in effect, prayer heals.
"The prayer studies have not shown clear effects," the article concedes, emphasizing that "so many people already pray for the sick that scientists cannot establish a control group."
Other tests--perhaps more viable--focus on the role of patients' own spiritual lives in their health, testing variables including church attendance and regularity of prayer against various indicators of physical health. But researchers were unable to perform tests on a cellular level, relying instead primarily on epidemiological research--which can often prove misleading if multiple variables are used. Because of this possibility for error, Sloan said that he does not believe conclusive positive results will be forthcoming.
But even if research could establish a clear correspondence between faith and health, Sloan said he believes it is patently unethical for doctors to inquire into the spiritual lives of their patients, as some have done.
"It's widely known and well documented that married people live longer than single people," he said. "But we would recoil if a physician ever recommended to a single patient that he or she ought to get married. There are aspects of our lives that, even if they are relevant to health, are out of bounds to medicine."
Introducing medicine into religion, Sloan says, is antithetical to the foundational principles of American democracy.
"This country was founded in large part to avoid religious persecution, to promote religious freedom," he said. "Patients ought to engage in whatever religious practices they want. And medicine doesn't have anything to add to that."
Harold Koenig, the director of Duke University's Center for the Study of Religion/Spirituality and Health, disagreed.
Inquiring into the spiritual lives of patients "just makes too much sense," Koenig told Newsweek. Koenig recommended questions including: "Is religion a source of comfort or stress?" and "Do you have any religious beliefs that would influence decision-making?" as questions that could be asked by doctors trying to get a read on their patients' religious awareness.
But Sloan countered that such practices would be absurd.
"[Koenig] has now said that in two minutes you can collect the spiritual history on patients and that's going to be adequate to guide you," Sloan said. "That's a discussion that is enormously complicated, and it's not something a physician can do in the 10 minutes that he or she has with a patient."
A better approach, he said, would be for physicians to "simply not treat their patients like collections of organ systems, but to treat their patients as people, understand them as people, and be nice."
At the root of the popular cry for spirituality in medicine, Sloan believes, reflects dissatisfaction with the way in which medicine is practiced today in the United States.
"Patients are just pissed off," Sloan said. "They're tired of being treated like pieces of meat by impersonal physicians and even more impersonal bureaucrats at some phone screening desk."
Sloan added that the media may deserve some of the blame for the public's interest in introducing religion into medicine. "Many media outlets no longer have dedicated science reporters," he said, adding that the absence of this expertise can lead the public to a warped understanding of tests that may already contain methodological flaws.
With supporters like former mutual fund tycoon Sir John Templeton--who spends as much as $30 million a year funding scientific projects that explore the nature of God--and classes at approximately 30 medical schools on religion and spirituality for medical students, it seems unlikely that the links being proposed between spirituality and health will be severed decisively any time soon.
Sloan, who considers the religion-in-medicine craze to be a medical fad like many before it, believes it will ultimately reach a peak and begin to fade out. "This is different," he said, "because it's about something that's institutionally very important in the United States. I think that it will fade eventually, but I'm concerned about what damage may be done in the meantime."