Journal Is Silent in Study Dispute

The medical study had profound implications, apparently offering scientific proof of the power of prayer, even the existence of God.

The article, with two Columbia University physicians listed as authors, said that women undergoing in vitro fertilization treatments in South Korea were twice as likely to conceive when strangers prayed for them. Making the findings even more spectacular was that the women didn’t even know they were being prayed for.

The doctor identified as the lead researcher told the New York Times that he and his colleagues found the results so improbable that they debated whether to publish them.

But questions about the study began soon after its publication in the September 2001 issue of the Journal of Reproductive Medicine. Several researchers, led by Dr. Bruce Flamm, an obstetrician-gynecologist at Kaiser Permanente in Riverside and a clinical professor at UC Irvine Medical School, questioned the study’s methodology.

“A high school student could probably set up a study on whether prayer is efficacious or not,” Flamm said. “This was not it.”

He found the study’s methodology so complicated as to be almost unexplainable. And the authors said several times that the women didn’t know they were in an experiment, considered a serious ethical breach.

Flamm wrote critical letters and e-mails to the journal’s editors and the scientists. He called. He left messages. And for nearly three years he has been ignored.

Then something happened that attracted attention to the study once more. The third researcher on the prayer study, Daniel Wirth, pleaded guilty in Pennsylvania to federal charges of embezzling $2 million from Adelphia Communications by submitting fictitious invoices for consulting services. Indicted on charges that included using false identifies for decades, Wirth pleaded guilty to conspiracy to commit mail fraud, bank fraud and money laundering.

Even though the journal identified Wirth as a lawyer, critics knew him for his articles on psychic healing in less scholarly journals, including a study claiming prayer had helped salamanders regenerate limbs.

Wirth, who is listed on the study as “Dr. Wirth” -- apparently in reference to his juris doctor degree -- also has a master’s degree in parapsychology from John F. Kennedy University in Orinda in the Bay Area.

Flamm’s concerns about the prayer study’s credibility, detailed in an article he wrote that will be published this week in the magazine Skeptical Inquirer, started to gain recognition with the spreading news of the indictment. “I had no idea this guy was going to do me the favor of getting arrested ,” Flamm said.

Questions remain.

Why have the journal and the authors ignored Flamm’s questions, especially since scientific journals typically provide a forum for debate by printing critical letters along with the authors’ responses? How did two professors from Columbia University Medical Center get mixed up with Wirth? How did such a seemingly questionable study pass the peer review process at the Journal.

The journal recently took the prayer study off its website -- not as a retraction, but because the publication was receiving so much “traffic” over the article that its small staff couldn’t keep up, said Dr. Lawrence Devoe, the journal’s current editor.

Devoe said he was going through mail generated by the prayer study and would send it to the authors for their response. “It will take some time,” he said.

Flamm said it sounded like another stalling tactic, considering that he sent an e-mail to Devoe a year ago that explained his criticisms and pointed out Wirth’s arrest. Besides, he said, even a layperson could figure out the controversy.

Marilyn Castaldi, a spokeswoman for Columbia’s medical center, said a six-member faculty committee began an inquiry last month.

Columbia already has acknowledged to the U.S. Department of Health and Human Services that federal guidelines were violated because the subjects did not know they were part of the study.

Dr. Rogerio Lobo, one of the study’s authors and then chairman of obstetrics and gynecology at Columbia’s College of Physicians & Surgeons, said the authors stood by the study.

“Oh, my God,” said Lobo, who promoted the story in the national media. “Why won’t this stuff just go away?”

The other author, Dr. Kwang Y. Cha, a professor in South Korea who was working with Lobo during a yearlong sabbatical, did not return calls seeking comment. He is medical director of the Cha Fertility Clinic in Los Angeles.

Wirth’s attorney said he had advised his client not to comment.

The study said that women undergoing in vitro fertilization, where the egg is fertilized outside the body and implanted in the womb, had a 50% pregnancy rate when people were praying for them, compared with a 26% pregnancy rate for women who had no one praying for them.

The women underwent the procedure in a Seoul hospital.

Christians in the U.S., Canada and Australia were faxed unidentified photographs of the women and asked to pray that “God’s will or desire be fulfilled.”

Some Christian groups embraced the study, celebrating the fact that one of the most prestigious medical schools in the country was alleging scientific proof that prayer works. Scientists, by implication, were saying that God existed.

The effect of religious beliefs and practice on health has long been a subject for scientific research. Studies have linked religion to increased well-being, optimism and meaning in life.

“Religion is a positive coping behavior in face of stress, adversity and loss,” said Dr. Harold G. Koenig, a psychiatrist who is director of Duke University’s Center for Spirituality, Theology and Health. “These effects are perfectly understandable based on known psychological, social and behavioral mechanism.”

Koenig said, however, that the results of more than 20 studies have failed to show that intercessory prayer, the kind tested in the Columbia research, is clinically significant.

Flamm noticed the study when a nurse dropped a copy of the Journal of Reproductive Medicine on his desk.

“The first thing I noticed was [that] it made an apparently miraculous claim,” he said. “I’m not accustomed in my medical career to seeing a miracle cure.”

Flamm, who attended UC Riverside as an undergraduate and received his medical degree from Wake Forest University in North Carolina, will not divulge his religion, if he has one, saying it shouldn’t make a difference. “Religions base things on faith,” he said. “A scientist should look at things scientifically, based on the merits.”

He also found problems with the study’s scientific design and had other questions. If prayer were so powerful, why did the women need to use in vitro fertilization? Why were the prayers to a Christian God? What about Buddhists, Jews, Muslims and others? And was God punishing the women who didn’t get pregnant?

Flamm sent his criticisms to journal editor Dr. George Wied. Wied died last month. . Flamm had written to professional journals before.

He assumed that the Journal of Reproductive Medicine would address his concerns the way other scientific journals do, by printing his letter and the authors’ response. But Flamm’s letters were never printed.

Scientists say this is unusual; give-and-take over research is routinely published in journal letters columns. Dr. Catherine DeAngelis, editor in chief of the Journal of the American Medical Assn., called it “peculiar” that a reputable journal would ignore letters from a qualified authority.

After his e-mails and a certified letter went unanswered in early 2002, Flamm spoke in early 2002 to the journal’s managing editor, Donna Kessel.

He said Kessel told him that she was aware of his concerns but that “we don’t want to add fuel to the flames. We won’t publish anything else,” and hung up.

Kessel did not return calls last week.

Flamm was not alone in trying to contact the journal, the university and the authors, although he was the most persistent. Irwin Tessman, a professor of molecular biology at Purdue University, also questioned the study. He seems to be the only researcher to reach Lobo, who told him Wirth was handling the questions.

Wirth already was known to those who look skeptically at alternative medical treatments. Flamm and Tessman easily had found a number of his papers on the Internet.

“There were 15 to 20 papers on outlandish subjects,” said Dale Beyerstein, a psychology professor at Langara College in British Columbia. “Surely that would have set off some alarm bells.”

Beyerstein said that over several years in the mid-’90s he tried trying to talk to Wirth about his work but never heard from him.

Wirth listed himself as president and research director of Healing Sciences Research International, which Beyerstein could never locate.Beyerstein finally sent to Wirth’s post office box a copy of a paper he was going to present at a meeting of the Committee for Scientific Investigation for Claims of the Paranormal, detailing his inability to reach Wirth.

This time Wirth replied -- with a letter threatening to sue. Beyerstein presented the paper anyway.

Despite his questionable past, Wirth managed to partner with the two Columbia researchers. Wirth told Science and Theology News he met Cha at a conference in 1999 and 2000 and talked about prayer studies.

He said he designed the study that would be carried out at Cha’s fertility clinic in Seoul and that Lobo reviewed the results.

And then Wirth was arrested. He faces the possibility of a maximum sentence of five years in prison. Sentencing is scheduled for Sept. 14.