Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7327.1450 (Published 22 December 2001) Cite this as: BMJ 2001;323:1450
All rapid responses
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!
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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.
Competing interests: No competing interests
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 ?
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests