Friday, June 1, 2012
Prayer as placebo
Faith and healing have been intertwined for millennia. Even before the dawn of monotheism, healers have either invoked the name of forces beyond their own or been regarded as conduits for some higher power. This has been the rule whatever the culture or religion, and it continues to be so outside the so-called Abrahamic religions. (This term seems to be taking over from Judeo-Christian in order to recognize that Islam also derives from Judaism.)
The shaman, the medicine man, the healer has been around long before physicians in the modern sense were recognized. I believe it was Hippocrates who was the first to emphasize the skills of the doctor over the power of the gods.
In my own tradition, appeals to God for healing go back to the time of Jesus. At my synagogue, our prayer service always includes a prayer for healing. As a rule, Jews don't get too carried away with "faith healing" as do some Christian sects, but our rabbi, after the prayer, does list members of the congregation and even members of the general public who lie on a bed of pain and who he would appeal be included in God's mercy.
In fact, perhaps an ironic example of his practice was that during the last few months of Christopher Hitchens' life, our rabbi always included him in his prayers, despite the fact that he was a widely published and erudite advocate of atheism. I soon learned to my astonishment that despite their differing views, the two were long acquaintances and good friends.
So how does my own faith inform my practice of medicine? I must say at the outset, I have none. Shortly after I attained the age of reason, I began to doubt and soon concluded that God could not possibly exist. I found completely unconvincing the answers that have been given by every religious leader to the age-old question, "If God is omniscient, omnipotent and benevolent, how can there be evil, suffering and natural disasters in the world?"
I suppose I started out as an atheist, but in more recent years I have recognized that it is not the existence of some higher power that I doubt, but his/her relationship to the universe in general and humanity in particular. In confronting the mystery of how or why the universe should even exist, I have to acknowledge that creation is at least one possible explanation. So in that sense I might be called an agnostic. But I have a much more skeptical attitude. I cannot rationally accept the idea that even if there was a God at the beginning and he is still out there, that the problems of humanity in general and all of us as individuals are worthy of his attention. You could say I am a lapsed agnostic.
Whether he is benevolent or not, I cannot believe that an all-powerful God is out there keeping watch over each and every one of the 7 billion souls on this planet, not to mention the likely presence of hundreds of trillions of creatures on all of the other habitable planets in the universe where life now, has or will exist. I just don't believe that we are so special. So the idea of praying to God for healing is to me nothing but wishful thinking.
Yet God often enters the exam room with me. Most of my patients belong to some faith, and many of them do pray. Many of them pray for healing for themselves or their loved ones. Many of them pray for me, that God should guide my hands. Not only do I accept their prayers, but I encourage them. If I know a patient or family member is religious and they are in serious trouble, I will even tell them that they or their family member will be in my prayers.
Am I a hypocrite? (You could say so, in that I took a Hippocratic oath, but all kidding aside, the words are just coincidental sound-alikes.) You could even accuse me of being dishonest with myself: on rare occasions before doing a colonoscopy on a high-risk patient, I utter a prayer under my breath that I will arrive safely at the cecum (beginning of the colon) and return without perforation or other mishap. As we say in Yiddish, "Go in health; return in health!" I am even reassured at some visceral level when I note that the blanket happens to one of the ones at my hospital that has three blue stripes at each end, because as it resembles a Jewish prayer shawl.
So how can I encourage my patients in their beliefs even though I don't share them? Here's one explanation: There are two fairly well-circulated clinical studies that are familiar enough to many of you that I won't take the time to find the citations on Medline. One concerned two groups of randomly selected, matched patients, one of which was prayed for by a convent of nuns who volunteered to do so. The prayer group had a better outcome than the control group even though the doctor and patient were blind to the allocations. In the second study that I believe came out of Boston, a group of patients were told by their physician that they were going to be given a placebo, but that it had been observed that "sugar pills" often work anyway. (Another irony. Isn't sugar recently considered toxic?) This time, the patients who knowingly took the placebo did better.
I am reminded of the story of the farmer who encountered his neighbor nailing a horseshoe over his barn door, long considered a totem of good luck. "I had no idea you were superstitious," said the farmer. The neighbor looked down from his ladder and replied, "Oh, of course I wouldn't be so foolish as to believe that nailing horseshoes on barns really brings luck! But I've heard it works even if you don't believe in it."
This in large part explains why I have no problem speaking to my patients as though I believe in God. It reassures them to think that in fact my hands are being guided. They like to think that my own prayer might enhance my ability as a healer. They might even believe that faith makes me a better individual, and this is the sort of doctor they want. And for me, I can't help but believe it helps them to deal with their illness or that of their loved one. And that is the essence of my thesis: prayer is at the very least a placebo, and placebos have been shown time and time again to be effective.
I want to conclude this entry with an anecdote. I was asked by our hospital chaplain to participate in an ecumenical prayer service observing the National Day of Prayer, in which hospital staff would all share our prayers for world peace. She needed someone to recite a Jewish prayer. Not wishing to offend, I told her I would be happy to but I didn't know any Hebrew. That didn't matter, she said, English was fine. But why not have our mutual friend who is in fact a Jewish chaplain at our hospital give the prayer, I said? I would have, she said, but she won't be back from her sabbatical in time. Finally, cornered, I confessed that I don't even believe in God. "That's all right," was the response, "You're in transition."
I immediately thought of the ending to the movie "Some Like it Hot", with Marilyn Monroe, Tony Curtis and Jack Lemmon, in which the millionaire played by Joe E. Lewis becomes infatuated with a cross-dressing Jack Lemmon, who is doing so in order to escape gangsters. In the final scene, escaping in his motor launch, Lewis proposes marriage to Lemmon. Lemmon offers objection after objection, each one dismissed by the importunate Lewis. Finally, Lemmon insists "But I can't marry you!" "Why?!" responds Lewis. "Because I'm a man!" says Lemmon. "So," says Lewis, "Nobody's perfect!"
To my surprise, the prayer service turned out to be quite moving, and I left the chapel with an unanticipated sense of peace and a new sense of purpose in my calling as a healer. Who knew?
David M. Sack, MD, is a Fellow of the American College of Physicians. He attended Harvard and Johns Hopkins Medical School. He completed his residency at Lenox Hill Hospital in New York City and a gastroenterology fellowship at Beth Israel-Deaconess, which he completed in 1983. Since then he has practiced general gastroenterology at a small community hospital in Connecticut. This post originally appeared at his blog, Prescriptions, a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
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