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.
Rapid Response:
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.
Competing interests: No competing interests