c. 1999 Religion News Service
UNDATED _ A new report by a team of researchers at Columbia University has voiced strong criticism of the plethora of recent studies linking the religious beliefs and activities of patients to better health.
The report, which has prompted a mixed response from physicians known for their support of integrating the two fields, questions the empirical evidence of many of the studies and voices ethical concerns about the role of doctors in their patients’ religious affairs.”We believe that it is premature to promote faith and religion as adjunctive medical treatments, despite the enthusiasm of the general public and elements of the medical profession,”the report concludes.
Dr. Richard P. Sloan, an associate professor in Columbia’s department of psychiatry, said he and his co-authors were prompted by numerous media reports to examine the”hundreds and hundreds”of research papers discussing whether religious practices influence health. He said the review is the first of its kind to be published by a major medical journal.
The report, co-written with biostatistician Emilia Bagiella and ethicist and psychiatrist Tia Powell, was published in the Feb. 20 issue of Lancet, a prestigious London-based medical publication.
It comes at a time when about 50 medical schools have included courses on religion, spirituality and health in their curricula and medical organizations have drawn large audiences to meetings discussing similar topics.
The researchers found that many of the studies they reviewed lack consistency or fail to address factors that could affect the study results.”We believe even in the best studies, the evidence of a relationship between religion, spirituality and health is weak and inconsistent,”they wrote.
Sloan cited an example of studies relating church attendance to mortality.”Those studies generally show that frequent church attenders live longer and are healthier and that’s interesting, but most of those studies fail to control for one essential … characteristic,”he said.”People who are too sick already can’t get to church. Rather than church attendance causing health outcomes, it’s really that health outcomes influence church attendance.” But other researchers who have studied links between religion and health think Sloan has chosen the worst of the available studies and is only considering the harm that comes from the integrating of the two fields rather than the benefits.”What we see Dr. Sloan is doing is throwing the baby out with the bath water,”said Dr. David Larson, president of the National Institute for Healthcare Research in Rockville, Md.
Larson’s organization focuses on conducting and encouraging research on the relationship between spirituality and health and has _ along with the John Templeton Foundation _ awarded grants of $10,000 and $25,000 to 27 medical schools that have developed curricula on medicine and spirituality.”The paper edges on the assumption that the only way to teach this is a bad way, the only way to have doctors address this is a harmful way, that this is a private matter,”responded Larson.”But it forgets most importantly that patients want this factor addressed.” Larson acknowledged that earlier studies did not address factors other than religion that could have caused a particular outcome.”In the ’90s, you really do need to control for other factors,”he said.”What we’re seeing is better and better research that controls more and more.” Sloan and his fellow researchers wrote that their questions about the data lead to concerns that some discussions about benefits of linking faith and medicine could be unethical.”When doctors depart from areas of established expertise to promote a non-medical agenda, they abuse their status as professionals,”they wrote.”Thus, we question inquiries into the patient’s spiritual life in the service of making recommendations that link religious practice with better health outcomes.” Sloan said respect for a patient’s religious beliefs _ especially a person’s desires about end-of-life issues such as life support _ is appropriate, but general integration of those beliefs into health care is not.”There’s a difference between taking into consideration a characteristic of a patient, whether it’s religious, financial, ethnic, etc., and taking it on as an object of intervention,”he said.”The latter we object to.” Dr. Dale Matthews, an associate professor of medicine at Georgetown University Medical Center in Washington, called the report’s comments about potential abuse”very inflammatory.””The reason why I, for one, bring up this issue is because … it’s a medical agenda, it’s not a non-medical agenda,”said Matthews, author of”The Faith Factor: Proof of the Healing Power of Prayer”(Viking).”My agenda is to gather all the resources that we can to enhance the healing process. For many people, that involves religion. … If someone has no interest in religion, of course I’m not going to force it on them.” The Columbia researchers also voiced an ethical concern about the potential harm to patients who might link their serious illness to moral failure.”To suggest that faith and religious practice promote health is to suggest the opposite, that lack of health and illness is the result of insufficient faith,”Sloan said.
Dr. Christina Puchalski, a Washington, D.C., physician who has developed medical school curricula dealing with spirituality and health, said doctors are not telling patients that they should be religious.”We should know how to refer to chaplains,”she said.”We’re being very clear that physicians should not take the place of priests or chaplains or rabbis.” Puchalski, an assistant professor of internal medicine and geriatrics at the George Washington University School of Medicine, said the curricula that address spirituality are not based so much on the research Sloan has questioned as on a general goal to train doctors to be more compassionate caregivers of patients.
But Puchalski said Sloan’s concern about potential abuse is an appropriate caution.”There are going to be some doctors who may be tempted to use this as an opportunity to proselytize,”she said.”That is unethical. … We do have to be very cognizant of where our job as a physician starts and ends and where a chaplain’s begins.”
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