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BEYOND SCIENCE: Leonard Leibovici Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial BMJ 2001; 323: 1450-1451 [Abstract] [Full text]

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Rapid Responses published:

A cautious approach is needed for the power of prayer

Andrew M Thornett   (21 December 2001)

So there is a God?!

Michael Gdalevich   (21 December 2001)

A nonsense joke for the New Year

Yair Yodfat   (21 December 2001)

There are thousands of suns in the sky above the clouds

Sergio Stagnaro   (21 December 2001)

You cannae break the laws of physics captain

John Hopkins   (21 December 2001)

Treat the control group

Martin Bland   (22 December 2001)

Evidence for Providence Based Medicine

Arthur Leibovitz   (22 December 2001)

The power of statistics, not prayer

Shehan Hettiaratchy, Carolyn Hemsley, Wellcome Trust Fellow in Microbiology, University of Oxford, UK   (22 December 2001)

I suggest to cross-over the study groups

Francesco Falaschi   (22 December 2001)

Occam's razor

j martin dace   (23 December 2001)

Irony doesn't travel well

Michael Foley   (23 December 2001)

A CHRISTMAS NIGHTMARE: AN UNETHICAL STUDY APPROVED FOR PUBLICATION IN THE BMJ

Eugenio Pucci   (24 December 2001)

TWO POSSIBLE EXPLANATIONS TO THE RETROACTIVE INTERCESSORY PRAYER EFFECT

Luis C. Silva   (24 December 2001)

An example of synchronicity?

Ian T Guy   (24 December 2001)

Re: Treat the control group

Ian Spencer   (24 December 2001)

Science and Statistics cannot explain how prayer works

Daniel O. Selo-Ojeme   (26 December 2001)

Confounding effects of future prayer?

Prisca M Middlemiss, n/a   (27 December 2001)

On behalf of the "Less Sophisticated" general public

Margaret M. Zacny   (28 December 2001)

Improbable Research

Eberhard W Lisse   (28 December 2001)

Prayer Study Design

Ronald L. Fredrickson   (28 December 2001)

Hobgoblins of Consistency

Doug Oman, Carl E. Thoresen   (29 December 2001)

Delay in publication?

Anthony H.C. Campbell   (30 December 2001)

All RCT require informed consent

Christopher I. Price   (30 December 2001)

Re: Treat the control group

Haim Shapiro   (31 December 2001)

The RCT - gold standard or golden calf?

Robert G. Newcombe   (31 December 2001)

Leibovici's paper is religious propaganda, not science

Riccardo Baschetti   (1 January 2002)

The effects of retroactive prayer: more questions than answers

Max Lagnado   (1 January 2002)

The Finger of God

Stephen L. Black   (2 January 2002)

Doctors prayer for more care

DE Barnes   (3 January 2002)

Misapprehension of principle

Stephan A. Schwartz   (3 January 2002)

Beyond Science?

Tobit S Emmens   (3 January 2002)

Efficacy of prayer underestimated?

Charles S. Harris, PhD   (3 January 2002)

Retroactive prayer - a solution to the bed crisis?

Adrian Fawcett   (4 January 2002)

Methodological concerns

William G. Taylor   (6 January 2002)

Pride and Prejudice, or Prayer?

Max Lagnado   (6 January 2002)

Time Paradox

Effi Peled   (8 January 2002)

Healing powers of the human mind

Joseph Watine   (8 January 2002)

I pray now for my own papers to be published

Luc-Marie JOLY   (11 January 2002)

Editors beware, everything is possible

Yakov Sivan   (12 January 2002)

Re: You cannae break the laws of physics captain

Michael J Brownnutt   (15 January 2002)

Re: Treat the control group

Tracey A Thomas-Falconar, n/a   (15 January 2002)

Down to earth

Santiago V Rosales   (15 January 2002)

A moment of seriousness

Dr Trevor Watts   (16 January 2002)

To whom did the prayer pray ?

Tomoyuki Hisa   (19 January 2002)

God and Us

Gabriel Onato, MD, PhD   (23 January 2002)

Blind faith in the Central Limit Theorem

Robert J. MacG. Dawson   (25 January 2002)

Therapeutic event or medical fact?

Peter Morrell   (25 January 2002)

Re: So there is a God?!

Tracey A Thomas-Falconar, n/a   (7 February 2002)

A Question From An Outsider Looking In

Alina Finn   (9 February 2002)

Regarding retroactive prayer

Gilbert J Custer, M.D.   (13 February 2002)

Religion and Science

Peter Morrell   (17 February 2002)

God Listens

William D. Misner Ph.D.   (23 February 2002)

Do the statistics add up?

Joseph T. Springer   (23 February 2002)

Randomised trials cannot be used in this way

Peter J Lachmann   (5 March 2002)

Rule of thumb

Gary S. Hurd, Ph. D.   (5 March 2002)

Author's comments

Leonard Leibovici   (12 March 2002)

Thought experiment

Timothy S. Roth, Pittsburgh, PA, 15601   (14 April 2002)

which gods ?

Joan S Brodie   (29 April 2002)

Re: Leibovici's paper is religious propaganda, not science

Michael A. Reeves-McMillan   (1 November 2002)

Re: The power of statistics, not prayer

Elliott Middleton   (2 November 2002)

Re: Religion and Science

Reginald.H. Le Sueur   (20 June 2003)

Re: A Question From An Outsider Looking In

Reginald Le Sueur   (29 June 2003)

Re: Re: Leibovici's paper is religious propaganda, not science

Reginald Henry Le Sueur   (1 July 2003)

Leibovici's paper is perfectly valid

Matthew H Lewis   (2 July 2003)

more propaganda, not science

L S Lerwis   (2 July 2003)

My manager is going to love this ...

Dr. Matthew L Grove   (2 July 2003)

Re: more propaganda, not science

Reginald Henry Le Sueur   (3 July 2003)

Re: Re: more propaganda, not science

M C Feliciello   (3 July 2003)

Re: Re: more propaganda, not science

L S Lewis   (3 July 2003)

Re: Re: Re: more propaganda, not science

Reginald Henry Le Sueur   (4 July 2003)

Re: Re: more propaganda, not science

Matthew H Lewis   (4 July 2003)

Re: Re: Re: more propaganda, not science

Reginald H. Le Sueur   (5 July 2003)

Re: Misapprehension of principle

Reginald H. Le Sueur   (7 July 2003)

Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem

Deepak N Rama, -   (6 December 2003)

Re: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem

Reginald.H. Le Sueur   (9 December 2003)

Is the power of thought able to create successively older forms of the entire universe once every 10 to the minus 43 of a second?

Richard G Fiddian-Green   (27 December 2003)

RE: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem

Haralabos Gouzinis   (29 January 2004)

RE: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem

Richard G Fiddian-Green   (1 February 2004)

Effect of Remote, retroactive intercessory prayer on outcome in trauma patients

Adam Starr, William Frawley, Michael Bolesta, Christopher Espinoza-Ervin   (23 June 2004)

Re: Effect of Remote, retroactive intercessory prayer on outcome in trauma patients

Howard Mann   (24 June 2004)

Re: Effect of Remote, retroactive intercessory prayer on outcome in trauma patients

Reginald.H. Le Sueur   (2 July 2004)

Re: which gods ?

Reginald.H. Le Sueur   (2 July 2004)

Leibovici's paper is not "flawless"

Sergio D Schvartzman   (17 October 2004)

The Hospital Called Earth

Michael A. Bedar   (13 April 2005)

a test for the "scientific" community

Martin Ploederl   (4 August 2005)

Data

Paulo Hubert   (28 December 2006)

Side effects of the Leibovici RCT of remote, retroactive intercessory prayer

Jose M Lopez-Lozano   (26 May 2008)

Free will, determinism and Laplace's demon.

Richard G Fiddian-Green   (8 February 2009)

Re: Free will, determinism and Laplace's demon.

Michael D Innis   (9 February 2009)

What if God tests us?

Paul E Shannon   (26 July 2009)

A cautious approach is needed for the power of prayer 21 December 2001
Andrew M Thornett, Deputy Head Adelaide University Rural Clinical School, University Campus, Whyalla, South Australia 5608 Send response to journal: Re: A cautious approach is needed for the power of prayer	The study by Leibovici is one of few to use rigorous scientific method to explore the role of intercessory prayer in health care.1 Using a randomised controlled trial design with a large group of patients, and selecting a range of appropriate outcome measures, the author demonstrated a statistically significant difference in length of stay and fever duration and concluded that prayer may be a useful treatment. However, these results need to be interpreted with caution. There was no significant difference between the two groups with regards to the most clinically important outcome (mortality), and the median values varied little between prayer and non-prayer on both length of stay (7 and 8 days) and fever duration (2 days each). The religous affiliation of the person saying the prayer is not given. Many religous groups do not accept the power of prayer given by those with different beliefs. If real, the effect of prayer demonstrated in this study may be unrelated to supernatural power and hence to a particular belief system, or may be belief-specific, reflecting the power inherent in a particular religion.Further work is needed in this area before conclusions can be made. 1. Leibovici, L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001;323:1450-1451.
So there is a God?! 21 December 2001
Michael Gdalevich, Deputy District Health Officer Barzilai Medical Center, Ashkelon, Israel Send response to journal: Re: So there is a God?!	A double blind, controlled study that proves a divine intervention? May be this is an oversiplification of the results of this study, but that's what it seems - the authors prove that there is a God. This is done by using a proven and proper study methodology. However, what about the pupose of the study? This should be defined prior to the rest of the research. How can one intend to prove an association with an unexplainable factor? If there is a God and wanted us to know (opposed to beleive) about it, he/she would find a way. If there is not - well there's always type 1 (alfa) error.
A nonsense joke for the New Year 21 December 2001
Yair Yodfat, Emeritus Professor in Family Medicine Hebrew University-Hadassah Medical School, Jerusalem, Israel Send response to journal: Re: A nonsense joke for the New Year	I would like to know how many readers believe in this nonsense paper. The research methodology was poor, non scientific and the results were most probably biased by the author's own belief.
There are thousands of suns in the sky above the clouds 21 December 2001
Sergio Stagnaro, Specialist i Blood, Gastrointestinal, and Metabolic Diseases 16037 Riva Trigoso (Genoa) Italy Send response to journal: Re: There are thousands of suns in the sky above the clouds	Sirs, I appreciate almost absolutely, without reserve, except one, ethical in nature, the conclusion of the intriguing Leonard Leibovici’s paper about effects of remote retroactive intercessory prayer on outcomes in patients with bloodstream infection in randomised controlled trial (BMJ 2001;323:1450-1451, 22-29 December ). Author’s conclusions state that remote, retroactive intercessory prayer is associated with a shorter stay in hospital and shorter duration of fever in diseased individuals. Therefore, its use in clinical practice should be considered, according to other articles conclusions, as regards beneficial effect in patients in an intensive coronary care unit, to which I dare add my recent, personal case (Last 9 July, at 5 hours a.m., I was involved by acute myokardial infarct, recognized forunately early – as “impending infarction” – , with the aid of Biophysical Semeiotic (http://digilander.iol.it/semeioticabiofisica), so that, when AMI ocurred,followed by cardiac arrest due to ventricular fibrillation, the car, driven by my young daughter was near the emergency room of our hospital, where my wife and skilled colleague were waitng for me. At first, I do not consider the “particular” condition of the retroactivity of intercessory prayer on outcomes in patients diseased with infection, due to the fact that knowledge of God is “instantaneous”. We can explain the prayer favorable influence on diseases outcome, either with extrasensory forces or with the existence of God. But does God really exists? In my opinion, scientist’s answer would sound “yes”. As a matter of fact, we scientists are, all life long, searching for truth, but know without any doubt that we reach exclusively “scientific” truths or, speaking in other words, temporary truth. Therefore, we are at a cross- roads: either the Truth does not exist (and we scientists are crazy dreamers), or there is “Esse per Se Ipsum”, Who have “constitutive and eternal” knoweledgement of truth, namely in an absolutely different way, the men are laking, since our knowlegement is “external, attributive,and thus transient” , while the former one is “Love, as knowledge sublimation”, according to Saint Gregorious from Nisc, VI century a.D.
You cannae break the laws of physics captain 21 December 2001
John Hopkins, GP Darlington DL1 5LW Send response to journal: Re: You cannae break the laws of physics captain	Dear Richard, As any student of Star Trek will tell you, the first rule of time travel is that you cannot change the course of history, otherwise you get into an infinite regress. In the case of Leibovici's study, if we accept that people can be made better by future prayer or other intervention then must have been made better at the first time of that intervention, when they were ill. In which case it would then be impossible for them to be subsequently allocated to the placebo arm of the study. That means this paper is not a randomised controlled trial. But then you knew that already ! Yours sincerely, Dr John Hopkins
Treat the control group 22 December 2001
Martin Bland, Prof. of Medical Statistics St. George's Hospital Medical School, London SW17 0RE Send response to journal: Re: Treat the control group	According to Clause 30 of the latest revision of the Declaration of Helsinki: At the conclusion of the study, every patient entered into the study should be assured of access to the best proven prophylactic, diagnostic and therapeutic methods identified by the study. To meet this ethical standard, the prayer should now be said for the control group. If the treatment is effective, this should have the effect of removing the difference between the groups. I await the results with interest.
Evidence for Providence Based Medicine 22 December 2001
Arthur Leibovitz, Director of Geriatric Ward - Shmuel Harofe Hospital Shmuel Harofe Hospital Send response to journal: Re: Evidence for Providence Based Medicine	Congratulations Dr Leibovici This is - a first Evidence of Providence Based Medicine
The power of statistics, not prayer 22 December 2001
Shehan Hettiaratchy, Fellow, Transplantation Biology Research Center Massachusetts General Hospital, Harvard Medical School, Boston, USA 02114, Carolyn Hemsley, Wellcome Trust Fellow in Microbiology, University of Oxford, UK Send response to journal: Re: The power of statistics, not prayer	It was very brave of both the author and the BMJ to publish this paper in a scientific journal and be prepared for the inevitable criticism from the outraged masses. The idea that retroactive intercessory prayers could have an influence on the outcome of septicaemia is intriguing and challenges our notions of cause and effect.However, if it is true, this is not the paper to prove it. The data on the the most significant finding,length of stay, appears to be skewed by a few abnormally high results in the control group.This is demonstrated by the fact that the median length of stay is the same in both groups but the maximum length of stay in the control group is twice that in the intervention group. This may represent a type I statistical error,despite the large sample size. From a cynical stand point, it is a shame that God cannot save your life but might get you out of hospital a few days earlier.Either way, it was a thought provoking paper but may just prove the power of statistics, not of prayer. Shehan Hettiaratchy MA FRCS Carolyn Hemsley MA MRCP
I suggest to cross-over the study groups 22 December 2001
Francesco Falaschi, medical doctor Pronto Soccorso Accettazione - IRCCS Policlinico San Matteo - 27100 Pavia Italy Send response to journal: Re: I suggest to cross-over the study groups	I suggest to treat the same group of patients inverting the study group and the control group. Any change in the outcomes would provide a clear evidence of the effect of the treatment. In other words I would pray for the other patiens too, to see if their previous hospital stay shortens. I also suggest to try to prove a dose-related response to the treatment; as there is no known adverse effect of the treatment it would be possible to use extreme doses (few seconds of prayer for multiple patients versus hours of prayer for a single patient). I would send a copy of the original paper for the IgNobel price of next year becaouse I suspect the it is the princpal aim of the author.
Occam's razor 23 December 2001
j martin dace, general medical practitioner waldron health centre, stanley street, london SE8 4BG Send response to journal: Re: Occam's razor	EDITOR - When assessing the effects of retroactive intercessory prayer, Leibovici (1.) fails to take into account Occam's razor, according to which 'It is vain to do with more what can be done with fewer'. (2.) It is more parsimonious to assume that there is some methodological problem, or even that the results are attributable to chance (despite the quoted confidence limits), than to accept that a short prayer said by one person for persons unknown except by name can affect the outcome of a set of events several years previously. Also in the discussion section Leibovici refers to retroactive prayer being 'associated with a shorter stay in hospital' and later he says 'no mechanism known today can account for the effects [of retroactive prayer]'. An association is not the same as an effect, which latter term implies causality. Even if there is an effect, Leibovici's paper does not provide evidence of a causal link. 1. Leibovici L, Effects of remote retroactive intercessory prayer BMJ 2001; 323:1450-1 (22 December) 2. Occam, W (1300-1350 CE) quoted in Russell B, A history of western philosophy, Unwin 1984:462-3 Competing interests: none.
Irony doesn't travel well 23 December 2001
Michael Foley, Consultant anaesthetist James Cook University Hospital, Middlesborough, UK TS4 3BW Send response to journal: Re: Irony doesn't travel well	The staff at the BMJ, and discerning readers, may be amused by this article demonstrating yet again the truth of Disraeli's aphorism about 'lies, damned lies and statistics'. That this is already accepted as evidence for the existence of God by one of your correspondents, and will doubtless be quoted by endless purveyors of religion and quackery, indicates that what may be entertaining to the informed reader is easily used as wool to pull over the eyes of the less sophisticated. Does the editor of the journal not have some responsibility to the wider public to point out the logical paradox in the paper? A second, cross-over trial can be performed in which the control group becomes the experimental group and is prayed for. Should the results of the second trial demonstrate that the new experimental group have retrospectively improved outcomes then that really would be a breakthrough in the study of the existence of the non-material world. Thus God would have been shown to exist and one could return to a comforting Universe where a paternal, loving anthropomorphic being gives us protection from reality. And fairies would take up residence at the bottom of my garden.
A CHRISTMAS NIGHTMARE: AN UNETHICAL STUDY APPROVED FOR PUBLICATION IN THE BMJ 24 December 2001
Eugenio Pucci, neurologist U.O. Neurologia, Ospedale di Macerata, via S.Lucia, Macerata, 62100, Italy Send response to journal: Re: A CHRISTMAS NIGHTMARE: AN UNETHICAL STUDY APPROVED FOR PUBLICATION IN THE BMJ	Dear Sir, I know that the essence of the Christmas BMJ is strangeness. But Leibovici’s article (1) is not only strange, and not scientific, but it is, above all, unethical. No informed consent was requested to participants. It has no impact in clinical practice, since, even on the basis of the menu by Oxman and colleagues (2), it is difficult to think about a retroactive consent. I argue whether a Jew would be accepted to participate in a trial in which a Palestinian prayed to Allah for him. Incidentally, what about adverse events in this randomised controlled trial? It is also unethical for a Christmas issue of a scientific paper. Investigating efficacy of distant healing through clinical trial is absurd because of the lack of a scientific rationale. Unfortunately, it is not only the case of the Christmas issue of BMJ, because there is the Cochrane review on intercessory prayer (3). It is tasteless to make jokes on the compelling and dramatic problem of the growing distrust in scientific medicine, which has brought to light a lot of alternative medicine which is trying to be scientific without having a scientific rationale. We really did not need strangeness to be added to this genre. I worry about the release of such material to the media. Here in Italy the turnover of fortune tellers and healers is enormous. People are turning more and more to the saints rather than to administrators and politicians to find solutions for a better healthcare management, which cannot be based on “beyond science” evidence of effectiveness. “Beyond science”, I prophesy that the BMJ Editorial team does not know that this is Christmas-time, the first in the New Millennium, the first of that historical period which the next generations will call the Technological Middle Ages. References (1) Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001; 323:1450-1451. (2) Oxman AD, Chalmers I, Sackett DL. A practical guide to informed consent to treatment. BMJ 2001; 323: 1464-1466. (3) Roberts L, Ahmed I, Hall S. Intercessory prayer for the alleviation of ill health (Cochrane Review). In: The Cochrane Library, Issue 4, 2001. Oxford: Update Software.
TWO POSSIBLE EXPLANATIONS TO THE RETROACTIVE INTERCESSORY PRAYER EFFECT 24 December 2001
Luis C. Silva, Senior Researcher Medical Science Higher Instute of Havana 11600, Cuba Send response to journal: Re: TWO POSSIBLE EXPLANATIONS TO THE RETROACTIVE INTERCESSORY PRAYER EFFECT	After reading the study by Leibovici(1), I have considered two competing conclusions: a) There was actually divine intervention. In such a case, it seems to me more plausible (it is more parsimonious) to suppose that, instead of deciding the length of stay and fever duration of each patient, He did something simpler for Him: to decide the outcome of the coin tossing (allocating those who had longer stays in the control group). If it is the case, there was not proper randomization and Leibovici´s study doesn’t offer anything new. b) The other possibility is that God did not played any roll in this study. Then, what I conclude is that this study adds more reasons to think that p values are not only a not useful tool, as suggested in the Uniform Requirements for Manuscripts submitted to Biomedical Journals (“Avoid relying solely on statistical hypothesis testing, such as the use of P values, which fails to convey important quantitative information”), but a misleading one. If you use a new methodological approach by means of which you prove that earth is cubic (not flat, not round), I would seriously suspect that it would be better to avoid such a method in future studies. 1. Leibovici, L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001;323:1450-1451. 2. International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts submitted to Biomedical Journals. Ann Intern Med. 1997;126:36-47.
An example of synchronicity? 24 December 2001
Ian T Guy, General Practitioner Fulcrum Medical Practice, Middlesbrough TS12 2ES Send response to journal: Re: An example of synchronicity?	The researchers seem to assume that there is a linear directionality of effect from the future to the past. It could be the other way round, for example an effect of events in the past affecting the fall of the coin used to choose the intervention and control groups. Or perhaps a more satisfy 'explanation' would be to say that the various events are acausally but synchronistically linked. Whatever the nature of the links, still a fascinating study. Jung would have loved it. Ian Guy
Re: Treat the control group 24 December 2001
Ian Spencer, Consultant Anaesthetist UHND DH1 5TW Send response to journal: Re: Re: Treat the control group	The paper would appear to demonstrate that one group of patients had improved outcomes due to intercessory prayer some 10 years later. Taking Professor Leibovici's conclusions and recommendations at face value then he has an ethical duty to treat the other group in a similar way; that this group still experienced a poorer outcome shows that he has not and indeed never will. Shame!
Science and Statistics cannot explain how prayer works 26 December 2001
Daniel O. Selo-Ojeme, Specialist Registrar, O & G Mid Essex NHS Trust, St John's Hospital, Chelmsford. CM2 9BG Send response to journal: Re: Science and Statistics cannot explain how prayer works	Editors - I congratulate the BMJ for the courage to publish the articles in the Christmas edition. I cannot understand Professor Leibovici's failure to acknowledge the simple conclusion of his study. The Coincise Oxford English dictionary defines prayer as a 'solemn request ... an entreaty to a person'. When you make a request or an entreaty, you expect it to be honoured or denied. In his study, some requests that were made were answered. It is as simple as that. We must understand that science cannot excplain the workings of God or predict the effectiveness of prayer. A creature cannot explain its creator. There is still a lot that is beyond science. There is faith and there is miracle. Competing interest: None
Confounding effects of future prayer? 27 December 2001
Prisca M Middlemiss, Medical Journalist Freelance W3 8EJ, n/a Send response to journal: Re: Confounding effects of future prayer?	Professor Martin Bland (Treat the control group) has surely said what should be the last rational word on retroactive prayer. Nonetheless, Leibovici's case rests on our abandoning any a priori assumptions about the linear nature of time. Logically, then, why has he failed to allow for the confounding effects of further, future and as yet unenacted prayers on his outcomes?
On behalf of the "Less Sophisticated" general public 28 December 2001
Margaret M. Zacny, Representative, General Public USA - 46322 Send response to journal: Re: On behalf of the "Less Sophisticated" general public	You might be interested to note that the MSN Home page featured a link to the BMJ article on rhythmic breathing through the repetition of the rosary and/or mantra. By now, I'm sure that millions of members of the general public have clicked on the available link and were able to enjoy an abbreviated version of the article. I'm also sure that, like me, millions of other members of the general public went one step further and performed a search on the words "British Medical Journal" and were then able to go directly to your site and download a PDF version of the article so that they could read it in its entirety. (You see, many of us "less sophisticated" members of the general public are rather curious, and from time to time we do such things.) While on the BMJ site, I took the opportunity to read the BMJ article on "remote, retroactive intercessory prayer.” Fascinating article!! So, explain to me how this thing works … are you telling me that if I pray for my dead Aunt Mildred, perhaps I can get her to retroactively change her will to include me this time? Please fill the general public in on how to perfect this retroactive prayer technique. After all, “enquiring minds want to know …” By the way … the general public is not amused … and we will, therefore, pray for you and your miserable little raisin-like souls (but not until later, because you’ve convinced us that it works better that way.) -- Margaret M. Zacny
Improbable Research 28 December 2001
Eberhard W Lisse, Obstetrician & Gynaecologist Swakopmund, Namibia Send response to journal: Re: Improbable Research	Editor, yet again, in your Christmas edition you publish a contender for the Ig Nobel prize, which as some of the commentaries don't seem to know is awarded by the Annals of Improbable Research.
Prayer Study Design 28 December 2001
Ronald L. Fredrickson, Retired Health Professional Home: 1567 Heredia Drive, Roseville, California, 95747 USA Send response to journal: Re: Prayer Study Design	I have yet to see a study of intercessory prayer which includes three groups: the unprayed for controls, the experimental group for which a positive prayer is used (pray for good results), and the experimental group for which a negative prayer is used (pray for bad results). I have been told that it would be unethical to pray for a bad result, but those who so believe must assume, a priori, that prayer is efficacious. In that case why do an experiment? I have been told also that God doesn't honor prayers for bad results. This presumes that the person who so believes can read God's mind. Why, then, during World War II or other such conflicts, did so many persons pray that the enemy would suffer bad results? When a prayer study is done in which the group prayed for positively immproves and the group prayed for negatively worsens, I'll become a believer. That seems to be the gist of this paper--- belief. Some things must be accepted on faith alone. No conflict of interest.
Hobgoblins of Consistency 29 December 2001
Doug Oman, Lecturer School of Public Health, University of California at Berkeley (Berkeley, CA 94720-7360, USA), Carl E. Thoresen Send response to journal: Re: Hobgoblins of Consistency	Dear Editor, "Consistency is the hobgoblin of small minds" proclaimed our countryman Ralph Waldo Emmerson. By this measure we see clearly that Leibovici, author of BMJ's newly published study of retroactive prayer,1 has no small mind, but rather one as supple and expansive as a brontosaurus, with which he himself recently declared his affinity.2 Leibovici's extraordinary intellectual suppleness is demonstrated by the new study's free-flying transcendence of Leibovici's own fervently pro-conventional argument, recently published in the BMJ, that "A deep model of the physical world is essential for choosing hypotheses to be tested and for learning from failures."3(p.1629) Yet we wonder about the depths to which Leibovici's mind may have descended, even as we marvel at his startling methodological innovations, which allow unprecedented efficiency and rapidity in study replication. "A list of the first names of the patients in the intervention group", he tells us, "was given to a person who said a short prayer for the well being and full recovery of the group as a whole."1(p.1450) When combined with instantly available "retroactively" measured outcomes, such brevity allows the intervention to be replicated many times per hour (using the same cohort but a different randomization), especially if the prayer is extremely short, and patient names are provided in electronic form. Indeed, given the BMJ editor's report that Leibovici asked "people" (italics added)4 to pray for patients, small-minded skeptics might wonder if he may already have conducted a large number of replications, not all producing equally statistically significant results. Anti-visionary or mean-spirited skeptics could argue that by employing his innovative study design, Leibovici might quickly conduct a vast number of replications - far larger than could ever be conducted in a full decade of research on most scientific topics, either "conventional" or "alternative", including even intercessory prayer as previously studied. We believe that Leibovici's radically efficient experimental design demands an accompanying innovation in reporting that is unnecessary for more conventional designs used in previous prayer studies. To exemplify responsible reporting and to facilitate future metaanalyses, we strongly urge Leibovici to offer an explicit public statement - absent from his recent article - about the total number of times he has implemented his study design using the same patient population and database. Leibovici deserves notice for a remarkable contribution, if not to science, to ethics, or to consistency, then perhaps to humor, of a sort. Doug Oman, Ph.D., School of Public Health, University of California at Berkeley, USA (DougOman{at}post.Harvard.edu). Carl E. Thoresen, Ph.D., Departments of Education, Psychology, Psychiatry/Behavioral Sciences, Stanford University, USA (Thoresen{at}Stanford.edu) 1. Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: Randomised controlled trial. British Medical Journal. 2001;323:1450-1451 (text online) 2. Leibovici L. Doctors and complementary medicine: Author's reply. British Medical Journal. 2000;320:1145 (text online). 3. Leibovici L. Alternative (complementary) medicine: A cuckoo in the nest of empiricist reed warblers. British Medical Journal. 1999;319:1629-1632 (text online). 4. BMJ Editor. Editor's choice: The BMJ takes reason's last step. British Medical Journal. 2001;323:0 (text online).
Delay in publication? 30 December 2001
Anthony H.C. Campbell, Retired consultant physician Send response to journal: Re: Delay in publication?	Was this paper by any chance supposed to have appeared at the beginning of April?
All RCT require informed consent 30 December 2001
Christopher I. Price, SpR Geriatric Medicine Sunderland Royal Hospital Send response to journal: Re: All RCT require informed consent	It is understandably difficult to scientifically examine interventions that are not easily quantified. However, like previous authors studying the effects of prayer, Leibovici has presented an incomplete description of methodology and inadequate examination of confounding variables (1). In particular it is not known whether the subjects in this study had previously been prayed for, and whether this important confounding variable was also distributed in favour of the intervention group. Consequently it seems more likely that the effect of prayer was to produce a positive outcome for the study rather than a favourable outcome for the intervention subjects. The retrospective outcome measures were also unreliable: length of fever may be subject to random interference from cooling measures and recording error, whilst length of stay can be influenced by many factors other than a single episode of sepsis. The discussion did not acknowledge these important sources of bias. However my main objection to the study is that it cannot be justified on ethical grounds. Leibovici states that “we cannot assume a priori that time is linear…or that God is limited by a linear time”. Therefore it was argued that the intervention could be delivered in retrospect. However, no matter how distant the separation of the illness and intervention, the author was acting with the hope of influencing the outcome without the informed consent of subjects (who had not even given permission for their records to be examined for this purpose). No matter what the mode of intervention and no matter how good the intention of investigators, it is morally unacceptable to intervene experimentally in the routine care of a patient without their permission. Ethical issues should also not be limited by linear time. Whilst it remains possible that such interventions produce benefits, all investigators should be bound by the same rules of study design and ethical integrity that apply to the global scientific community. 1. Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001; 323: 22-29.
Re: Treat the control group 31 December 2001
Haim Shapiro, Physician, Clinical Hypnosis Unit Wolfson Hospital, Holon 58100, Israel Send response to journal: Re: Re: Treat the control group	Only a randomized, controlled study can truly assess the effectivity of an intervention such as intercessory prayer.Since the control group received the best known medical treatment, the trial is ethical (except perhaps the lack of informed consent). Therefore one cannot treat the control group for methodological reasons. If we determine that intercessory prayer is effective, the control group deserve the same treatment, but giving them the treatment disqualifies the trial and therefore there is no reason to give them the treatment..... We are left caught in a bind (a direct result of research methodology)that shows just how far from perfect our assessment and understanding of reality really are ... This may be what many scientists and physicians find most difficult to accept. The need for humility may be what this trial is meant to teach us.
The RCT - gold standard or golden calf? 31 December 2001
Robert G. Newcombe, Senior Lecturer in Medical Statistics University of Wales College of Medicine, Cardiff CF14 4XN. Send response to journal: Re: The RCT - gold standard or golden calf?	Many previous correspondents have drawn attention to methodological, ethical and epistemological difficulties attaching to this study. To the former I would add just two - use of covariates, and publication bias. In an RCT comparing, say, two blood pressure lowering agents, the usual practice is to use the pre-randomisation baseline value of the parameter as a covariate - the purpose not being to remove bias, which proper randomisation does effectively, but to increase precision. In this study, both of the "outcomes" on a continuous scale that are reported in table 2 - length of stay and duration of fever - were known, or determinable, before the randomisation took place, just as were the data on gender, age, source of infection etc. shown in table 1. Yet it would be inconvenient to use each of these outcomes as a baseline covariate for itself, as the difference in outcome between intervention and control groups would of course then disappear. This illustrates that the validity of the standard RCT methodology and interpretation becomes highly questionable once we abandon the axiom that causality can only occur forwards in time. Furthermore, the p-values reported for these two outcomes are at the level that is conventionally regarded as "statistically significant", though they are neither extreme nor independent of each other. Would the study have been considered for publication, either by the author or the journal, had statistically significant benefit not been attained? (Indeed, what would have ensued had the study shown significant harm?) In this instance, the reason one feels compelled to ask this seems to be prior scepticism rather than sample size which appears to be adequate. One correspondent has stated he has no conflict of interest. I feel I must declare that I, and all of us, have a most serious personal interest when it comes to the barely disguised further agenda of this study, which many have already debated. The p-value attained in an RCT represents extremely limited information bearing on this issue, compared to the vast amount of information we have about the universe, even though the former is experimental and the latter observational. If the issue merely relates to the existence of a transcendent being that we can manipulate within an RCT, there is little to be concerned about, as we are then more powerful than this being. But - bearing in mind that this study originated in Israel - if the one in question is the God whom the twelve tribes of Israel worshipped, the God of Abraham, Isaac and Jacob, the one presented in the Hebrew and Christian Scriptures as Almighty, we dare not view the issue in a detached and disinterested manner. In these Scriptures he is presented as the rewarder of those who diligently seek him, but who is not mocked.
Leibovici's paper is religious propaganda, not science 1 January 2002
Riccardo Baschetti, CP 671, 60001-970 Fortaleza (CE) Brazil retired medical inspector Send response to journal: Re: Leibovici's paper is religious propaganda, not science	Considering that 93% of leading scientists do not believe in God [1], it is highly improbable that the poorly significant, unimpressive results that Leibovici [2] ascribes to intercessory prayer have to do with divine interventions. His unscientific paper simply represents a cunningly disguised form of religious propaganda, which is reminiscent of the so-called "scientific creationism" [3]: sheer religion camouflaged with scientific terms to convince simpletons that the earth was created by God, only about 6,000 years ago [3]. Leibovici's implicit message that God uses omnipotence to comply with human prayers, instead of being comforting, is both discouraging and worrying. It is already disquietingly absurd to believe in a good and omnipotent God capable of creating the entire universe but unable or unwilling to stop mere earthquakes, which, despite having nothing to do with the "original sin", have painfully massacred thousands of innocent babies during human history. It is even more disquietingly absurd, however, to imply that God prefers to use omnipotence to shorten, by a single day, the length of stay in hospital of some patients "benefited" by intercessory prayer. As someone stated most rightly, "religion is the rough equivalent of firing an arrow at a blank target, then claiming marksmanship by painting a bull's-eye around the point of impact". Leibovici's grotesque paper [2] concurs to paint that bull's-eye. The fact that leading scientists overwhelmingly reject God [1] should lead humankind to rely on reason, not on medieval superstitions. Reason and science unite people, whereas religions, being mutually incompatible, generate and perpetuate divisions and wars. Religions, as mere products of the last 0.1% of human evolution, should be disregarded if they are at odds with the biological ethics that have wisely guided humankind for millions of years [4]. 1. Larson EJ, Witham L. Leading scientists still reject God. Nature 1998;394:313. 2. Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001;323: 1450-1. 3. Dalrymple GB. Radiometric dating and the age of the earth: a reply to scientific creationism. Fed Proc 1983; 42:3033-8. 4. Baschetti R. Use of stem cells in creation of embryos. Lancet 2001;358:2078.
The effects of retroactive prayer: more questions than answers 1 January 2002
Max Lagnado, Medical Director Chameleon Medical Communications, Park House, 111 Uxbridge Road, Ealing, London, W5 5TL Send response to journal: Re: The effects of retroactive prayer: more questions than answers	Editor– Leibovici should be congratulated for challenging us to question our thinking about the nature of time and the potential therapeutic effects of prayer.1 However, as with all scientific findings we should view them within the context of the study's limitations. In particular, can we be sure that the differences in outcomes between the intervention and control groups were due to prayer rather than due to differences in baseline characteristics? For example, were there differences in the day of the week that patients in the two groups were diagnosed or treated? This would be especially important if the control group was more likely to have been investigated and treated on a weekend, when arguably the level of care is inferior to the rest of the week. And, since the patients were treated over a 7-year period, were there differences in the distribution of the year of treatment for the two groups? If there were, changes in the management of bloodstream infection over time may have confounded the results. Also, Table 1 of the paper shows that fewer patients in the intervention group acquired their infection while in hospital. Although the difference was small (about 2%), can we assume that it had no affect on outcome? Professor Leibovici states that he had no competing interests. However, competing interests include religious beliefs, which may have affected the way this study was designed, analyzed or interpreted. Are we to assume that Leibovici had no a priori beliefs about religion and spirituality? These potential biases, together with other methodological limitations presented in the rapid response section of bmj.com, are not reasons to question Leibovici's integrity nor should they distract us from the originality of his study. However, they should serve to remind us that scientific inquiry, for all its supposed rigour, can not provide a definitive answer to every question. I thank Leibovici and the BMJ for providing me with some (non-alcoholic) cerebral nourishment during the festive period. 1. Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001;323:1450–1.
The Finger of God 2 January 2002
Stephen L. Black, Professor of Psychology Bishop's University, Lennoxville, Quebec J1M 1Z7 Send response to journal: Re: The Finger of God	Applying the Talmudic method (which seems appropriate here), either this study of Leibovici(1) shows God's intervention or it does not. If it does not, then the experiment must be faulty. As Dace(2) points out, the great principle of William of Ockham leads us to prefer this explanation in science. But suppose it does show God's intervention. The time-bending aspect of this report is not of concern, as once the supernatural is invoked, the sky's the limit (literally). If God can intervene to promote faster recovery on request, then surely He can reach back in time to do so. But consider the implication of accepting what Gardner(3) calls "the superstition of the finger", that "God finds it necessary at intervals to abrogate natural laws by injecting a finger into the universe to tinker with it". Charles Darwin, for one, argued against this belief, concluding that "there seems to me too much misery in the world" to believe that God takes such a personal and protective interest in how we live our lives(4). But the argument against the God of the finger becomes even stronger if we accept Leibovici's experiment. We must only recall recent horrific events--in Afghanistan, in the Balkans, in Israel, and in New York--to realize that God is unwilling to lift his finger to prevent great suffering and death among the innocent, and is unmoved by the many impassioned prayers that he do so. Then why does he choose to respond when called upon by perfunctory, impersonal prayer on behalf of long-ago events involving far lesser suffering? The implication of Leibovici's conclusion is that God may intervene, but He does so in a profoundly cruel, capricious, and trivial manner. Those who believe in a just and loving God should obtain little comfort from the outcome of this experiment. They should pray that it is not true. 1 Leibovici, L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infections: randomized controlled trial. BMJ 2001; 323:1450-1451. 2 Dace, J. Occam's razor. Electronic response, BMJ 2001;323: 1450- 1451 at http://bmj.com/cgi/eletters/323/7327/1450#18236 3 Gardner, M. Phillip Johnson on intelligent design. In: Did Adam and Eve Have Navels? New York: W.W. Norton, 2000, p. 22-23. 4 Milner, R. The first evolutionary psychologist. Scientific American, Jan. 2002 [http://www.sciam.com/2002/0102issue/0102reviews1.html] Competing interests: none
Doctors prayer for more care 3 January 2002
DE Barnes, General Surgical SHO James Cook University Hospital, Middlesbrough, TS4 3BW Send response to journal: Re: Doctors prayer for more care	Sir -I read with interest the forementioned article that concluded with great conviction that a prayer to sub group of patients with blood borne infection led to a significantly better outcome in the interventional group. -I would like to know if this effect was dose dependant, and if the relatives and general prayers for the sick that happen across the world were banned from the control group during this period of "intervention". -Whilst I am a firm believer in god and that patients and relatives gain comfort through prayer, this study was fundamentally flawed. Furthermore I have concerns that it could be used inappropriately by those wishing to further their alternative medical practice by quoting this "conclusive evidence" from your' well respected journal.
Misapprehension of principle 3 January 2002
Stephan A. Schwartz, Research Associate Cognitive Sciences Laboratory 90212 Send response to journal: Re: Misapprehension of principle	Those correspondents who suggested that the controls should be included in a cross-over study where they become the treated sub-population in a subsequent study have, I believe, misunderstood what is going on. This study is not about reaching back from the future into the past to change it but, instead, affecting the way in which it occurred in the first instance, when these clinical events were present tense. Nor is this study a singular piece of benighted research, as others seem to suggest. BMJ readers may find the following URL of interest, http://www.fourmilab.ch/rpkp/ There they will find a number of papers addressing various aspects of this subject, and I particularly draw their attention to the work of physicist Helmut Schmidt. Readers may also want to consider a just published study carried out by researchers at Duke University’s School of Medicine, which also deals with retroactive Therapeutic Intent (TI). (1) (TI is, I think, a better term than prayer, because the now considerable literature on this subject suggests that any form of religious belief, or none at all, seems capable of achieving the effect.) Using a well-designed randomized, controlled, double-blind protocol, the Duke study involves prayers from religious groups around the world for people experiencing severe chest pains who are in danger of imminent heart attacks. The treatment they received to relief their crisis was cardiac catheterization and angioplasty. As readers will know, the emergency nature of these treatments means the procedures are carried out immediately upon the patient being admitted. That turns out to be the crucial aspect of the retro-active aspect of this TI research, because although the prayer groups were notified as soon as possible after the patient was admitted, the initiation of the actual TI sessions often began after the medical treatment had already been completed. Both treated and control groups received the same level of medical intervention. The TI practitioners had no contact with the patients, and the health professionals administering the treatments, and the patients themselves did not know about the TI involvement. The outcome measure was the number of complications each patient experienced, with the comparison being made between the subgroups. The TI recipients experienced, a 50 to 100 percent reduction in side-effects compared to the controls. Although this was just a pilot study with a patient population too small to reach any definitive conclusions, the results have proven so provocative that researchers at more than half a dozen medical centers in the U.S. have taken up this line of inquiry. The study had another aspect that should be mentioned. The TI practitioners were scattered all over the world, including Nepal, India, Israel, and France, as well as in the U.S., and their TI was expressed through a wide range of religious traditions. No difference was noted concerning one tradition being more powerful or efficacious than any other. Skeptics may find this line of inquiry philosophically offensive but the gathering corpus of research suggests that TI, whether retroactive or real-time has the power to affect clinical outcome. (1) Krucoff MW, Crater SW, Green CL, Maas AC, Seskevich JE, Lane JD, Loeffler KA, Morris K, Bashore TM, Koenig HG. Integrative noetic therapies as adjuncts to percutaneous intervention during unstable coronary syndromes: Monitoring and Actualization of Noetic Training (MANTRA) feasibility pilot. American Heart Journal. 2001;142(5):760-767. -- Stephan A. Schwartz
Beyond Science? 3 January 2002
Tobit S Emmens, R&D Manager Department of Mental Health, Wonford House Hospital, EX2 5AF Send response to journal: Re: Beyond Science?	It has been with interest that I have read this paper, the paper on the Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms and all the associated rapid responses. I think that perhaps a more appropriate title for the section would have been: Before Science. From the beginnings of recorded time up until the fairly recent past (1700s and the advent of people such as Descartes), techniques such as mantras and intercessory prayer have formed a substantial part of any available healthcare service, and in many parts of the world are still being used today. Whether or not the science or ethics are sound in this research, we should treat techniques such as prayer with respect. Rather than mocking such research we should applaud those that are breaking "new" scientific ground. Just because we ignore, are unaware, or do not understand it does not mean that it cannot be possible. Just as, if a technique or procedure is yet to have a clear scientific rationale does not mean that it is invalid. Many thanks for such stimulating topics of discussion.
Efficacy of prayer underestimated? 3 January 2002
Charles S. Harris, PhD, Webmaster, The Nurture Assumption home page: http://home.att.net/~xchar/tna/ Middletown, New Jersey, USA 07748 Send response to journal: Re: Efficacy of prayer underestimated?	Leibovici found statistically significant ameliorative effects of retroactive intercessory prayer. Regrettably, the reported magnitude of effects was disappointingly small (see Table 2). However, it may well be that the efficacy of prayer was underestimated--perhaps greatly underestimated--in this report. As spelled out in the Methods section, "A list of the first names of the patients in the intervention group was given to a person who said a short prayer for the well being and full recovery of the group as a whole." Now, it is highly likely that some--perhaps many--of the control group members shared some of those first names. Thus an undetermined number of control group members may have inadvertently benefitted from the intercessory prayer, thereby spuriously bringing the control group's data into closer agreement with the intervention group's. Indeed, although other commentators here have decried the researcher's possibly unethical behavior in withholding effective treatment (prayer) from the control group, this trial may in fact already have had vast, unmeasured, beneficial effects on a large segment of the general public: those who share first names with the intervention group. One could ascertain whether such collateral effects have actually occurred, by comparing hospital records for patients whose first names do or do not appear on the list. Such a tally of several hundred thousand records from many hospitals would, I venture to predict, reveal statistically significant differences (albeit perhaps for conditions other than bloodstream infection and outcome measures other than duration of hospital stay).
Retroactive prayer - a solution to the bed crisis? 4 January 2002
Adrian Fawcett, Consultant surgeon Central Middlesex Hospital, Park Royal,London NW10 7NS Send response to journal: Re: Retroactive prayer - a solution to the bed crisis?	Unfortunately, it seems our management staff have got hold of this article. As a result, all elective work in surgery has been cancelled for the next week,as has all annual leave. Why? Because of a waiting list initiative. Management have decided that if retroactive prayer can improve outcomes in blood infections it may work in other cirumstances too. We, the surgical staff, have each been allocated a particular disease, and informed we must pray for all sufferers of said disease admitted to the hospital between 1990 and 2001. Though no specific training has been given, clinical governance demands we each stick to our specialities, and my firm has thus been given strangulated piles,perianal sepsis and retained rectal foreign bodies as the focus of our heavenward pleadings. Management hopes that by the power of prayer we will shorten in-patient stays of years gone by to such an extent that previous bed crises will have become (a thing of the past?) no more than a figment of our imaginations. If sufficient resources are mobilised, on our return to work we will find that so many bed-days have been saved by early discharge that we have no waiting lists, no trolleys in corridors and in fact fewer people in our clinics because some patients never came to hospital at all because they were cured at home.......or because they had heard we'd all gone crackers.
Methodological concerns 6 January 2002
William G. Taylor, Part-time tutor University of Sheffield, England Send response to journal: Re: Methodological concerns	I have two sorts of concern. 1) There is no detail regarding the methodology of the primary intervention, ie application of prayer. Readers could expect more detail if only in the interest of replication. Further, what assumptions about the modus operandi of prayer underlay the design of their 'treatment'? 2) The data supporting the conclusion is very weak. The reader has a set of three significance tests, one of which gives a non -significant result and another of which gives a barely significant result that amounts to weak evidence. This leaves only one test that provides strong evidence to reject a hypothesis of 'no effect'. Regarding this third test we are told nothing about the clinicians responsible for decisions about patient discharge. Presumably several clinicians were involved. Was there no control of this variable? It was needed. What about post-experimental control using statistical methods?
Pride and Prejudice, or Prayer? 6 January 2002
Max Lagnado, Medical Director Chameleon Medical Communications, Park House, 111 Uxbridge Road, Ealing, London W5 5TL Send response to journal: Re: Pride and Prejudice, or Prayer?	The finding that retroactive intercessory prayer improves outcomes in patients with bloodstream infections (albeit to a modest degree) is provocative.1 Two weeks after the publication of this paper 25 electronic letters had been posted on bmj.com, most of which were critical of the study or the author(http://bmj.com/cgi/eletters/323/7327/1450, accessed 4/1/2002). Leibovici (the author of the paper) and the authors of three of the electronic letters stated that they had no competing interests; the remaining contributors to bmj.com made no explicit statement about their competing interests. The BMJ encourages all contributors to disclose any competing interests, particularly those that are of a financial nature. However, the BMJ also gives authors the opportunity to declare “a deep personal or religious conviction that may have affected what you wrote and that readers should be aware of when reading your paper.”2 Can we safely assume that none of those who contributed to the debate about retroactive prayer held an a priori belief about religion or spirituality? Surely most, if not all, of us have beliefs and prejudices about the validity of spirituality and religion. And once a belief about a subject, such as religion, is formed, pride, ego or fear can often get in the way of revising your view even when new information becomes available. Moreover, it is not realistic to expect those who contribute to a debate to be able to relinquish their beliefs in order to move from a subjective to an objective view. Perhaps we should follow the advice of Peter Senge, an expert on systems thinking, who advocates a “commitment to the truth”.3 This approach means seeking out and acknowledging (at least to ourselves) beliefs that may influence our ability to challenge our thinking. This self-awareness, argues Senge, reduces the hold such beliefs may have on our ability to "see more of the playing field". The lack of acknowledgements about competing interests suggests that many of us who contributed to the debate about retroactive prayer did not follow Senge’s approach. If we had, would our responses have been different? Competing Interests I believe that there is a God. References 1. Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001;323:1450-1451. 2. BMJ. BMJ declaration of competing interest. http://bmj.com/cgi/content/full/317/7154/291/DC1#aut (accessed 4/1/2002). 3. Senge P. The fifth discipline. The art and practice of the learning organisation. Random House;1990.
Time Paradox 8 January 2002
Effi Peled, CEO DynamicTools Ltd, POB 8326, Haifa Israel Send response to journal: Re: Time Paradox	This article deals with a time paradox just like the old one: What happens if I travel back in time and kill my Grandfather? In this case, we cannot make any calculations based on passed data since it leads to a paradox: When we change the results retroactively, the results are changed for us in the past (in our past) since we have only one past - we won't know about the change at all. The original results (pre-intervention) are lost for us! So for those responses suggesting to pray for the control group and see if the results change - it's a parctice in futility - when we'll check the results after the prayer we will see no change because the past was changed hence the results will stay the same for us. An observer standing 'outside' our time-line may be able to see the change since he is sorts-of "time-independent" but for the rest of us - we have only ONE past and if someone changes it we have no way of knowing about it. Effi Peled
Healing powers of the human mind 8 January 2002
Joseph Watine, consultant, laboratory medicine Hôpital de Rodez, France Send response to journal: Re: Healing powers of the human mind	Assuming that the methodology used in Leibovici’s study is not biased (which remains to be demonstrated), it seems to us that Leibovici’s conclusion that God might account for the observed results [1] is only be one of the possible explanations. Among the numerous other possibilities, one could propose the following hypothesis: - the human mind has got healing powers, - the patients’ horoscopes (which, unfortunately, were not indicated in the Materials and Methods) can potentialise or antagonise these healing powers, - the man who did the prayers was in fact an angel, - the “random number generator” that was used to randomise the patients was a tool of the devil, - the prognostic profiles of the patients in the control group were poorer than those patients in the "treated" group (this might of course mean that some of the patients in the control group were great sinners), etc. [1] Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001;323:1450-1451 (22-29 December).
I pray now for my own papers to be published 11 January 2002
Luc-Marie JOLY, medical doctor Hôpital sainte Anne, Paris, France Send response to journal: Re: I pray now for my own papers to be published	Lebovici's result looks like a miracle but the only true miracle I can see is the publication of this paper in the BMJ. Anyway, I immediately started to pray for my own papers of low scientific content also to be published in the BMJ (retroactively of course). I'm now every day looking in the Medline database for the doubling of my own publications. If such a event arise, I promise never to make jokes about Lebovici's paper, because such evidence will convice me with a very low p value, and of course that God exists. On the other and, if all my already published papers suddenly disappear from the Medline database, it would be clear evidence that the Devil exists, and that he has punished me.
Editors beware, everything is possible 12 January 2002
Yakov Sivan, Director, Pediatric Intensive Care Unit Tel Aviv Medical Center, 6 Weizman street, Tel Aviv, Israel 64239 Send response to journal: Re: Editors beware, everything is possible	I congratulate the Editor for publishing Leibovici's paper. This paper has learnt us an important lesson. Nevertheless, a much greater and more important is the lesson journal editors and members of the editorial boards should take home. We, readers, face new information and many many new publications each day from so many journals in each discipline. Although we should read every paper relevant to us very carefully, we still rely on editors and their assistants to do a major correct selection analysis and filtering part for us. So many times have we fallen into the traps of "a randomized, placebo controlled, double blind, prospective large sample" studies that do affect practice. The examples are countless, just a couple from one narrow specific area: the "proven" relationship between the sudden infant death syndrome (SIDS) and DTP immunization and the preventive irradiation of the thymus for every normal newborn to prevent SIDS. There is one way to stop this from going on. Editorial boards should be much more careful when evaluating a new manuscript. The routine of relying on referents should be taken with great care and the editorial boards should have their own (even reimbursed) professionals. Not all outside referees go into the very small details and the result is publications of so many papers that do not increase real knowledge or therapy. The number of journals should thus be cut by no less than 50% (should I say 70%) which will increase the importance of each paper published and the exposure of the readers to the more important information.
Re: You cannae break the laws of physics captain 15 January 2002
Michael J Brownnutt, Physics student at Erlangen University Lehrstuhl für Optik, FAU, 91058 erlangen Send response to journal: Re: Re: You cannae break the laws of physics captain	I read with interest the response of Dr Hopkins to the BMJ regarding retroactive prayer. (You cannae break the laws of physics.) However, I must ask what physicists do all day, if the famous quote is true. Everyone from Aristotle through Newton to Einstein and Feynman made their living breaking the laws of physics. (Newton, for example, did especially well with calculus by breaking the laws of maths too.) Currently the standard model is the best tested and verified theory in the history of mankind. Flawless in every prediction it makes. Huge experiments have shown its every intricacy to stand firm. And billions of dollars are being spent by physicists and mathematicians working round the clock because they know it *will* break. The world physics community looks forward with excitement and expectation to the day when their best ever theory is toppled. When that happens, there will be partying. The fun and vibrancy of physics comes from knowing that "Now we see but a poor reflection as in a mirror". There is more to know, the raison d'etre of a physicist is to break the laws of physics. I am no medic, but i make no apology for discussing the philosophy of physics. I hope i have shared a little of of my manic eagerness about science, that I hope should never be squashed by being told things cannot happen. "It's not physically possible" should certainly never be grounds for throwing out a result. Mike Brownnutt "Many school students are put off physics because they think that we know it, and maybe there are just one or two final pieces to put in the puzzle. What they do not realise is that we have only found some of the pieces, if we are lucky one or two are the right way up, but we do not have the faintest finger-tip hold on what any of it means." Dr. T. Bricheno, Nortel Networks
Re: Treat the control group 15 January 2002
Tracey A Thomas-Falconar, maintenance housing for homeless persons, n/a Send response to journal: Re: Re: Treat the control group	I hope that your suggestion to treat the control group with prayer, and to monitor the results, was sincere rather than hostile to the study. I noticed that the study was unfunded, so this follow up may not be possible. Perhaps we can each of us say a prayer for the control group. It can do much less harm than many medical interventions can and do. Peace!
Down to earth 15 January 2002
Santiago V Rosales, Primary Care Pediatrician Barcelona, 08015 Send response to journal: Re: Down to earth	Retroactive praying may not help much but prospective praying does comfort patients who believe in God, as they are comforted by a sympathetic, friendly, optimistic staff. Since it seems that Leibovici has plenty of time to run this sort of studies, may I suggest him that, coming down to earth, he designs a study that puts into numbers the effectiveness of having sensitive health administrators and supportive, smiling staff in the outcome of the patients they look after?. I dare to suspect that the results would help to humanise the practice of our medicine more than merely documenting a supposed effect of retroactive praying. No competing interest
A moment of seriousness 16 January 2002
Dr Trevor Watts, Senior Lecturer and Consultant in Periodontology Guy's King's and St Thomas' Dental Institute, London SE1 9RT. Send response to journal: Re: A moment of seriousness	I have read this paper (1) and the rapid responses with a deep feeling of concern. I distrust not only the findings of the study (if it is not intended to be a humorous offering for the Christmas BMJ), but also the premises and methodology on which it is based. Prayer is not just about getting what you want. It is part of a living relationship with a living God. The person who trusts God wants to remain in fellowship with Him, and prayer is part of the relationship, which also includes a desire to understand God in an appropriate way (for instance, through reading His revelation in the Bible) and a personal commitment to improve behaviour. Sometimes God may answer "Yes", sometimes "No", sometimes He tells us to wait, and sometimes He gives an answer which is unexpected, but also effective in resolving the problem about which we worried. As a Christian and a consultant, I know the value of my living relationship with God. To think of prayer - communication with an infinite omniscient Lord - as a mechanism within His creation for getting what I want from Him, is something which repels me. He has put other mechanisms in the creation for me to use. There is no way in which I could manipulate His actions, but there is also no way I would want to. I much prefer to trust His infinite wisdom against my limited knowledge and understanding. Competing interests: should be obvious from the above. 1. Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001; 323: 1450-1451.
To whom did the prayer pray ? 19 January 2002
Tomoyuki Hisa, Research Fellow NCI-Frederick, NIH, Frederick, 21702 USA Send response to journal: Re: To whom did the prayer pray ?	Dr. Leibovici, whose institution is lacated in Israel, wrote that the prayer pray God. Which God ? To Christ, to Allah, or to Buddha ? And, is there statistically significant difference on beneficial effect among them ?
God and Us 23 January 2002
Gabriel Onato, MD, PhD, Senior Registrar in Medicine MOH Hospitals, Kuwait, 67242 Send response to journal: Re: God and Us	Dr Leibovici has put forward an idea that although reasonable, in and of itself, is seriously flawed in a multitude of ways. A lot of doctors have pointed out scientific flaws, but as this is an article related to religion, how about religious flaws: First, this study comes from a violent society where human rights abuses occur daily and thus we can not take it for granted that God looks favourably on any prayers said therein, regardless of the religiousity of Dr Leibovici. Current day Israel cannot be accepted as the ground for such testing and is a fatal flaw in this paper. Second, assuming that the above factors are not applicable, such a paper must have a religious scholar as a co-author, and a significant description of the prayer procedure before we can even begin to talk about its validity let alone its publication.
Blind faith in the Central Limit Theorem 25 January 2002
Robert J. MacG. Dawson, Associate Professor Dept. of Mathematics and Computing Science, Saint Mary's University, Halifax, NS, Canada B3H 3C3 Send response to journal: Re: Blind faith in the Central Limit Theorem	Dr. Leibovici's article ("Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomized controlled trial") provides a classic example of the dangers of assuming that, if one only assures that N>30, the omniscient, omnibenevolent, and omnipotent Central Limit Theorem will take care of the rest. We note that (for instance) the median stay in hospital was 8 days for the control group, while the maximum was 320; for the duration of the fever, the figures were 2 and 50. With such enormously skewed data, the means must be largely determined by the handful of patients in each group whose stay is longest. The fortuitous (and not improbable) inclusion of more of these patients in one group or the other will create differences in the mean that would be highly improbable in data from equivalent normally-distributed populations. The release of the entire data set would be a service to those teaching statistics or writing textbooks on the subject! -Robert Dawson
Therapeutic event or medical fact? 25 January 2002
Peter Morrell, Researcher, History & Philosophy of Medicine UK Send response to journal: Re: Therapeutic event or medical fact?	Sir, In Leibovici's study of the alleged effect of prayer on patients, then some light may be shed on this matter by considering the two terms 'therapeutic event' and 'medical fact'. Many readers of this article will doubtless feel that what happened in this study was a kind of 'therapeutic event'; while others will dispute this and say that prayer could not possibly have acted as a cause of the measured 'effect' in the patients. In other words, that it was coincidence rather than a genuine therapeutic effect. Some readers will have been sufficiently convinced by the validity of these 'therapeutic events' - and perhaps others like them in the orbit of their own experience - that they would even go so far as to regard them as 'medical facts'. Others would strongly resist such an interpretation. Likewise, some would be well disposed towards 'prayer' as a possible therapeutic agent, while many would oppose the idea in principle. It is therefore helpful to consider more carefully what actually comprises a 'therapeutic event' and how one might distinguish it from a 'medical fact'. It is a far from simple matter. In order for any therapeutic event to become more powerful, more elevated in status, then it must in the first instance, be repeated, and the more often it becomes repeated, in as many different circumstances as possible, the sooner it starts being taken seriously by a wider range of clinicians. However, just as 'one man's meat is another man's poison', so one person's 'therapeutic event' will be seen by others as a delusion or written off as pseudo- science. There inevitably enters the picture, therefore, the whole matter of collective belief and collective disbelief - fickle and non-rational factors that can confound the otherwise clear conceptual waters. In order for any 'therapeutic event' to even be considered as a 'medical fact', let alone be converted into one, it must somehow therefore gain the approval and collective belief of most clinicians. Until it does so, then it merely loiters on the borders of the real, residing in some grey hinterland where many other matters live that are neither entirely real nor entirely false. Many of these may also be beliefs and assumptions. These days, the usual means by which 'therapeutic events' get transformed into 'medical facts', and thus embroidered into the fabric of accepted 'medical truth', is through RCTs and the elucidation of 'chemical pathways'. In former or ancient times, very different criteria were used to validate a 'medical fact'. In any medicine prior to about 1800, prayer was certainly accepted, and without question, as a therapeutic agency, and also God. As these are no longer acceptable, then clearly, the mixing of RCTs and prayer represents a novel ways of bringing together the old and the new! Nevertheless, in former times very different preconceptions existed and very different criteria held dominion. Manifestly, the means used to convert a 'therapeutic event' into a 'medical fact', in any age, is very largely contingent upon the society one lives in, the state of medical knowledge [or beliefs] and the agreed-upon therapeutic norms in vogue. In any age, it is largely theory-driven rather than empirical. Another problem concerns the theories, ideas and constructs we bring, as preconceptions in our minds, to the observation process, and which can crowd out and obscure the simple empirical 'purity' of what is being observed. These constructs can strongly influence one's judgement and perception to such a degree that different people will judge them very differently and even see them very differently. Moreover, this will be solely due to differences in the mental constructs of the observers. In this case, such constructs can either be scientific preconceptions antagonistic towards the very idea of prayer as a therapeutic agency, or religious constructions in favour of prayer. This would also include whether one viewed this study as a non-mediated empirical fact mysteriously connecting 'prayer' and 'patients', or whether one additionally believed in an intermediating agency such as God. The options there are wide open. Such constructs can act as if to 'poison' the pure observation of the event itself and make it into something entirely different or something it was not. If prayer really does act as a therapeutic agent, then the stark empirical reality of this 'fact' will, one hopes, shine through every study made of it. If it does not, then that also will become unambiguously apparent from such studies. However, the empirical reality of the therapeutic event cannot be elevated in status automatically to 'medical fact' unless and until it is corroborated through repeated studies and investigated much more thoroughly by different teams and in different places. If all those conditions are satisfied, then there remains no obstacle to such 'therapeutic events' being elevated to the status of 'medical fact', no matter how outrageously they may offend accepted theory. We might also say that what is a bare empirical 'therapeutic event' should largely be left untainted by the encroachment of constructs, or reinterpreted to fit any pet theory. These must be regarded as inappropriate deviations from neutrality, whether they veer towards science or towards religion. To gain more credibility, therefore, what this study needs is endless repetition. It might then be possible to consider a provisional mechanism whereby a group of people 'praying' can come to have such a strong correlation with another group of people 'getting better', in a truly cause and effect type manner. In advance of such studies being undertaken, it is simply not possible to decide if this was a genuine therapeutic event or whether it was fictional. Nor is it possible, even if it was real, to say whether the event described involved any type of religious construction such as God, even though that is how it has been regarded by several BMJ correspondents. It is perfectly possible to imagine that the two categories - 'prayer' and 'patients getting better' - could be connected by a self-mediated phenomenon [a natural force] involving no other intermediating entities, and thus involving no religious aspect whatsoever. Finally, we might object that within the orbit of one's own experience there are many things that one might regard as valid 'therapeutic events', which others would reject outright as fictions. Thus, the orbit of one's own experience is not quite the same type of epistemological arena as that of the entire profession, in terms of determining what is and what is not a 'therapeutic event' or a 'medical fact'. The difference seems to lie both in the nature of the evidence, or proof, that is deemed acceptable in each arena, but also in the type of beliefs that hold sway. To the world's end a religious person is more disposed to accept prayer, just as a scientist is predisposed to accept a chemical mechanism. Who is to choose between them? For any individual they may be equally valid; not so for the profession, however. Manifestly, in different epochs what are construed as 'therapeutic events' or 'medical facts' varies greatly, and yet they always seems consistent with the dominant beliefs of the day, that is the collective beliefs of the profession. Lest we need reminding, in any true science, the primacy of empirical facts must always be allowed to stand supreme over the dictates of theory or beliefs. No matter what the temptation, no theory can ever be as precious that it is impervious to new facts. If prayer really does induce therapeutic events, then this must be accepted as an empirical medical fact, regardless of how unpalatable and unwelcome it may be, especially in those quarters where scientists' inadvertently mistake their models for reality, as did Cardinals of old.
Re: So there is a God?! 7 February 2002
Tracey A Thomas-Falconar, maintenance housing for homeless people, n/a Send response to journal: Re: Re: So there is a God?!	My theological response to you is that if science were to prove the existence of God, the quality of the resulting faith would be all the poorer. We cannot know God with the same mind or senses as we know an orange or a medical fact. Proof is useless to us and to God. It would be like believing in telephones, but not having the means to use one. Re: A nonsense joke for the New Year Holy knee jerk response! You should look into that! Every scientific experiment is based on the beliefs of the experimentor. I learned in Grade 3 that that is called a hypothesis. What you want to see has always influenced what you do see. And to complicate matters, doesn't particle physics now understand that what you are looking for (to measure) appear to influence the outcome of the experiment? Re: The power of statistics, not prayer That God would get you out of hospital earlier is proof that God has mercy! Re: Leibovici's paper is religious propaganda, not science The writer apparently already suffers from religious zeal which is clouding his vision: His religion is blind faith in Science itself. Re: The Finger of God I hope the writer is not serious in his conclusions about God and human tragedy. If he is, he is a tormented man! Places of worship and learning are full of such men and of such treachrous questions. The writer has lept upon the question of free will and has taken a Doctrine of Predestination tack, as in "God can fix it, so if "HE" has not, then everyone deserved what they got." (Obviously this is not true) I personally speculate that the person who follows such thinking believes in a Satan but not a God. Consider a universe governed by a malevolent, malicious and cruel Satan. How could we then account for the presence of good, of generosity, of love, of selfless giving, of the absence of destruction in many places at many times for that matter? As for earthqquakes, shit happens. I step on bug and mean no harm. It is our human duty, if we believe in good at all, to prevent any tragedy we can, and to alleviate any suffering we can. For me this translates into applying environmental values and working with homeless people. Does it not translate into your work? May you find a merciful God in the midst of this stricken world.
A Question From An Outsider Looking In 9 February 2002
Alina Finn, Human N/A Send response to journal: Re: A Question From An Outsider Looking In	I am an average person who stumbled upon a link to this article in a round-about path from "The Hound of the Baskervilles effect: natural experiment on the influence of psychological stress on timing of death"; BMJ 2001;323:1443-1446 (22-29 December). Please excuse my unfamiliarity with your journal and this forum. I am not a member of any medical or scientific professions and my comments and question may be of little (if any) value or interest. Still, there is something I would like to know and I hope you can answer it for me. Before asking my question, I would like to point out that many people believe that an omniscient God knows each of us before we are born and, therefore, knows what our choices and experiences will be throughout our lives. The idea of free will excludes the creation of mindless robots set on earth to follow commands unblinkingly, but He does know the plot of the tale. Given this foreknowledge of each person, it is not a far reach to presume that God would then know if a person was going to pray at a given time and, when that time came, what the petition of the person would include. Thus, prior to the illness or event in the person's life, God would have already chosen whether or not to act on the petition and, if the answer was affirmative, what action He would take. Like an arrow shot from a bow, His plan would have been set in motion at one time in the past, traveled (and unfolded) over time, and reached its target at the appropriate hour. Because he or she only sees the end result of God's work, the answer would seem to the petitioner (person) as having only just arrived at that moment. The petitioner has no knowledge of God's schedule or of what pieces of the puzzle must be moved into place before a prayer may be answered. Having said all that, and assuming anyone has read to this point, I'll get to my question. The tongue-in-cheek and sarcastic responses to this article may well be scientifically justified. Perhaps the methods are flawed and no viable conclusion could ever be reached from such a study. I am not concerned with the validity or content of Leibovici's study as much as the issue of prayer in the medical profession. Riccardo Baschetti, CP 671, 60001-970 Fortaleza (CE) Brazil retired medical inspector, in his January 1 2002 response titled "Leibovici's paper is religious propaganda, not science" referenced this article: 1. Larson EJ, Witham L. Leading scientists still reject God. Nature 1998;394:313. The article reportedly states that 93% of leading scientists do not believe in God. While this doesn't address what any of the non-leading scientists believe, it leaves a paltry 7% who claim a connection with and understanding of the religious and/or spiritual beliefs of patients. I would like to know how the non-spiritual or non-religious physicians think of their patients who embrace and practice their religious beliefs during either their own illness(es) or the illness(es) of loved ones. If spirituality or religious beliefs are viewed as "far-fetched" or "superstition" or even "a crock of malarky", how difficult is it for the non-religious physician to contain his or her own beliefs (or lack there of) and maintain a calming or sympathetic presence for the patients? How often the patients or loved ones are seen as less intelligent for embracing their faith in times of trouble? Are the physicians trained to deal with spiritual patients or patients with different spiritual beliefs? There are billions of spiritual people (varying religions in varying degrees) on the planet who may need the services of a physician or hospital at one time or another. The number of non-religious scientists and physicians is also quite large. With two such disparate groups in constant proximity I have to wonder how it all works out. I have been a patient. I have never been on the other side of the stethescope, so to speak. I'd like to know what the doctors are thinking. Thank you, in advance, for any input. *For a list of major religions of the world ranked by number of adherents, visit: http://www.adherents.com/Religions_By_Adherents.html
Regarding retroactive prayer 13 February 2002
Gilbert J Custer, M.D., private practice Austin, Texas, USA 78746 Send response to journal: Re: Regarding retroactive prayer	The design of this study reminds me of slit lamp experiments in physics. Electrons or photons travelling through two slits create an interference pattern on the target screen. The interference pattern is disrupted if one monitors which slit the electron or photon went through. It is as if all the possible trajectories of the electrons or photons occured through the two slits until you measure it, then you force reality to choose what happened. Likewise in this study, the outcome of the patients may have had many possibilities, until you force reality to choose by measuring it. Quantum physics suggests a certain acausality in our world, so perhaps we can nudge the past a little with prayer, at least until we carefully measure it. Thank God we can't measure everything!
Religion and Science 17 February 2002
Peter Morrell, Researcher, History & Philosophy of Medicine UK Send response to journal: Re: Religion and Science	Sir, "My theological response to you is that if science were to prove the existence of God, the quality of the resulting faith would be all the poorer," [1] Tracey Thomas-Falconar can rest assured that no such "resulting faith" is likely because God's existence can never really be proved by science. To propose otherwise, or to pin much hope on such a broken dream, is to misunderstand the nature both of religion and of science. It is worth probing at the reasons that underpin this poorly understood issue. Science first arose as a system of worldly knowledge primarily regarding the nature of matter and the world fabric, and was not initially conceived in direct conflict with theology. For example, it is quite true that its early pioneers did not deliberately set out to create an overt challenge to religious truth or to overthrow its long-standing domination of man's intellectual understanding of the world. In fact, most early scientists were religious persons who saw science as proof of God's presence in and the divine nature of the world. However, it pretty soon began to have a challenging effect upon the accepted truths of theology. What happened is that in investigating the nature of matter and forces, soon no place was left for well-established concepts like essence, soul, spirit and God, which could not be easily integrated into the new worldview. Thus, life itself pretty soon came to be regarded in the same sense, as just another aspect of the machine-like world of substances: objects moving solely due to the forces acting upon them. And viewed in aggregate, the work of figures like Bacon, Galileo, Kepler, Copernicus, Descartes, Locke and Newton, increasingly favoured a secular and strictly mechanical view of the universe, in which solely material objects are moved about by measurable forces; a part mechanical and part mathematical universe, that increasingly seemed to exclude any need for spirit, essence, soul or God. Religion got progressively squeezed out of the picture. In this view, the world was depicted as little more than a complex clock set in motion and regulated solely by itself [blind matter], apparently with no underlying purpose or meaning and no maker. By 1700 or so, this was the overwhelming impression most leading intelligent people had come to adopt about our world. And in the last three centuries this impression has been repeatedly reinforced by every scientific development since. Therefore, it is clear that science and religion have been permanently rent asunder and are unable to find much common conceptual ground. Manifestly, religion is an aspect of life that is quite distinct and separate from science, that does not concern itself with matter and forces, but with the alleged spirit, soul or God that lies behind substance and which drives each living thing and the universe as a whole. Not being composed of any material substance, then clearly such entities, if they exist at all, could not possibly be proven or disproved by the solely material methods of science. Being rooted strictly in matter and energy, science describes all phenomena exclusively in those terms. It can only ever at best approach the concepts of religion as rather nebulous and conceptually rarefied forms of 'energy', and thus cannot really find the right concepts or terminology to even apprehend religious ideas. Such 'energies' are not measurable or detectable by normal scientific methods and therefore are deemed not to exist. So completely have the two divisions of life experience been divorced from each other for four centuries, that little meaningful dialogue between them seems possible. For such reasons, it is therefore difficult to describe religious matters in the language of science. Religion was really abandoned and ignored while science glittered so much the brighter after about 1700, and held much greater fascination for many intellectuals. Religion was not comprehensively defeated or invalidated by science as if in some grand contest. Such would be a very false impression. The two are simply very different types of knowledge and it is hard to see how each might genuinely judge the other, using its own rules and methods, that can never be bent to such a purpose, as they each apply only in their own respective domains. Religion also concerns itself with other complex matters. These include ethics, human conduct and life's meaning and purpose. These topics are not easily translated into the scientific worldview and when discussed by scientists tend to be regarded in a very simplistic way. Yet, they are in reality, complex, subtle and negotiable matters, largely irreducible to the monochromatic, either-or and cause-and-effect patter of science. Although the advantage of science is that it is backed by proof, yet this proof is always only material in nature [energy, matter, forces, etc] and can never be employed to prove or disprove those immaterial matters lying at the core of religion and metaphysics. The views of science also include belief [assumption and inference] which is a human element found in all systems of knowledge to some degree. Thus, the proof that science offers is only able to prove material things. This obvious point creates the problem that any views it generates on immaterial matters must automatically remain as opinions based upon consideration of their likely probability, and not as proven views. Scientific knowledge is also based upon reductionism which cannot be applied successfully to complex systems like human affairs and metaphysics, which are not amenable to reduction or simplification. And nor can religious truths be measured or weighed in the same sense as those in science, because they have a very different reality and nature. Thus, it is clear that the tools used in each discipline are too different from each other to be mutually transferable or applicable in both domains. Religion is not primarily concerned with matter and forces, but with complex human affairs, and the granting of greater life meaning or purpose. This means that it quite centrally concerns itself with transforming oneself into a happier and more contented person, someone who feels better about themselves and the feeling that they live a useful life underpinned by a sense of duty and compassion, of true spirituality. It is difficult to see how science, in any sense, could ever confer such self- beliefs. In denying vitalism, soul, God, spirit or essence, and in enforcing our mortality as the only reality, it denies soul and afterlife. Such is inevitably a somewhat nihilistic and molecularised view that declines to elevate any inherent value to living things over and above the value of mere molecules, as if we exist solely in the non-living world. Such is a blatantly anti-religious and anti-spiritual philosophy that replaces hope, joy, optimism and value [respect for life] with a dead-end materialism, a world solely composed of molecules. It is in this precise sense that any religion is better than none, because all religions claim man is more than mere molecules. This cannot be scientifically proven, because such proof would need to be of a material nature. Religious belief therefore adds an extra dimension to the scientific fixation with molecules as the only reality. For example, in a non- molecularised worldview prayer might well be conceived to operate through a mutual empathy or resonance connecting all life-forms that would be lacking between objects of non-living matter. However, I would repeat a comment I made previously about Leibovici’s study [2], that the concept of prayer’s alleged healing power as a ‘therapeutic event’, need not necessarily involve any link whatsoever to religion or God. A person can also believe in religion as well as being a good scientist. The one need not afflict the other. As an individual, one can have a foothold in both paradigms and let them both harmoniously co-exist in the same mind without much conflict arising between them. Alternatively, one does not even have to believe in God; one can still believe in a spiritual reality such as pantheism, that things have spirits that lie behind the familiar physical and chemical reality. Daft as it certainly sounds to the hardened scientist, such a view is very reasonable purely as a means to reinforce a sense of hope and joy, which seems preferable, quite frankly, to the stultifying nightmare of scientific materialism, and which truly is bereft of any hope. Any spiritual view of life inevitably gives greater comfort and meaning to one's life and feeds all the arts, underpinning the works of such giants as Swift, Blake, Wordsworth, Shakespeare and Yeats. The only proof religions can offer is the comfort they seem to give the suffering and the elegance or good sense of their arguments. Such comprise powerful, valid and convincing proofs for many people, though admittedly not for most scientists. Sources [1] BMJ letter, Re: So there is a God?! 7 February 2002, Tracey A Thomas-Falconar, http://bmj.com/cgi/eletters/323/7327/1450#18723 [2] Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial, Leonard Leibovici, BMJ 2001; 323: 1450-1451, and ensuing e-letters http://bmj.com/cgi/content/full/323/7327/1450
God Listens 23 February 2002
William D. Misner Ph.D., ECAPS, Research & Product Development Spokane, WA 99205 Send response to journal: Re: God Listens	That there is God and He listens is a wonderful concept to not only embrace but to experience. For those who would question the sequence presented by the numerical date, take note that while rain falls on an arena, but only those who chose shelter stay dry. The participants in this study were non-participants in the sense that they did not play a role decisively in prayer outcome. The "significant" outcome differences may God has a mind of His own on whom He will assist and those whom He elects not to assist. In old testament history, God's intervention to rescue individuals was select also...suggesting further that as God, He acts according to His plan in time and space, for an outcome past finding out. That God hears our prayers then intervenes in favorable significance for some, while others are permitted to travers the crisis is beyond a finite conclusive experience.
Do the statistics add up? 23 February 2002
Joseph T. Springer, Professor Kearney, NE 68849 Send response to journal: Re: Do the statistics add up?	When I look at Leibovici's article, it seems obvious that the 2 treatments showed no statistically significant difference in mortality rate, as he stated. But when I look at the data in Table 2, it is not at all obvious how "Duration of fever" produced a statistically significant difference between treatments. In every measure the 2 groups showed very similar results. Even with "Stay in the Hospital" the only category that showed much difference was "Maximum". Does this category refer to the longest stay in the hospital experienced by at least one person in the group? If so, how does this produce a statistically significant difference? Regardless of any other problem people have cited with this paper, I would sure appreciate a better explanation of the statistics. If these are wrong, then the whole study is wrong.
Randomised trials cannot be used in this way 5 March 2002
Peter J Lachmann, Emeritus professor of immunology Centre for Veterinary Science, Madingley Road, Cambridge, CB3 0ES Send response to journal: Re: Randomised trials cannot be used in this way	The wealth of responses you have had to Prof Leibovici's paper suggests that not everyone regards it as a hoax. There is therefore some justification for looking at the study more closely. It is an essential feature of randomised trials that they can be replicated. For prospective studies this involves a further set of subjects; but in a retrospective study of a retroactive effect there is no reason not to replicate the study by randomising the population again and repeating the prayers by either the same or a different person. If the results were consistent on a number of occasions this would enhance their credibility. However, it is not necessary to put Prof Leibovici to the trouble of repeating the experiment because a little further thought shows that it cannot give a meaningful result. If a population of 3393 subjects is randomised into two groups on n occasions, the probability (p) of any subject being placed in only one of the groups is (0.5)^n; and the probability that the subject falls into both groups is therefore (1-p). The probability that all 3393 subjects fall into both groups is (1-p)^3393 and the probability that any one subject does not fall into both groups (q) is 1-(1-p)^3393. For n=20 q= .00323 or 1/310 For n=30 q= .0000031 or 1/323,237 For n=40 q falls below the limits of my calculator! Thus, quite modest numbers of repeat randomisations show that no meaningful result is possible because all subjects occur in both groups. If this were not to be the case, then the randomisation is faulty and the study fails on that account. A retrospective randomised study simply cannot answer the question that Prof Leibovici is posing. This says nothing, one way or the other, about the efficacy of prayer.
Rule of thumb 5 March 2002
Gary S. Hurd, Ph. D., Director of Education, Orange County Natural History Museum, CA USA 33902 Silver Lantern Dana Point Ca 92629-2355 USA Send response to journal: Re: Rule of thumb	I won't extend much beyond the many comments already published in BMJ. I used to teach statistics to medical students and faculty when I was on the faculty of the Medical College of Georgia. I really had to pound it into their heads that even at p<0.05 you are going to be WRONG 5 out of 100 times. There is a rule of thumb (I think it could be formalized if anyone wants to make the effort)that I (think I) made up: In a dichotomous randomization trial, your main results must exceed the delta (i.e. measured change, or differences) obtained from a nonselected naturally dichotomous variable in the raw data or subpopulation. When I looked at the data presented in tables 1, and 2 of Leonard Leibovici’s paper on prayer in BMJ, I see that his randomization yielded a sex ratio and some locus of infection differences with distribution spreads equal to or larger than his principle results. So, applying my "rule of thumb," to conclude that Leibovici’s prayer result is "good" we are also forced to conclude that the "focus of prayer," by implication God, is particularly focused on male urinary tract infections. I doubt that this is the case. Rather, I believe that male urinary tract infections are perhaps easier to treat resulting in lower mortality, and shorter hospital stays. Or even more likely, the experiment proves nothing at all. Even the hospital stay data are weak on other grounds.
Author's comments 12 March 2002
Leonard Leibovici, Professor Dept. of Medicine, Rabin Medical Center, Petah-Tiqva 49100, Israel Send response to journal: Re: Author's comments	The purpose of the BMJ piece was to ask the reader the following question: Given a 'study' that looks methodologically correct, but tests something that is completely out of our frame (or model) of the physical world (e.g., retroactive intervention or badly distilled water for asthma) would you believe in it? There are three ways to deal with this question: 1. To answer in the affirmative. But this leads to such paradoxes (some described by the responders to this article) that it is incompatible with our scientific work, or even with our daily life. 2. To look for methodological or statistical faults. Here an obvious one was that the duration of fever and the duration of hospital stay are related. But what if the next 'study' will sport perfect methodology and statistics? 3. To deny from the beginning that empirical methods can be applied to questions that are completely outside our scientific model of the physical world. Or in a more formal way, if the pre-trial probability is infinitesimally low, the results of the trial will not really change it, and the trial should not be performed. This is what, to my mind, turns the BMJ piece into a 'non-study' although the details provided in the publication (randomization done only once, statement of a wish, analysis, etc.) are correct. The article has nothing to do with religion. I believe that prayer is a real comfort and help to a believer. I do not believe it should be tested in controlled trials.
Thought experiment 14 April 2002
Timothy S. Roth, Software development Digital Site Systems, 4516 Henry St.,, Pittsburgh, PA, 15601 Send response to journal: Re: Thought experiment	A possible scenario for an experiment on retroactive prayer: Al and Bob decide to do a research project on retroactive prayers. They gather 1000 case histories of stays in the hospital a few years ago. They randomly divide the case histories into two groups of 500. One group will receive prayer and the other won't. Al takes the two lists back to his computer to do statistics on the case histories that have already been entered into the computer. Bob takes the list of patients to be prayed for to meet with the people who will be doing the prayers. Al has a fast computer. Before Bob can even convene his meeting, Al tells him not to bother since he already has the results. This has to be wrong. If an experiment was published in the British Journal of Medicine, it could not have been along the above lines.
which gods ? 29 April 2002
Joan S Brodie, neuroscience research student Institute of Psychiatry, London SE5 8AF Send response to journal: Re: which gods ?	I wonder if any particular God or gods are more effective when involved in intercessory prayer than others. Since it seems possible to pray retroactively, might it be be a good idea to include gods that people used to worship, though almost nobody believes in any more, such as Greek, Norse gods etc.? Has anyone tested an obvious control test of praying to 'the invisible purple unicorn' or similar known-to-be imaginary being ? Presumably it would be necessary to compare this against prayer to a living person (not a god). What format did the prayer take ? Shouldn't a group have short non- prayers be said for them (e.g. reading from the back of a packet of cornflakes). I like the line - "There was no sham intervention.". To be honest if I thought I was in a hospital where people were praying for me, I'd want to get out of there pretty quickly too, so I'm not suprised at the outcome ! (I have had a look at the other papers published in that issue of BMJ and have taken the requisite dose of salt). Jo Competing interest : member of the National Secular Society, UK
Re: Leibovici's paper is religious propaganda, not science 1 November 2002
Michael A. Reeves-McMillan, None Auckland, New Zealand Send response to journal: Re: Re: Leibovici's paper is religious propaganda, not science	I note two things about Riccardo Baschetti's response. 1. He makes the logical leap that because 93% of scientists do not believe in God, divine intervention is highly improbable and humankind should rely on reason. This is a non sequiteur. 2. He has a clear religious (or anti-religious) position, which except for its polarity appears not to differ from the religious positions he criticises in terms of personal emotional commitment leading to intellectual conclusions. Competing interests:   None declared
Re: The power of statistics, not prayer 2 November 2002
Elliott Middleton, SVP Risk Textron Financial 72201 Send response to journal: Re: Re: The power of statistics, not prayer	Editors: I am a Saturday morning surfer with a Ph.D. in Economics who manages risk on a large portfolio of small business loans. As such, I build statistical models every day, using them to make bets that materially affect my and my family's well-being. My prior belief, having read the literature on scientific evidence for paranormal effects, is that prayer could work, including retroactively. However, the method and results of this study were not satisfying. First, the p values were indeed weak (I routinely require p<.001 in models I'm betting on). Second, a replication would have been convincing--not on the same patient group with a different outcome, which contradicts any reasonable hypothesis of the underlying physics, but with another group of patients, outcomes, and prayers. I encourage BMJ to continue to publish well-constructed studies of paranormal healing "effects" or synchronicities. Elliott Middleton, Ph.D. Competing interests:   None declared
Re: Religion and Science 20 June 2003
Reginald.H. Le Sueur, retired home-JE3 7BE Send response to journal: Re: Re: Religion and Science	I find it sad that your contributor should be so unimpressed by Science as to refer to it as "dead-end materialism", or "molecularised view". There is nothing dead-end about the wonders that science continues to reveal to us on an almost daily basis, especially when compared with the, by contrast completely non-prgressive religious view, whose whole methodolgy is backward-looking. Molecules carry within themselves, and their constituent atoms and sub- atomic particles and forces, the ultimate secrets of Nature, which by definition must be the most fascinating concepts imaginable, and with which prayers and incantations left over from a bye-gone age cannot compare. Competing interests:   Atheist Medical Doctor
Re: A Question From An Outsider Looking In 29 June 2003
Reginald Le Sueur, retired Jersey JE3 7BE Send response to journal: Re: Re: A Question From An Outsider Looking In	Your contributor appears to be following a practice I have often noticed among Christian believers, of wanting their cake as well as eating it. Alina Finn appears to assign to God a completely deterministically foreordained knowledge of how things will turn out, specifically on this occasion, concerning the outcome of prayer, and yet, paradoxically in the same breath says we still have freewill, in order not to be mindless robots carrying out orders unblinkingly. Suely you cannot have it both ways? As far as the behaviour of non-spiritual,ie atheist physicians is concerned, in our attitude to the sick and the dying, simple good manners ensures that we would never try to de-convert, ridicule or criticise such patients in their final hours of most need, but would go along with what ever belief systems they hold, while suppressing our own,or lack of them. Nor would we make judgements concerning their intelligence or lack of it. That is not our job. in keeping with M/s Finns evident belief in determinism, we would hold that such patients beliefs have been pre- ordained by their cultural conditioning, and cannot easily be undermined by appeals to rationalism, which would in any case be inappropriate to the occasion. Competing interests:   Atheist mecical Doctor
Re: Re: Leibovici's paper is religious propaganda, not science 1 July 2003
Reginald Henry Le Sueur, retired JE3 7BE Send response to journal: Re: Re: Re: Leibovici's paper is religious propaganda, not science	The reason 93% of scientists do not believe in God is: 1. They recognise that discussion of Divine intervention is itself a logical fallacy unless you can demonstrate the existence of "the Divine", in other words God. God's existence is unproven and unprovable, therefore any talk of his alleged activities, eg intervention of any kind,is meaningless. The particular fallacy is that of the Double question or statement; of assuming one thing in order to prove another, eg: "When did you stop beating your wife?" 2. Scientists do not hold to the Post-Modernist fallacy of claiming that any opinion is as good as any other. The evolution of the Universe is rational and causal, and does not require divine, or any other arbitrary interference. This makes activities by such an interfering and improbable Agent highly unlikely. Competing interests:   Atheist medical Doctor
Leibovici's paper is perfectly valid 2 July 2003
Matthew H Lewis, PhD Macclesfield, SK10 1DD Send response to journal: Re: Leibovici's paper is perfectly valid	Dr Le Sueur makes an unarguable assertion but misuses it as a reason why 93% of scientists do not believe in God. As Dr Le Sueur points out, and as demonstrated by Immanuel Kant, the existence or non-existence of God is [scientifically] unknowable. It cannot be known in the same way that we can know 93% of scientists do not believe in God. Therefore, necessarily, it is possible to explain every observation without requiring the existence of God. But as any scientist will tell you, this is not proof that God does not exist. Every scientific observation is consistent both with the existence and non-existence of God (I would be interested to learn how to determine probabilities given this fact). So where does that leave us? As with most philosophy it leaves us where we thought we were anyway. Belief in God is a matter of faith, not logic. As for Leibovici’s paper, long may the BMJ continue to publish such well-powered, CONSORT-compatible reports, even when they contradict entrenched philosophies -- mine included! Competing interests:   Clearly in a small minority of scientists
more propaganda, not science 2 July 2003
L S Lerwis, GP Surgery, Newport, Pembrokeshire UK SA42 0TJ Send response to journal: Re: more propaganda, not science	Dear Reginald.. I quote you :- ' The evolution of the Universe is rational and causal, and does not require divine, or any other arbitrary interference. ' So why do you assume that 'Divine = arbitrary' ? Why do you think a rational and causal universe needs no explanation ? Whatever it is that causes the Laws of Physics, may I not call it God.. ? On what basis can you be sure that the 'prescient cause' of the Universe (pre-BigBang) may or may not continue 'immanent' in the unfolding progress of that specified time-space ? I am irreligious. I have no personal experience of 'God'.. But I'm damn sure that the Universe of Cause and Reason is way beyond your comprehension and mine. Stephen Hawking believes we may never know the mind of God... But he has, without your arrogance, glimpsed at some of those thoughts ! The whole point of the original Leibovici article was to challenge our cherished assumptions ( such as our habitual assumption that cause must precede effect in time - unless you are 'outside time' ie: God). He forces us, in a very original manner, to think more clearly about 'cause and effect', and our underlying 'fixed ideas'. I recommend you drop your prejudices , and read the ensuing correspondence from beginning to end.. You might learn something about yourself, God willing. Competing interests:   None declared
My manager is going to love this ... 2 July 2003
Dr. Matthew L Grove, Consultant Rheumatologist NTGH, NE29 8NH Send response to journal: Re: My manager is going to love this ...	"So let me get this right ... you want to allocate £10K in the budget for an end-of year prayer session for all the patients who have been through ITU?" "Yep." "And this will reduce our ITU stay by 1 day per patient prayed for?" "Yep." "And if we're over budget by the end of the year, and can't afford the prayer session, it doesn't matter as we'll still get the therapeutic effect - just so long as we make a solemn promise to pray for everyone the year after that instead?" "Yep" "But we could put it back another year or two if we're still short of cash ..." "Yes - just so long as we squeeze in a prayer session sometime before 2013 we should get the benefits ..." Competing interests:   None declared
Re: more propaganda, not science 3 July 2003
Reginald Henry Le Sueur, retired JE3 7BE Send response to journal: Re: Re: more propaganda, not science	Dear Dr. Lewis, if I might try and clarify the points you raise; I believe that "Divine=Arbitrary": because if we are considering the Judeo- Christian God, then, if I am not mistaken, this God has Freewill,(and has given it to us as we are made allegedly, in his image). Surely a being with freewill is liable to take arbitrary decisions, and intervene randomly,to reverse known laws of Physics as he thinks fit?-this has always been God's historical role. And yet we do not see this happen. Physical laws do not change randomly from day to day, as far as we can observe. This is why I maintain that we live in a rational Universe. Of couse a rational causal Universe requires explanation, I have not denied this; but the explanation is to be sought through rational ,causal processes; whereas the whole essence of God is,although believers might deny it,that he can over-rule causal processes, reverse or abolish natural law, and indeed answer prayer. We have no knowledge of a "prescient cause" of the Universe , and cannot therefore assert that it continues immanent in the unfolding of anything. The Universe may well be beyond our comprehension, but we still have to try and comprehend it, and I suggest that ad hominem assertions as to my supposed arrogance and prejudice are unfounded. The Leibovici article may well have proved something for all I know,and if this is the case we might as well abandon science and just ask Jesus to fix everything. Competing interests:   Atheist medical Doctor
Re: Re: more propaganda, not science 3 July 2003
M C Feliciello, n/a Leeds Send response to journal: Re: Re: Re: more propaganda, not science	Forgive my woolly thinking, but I understood the author of the original article to have offered a clarification of his aims (1)and it seemed to be more concerned in examining our current or future ontology and epistomology when considering the validity of any research undertaken under empirical methodology. Regards MCF (1) Professor Leonard Leibovici 12.03.02 BMJ Rapid Responses Competing interests:   None declared
Re: Re: more propaganda, not science 3 July 2003
L S Lewis, GP Newport, Pembrokeshire, SA42 0TJ Send response to journal: Re: Re: Re: more propaganda, not science	I am not very hopeful that I can change your mind, which defines God as an arbitrary and irrational force, and thus loading the dice, you win !! But perhaps we are mistaken in your assumptions. Is there any play of chance in this Universe ?? Can I give you something to think on .. Do YOU have 'Free Will' ? If 'yes' .. then how can this be compatible with a rational determined Universe ? Surely you can be as arbitrary as your 'Judaeo- Christian God' ? If the answer is 'no ' .. then your thoughts and actions are immutable and pre-determined.. and I have no chance of changing them - unless, of course, I pray very hard to my pal the omnipotent ?? Competing interests:   Free Will vs. Cause and effect
Re: Re: Re: more propaganda, not science 4 July 2003
Reginald Henry Le Sueur, retired JE3 7BE Send response to journal: Re: Re: Re: Re: more propaganda, not science	Hello Dr Lewis, thanks for your further reply. As you say, this discussion is now more concerned with the Freewill v. Determinism debate which has raged for centuries. I think therefore the answer lies in the middle, or else both are correct. I adopt an Evolutionary perspective, and think that we humans have reached a critical evolutionary point, where, unlike other animals, we have acquired enough grey matter to be able to produce abstract thought and make decisions. If we can make decisions we therefore have Freewill of a sort, which we can use to break free of our genetically determined animalistic behaviour.So,to try and answer your question; yes I have freewill, but of course other aspects of my being are biologically and genetically determined. My freewill is a kind of epiphenomenon loosely attached to the rest of me. There is plenty of room for chance in the Universe. Even if the Universe evolves under strict causal paths, there are random events which may produce a switch from one causal chain to another, rather like a missile locking on target, but being able to change its pre-programing, and lock onto a different one. So yes, to your other question, we can now be as arbitrary as the Jud.- Chr. God, within the constraints of our genetics. In fact, we have become minor gods ourselves. Certainly this was the impression given to "primitive" people who encountered Europeans, and their "magic" for the first time. I think we have somewhat diverged from the topic of Prof Leibovici's study, and it might be more appropriate to continue by e-mail if you wish. Regards, Reg. Competing interests:   Atheist medical Doctor
Re: Re: more propaganda, not science 4 July 2003
Matthew H Lewis, PhD Macclesfield SK10 1DD Send response to journal: Re: Re: Re: more propaganda, not science	Dr Le Sueur writes that ‘the whole essence of God is, although believers might deny it, that he can overrule causal processes, reverse or abolish natural law, and indeed answer prayer.’ Not this believer. Because causal processes and natural law are not the rock-solid foundations Dr Le Sueur thinks they are. Firstly, causal processes and natural ‘law’ are concepts imposed by us on the mishmash of raw experience in order to assimilate experience into understanding. By analogy, my ability to use English has just imposed certain rules on the concept I was trying to communicate in the previous sentence. That concept can never be known by anyone else (perhaps even by myself) without first being formatted by language. Along with cause and effect, we can add space and time, substance, and possibility (as opposed to reality) to the list of ‘formatting’ concepts. Subsequently, Lo and Behold! we discover science and then build up a picture of natural ‘law’ and guess what? It is ruled by cause and effect, linearity of time, continuity of space, matter and energy and so on and so forth. Natural law fits pre-existing rules defined by us. At the fringes of physics we see the authority of these ‘laws’ begin to unravel. Secondly, in the Venn diagram of life, science is a small domain and, sorry to say, is not as important as contemporary society thinks. Above all, science has no overlap with the domain of ethics. Science can tell us nothing about the really important questions to do with right and wrong. ‘Should I invade Iraq, should I give £1 to this beggar, etc.’ These days, science is a still a little useful, but mainly at the fringes of things. Just look at all that bleating about what a revolution the complete sequencing of the human genome would bring. These days, science is all mouth and no trousers. Competing interests:   Clearly in a small minority of scientists
Re: Re: Re: more propaganda, not science 5 July 2003
Reginald H. Le Sueur, retired JE3 7BE Send response to journal: Re: Re: Re: Re: more propaganda, not science	Sorry, I unintentionally mislead you in my attempt to be ironic and play God's Advocate. My actual stance is the inversion of what I was trying to convey as what I think very many believers accept as God's immanence in the world, including answering prayer. Of course we make our own morality, and scientific theories out of the "mismash of raw experience", as you rightly put it. This is the philosophy of Naturalistic metaethics, whch as a metaphysical naturalist, I believe is correct, and must of necessity hold to as an atheist. Competing interests:   Atheist Doctor
Re: Misapprehension of principle 7 July 2003
Reginald H. Le Sueur, retired JE3 7 BE Send response to journal: Re: Re: Misapprehension of principle	I find your article re Therapeutic intent very interesting, but am a little worried about the 50-100% reduction in side-effects compared with controls. I am probably being naieve, and have little knowledge of the practicalities of controlled trials; but which is it, 100% or 50%, or whereabouts in between? Surely if one is assessing clinical responses in a fixed small number of patients in a trial of any kind, one should be able to produce precise percentages linked to to individual patient responses? Competing interests:   atheist doctor
Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem 6 December 2003
Deepak N Rama, Medical Officer Dept of Pathology, Singapore General Hospital, Singapore, - Send response to journal: Re: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem	Dear Sir, The assumptions implicit in the design of this study remind me of a famous and contentious problem in logic and philosophy called Newcomb's Problem (or Newcomb's Paradox). The details of the problem statement vary a little depending on the source but you can find a fair description in these two web references : 1) Newcomb Reference 1 2) Newcomb Reference 2 Here is a simple representation of the temporal sequence of Newcomb's (thought) problem being carried out from the perspective of a human onlooker (not to scale, meant to show humanly perceived event order only) : Time 0 ----------------------------------------- T         (a)       (b)                                            (c)                     ---------------------------------- 1           -------                     ---------------------------------- 2 (a) The challenge of the two boxes is posed to a participant. Box alpha contains $1000 and Box beta is the mystery box that may contain either a million or nothing. A Being purporting to be perfectly omniscient tells the participant that if he/she chooses only box beta then box beta will indeed contain a million dollars. If on the other hand, the participant decides to be "greedy" and chooses to take both boxes, box beta would be empty and the participant would be only a 1000 dollars richer. The Being assures the participant that It (the Being) has perfect knowledge of the future and has already seen the outcome of the decision that the participant will make and has either placed or not placed the million in box beta accordingly. However, there will be no further tampering with box beta once the experiment has begun, from the perspectives of participants and onlookers. (b) The participant weighs the options and makes a decision, differentiating the participant into one of two groups 1 and 2. Group 1 takes only box beta and Group 2 takes both boxes. Many participants are posed the same choice, and soon sizeable numbers are present in Groups 1 and 2. (c) When the results are analysed it is found that every member of Group 1 has become a million dollars richer whereas every member of group 2 is only a thousand dollars richer. When one tries to decide on the best strategy to follow when making one's choice, a paradox results. Two widely accepted and supposedly equally valid principles in logic (the evidential expected utility (EEU) principle and the causal expected utility (CEU) principles respectively) give opposite strategies as optimal. The EEU would lead one to pick only box beta while the CEU would lead one to pick both boxes as a means of maximising gain. Because of the paradox inherent in coming to an indisputable choice, it is held by many logicians that the problem simply is *not consistent* with our accepted logical framework. In this case, the existence of such an omniscient predictor becomes impossible to accept. Now, in this clinical study, the author purports to test the assumption that prayer can *retroactively* alter outcomes. But I think something else may be "tested" here. Let's take a closer look at the situation along the temporal scale of a human onlooker (this is not to scale and is meant to show humanly perceived event order only) : Time 0 ----------------------------------------- T          (a)(b) (c)          (d)  (e)  (f)                    (g)                     ---------------------------------- 1           -------                     ---------------------------------- 2 (a) Various presumably unrelated patients become ill and get admitted to hospital (b) They get treatment according to established clinical protocols individualised to their respective conditions. (c) Depending on various factors, one would assume patient, disease and medical treatment factors the patients differentiate into two groups, 1 and 2, the former doing on the whole better than the latter in certain parameters like length of fever and duration of stay. Mortality, however, doesn't differ a great deal between these two groups. (d) The study is begun. The profiles of patients recorded at stage (a) are collected in a fashion that is blind to how they are currently faring and each patient is assigned a numerical code. (e) A random number generation is carried out. This is essentially a statistical game that divides the patients presumably randomly into two groups A and B. (f) A is assigned to be the "Treatment" group and intercessory prayer is carried out. B is called the "Control" group and nothing in particular is done here. (g) The results are obtained by comparing groups A and B with 1 and 2. Remarkably, a significant concordance is found between groups A and 1 and groups B and 2. In other words, the "Treatment" group bore a remarkable resemblance to the subset of patients doing better in certain areas. Finally, the author drew the dubious conclusion that prayer somehow retroactively caused Group A to fare better. Critique : When the experiment is conceptualised in this fashion, parallels between this real experiment and the thought experiment of Newcomb become evident. I believe the differentiation of patients into a better faring (1) and worse faring (2) group is analogous to the Newcomb situation where box beta is filled and empty respectively. The critical randomisation step can be likened to many persons making a choice between taking a single box and taking both boxes. (Of course, the analogy is not perfect because the person in the Newcomb problem is making a conscious choice whereas the randomiser is supposed to be a simple probabilistic machine. Nevertheless, the supposedly omniscient Being postulated by the author should have no difficulty in "seeing" the randomiser's "choices" for "treatment" (A) and "control" (B) and aligning those with the respective groups 1 and 2 respectively. So the presumed sentience of the choice-maker in Newcomb's experiment becomes largely irrelevant to the analogy, in my opinion). When the results of the experiment are analysed (by looking at the differences between "treatment" and "control" groups), it is found, astonishingly that Group A (by randomisation) is practically the same as Group 1 (by outcome) and Group B (by randomisation) is practically the same as Group 2 (by outcome). The correlation is not perfect as in the Newcomb thought experiment, but is accepted as being "good enough" by means of statistical tests. This is not extremely damaging to the analogy as there are variations on the Newcomb problem that stipulate degrees of fallibility of the predictor. The fundamental logic involved in analysing these variant scenarios remains unchanged. The author started with a postulate affirming the existence of an omniscient Being for whom the human perception of time and the restrictions imposed thereof are largely irrelevant. This is analogous to the stipulate of the Newcombian predictor. The author concluded after his results were analysed, that his postulate of such a Being was indeed vindicated. This is again akin to the establishment of the Newcomb problem where every choice made by numerous participants is shown to have been predicted correctly by the Being. So there's a pretty good concordance between the thought experiment of Newcomb and this real study. But here's the rub : the very statement of the Newcomb problem is largely seen as being *impossible* within our accepted logical framework. This is because of the resulting paradox in decision making that I've alluded to above. Why, then, should we accept the similar premise and conclusion espoused in this experiment to be any more valid ? It should be equally invalid !! A related and equally serious objection arises when you consider this sort of "non-intuitive" premise to the experiment. The statistical tools used in analysing the data are derived from an application of probability theory, which is in turn derived from a logico-axiomatic structure that coheres with our expectation of how the world works. When you put forth an assumption that goes contrary to our expected ideas about causality, how can you possibly use those same mathematical and logical tools to analyse your data and then claim that your assumption has been proven ? Furthermore, if the effect were assumed to have been established as valid (which it really hasn't, but let's assume so for argument's sake), what gives the author the licence to conclude that the effect of the Being was on the clinical outcomes of the patient (an actual therapeutic effect) rather than simply on the choices of the random number generator ? In other words, the clinical outcomes of the patients may have been completely independent of the putative intervention of the Being, instead the intervention may have acted solely on the randomisation to ensure that the "correct" numbers in groups A and B are chosen such that they concord with the groups faring better (1) and worse (2) respectively. Finally (and this is the simplest objection to put in words and the one a layman would most readily relate to), prayer as a religious person understands it, is almost never presumed to act in this "retroactive" fashion. A person most commonly prays in order to affect the outcome of something that lies in his immediate or distant future. I'm not religious myself, but I have seen friends praying over sealed exam result slips prior to opening them !! I suppose that would be my closest experience to someone attempting to beseech a deity to alter an outcome that appears from a disinterested onlooker's perspective, to have been already *causally decided* (no known physical process can instantaneously alter the results printed on that sealed slip) but not yet *inspected* (they hadn't unsealed the slip). This, I think, is somewhat akin to what this study tries to demonstrate, the ability of prayer to alter an outcome (medical outcome) that appears to have been already causally decided (based on medical interventions and patient and disease factors) but inspected later (after randomisation and result analysis). However, this still isn't cohere with what a religious person would normally associate with praying for a sick person's recovery, that would most commonly be in "real time" as it were. To sum it all up, my objections to the study are : (a) The premise is not consistent with our established logical system and hence it cannot be tested with tools based upon that system. (b) An analogous thought experiment leads to a logical paradox implying that the premise and conclusion of the experiment are logically insupportable. (c) Even if the validity of the results is to be accepted, the conclusion to be drawn is entirely unclear as to where exactly the intervention acted in a temporal sense. (d) The concept of praying for someone's recovery, as it being presented here, is rather at odds with what most people would understand it to be. Based on the above objections, I believe both the premise and the conclusion of this study to be seriously flawed. The objections I have raised are most pertinent to the logical incongruities inherent in testing for a phenomenon "retroactively", they by no means apply to other controlled studies that study the effects of prayer in a forward time direction. Thank you for your patience. -- Dr R N Deepak   Competing interests: None declared
Re: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem 9 December 2003
Reginald.H. Le Sueur, retired Jersey. JE3 7BE Send response to journal: Re: Re: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem	Congratulations on a masterly analysis, and rebuttal of the proposition. Competing interests: atheist Doctor
Is the power of thought able to create successively older forms of the entire universe once every 10 to the minus 43 of a second? 27 December 2003
Richard G Fiddian-Green, None None Send response to journal: Re: Is the power of thought able to create successively older forms of the entire universe once every 10 to the minus 43 of a second?	In his review of "Our living multiverse", the atronomer royal Sir Martin Rees wrote that Fred Adams "describes clearly and accessibly, our new insights into the grand scheme of cosmic evolution" (1). My assumption is, therefore, that the following sentences included in the book are scientifically credible: "But consideration of quantum gravity---which is ultimately responsible for launching universes into existence--indicate that the natural life-time of a universe is only about 10 to the minus 43 seconds. Our universe has already lived an advanced age of 12 billion years". As these two sentences are diametrically opposed to one another either one or the other is false. Given the enormous success of quantum theory it would seem unlikely that its predictions are invalid. In which case our perception of ageing must be wrong as indeed Julian Barbour has concluded in his book, "The end of time" (2). Both statements are, however, compatible with the Alice hypothesis which incorporates Julian Barbour's ideas and suggests that the hypothetical bosonic and fermionic phases of existence alternate with one another at a rate of once every 10 to the minus 18 of a second [attosecond] (3). Fred Adams's statement suggests that these two hypothetical forms of existence might rather alternate with one another one every 10 to the minus 43 of a second. As power is the rate at which energy can be delivered the implication is that even quantum amounts of energy delivered at a rate of 10 to the minus 43 of a second might be sufficient to generate the power necessary to create at this rate progressively older fermionic expressions of the entire universe and give the illusion of the ageing universe and its inhabitants with which we are famiiar. Indeed the late Sir James Jeans once concluded that “The universe is best pictured ..as consisting of pure thought….If the universe is a universe of thought then its act of creation must have been an act of thought”. Fred Adams adds in his book that, ".To live so long, its [the universe's] current density cannot exceed a critical value. Overly dense or overweight universes die because their immense gravity halts their expansion ushering in a collapsing phase, and crushes life out of most biologically viable environments. But the cosmic density cannot be too small either. Diffuse universes grow too quickly to force [stable] astronomical structures....In order to produce us, a universe must attain a well-defined range of density values". In so saying Fred Adams is referring to the hypothetical influences of omega, the mass/energy density ratio which has been found to be 1 with a variance of about 4%. Various proposals have been made for addressing the conceptual problems having an omega less than 1 creates. These include reintroducing Einstein's cosmological constant which Einstein considered his greatest error, adding a time varying term to his field equations, adding a time factor to constants such as the speed of light, and considering the possibility of multiverses as Fred Adams has done (4). That these adjustments are even being contemplated reveals just how uncertain theoretical physicists and cosologists are about the nature of the universe, its origin and its ultimate fate. The Alice hypothesis is incompatible with light having a constant speed because it would only travel in the bosonic phases of existence (5). It is, however, compatible with a variable speed of light as previously observed (3). Furthermore the Alice hypothesis calls for the existence of a multiverse not in the sense that Fred Adams or Everett have considered it but within our own universe. In terms of the Alice hypothesis all matter enters wormhole or black hole and emerges in a new orthoscopic fermionic form in a new universe every 10 to the minus 18 or perhaps more accurately once every 10 to the minus 43 of a second. If the velocity of a mass is an illusion created by travel at the speed of light in successive bosonic forms of existence alternating with successive static fermionic expressions of that mass, as proposed in an earlier communication, then gravity and temperature should be similarly effected. The implication is that the temperature and gravity of a mass may also decrease as the energy density rate relative to mass density rate increases. In which case the 2.7degrees Kelvin ripples in cosmic background temperature detected by the COBE probe may be interpreted as evidence in support of the Alice hypothesis rather than as evidence of an "echo of the Big Bang" as others have proposed. The same should apply to gravitational waves if their existence is confirmed by LIGO. If indeed evidence in support of the Alice hypothesis then the ripples in cosmic backgound temperature and gravitaional waves should be in sync, and also occur in the order of once every 10 to the minus 43 of a second. If the Big Bang and even Fred Hoyle's steady-state universe are conceptually flawed and the Alice hypothesis is valid, as the above deductions imply, religious views would not necessarily be undermined (6). The nature of a superior being would, however, be closer to Spinoza's concepts (7) than to Einstein's. Be that as it may spiritual dimensions would be be greatly expanded by proof of the validity of the Alice hypothesis. Certainly the possibility of an intelligent superior being using the power of his/hers/its thought to create successively older forms of the entire universe and all its inhabitants once every 10 to the minus 43 of a second should be enough to extend the intellectual dimensions of any academic theologian (8). Our understanding of spiritualty would seem to have far more to gain from organised religions promoting the advances of science than from placing contraints upon it as in past centuries or trying to mold its evolution to conform with preconceived beliefs as so many have done in the past. 1. Fred Adams. Our living multiverse: a book of Genesis in 0 + 7 chapters. Pi Press, New York, 2004. 2. Julian Barbour. The end of time. The Orion Publishing Group, London, 1999. 3. Patrick Bracken and Philip Thomas Time to move beyond the mind-body split BMJ, Dec 2002; 325: 1433 - 1434. (Electronic correspondence). 4. Wiggins AW, Wynn CM. The five biggest unsolved problems in science. John Wiley & Sons, Inc, Hoboken, NJ, 2003. 5. João Magueijo. Faster than the speed of light. Perseus Publishing, 2003. 6. Max Jammer. Einstein and religion. Princeton University Press, 1999. 7. Antonio Damasio. Looking for Spinoza. 2003. 8. Brian Olshansky and Larry Dossey Retroactive prayer: a preposterous hypothesis? BMJ, Dec 2003; 327: 1465 - 1468. (Electronic responses). Competing interests: None declared
RE: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem 29 January 2004
Haralabos Gouzinis, Philosopher Cambridge, CB3 0DU Send response to journal: Re: RE: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem	"...The Being assures the participant that It (the Being) has perfect knowledge of the future and has already seen the outcome of the decision that the participant will make and has either placed or not placed the million in box beta accordingly. However, there will be no further tampering with box beta once the experiment has begun, from the perspectives of participants and onlookers...." and then... "...When one tries to decide on the best strategy to follow when making one's choice, a paradox results. Two widely accepted and supposedly equally valid principles in logic (the evidential expected utility (EEU) principle and the causal expected utility (CEU) principles respectively) give opposite strategies as optimal..." I find that It cannot exist within any logical framework. Take the definition of It above and an introductory book on Logic. How many pages do you think you can go through until you hit the first contradiction? Regards Haralabos Gouzinis Competing interests: Logic
RE: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem 1 February 2004
Richard G Fiddian-Green, None None Send response to journal: Re: RE: Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem	"...When one tries to decide on the best strategy to follow when making one's choice, a paradox results. Two widely accepted and supposedly equally valid principles in logic (the evidential expected utility (EEU) principle and the causal expected utility (CEU) principles respectively) give opposite strategies as optimal..." Might this be a philosophical formulation of Heisenberg's uncertainty principle? Competing interests: None declared
Effect of Remote, retroactive intercessory prayer on outcome in trauma patients 23 June 2004
Adam Starr, Associate Professor of Orthopaedic Surgery University of Texas Southwestern Medical Center, Dallas, Texas, USA, William Frawley, Michael Bolesta, Christopher Espinoza-Ervin Send response to journal: Re: Effect of Remote, retroactive intercessory prayer on outcome in trauma patients	Dear Sir, We did a statistical appraisal of whether remote retroactive intercessory prayer affects in-hospital mortality or hospital length of stay after hospital admission for trauma. The intercessory prayer was done 1 month to 8 years after the patients’ hospitalisation. The hypothesis was that remote, retroactive intercessory prayer shortens hospital stay and lessens mortality after trauma. Our medical centre’s institutional review board approved this study. All patients recorded in the trauma registry of a Level 1 trauma centre between January 1996 and May 2004 were included in this study. The trauma centre serves a metropolitan area of greater than 3 million inhabitants and has approximately 4,000 trauma admissions per year. In June 2004 the patients were stratified into subgroups using bifurcation values for each of four variables known to have a strong impact on mortality after trauma. The variables were age, systolic blood pressure on arrival, Glasgow Coma Score on arrival, and Injury Severity Score. Their lower grouping values were age less than or equal to 55 years, systolic blood pressure on arrival less than or equal to 100mm Hg, Injury Severity Score less than or equal to 8, and Glasgow Coma Score on arrival less than or equal to 8. Within each subgroup, a block randomization into two groups was performed using a pseudo-random number generator. Once randomisation was complete the two groups of patients’ names were printed out, using the first name and last initial. A coin toss was used to designate the study group. The list of names for the study group was given to an intercessor who prayed for the health and well being of the people in the study group. Two outcome variables were measured: length of hospital stay, and in- hospital mortality. The Mann-Whitney test was used to compare the study and control groups to verify they were comparable with regard to age, Glasgow Coma Score on arrival, systolic blood pressure on arrival, and Injury Severity Score. For these variables, a 2-sided analysis was done based on a null hypothesis of no difference between the two groups. A 1-sided Mann-Whitney test was used to compare the study and control groups’ hospital lengths of stay. The test was based on a null hypothesis that the stays of members of the control group tended to be shorter. Fisher’s exact test was used to compare the study and control group’s mortality rates. This test was 1-sided, where the null hypothesis is that the mortality rate of the control group does not exceed that of the prayer group. Our sample size of over 33,000 patients was sufficient to detect a 1% difference in mortality rate, if such a difference existed, with 99% power with a Type I error of .05. Of the 33473 trauma registry patients, 16736 were randomized to the control group and 16737 were randomized to the study group. There were no significant differences between the groups with regard to age, systolic blood pressure on arrival, Glasgow Coma Score on arrival, and Injury Severity Score. Median length of stay was 2 days for the control group (range 0 to 375 days) and 2 days for the study group (range 0 to 730 days). The p-value for the associated test of hypothesis was .27. In-hospital mortality for the control group was 4.6% and 4.6% for the study group (p=.44). Our study’s findings conflict with those reported by Leibovici (1) who showed that remote retroactive intercessory prayer was beneficial. It may be argued that the outcomes we studied – mortality and hospital stay – were not appropriate measures to assess improvements in “well being”. It is arguable that, in some cases, death may end suffering, and so bring a form of benefit to a patient. Similarly, a shorter hospital stay may not necessarily reflect improved health or well-being. Additionally, we did not assess the long- term health outcome or the patient’s sense of well-being. It is possible there were differences in the two groups that we did not assess. Nor did our study make an effort to control for prayer that may have been said on the patients’ behalf by other people, such as family members or friends. However, our aim in this study was to assess objective and measurable outcomes that are important to clinicians. Our thought (and perhaps it is a biased one) was that survival was better than death, and that a shorter hospital stay was better than a long one. Although we cannot claim we have shown remote retroactive intercessory prayer provides no benefit to trauma patients, we think we can claim to have shown it is quite unlikely that it affects in-hospital mortality or length of stay. This study does not prove that intercessory prayer has no benefits. There are several compelling studies which appear to show the benefits of prayer, and we feel further research in this area is warranted. 1. Leibovici L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ 2001, 323:1450-1 Competing interests: None declared
Re: Effect of Remote, retroactive intercessory prayer on outcome in trauma patients 24 June 2004
Howard Mann, Dept. of Radiology University of Utah School of Medicine 84132 Send response to journal: Re: Re: Effect of Remote, retroactive intercessory prayer on outcome in trauma patients	Prof. Starr, Thanks for providing details of your study. What should one make of it ? As with Leibovici's study, which you cite, one may regard your study as, to use Leibovici's description of his own published trial, a "non study." I urge you to peruse his response [1] to Rapid Responses concerning his study. I'm puzzled by investigators' use of the randomized controlled trial to pursue "clinical" questions when there is a conspicuous absence of antecedent basic scientific evidence, or even biological plausibility, to support the contrived hypothesis being addressed. This is commonly the case when the randomized controlled trial is used to evaluate so-called Complementary and Alternative Medicine interventions. Sehon (among others) has many informative things to say about this state of affairs[2]. Here is a short excerpt: "But there is also a more fundamental way in which RCTs cannot stand apart from basic science. Even when a clinical trial returns positive results in the treatment arm that satisfy tests of statistical significance, we will have more confidence in these results when they have some antecedent biological plausibility. Put more generally, we would suggest that the degree of confidence appropriate for a clinically tested claim is a function of both the strength of the clinical result and the claim's antecedent biological plausibility. " Sehon approaches the notion of evidence-based medicine -- and the place of the randomized controlled trial in it -- from the perspective of the Quinean web of belief. It's well worth reading. Howard Mann 1.http://bmj.bmjjournals.com/cgi/eletters/323/7327/1450#20476 2. http://www.biomedcentral.com/1472-6963/3/14 Competing interests: None declared
Re: Effect of Remote, retroactive intercessory prayer on outcome in trauma patients 2 July 2004
Reginald.H. Le Sueur, social security Designated Medical practitioner Jersey. JE3 7BE Send response to journal: Re: Re: Effect of Remote, retroactive intercessory prayer on outcome in trauma patients	These desperate attempts to prove the existence of a god by the highly improbable mechanism of retroactive intercessionary prayer, otherwise known less grandly, as god-bothering, have demonstrated their futility by the fact that a supernatural event cannot be proved-there is always the possibility of a natural cause for any apparent miracle. The cure itself cannot be proved, on account of the fact that the original diagnosis may have been wrong, and also because the passage of time may in due course falsify any apparent cure or answering of a prayer. The original clincial diagnosis and follow-up is usually, as in the Leibocci trial, carried out by highly biased clinicians with a religious axe to grind. The apparent answering of prayers takes no account of the logical fallacy of Post hoc ergo propter hoc,- a very common Christian mistake. Any apparent beneficial effects are mainly extremely marginal, with less than significant percentage over chance. This in itself is very strange; one would expect a benevolent, immanent caring god to give definite indisputable evidence of his power,-not vague results which only provoke interminable arguments. Not surprisilngly this has given rise to the concept of "Deus Absconditas",- the withdrawn or absent god. Not so long ago Dr.Stephen Unwin used Bayesian theory to come up with the remarkable result of a 67% likehood of God's existence. The trouble with this is that the posterior likehood of this is based on highly subjective interpretation of the "evidence" for God's activities, and is therefore not valid. Creationists, using their own desperate tactics against evolution often ask what use is (say) 5% of a wing? One could well ask, what use is 67% of a god? Competing interests: Atheist medical Doctor
Re: which gods ? 2 July 2004
Reginald.H. Le Sueur, Social security officer Jersey. JE3 7BE Send response to journal: Re: Re: which gods ?	Purple Unicorns?-you must be a heretic Sir! The only true deity is the Great Invisible Pink Unicorn. Have you not beheld her in All the Glory of Her Ineffable Pinkness? Competing interests: Member of National Secular Society
Leibovici's paper is not "flawless" 17 October 2004
Sergio D Schvartzman, Physician Neuquen (8300) Argentina Send response to journal: Re: Leibovici's paper is not "flawless"	Would you accept a RCT in which it is suspected that a considerable number of individuals in the control group were given the active drug? Since this study does not offer major precisions about the applied intervention (e.g. What kind of prayer? Prayers from who? Where was it made? To what God?), we must assume that any prayer should produce the same effects, and there is no way to rule out that any individual from the control group (or his/her relatives) had not prayed to God for their health during their time of illness. Control subjects, to be considered as such, must not have received any prayer, at any time (since “God is not limited by a linear time, as we are”). Therefore, the study is invalid, or it can lead us to a dangerous conclusion such that a prayer said ten years later by an unknown person is more effective than one said at the moment by a beloved one; and its consequent recommendation would be: if you need God’s help, don’t pray now, do it in a few years, it will be better. However, even if we accept the study and its conclusions as valid, it should be reproducible. Let’s suppose, then, that we want to reproduce this same study, but now with a crossed design (like a RCT in which those who were initially given placebo will receive the active drug). The subjects in control group should then improve their condition like those who received the intervention in the first place. That is obviously impossible, but… why? What are God’s excuses to not help these people? None of the following would be acceptable: - Sorry, there’s nothing I can do, it happened in the past. - I’m sorry, I have already helped the other group. - I’m not allowed to help control subjects. Anyway, it would be enrichening to go on discussing about Religion, but only a miracle could turn this work into strong evidence about the effectiveness of praying. Finally, all this discussion is absolutely irrelevant, since regardless what science may prove or not, human beings will go on praying, because it is a matter of faith. Besides, it is cost-effective. Competing interests: None declared
The Hospital Called Earth 13 April 2005
Michael A. Bedar, Outreach, Tree of Life Foundation Patagonia, Arizona, U.S.A. Send response to journal: Re: The Hospital Called Earth	Throughout the studies on intercessory prayer, I have been seeing the study population as a mere microcosm for what the studies might really be studying. Taking "healing" (and all measurements like length of hospital stay and mortality) to be metaphorical for the process each person goes through to live a more fulfilling life, these studies, however indicative their statistical results, may come bear on the role of prayer for our planet and humanity. I received some inspiration for this comment from www.peaceeveryday.org Sincerely, Michael Competing interests: None declared
a test for the "scientific" community 4 August 2005
Martin Ploederl, Research Assistant Hellbrunnerstr. 34, 5020 Salzburg, Austria Send response to journal: Re: a test for the "scientific" community	Not long ago a colleague gave me the Leibovici-paper without any comments. I read it once, and than again. I was sure, that it is a joke, and I definitely do not believe in retroactive praying. Of course, after reading several times, the caveats appeared, as they do in any paper. I thought that maybe Leibovici put the readers to a test: take a published pharmacological case-control study of a high impact journal, and reframe it into a faked study, using same methodology and stats, but only change the treatment into something esoterically. Look at the responses of the scientific community. The reframed study will be criticised because of bad stats, interpretation, description of methodology, etc. Question: Would the scientific community would be as critical to mainstream pharmacological studies as it would be for the faked study? I do not think that Leibovici paper has a worse methodology compared to most published studies. Competing interests: None declared
Data 28 December 2006
Paulo Hubert, Graduate student Universidade de Sao Paulo Send response to journal: Re: Data	Can I possibly get the data you used for the statistical tests? I am a statistician, and I would like to see what the results would be if Bayesian techniques were used. Competing interests: None declared
Side effects of the Leibovici RCT of remote, retroactive intercessory prayer 26 May 2008
Jose M Lopez-Lozano, Infection Control Team Hospital Vega Baja, Orihuela 03314, Spain Send response to journal: Re: Side effects of the Leibovici RCT of remote, retroactive intercessory prayer	An important side effect of the Leibovici paper is its impact on the religious community. Please search in Google: “Leibovici” and then “prayer” on ‘search within results’ (at the bottom of the page). You will have a lot of entries where many religious congregations take the Leibovici ‘experiment’ as a proof of the prayer benefits or of the existence of God. Evidently these persons didn’t read the Leibovici auto-reply (Author's comments, BMJ, 12 march 2002, Leibovici L). Competing interests: None declared
Free will, determinism and Laplace's demon. 8 February 2009
Richard G Fiddian-Green, FRCS, FACS None Send response to journal: Re: Free will, determinism and Laplace's demon.	In addressing "Some Logical and Philosophical Objections and a Parallelism to the Newcomb Problem" I quoted the statement that, "When one tries to decide on the best strategy to follow when making one's choice, a paradox results. Two widely accepted and supposedly equally valid principles in logic (the evidential expected utility (EEU) principle and the causal expected utility (CEU) principles respectively) give opposite strategies as optimal...", and asked if "this [might] be a philosophical formulation of Heisenberg's uncertainty principle?" The uncertainty principle holds that it is not possible to define the position and momentum of a particle at the same time. In his book, Universe in a Nutshell", Steven Hawking claims that acceptance of the validity of this fundamental law in quantum mechanics renders LaPlace’s scientific determinism false. Heisenberg's uncertainty principle may, however, be interpreted as proof of the validity of the Alice hypothesis which posits that bosonic forms of existence, in which all movement occurs, alternate with fermionic ones, where all matter resides in a succession of incrementally different static forms. If then, as the Nobel Laureate Eric Kandel claims (1), free will is exercised uncosciously and, as posited in the Alice hypothesis, all thought and executive decision making occurs within bosonic phases of existence and fermionic complexities are dictated by antecedent bosonic simplicities (2), what is free will? Might it be the products of an individual unconscious, a collective unconscious, and/or a "Creator's" unconscious? Might it, and even the power of prayer, be the product of all three. Laplace strongly believed in causal determinism, which is expressed in the following quote from the introduction to the Essai: “ We may regard the present state of the universe as the effect of its past and the cause of its future. An intellect which at a certain moment would know all forces that set nature in motion, and all positions of all items of which nature is composed, if this intellect were also vast enough to submit these data to analysis, it would embrace in a single formula the movements of the greatest bodies of the universe and those of the tiniest atom; for such an intellect nothing would be uncertain and the future just like the past would be present before its eyes.[22] ” "Determinism is the philosophical proposition that every event, including human cognition and behavior, decision and action, is causally determined by an unbroken chain of prior occurrences"(Wikipedia). Pierre- Simon, marquis de Laplace is credited with being the father of scientific determinism. Laplace's Demon: "This intellect is often referred to as Laplace's demon (in the same vein as Maxwell's demon). Note that the description of the hypothetical intellect described above by Laplace as a demon does not come from Laplace, but from later biographers: Laplace saw himself as a scientist that hoped that humanity would progress in a better scientific understanding of the world, which, if and when eventually completed, would still need a tremendous calculating power to compute it all in a single instant" (Wikipedia). When asked by Napoleon why he hadn't mentioned God in his book on astronomy, Celestial Mechanics, Laplace replied, "Je n'avais pas besoin de cette hypothèse-là" (I had no need of that hypothesis) (Wikipedia). 1. Eric Kandel. Free will is exercised unconsciously. In: John Brockman. What Is Your Dangerous Idea? cmaj.ca -- eLetters for Cavalcanti, 171 (4) 328[Read eLetter] Might biochemical fermionic complexities be dictated by antecedent bosonic simplicities? Richard G Fiddian-Green (26 August 2004) ... www.cmaj.ca/cgi/eletters/171/4/328 Competing interests: None declared
Re: Free will, determinism and Laplace's demon. 9 February 2009
Michael D Innis, NA Home Send response to journal: Re: Re: Free will, determinism and Laplace's demon.	Editor Laplace “ We may regard the present state of the universe as the effect of its past and the cause of its future". Omar Al-Khayyam "The dawn of the first day of creation wrote what the evening of the last day shall read" I prefer Omar's version of destiny. Michael Innis Competing interests: None declared
What if God tests us? 26 July 2009
Paul E Shannon, Con Anaes Doncaster Royal Infirmary. DN1 5LT Send response to journal: Re: What if God tests us?	If people read their Bibles, they would know that you cannot test God, 'Do not test the LORD your God', Deut.6:16. However, God may test us! 'I will refine them like silver and test them like gold', Zech. 13:9. Competing interests: Evangelical Christian.