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Blind Faith: The Unholy Alliance of Religion and Medicine

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Does the practice of religion bring health benefits to the faithful? Not likely, says Richard Sloan. He has been simmering for years about the poor research that says otherwise, prompting him to co-author a literature review for "Lancet" in 1999 and now this book. Much of the research reviewed in "Blind Faith" has been supported by advocacy foundations that think religion is good for your health and don't mind using the tools of science to prove it. Relentlessly, they misuse these tools and an uncritical media propagates their invalid conclusions.

Suppose you want to see if religion influences health. Since it's not feasible to randomly assign half your group to be religious and half irreligious, the groups are "self-selected" by church attendance surveys. Never mind that church attendance is known to be over-estimated in face-to-face interviews and that attendance doesn't necessarily measure devoutness - those details are routine hazards of epidemiological research.

In five years your data shows the mortality rate to be higher for non-church-goers. Should that be proof of a health benefit or is it more likely that people too sick to attend are also the ones more likely to die. What about the influence religion might have on smoking, drinking, drug usage, and a hazardous life-style? Is resultant better health the direct effect of religion or is a byproduct of a healthier lifestyle - called a "confounder"? Observational studies of this type are all that's available in much of epidemiology. Confounding is a serious problem, subject to biased interpretation. A randomized, double-blind experiment is much preferred.

Ideally, all studies would be randomized and double-blinded - you take a group of people, randomly divide them into 2 groups, apply the variable to one group and a give placebo to the other, without the researchers or either test group knowing which group is which. Then you compile and evaluate the results. Standard methods are used to minimize bias and statistics are applied to see if the differences are significant.

Many randomized and double-blinded studies intend to show that intercessory prayer (IP) improves surgical outcome. Most of them have significant methodological flaws, commonly misusing the data. The researchers are looking to prove their stated hypothesis, but dozens of outcome variables may be incidentally measured. If you measure enough variables, some will achieve significance. These should be identified and researched with another study. Instead, a biased researcher might say, "Eureka! The prayers were answered." This is called the "sharpshooter's fallacy" - drawing the bull's eye on the barn after the arrows have reached their mark.

The following things good researchers take great care not to do:
1. Use anecdotes
2. Ignore confounding factors
3. Confuse correlation with causation - Factors associated with health outcomes may be markers but not causally related
4. Scientific conclusions cannot be based on the sharpshooter's fallacy

The authors writing articles about the religion/health issues are guilty of all these things and more. As a result, their articles are almost always published in the same group of sub-par journals, released as abstracts, or leaked to the press without peer review. They are then restated inaccurately in religious periodicals until they reach the myth stage.

The best part of this book is Part Two: Reading the Evidence. It is a well-done expose of religion-inspired efforts to skew data. The rest of the book (rightfully) takes to task those Doctors who want to evangelize while they practice medicine, but I don't see this as the burning issue Sloan does. Throughout the book, he questions the validity of doing these studies at all - because it trivializes religion. Religion shouldn't get this free pass and I eagerly welcome the few well done studies - the poor ones are not going to disappear. There is much to be said for relentless application of the scientific method - no other method has ever worked so well in uncovering the truth. If certain myths fall by the wayside, so be it.

Fast read, non-technical. Good overview on how to evaluate the quality of studies, medical journal reviews, and the process of scientific experimentation. The third section of the book seemed to bog down and become more "opinion-based" rather than fact- or statistically-based.

There is a growing movement to incorporate religion into the practice of medicine. Proponents claim that hundreds of studies have shown the benefits of intercessory (distance) prayer, energy healing, and so on. Anecdotal stories of miraculous interventions abound. The media has been glutted with supporters of various religious links to healing and medicine.

But is it true? Does solid, empirical evidence really exist to prove these claims?

Richard Sloan, Ph.D. and behavioral medicine professor at Columbia University, disputes the validity of these findings. In his new book, BLIND FAITH: THE UNHOLY ALLIANCE OF RELIGION AND MEDICINE, Sloan examines the impact of religion on healthcare. He not only takes a critical look at the sources of supporters' research, but at the mental, spiritual, and physical effects of blending religious ideals with medical cases. In addition, he raises the concern that sponsoring such research is harmful to religion; that to take something transcendent and try to make it scientific is to trivialize it. Toward the end of the book, Sloan posits:

"Recognizing the effort to bring religion into clinical medicine as bad science, bad medicine, and bad religion is not a critique of religion at all. In fact, it's an effort to protect religion against the trivialization of being simply another part of the scientific enterprise."

Ultimately, Sloan does not dismiss the importance of religion to patients and some doctors. However, he uses this platform to expose the dangers of mingling religion and health in inappropriate ways.

"But recognizing that religious and spiritual concerns arise in times of illness doesn't mean that doctors should take these concerns on as part of their responsibility," Sloan writes. "... doctors lack the time, the training, and the experience to engage in spiritual interactions with patients."

This book is an important look at a growing movement. Sloan's voice needs to be heard above the din, lest the system goes completely awry.

Reviewed by Christina Wantz Fixemer
10/17/2006

I agree with points made by reviewers below, especially the criticism of Sloan's last two chapters in which he suggests that religion deserves a free pass from scientific inquiry. Christianity, for example, has been proven "false" on many points from the sciences of biology, archaeology, and history. Should archaeologists not try to prove or disprove the sometimes outrageous claims of the Bible followed by billions? Are archaeology and critical history not "science"?

Besides this, I would add one comment. I work as an RN and have met many, many doctors, both young and old. As a whole, physicians are the most irreverent group of people I've ever met! I chuckled even picturing the doctors I know getting "spiritual" with their patients (and, keep in mind, I live in Oklahoma, the Bible Belt if ever there was a place). Nurses and other auxillary staff also tend to be an undevout crowd as well. So, perhaps Sloan is making a proverbial mountain out of a molehill. It's telling that Sloan returns over and over again to the same few doctors in his book -- because, in reality, there is no groundswell towards an "Alliance of Religion and Medicine." There's no need to lose sleep over this issue.

Still, Sloan's work is appreciated because I have heard (and maybe even said in the past) that there is "strong evidence supporting the health benefits of religion." Now, I can no longer say that.

Will attending church or reading the Bible help you live longer? Help you have less complications after surgery? Help your blood pressure go down? Columbia professor Richard P. Sloan introduces us to the major players in this new area of Christian evangelism. The studies purporting to show any health benefits from going to church or "being religious" are all so flawed as to render them useless. Using his epidemiological knowledge, Sloan carefully shows the reader how one should analyze claims from the media and claims in journals that purport to show a connection between religious behavior and improved health. In an organized, straightforward approach, Sloan one by one rips these shoddy studies and their charlatan authors to shreds. It's just beautiful, and Sloan should be applauded for using common sense, caution, and science to analyze this growing movement. He's right--trying to bring religion into medicine is a very bad idea with all sorts of negative consequences for patients, physicians, and the general public.

Somehow, after a beautiful twelve chapters, something goes horribly wrong. Professor Sloan bumps his head, is pressured to soft pedal to sell more books, or something--but the rational, sensible flavor of the book just goes out the window. He has just taken us on a very pleasant journey using a clear head, reason, and science to find the truth of this important matter. But now, we must throw all those tools away because we're going to talk about religion.

We must keep religion away from medicine, we read on p. 241, because we might "dumb down religion by eliminating what is distinctive about different religious traditions." Tradition is right--that's all there is to any religion; and therefore, there is nothing really distinctive at all to lose. Better still, "...religion and science are independent approaches to knowledge, and neither can be reduced to the other" (p. 253). What? We can't or shouldn't use science to see if the Earth is the center of the universe? We can't use science to see if the world was destroyed by a universal flood six thousand years ago? You bet we can, and we should.

As if he hasn't already hasn't weakened his argument enough, Sloan tells us that "religious truths are considered to be enduring and not subject to change. Scientific truths, on the other hand, are completely dependent on evidence, and as new evidence merges, scientific truths change accordingly" (p. 254). This is pretty misleading. Religion is a set of stories invented to explain thunder and lightning (when we didn't yet know how they come about), a set of stories to quell our fear of dying. That's it; and implying that religion is the one constant in life while science is always changing its mind is incredible. Scientific truth is real and lasting; it is like a building that keeps getting taller--very, very infrequently do we ever adjust anything in the lower levels of the building.

On p. 260, we are told that if we use religious practice as another recommendation to improve health, "a great deal will have been lost" and we will "strip [religion] of its transcendence". The only thing (of value) that will be lost is religion's pretense to reality. Losing some Bronze-age myths is certainly nothing to bemoan. "[It is a] fact that religion and science represent different approaches to knowledge, wisdom, and truth, each with its own operating principles. This does not make one superior to the other" (p. 264). Stephen J. Gould's overlapping magisteria again. The reader should remember that religion has usually been an obstacle to truth--real, palpable truth--like evolution, cosmology, geology, archaeology, and anthropology. Religion is not an even remotely valid approach to obtaining knowledge or wisdom of any kind, as history has shown since the Enlightenment.

On a different tack, Professor Sloan tells physicians that if a patient tries to bring religion into a medical encounter, they should refer patients to specialists (clergy of some kind). This seems to insult specialists like oncologists, radiologists, or gynecologists by lumping them in the same boat with more "specialists" like palm readers, crystal gazers, and tea-leaf readers. Being well versed in debunked and mythological creeds won't help anyone, sick or not. In summary, the last two chapters of this book are so incongruous with the rest of the book that I can only hope Sloan was forced to include them. This is a great work, but skip the last two chapters!

Dr. Richard Sloan tackles an area that has not been debated much in the public arena--yet. But with the not-so-stealthy attempt to turn America into a nation of Christian law, being led by the White House, we had better discuss the implications of faith on laws pertaining to healthcare.

'Blind Faith' goes into great detail about what makes a scientific study credible. Sloan then puts various claims of 'faith causing healing' up against those tests. Faith fails every time when held to scientific principles. Sloan also rips to shreds biased 'studies', funded by the religious right which are inaccurately reported to try and prove that faith heals.

Consider for a moment the religious right in charge of funding for stem cell research-- which has been proven to lead to cures for a variety of debilitating diseases. Guaranteed they'll be no cure for the aliment afflicting you or your loved one if religious zealots have their say.

Recall the Terry Schiavo debacle--which had elected officials rushing back to Washington from recess to try and intervene in something which was NONE OF THEIR BUSINESS in the first place!!

And think about your right to have a living will wherein YOU decide when your life should end, not some bible-thumping do-gooders with selfish, baseless, myopic agendas. These are just a few of the examples Dr. Sloan explores in this well-researched, well-reasoned book.

If these thoughts trouble you, then I recommend you pick up this book which provides good reading for students of science and proponents of church state separation.

Watching the network news, one would be led to believe that it has been scientifically proven that intercessory prayer heals the sick and that being a Christian is better for your health than being a Jew, Muslim, Buddhist, or atheist. Is this really the case, or have we been misled by an uncritical media and a handful of agenda-driven pundits masquerading as scientists? "Blind Faith" attempts to answer this question and more.

Richard P. Sloan's work discussing the recent spate of studies that purport to link religious practices with quantifiable medical benefits is devastatingly effective in cutting the legs out from under this so-called research. Sloan first explains that there are far fewer studies regarding religious effects on health than the public has been led to believe, because unscrupulous researchers will often include any study that asks even obliquely religious questions of its participants in their lists of "religion and health outcomes" experiments, then he goes on to systematically dismantle the few meaningful studies that remain. He spends a considerable amount of time, for example, explaining the flaws in the much-touted "definitive studies" MANTRA and MANTRA II. (It is worth noting that MANTRA II was almost uniformly negative in its conclusions, but that its authors were making references in the media to the tentatively positive results in its parent study MANTRA right up until a few days before the MANTRA II results were published. Why?)

At each step of this journey, Sloan explains to the readers how statistical artifacts, poor experimental procedures, and various other caveats hamper the study of religion and health, rendering questionable essentially all of the conclusions that studies like MANTRA II have purportedly reached. Prominent among the woes of these studies is something called the "sharpshooter's fallacy", which Sloan explains as emptying your gun into a wall and then drawing a bull's eye around your bullets. As applied to science, that means testing an enormous amount of variables simultaneously and then selecting any outcomes that seem to support your hypothesis as confirmation. One of the health studies Sloan critiques dealt with over a 160 variables -simultaneously-, and its authors crowed loudly about apparently significant results regarding only a handful of these variables. Sloan notes that, from a statistical standpoint, one is almost certain to find some statistically significant result by random chance alone when testing for that many variables at once. In another instance, Sloan wryly notes that two different studies drawing from the same set of data were reported to show positive results associate with different variables in each study.

Sloan is careful to use a very measured voice when talking about religious issues. It is not his intent to attack religion itself as a social enterprise, but rather to show that attempts to scientifically quantify potential religiously-derived health benefits is an enterprise that is both scientifically bankrupt and demeaning to religion. He repeatedly channels the late Stephen Jay Gould, invoking the deceased author's principle of "Non-Overlapping Magisteria" dozens of times, especially during the book's concluding chapters. Basically this concept states that science and religion represent to different paths that lead to two different kinds of truth and thus neither one has anything to say about the other. I would be tempted to argue that this idea only goes so far, but it largely works for the arguments that Sloan uses it to make.

If I had to name one complaint about this book, it would be that Sloan does little to address the backgrounds of some of the researchers involved in these pseudoscientific studies. While he is clear about noting which researchers have collaborated with each other and whatnot, he makes some tantalizing references to a handful of the scientists in question being affiliated with various prominent fundamentalist organizations. While I understand that it was Sloan's intention to discuss the underlying science itself rather than the personalities driving it, I still would have liked to have seen some of this elaborated on.

Overall this is a solid book that breaks down a complicated subject into bite-sized portions and helps the reader to look past the ongoing media hype that surrounds what amounts to shoddy research and wishful thinking on the part of its proponents.

The lengths some religous people will go to promote the idea of miracles is amazing. You would think they would "fear God" and not twist the truth. Richard Sloan documents it all. A bit wordy at times, but the book is worth reading.

The author has researched his subject well. Dr. Sloan presents a clear cut case for how those with a religious agenda sidestep / play fast and loose with the scientific method, and ignore it's tenets in order to push their agenda.

He dissects a number of "studies" demonstrating how lack of controls, data fishing, and various other methodological weaknesses distort results, and lead to fallacious claims of the health benefits of religious practices / spirituality. Additionally, he exposes Evangelical attempts to use doctors to proselytize and gain "recruits" among patients, a clear violation of ethics from any number of perspectives.
I gained a good insight to the issue.

On the down side: I found his style dry, text bookish, exasperatingly repetitive and geared to the lowest common denominator. Very little detail where more was warranted, too much detail where none was necessary.

We are introduced to ancient cultures belief in the supernatural and their perception of its connection to illness and health. These short and colorless chapters of a few paragraphs each are so basic as to be tantamount to a cut and paste from Wiki.

He refers back time and again to a handful of the same flawed studies and their authors to recount, again, the procedural defects and decry their questionable veracity.

He has this annoying idiosyncrasy of incessantly refering to points made in prior chapters, or promising to clarify and expand in future chapters. It's as though he is compelled to refresh the reader's memory or provide a coming attraction of whats to come.

Most chapters are summarized by a "what did we learn" recap in a bullet point check list style; preparation for tomorrow's quiz?

Some very simple concepts are explained ad nauseum, to the point where it was akin to whipping a dead horse. In a late chapter on the recent upsurge of religion courses being taught in medical schools, he went to extraordinary lengths to explain how the very few credits in religion ill prepare doctors, and make them no more qualfied, to offer religious guidance than any other layman. Fine. But he takes virtually an entire chapter to describe class hours / months, credit load, the various medical disciplines etc., etc., etc., to make the simple point. It was overkill to the point of tedium.

I found at least five instances where he committed the same errors as those he exposes, or contradicts himself, or asserts an embelished conclusion to a case study where no grounds for that conclusion existed.

His closing chapters included a lengthy tip of the hat, and what I can only describe as feigned respect, for religion as a meaningful and profound experience that is "demeaned" by trying to couple it with science, virtually gag worthy. It reads as though he is throwing a bone to theists in order to gain their support and approval for his position of separation of medicine and religion.

Bottom line: it's a short read and worth the few hours to get an insight to the potential threat that bad science promulgated by the religiously fanatical represent to the medical field and the future quality of healthcare in the US. But don't expect any "eureka" break throughs, or entertainment value. This reads like a series of lecture notes stretched out to fill a volume.

This is the definitive book on religion and medicine: they are different and do not mix very well. Most of the research on the effect of religious activity on health has been sloppy, and the results have been negative. Neither going to church nor prayer will guarantee better health or longer life.

Physicians have neither the time, nor the expertise to counsel patients on questions of religion, or meaning, or spirituality. For this there are other experts,-- ministers, priests, chaplains, etc. -- trained in the ministry and theology, as well as in counseling.

This is a very good book. It is especially solid on science and medical research, explaining what conclusions can realistically be drawn and what can not be drawn from the existing research, but also what is possible to research at all.