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November 2003 Articles of the Month
 
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Presbyterian, Philadelphia PA.

 

Harris, W. S., Gowda, M., Kolb, J. W., Strychacz, C. P., Vacek, J. L., Jones, P. G., Forker, A., O'Keefe, J. H. and McCallister, B. D. [Mid America Heart Institute, Saint Luke's Hospital, Kansas City MO]. "A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit." Archives of Internal Medicine 159, no. 19 (October 25, 1999): 2273-2278.

Joyce, C. R. B. and Welldon. R. M. C. [London Hospital Medical College]. "The objective efficacy of prayer. A double-blind clinical trial." Journal of Chronic Diseases 18, no. 4 (April 1965): 367-377.

Leibovici, L. [Department of Medicine, Beilinson Campus, Rabin Medical Center, Petah-Tiqva 49100, Israel]. "Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial." BMJ: British Medical Journal 323, no. 7327 (December 22-29, 2001): 1450-1451.

 

SUMMARIES AND COMMENTS: Research on the efficacy of remote intercessory prayer has received much attention in recent years and at times has dominated the popular dialogue about the significance of spirituality to health and health care. This research seems to grab people's attention and generate heated debate. To some it speaks to the validity of a long-revered religious practice of praying for others. To some it stretches the very boundaries of empirical science. To some it is a ridiculous venture, and to some it is a daring inquiry. Meta-analyses and levels-of-evidence assessments of the current body of the research support further inquiry, based upon the seemingly positive health effects indicated by some well-designed studies. However, the greatest value of the studies at this point lies perhaps not in their results about whether intercessory prayer "works," but rather in the larger questions they raise about methodology and assumptions: What research methods could be appropriate here, and what assumptions--theological or otherwise--may inform the investigative process? The three articles described below present excellent opportunities for contemplating and discussing the nature of research on intercessory prayer.

The 1999 study by Harris, et al. is probably the best example of an intercessory prayer study to date, following (intentionally) in the footsteps of Randolph Byrd's 1988 report of "Positive therapeutic effects of intercessory prayer in a coronary care unit population" [Southern Medical Journal 81: 826-829] that originally spurred the current debate about intercessory prayer research. Harris and his colleagues worked with a consecutive sample of 990 patients admitted to a coronary care unit of a university-associated hospital, dividing them into a control group and an intervention group whose members were the focus of intercessory prayer (for four weeks, by first name only) by a team of Christians from outside of the hospital who did not know or ever meet the patients. The study was completely blinded, with "neither patients nor medical staff aware that a study was being conducted" [p. 2275]. Patients' courses during hospitalization were scored according to a measure (MAHI-CCU) developed for this study to track clinical outcomes. The intervention group was found to have an 11% reduction in their MAHI-CCU scores when those scores were weighted and a 10% reduction when the scores were unweighted, compared to the control group. There was no difference in the length of stay in the hospital between the two groups, though the intervention group contained two patients whose length of stay was extraordinarily long. When the two groups were scored according to a hospital course measure used by Byrd, no significant difference was found, but the authors hold that their study generally supports Byrd's overall findings. They conclude that the present study "suggests that prayer may be an effective adjunct to standard medical care" [p. 2273, abstract].

It is important to recognize that the authors do not claim to be investigating the mechanism of intercessory prayer but a phenomenon. Moreover, they caution: "...we have not proven that God answers prayer or that God even exists" [p. 2277]. Their carefulness to make these points hints at their sensitivity to the potential polemics into which their research might play. It seems also telling that they recount in the discussion of their findings the anecdote of how James Lind accurately observed that lemons and limes cured scurvy, though the natural explanation of that observation would not be clarified until "centuries later" [p. 1277]. The authors are willing to allow that their findings are the result of mere chance (1 in 25). There is a modesty about the scope and claims of the study, befitting the scientific method. However, it is worth considering the perspective of the intercessors, who all agreed with the following statement:

I believe in God. I believe that He is personal and is concerned with individual lives. I further believe that He is responsive to prayers for healing made on behalf of the sick. [p. 2274]
Can a study that incorporates such a statement as a qualifier for selecting intercessors be about the phenomenon of intercessory prayer without being also to some extent about a theologically grounded sense of mechanism? The research methodology employed in the study may be sophisticated and well explained in many respects, but the theological propositions implicit in the study--propositions that do in fact pertain to mechanisms--seem passed over lightly. The study may disclaim being an investigation of mechanisms, but it clearly incorporates a sense of them and of a theology behind them. That the authors note that one possible explanation for the effects of intercessory prayer could be "real but currently unknown physical forces that are generated by the intercessors" [p. 2277] does not offset the dogmatic character of the qualifying statement to which the intercessors assented. In the end, the work by Harris and his colleagues may pose especially well for readers a question of whether scientific methodology can transcend dogmatism when applied to the phenomenon of intercessory prayer.

The Harris, et al. study may be the most substantial published so far, but it is worth noting that the overall challenge of research on intercessory prayer was well presented in the very first study in the modern literature, in 1965: "The objective efficacy of intercessory prayer." Joyce and Welldon's study used a small sample of 48 outpatients at London Hospital who were suffering from "chronic stationary or progressively deteriorating psychological or rheumatic disease" [p. 368]. The patients were randomized into demographically similar pairs for division into control and intervention groups, and the latter received prayer for six months from prayer group members who lived at least 30 miles from the hospital and who were given only patients' first names and fictitious last initials. At the conclusion of the intervention, there was no significant difference found between the two groups, but the authors comment that this is "hardly surprising" [p. 374] because of the small sample size. It is not these results, however, that make this initial modern study of intercessory prayer remarkable, but rather the authors' good grasp of the context and dynamics of such a scientific investigation.

First, Joyce and Welldon are clear about the religious context of this work, quoting a statement from the Archbishops' Commission on Divine Healing: "Scientific testing can be a valuable corrective of rash claims that healing, ordinary or extraordinary, has occurred, and it may bring to light natural healing virtues in religious rites; but it is idle for the Church, or anyone else, to appeal to science to prove the reality of supernatural power or the truth of theology or metaphysic" [p. 367]. In this light, the authors modestly label their project a "statistical inquiry" [p. 368]. Second, they seem tuned in to the potential relevance of the attitude of those carrying out the study--whether a person is a "believer" or a "skeptic." The two authors state at the outset that they represent these contrasting attitudes with regard to intercessory prayer, and they go on in discussion to say how valuable to this research may be such cooperation across these lines of difference, especially in the development of "mutually acceptable language" [p. 375] with which to approach the subject. Third, they pay special attention to the prayer intervention, describing it in detail and noting that it required that the intercessors depart from their normal practice in order to carry it out: i.e., "They had no access to the patient, and hence no collaboration, voluntary or otherwise, from him: nor were they permitted any feed-back about their performance..." [p. 374]. The authors concede that this departure from the norm for prayers may itself have implications for study outcomes. They demonstrate a subtle understanding of the experience of carrying out this research.

In these ways, the article is distinguished by the authors' level of sensitivity to aspects of the research process that underlie practical methodology. The detailed description of the particular prayer form employed is a further example of the depth of the authors' sense of their field of inquiry.

The prayer was in each case based upon a method of silent meditation, which has been practiced for centuries in the Church. Here the emphasis is not on words or petitions but the gradual development of a disciplined silence in which the meditator attempts to still his own thoughts or at first completely to disregard them and to focus his own attention upon a short sentence--often from the bible--which expresses some positive affirmation about God. He attempts to use the words of the sentence to employ the parts of his mind which require [him] to think in words but to concentrate his efforts on holding the rest of his mind open to God. Into this prepared state of mind the meditator then brings the mental image of the particular patient and repeats his name, without dwelling on the disease or making any kind of verbal petition but thinking of the patient in the context of the love and wholeness of God. This type of prayer, which has been called "the practice of the presence of God," conceives God as the "very ground of one's being" and would seem to involve the deeper levels of consciousness. [p. 371]
Whether such an apparently fine understanding of this process of prayer actually led these researchers to some superior methodology is debatable, but their description surely allows the reader a great degree of insight into the particular intervention, which in turn invites critical assessment of the character of the religious elements of the methodology. Joyce and Welldon set early on an admirable standard for the critique of intercessory prayer research: that it attend not only to the use and explanation of statistical analysis, population, measures, etc.; but to the nature of the prayer intervention. There is perhaps no better study than theirs to spur thinking in this area. It is unfortunate that this study is today so seldom referenced for its insights.

The third study selected for this month, that by Leibovici, is chosen in part because it is relatively recent and highly controversial, but also in part because it highlights the issue of whether there are limits to which scientific methodology may accommodate theological propositions. Leibovici's research stands in contrast to every other published study--and in conflict with established scientific methodology (and some might say even common sense) in that it attempts to examine the effects of intercessory prayer retrospectively on patient cases that have already been closed. A total of 3393 patient cases involving bloodstream infection were culled from a university hospital's records (1990-1996) and randomized into intervention and control groups. Patients in the intervention group then, in 2000 (4-10 years later), became the recipients of a "remote, retroactive intercessory prayer" for their "well being and full recovery." Data on patient outcomes was subsequently obtained from a review of the selected patient records. The results: "Mortality was 28.1% (475/1691) in the intervention group and 30.2% (514/1702) in the control group (P for difference=0.4). Length of stay in hospital and duration of fever were significantly shorter in the intervention group than in the control group (P=0.01 and P=0.04, respectively)" [p. 1451].

Shortly following publication, there was a barrage of letters critical not only of the study itself but of the British Medical Journal, ranging from chiding to sarcastic (and it is worth noting that many of these letters turn up in data base searches on intercessory prayer). Nevertheless, if all of the furor can be set aside for a moment, the study is, for the pastoral care researcher, an intriguing example of research that works out of a theologically plausible proposition: namely that God is not "limited by a linear time as we are" [p. 1450]. Leibovici does not elaborate on this striking statement, but the implicit argument seems obvious: from the perspective of many theological traditions, the concept of God's omniscience assumes a divine capacity to know the future as well the past. Therefore, intercessory prayers offered after the fact may be seen to be no different than those offered before an event, at least from the vantage of God. However, the article avoids speculation about the mechanism of intercessory prayer and claims merely to report an observation in the spirit of the observations of Harris, et al. In fact, Leibovici even quotes Harris, et al. about James Lind's observations regarding scurvy (referenced above)--that those observations were accurate even though they could not be fully explained for many years.

The Leibovici study no doubt deserves criticism (e.g., at the very least for his extravagant claim that his design was "flawless" and has "proved that an effect was achieved" [p. 1451]), but for the pastoral care researcher the overarching question is whether this project is really more outlandish than other studies that also have worked out of theological propositions in one form or another. Does research into intercessory prayer necessarily demand that any theology involved be science-friendly? Is Leibovici's assertion, that his scientific observation is no different in character than that made by Harris et al. or by James Lind, acceptable? The study may strike readers as counter-intuitive, if not absurd, but it nevertheless serves as a call to contemplate what assumptions--theological or otherwise--may be present in research on intercessory prayer.


 

Suggestions for the Use of the Articles for Discussion in CPE: 

CPE students may be interested to know that one of the authors of the article by Harris, et al., is a chaplain: Jerry Kolb. In general, this article would seem a good choice for discussion, as it is well written and formatted with tables and a separate box dealing with methodological issues. While some familiarity with the predecessor study by Byrd would be helpful, it is not necessary; this replication stands on its own. Students could be asked to think about the specifics of the study, but also about the very idea of intercessory prayer research, and the latter alone would probably produce animated discussion. If some hold the views that this research "tests God," or exceeds the capacity of science, then there could be an effort to clarify the group's thinking about what lines are being crossed--a topic that touches on the broad issue of how research, as a particular means of gaining knowledge, relates to spiritual/pastoral subjects. Supervisors should be careful, however, not to let the controversial character of intercessory prayer research distract students from an appreciation of the full range of published research that is pertinent to pastoral care.

The article by Joyce and Welldon may also be a good choice for general discussion, but some students may become bogged down in the discussion of statistics. Students with an advanced knowledge of research, however, may find the authors' statistical approach fascinating. Discussion could also involve the question of whether the attitude of the researchers--whether they are "believers" or "skeptics"--is important to the research process. One unusual and intriguing aspect of the article is its reference to the 19th century background to inquiry into intercessory prayer.

Discussion of the Leibovoci study could follow from the COMMENTS made in the first section of this Articles-of-the-Month page, but the article is probably best reserved for students well versed in the research literature, as it may be too provocative a piece to serve as a introduction to the study of intercessory prayer.


 

Other Items of Interest: 

I. For examples of other studies of intercessory prayer, see:

Aviles, J. M., Whelan, E., Hernke, D. A., Williams, B. A., Kenny, K. E., O'Fallon, W. M. and Kopecky, S. L. "Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial." Mayo Clinic Proceedings 76, no. 12 (December 2001): 1192-1198. [This study involving 799 coronary care unit patients found no significant effect on medical outcomes as a result of intercessory prayer.]

[Added 3/31/06:] Benson, H., Dusek, J. A., Sherwood, J. B., Lam, P., Bethea, C. F., Carpenter, W., Levitsky, S., Hill, P. C., Clem, D. W., Jr., Jain, M. K., Drumel, D., Kopecky, S. L., Mueller, P. S., Marek, D., Rollins, S. and Hibberd, P. L. [Duke University Medical Center]. "Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer." American Heart Journal 151, no. 4 (April 2006): 934-942. Comment on pp. 762-764. [This study involving 1802 patients at six US hospitals found no evidence of the effect of remote (double-blind) intercessory prayer on "complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications" (--from the article's abstract). See also the article by Dusek, et al. (below) describing the STEP study design and method.]

Byrd, R. C. "Positive therapeutic effects of intercessory prayer in a coronary care unit population." Southern Medical Journal 81, no. 7 (July 1988): 826-829. [Byrd's study remains the centerpiece of the overall debate about intercessory prayer research. It concludes that "prayer to the Judeo-Christian God" produced beneficial therapeutic effects in his sample.]

Cha, K. Y., Wirth, D. P. and Lobo, R. A. "Does prayer influence the success of in vitro fertilization-embryo transfer? Report of a masked, randomized trial." Journal of Reproductive Medicine 46, no. 9 (September 2001): 781-787. [This South Korean study involving 219 women found that those receiving intercessory prayer had a significantly higher implantation rate and a higher pregnancy rate.]

Dusek, J. A., Sherwood, J. B., Friedman, R., Myers, P., Bethea, C. F., Levitsky, S., Hill, P. C., Jain, M. K., Kopecky, S. L., Mueller, P. S., Lam, P., Benson, H. and Hibberd, P. L. "Study of the Therapeutic Effects of Intercessory Prayer (STEP): study design and research methods." American Heart Journal 143, no. 4 (April 2002): 577-584. [This is a report of only the design and methodology of a major study of 1802 patients in 6 hospitals. It is obviously a precursor to a report of the data and results of the study, but as of August 2003, the principal author had e-mailed that such a manuscript was still in process.]

[Added 3/31/06:] Krucoff, M. W., Crater, S. W., Gallup, D., Blankenship, J. C., Cuffe, M., Guarneri, M., Krieger, R. A., Kshettry, V. R., Morris, K., Oz, M., Pichard, A., Sketch, M. H, Jr., Koenig, H. G., Mark, D. and Lee, K. L. "Music, imagery, touch, and prayer as adjuncts to interventional cardiac care: the Monitoring and Actualisation of Noetic Trainings (MANTRA) II randomised study." Lancet 366, no. 9481 (July 16-22, 2005): 211-217. [This study involving 748 patients undergoing percutaneous coronary intervention or elective catheterisation in nine USA centers found no evidence of effect from off-site (double blind) intercessory prayer.]

Matthews, D. A., Marlowe, S. M. and MacNutt, F. S. "Effects of intercessory prayer on patients with rheumatoid arthritis." Southern Medical Journal 93, no. 12 (December 2000): 1177-1186. [This study of a cohort of 40 patients found no special benefit as a result of distant intercessory prayer, though in-person intercessory prayer showed a significant, positive effect.]

O'Laoire, S. "An experimental study of the effects of distant, intercessory prayer on self-esteem, anxiety, and depression." Alternative Therapies in Health and Medicine 3, no. 6 (November 1997): 38-53. [Thus study divided a group of 496 patients into a subject group (n=406) and an agent group (n=90) who prayed for the members of the subject group. Agents were found to score better than did subjects on objective measures employed in the study. Factors correlated with improvement of scores among subjects were their views of the locus of God's action, belief in the power of prayer, and whether they thought they had been assigned to a control or intervention group.]

[Added 2/10/09:] Rath, L. L. "Scientific ways to study intercessory prayer as an intervention in clinical research." Journal of Perinatal and Neonatal Nursing 23, no. 1 (January/March 2009): 71-77. [This article by Linda L. Rath, PhD, RNC, NNP-BC, Asst. Professor, University of Texas School of Nursing at Galveston, and University of Texas Medical Branch, Galveston, TX, focuses on methodological issues in the study of intercessory prayer but also reports a study of Christian Intercessory Prayer on critically ill preterm neonates. CIP was used to influence stress levels in this population, measured indirectly via salivary cortisol levels and behavioral state assessments. Results were not statistically significant, but the author attributes this to a small sample size and holds out the prospect for significant results with further studies of a larger population. (Abstract:) The purpose of this article is to share a "research journey" to study the somewhat controversial subject of Christian intercessory prayer (CIP) utilized as a clinical intervention, and the knowledge gained along the way. This article will explore the steps in the development and implementation of clinical research to scientifically examine a phenomenon that many say cannot-and should not-be studied. The sequential steps in developing this area of study are detailed and explained from the conception of the initial idea through utilization of concept analysis and literature review to develop the researchable topic. The subsequent development of both qualitative and quantitative pilot studies to investigate CIP in depth is presented to illustrate how the intervention of CIP can successfully be incorporated into clinical research. This article provides guidelines for future researchers who may want to utilize CIP as an intervention.]

Sicher, F., Targ, E., Moore, D. II and Smith, H. S. "A randomized double-blind study of the effect of distant healing in a population with advanced AIDS. Report of a small scale study." Western Journal of Medicine 169, no. 6 (December 1998): 356-363. [In this study of 40 patients with advanced AIDS, an intervention group received prayers from self-identified "healers" from around the United States. At 6 months, the intervention group was found to be doing better physiologically and attitudinally, compared to the control group, though there was no difference in CD4+ counts.]

II. For some overviews and assessments of intercessory prayer research, see:

Astin, J. A., Harkness, E. and Ernst, E. "The efficacy of 'Distant Healing': a systematic review of randomized trials." Annals of Internal Medicine 132, no. 11 (June 6, 2000): 903-910. [The article reviews 23 studies of "distant healing" (considered here to be prayer, spiritual healing, mental healing, or therapeutic touch) and concludes that further study is warranted in light of fact that 57% of these studies showed a positive effect.]

Halperin, E. C. "Should academic medical centers conduct clinical trials of the efficacy of intercessory prayer?" Academic Medicine 76, no. 8 (August 2001): 791-797. [The author reviews arguments for and against intercessory prayer studies, including the philosophical bases and pitfalls of such research.]

Powell, L. H., Shahabi, L. and Thoresen, C. E. "Religion and spirituality. Linkages to physical health." American Psychologist 58, no. 1 (January 2003): 36-52. [The authors apply a levels-of-evidence approach to assess the current body of research on linkages between religion/spirituality and health. The hypothesis that being prayed for improves physical recovery from acute illness--one of 9 hypotheses assessed--was found to be supported by "some evidence" (as opposed to "persuasive evidence," "inadequate evidence," or "consistent failures to show evidence.")]

Roberts, L., Ahmed, I. and Hall, S. "Intercessory prayer for the alleviation of ill health." Cochrane Database of Systematic Reviews, 2000. [This article on a subscription database offers a very thorough assessment and finds that "evidence presented so far is interesting enough to justify further study" but that there are too few studies to justify general conclusions at this point.]

Targ, E. "Research methodology for studies of prayer and distant healing." Complementary Therapies in Nursing and Midwifery 8, no. 1 (February 2002): 29-41. [This is an overview of methodological elements that may be of interest to researchers, especially those newly interested in intercessory prayer.]

III. For a more complete listing of studies and assessments of intercessory prayer, click HERE for a bibliography (PDF) compiled by John Ehman.

IV. Chaplains should be especially aware of the following book by Larry VandeCreek, DMin:

VandeCreek, L., ed., Scientific and Pastoral Perspectives on Intercessory Prayer: An Exchange Between Larry Dossey, MD, and Health Care Chaplains. New York: Harrington Park Press (An Imprint of the Haworth Press), 1998. [This volume was co-published simultaneously in The Journal of Health Care Chaplaincy 7, nos. 1/2 (1998).]

 


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