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
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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.
Competing interests: No competing interests
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).
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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?
Competing interests: No competing interests
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.
Competing interests: No competing interests
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).
Competing interests: No competing interests
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!
Competing interests: No competing interests