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 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.
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
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?
Competing interests: No competing interests
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
Competing interests: No competing interests
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!
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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.
Competing interests: No competing interests
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@post.Harvard.edu).
Carl E. Thoresen, Ph.D., Departments of Education, Psychology, Psychiatry/Behavioral Sciences, Stanford University, USA (Thoresen@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).
Competing interests: No competing interests