Lancet Essay Rips Faith-Health Link (May 1999)

At last, The Lancet to the rescue!

Following a barrage of media and medical hype promoting religion as medicine, the February 20, 1999 issue of The Lancet, the prestigious British medical journal, features welcome balance. “Religion, spirituality, and medicine,” an article by R. P. Sloan, E. Bagiella and T. Powell, strongly questions the assumption that religion should be prescribed by doctors.

The authors, including Dr. Richard P. Sloan, of Columbia University, reveal the dismaying fact that nearly 30 medical schools in the United States include courses on religion, spirituality and health. Mind/Body Medicine has recommended that the “wall of separation” between medicine and religion be torn down, and predicts that the “medicine of the future is going to be prayer and Prozac.” A publication of the American Medical Association even recommends that clinicians ask patients, “What can I do to support your faith or religious commitment?”

The authors briefly analyze many studies assessing the effects of church attendance, prayer, comfort from religion, and health differences as a function of denominational affiliations or orthodoxy of belief. They conclude that such studies fail to control for factors such as behavioral and genetic differences, age, sex, education, health status, etc.

One study of recovery rates of elderly women who had surgery for broken hips associated religiosity with better ambulation, but failed to control for the all-important variable of the age of the patients.

A widely reported study cited a positive association between church attendance and health, but the researcher himself later admitted the finding was probably due to failure to control for functional capacity. In other words, people in poorer health are less likely to go to church.

The writers also asserted: “Published work on religion and health lacks consistency, even among well-conducted studies.”

The authors’ strongest arguments were saved for the question of ethics. “When doctors depart from areas of established expertise to promote a non-medical agenda, they abuse their status as professionals. Thus, we question inquiries into a patient’s spiritual life in the service of making recommendations that link religious practice with better outcomes.”

Even if religion were shown convincingly to be related to better health, they argue, it would simply join such factors as socioeconomic or marital status. For instance, while studies show being married is associated with lower mortality, “we would consider it unacceptable for a physician to advise an unmarried patient to marry. . . . This is because we generally regard financial and marital matters as private and personal, not the business of medicine, even if they have health implications. There is an important difference between ‘taking into account’ marital, financial, or religious factors and ‘taking them on’ as the objects of interventions.”

The Lancet article adds: “Linking religious activities and better health outcomes can be harmful to patients, who already must confront age-old folk wisdom that illness is due to their own moral failure. Within any individual religion, are the more devout adherents ‘better’ people, more deserving of health than others? If evidence showed health advantages of some religious denominations over others, should physicians be guided by this evidence to counsel conversion? Attempts to link religious and spiritual activities to health are reminiscent of the now discredited research suggesting that different ethnic groups show differing levels of moral probity, intelligence, or other measures of social worth. Since all human beings, devout or profane, ultimately will succumb to illness, we wish to avoid the additional burden of guilt for moral failure to those whose physical health fails before our own.”

The authors conclude: “Even in the best studies, the evidence of an association between religion, spirituality, and health is weak and inconsistent.

“We believe therefore that it is premature to promote faith and religion as adjunctive medical treatments. . . . caution is required. There is a temptation to conclude that this matter can be resolved as soon as methodologically sound empirical research becomes available. Even the existence of convincing evidence of a relation between religious activity (however defined) and beneficial health outcomes may not eliminate the ethical concerns that we raise here. Religious pursuits, such as decisions to marry or have children, are qualitatively different from health behaviours such as quitting smoking or eating a low-fat diet, even if they are linked unequivocally to health benefits. . . . suggestions that religious activity will promote health, that illness is the result of insufficient faith, are unwarranted.”

Freedom From Religion Foundation