Is Prayer a Health Promotion Strategy?

I believe health promotion is a cradle to grave proposition. That is, in all circumstances, there are things that can be done to enhance one’s well-being and health related quality of life. Obviously there are many missed opportunities for individuals and communities. Central to many peoples’ way of life is a turning to religion and prayer when they want their health to be better. Can this be considered health promotion?

Recently I read about an interview with Christopher Hitchens. He is a book author and journalist on many topics, but is most well known for being a very vocal atheist. It happens that Hitchens has pancreatic cancer with a prognostic window of only a few months. The central question of the interview was, as an atheist, how does he face death. There is the old saying “There are no atheists in a fox hole,” and by extension, there are no atheists with terminal cancer. Is this true? was the question.

I’m not going to answer that question. However, millions and perhaps billions of people (of many different faiths) with severe, and even more minor illness will turn to religious beliefs and practices, including prayer, hoping to get a reprieve or at least some relief. Is this a kind of health promotion?

With all proposed health promotion tools, the key question is “What is the evidence?” Does red wine really promote cardiovascular health? What is the evidence? Does fluoride really protect teeth without inflicting its own toxicity? What is the evidence? What is the evidence that hypnosis can help someone quit smoking? These are all fair questions if health promotion is guided by science and not by anecdote and folklore.

Of course applying standards of evidence to prayer and religiosity may not be appropriate. Religion is experiential, transcendent, right-brained, it is revealed truth, not discovered by the scientific method. At the same time, people of faith ask for and anticipate concrete healing. It is an objective question to ask whether they get it. Hitchens claims that his atheism has not wavered but many Christians are praying for his own miraculous healing. So we return to the question, can religious belief and practice protect from disease and promote health?

There is an institution called the Cochrane Library which produces systematic reviews of the medical and health literature. They will identify a specific question and search the world’s published literature to assess the consensus of all the research on that topic. They have very careful procedures to weed out opinion pieces and junk science, in an effort to base their conclusions on the best science available. As it happens, there is a Cochrane systematic review on what believers call intercessory prayer. They tried to answer the question, “Does someone who is prayed for, in addition to receiving routine medical care, have better results than someone only receiving medical care?”

The review found ten studies meeting high scientific standards; these studies captured about 7600 research subjects. The studies were set up with treatment groups who were receiving routine care plus standardized prayers from trained interceders; the control groups got medical care only. Because there might have been people outside of the study conditions who were praying for the research subjects, groups were randomized to minimize confounding of the experiments. Some studies were blinded: subjects didn’t know if they were being prayed for. On the other hand, if the intervention is about divine intervention, blinding techniques seem to be futile, certainly from the perspective of believers.

In the end, the result was that findings on this question are inconclusive. There were studies showing no effect but also some studies showing beneficial impact of prayer on health outcomes. The Cochrane researchers found no evidence to discourage praying for people’s health, but also not much evidence to recommend it. They admit that the whole enterprise of using the scientific method to test this question is problematic. It is difficult, and may be impossible to replicate real family and community circumstances, where prayer for a sick person is occurring, in an experimental design that controls as many variables as possible. In the end, neither proponents nor skeptics are likely to change their minds.

And the quest for evidence continues.