Doctors aren’t chaplains

RICHARD P. SLOAN, director of the behavioral medical program at Columbia University Medical Center and the New York State Psychiatric Institute, is the author of "Blind Faith: The Unholy Alliance of R

HOW WOULD you like your doctor, at your next examination, to ask not only about your diet and symptoms but about your spiritual life?

How would you like your surgeon to ask, while you’re on the gurney ready to be wheeled in for an operation, if you’d mind if he says a quick prayer?

Or if he suggested that perhaps you should?

These questions are not farfetched these days. A concerted effort is underway to make religious practices part of clinical medicine. About two-thirds of U.S. medical schools now offer some form of training on the role of religion and spirituality in medicine, according to Dr. Harold Koenig of Duke University.

With support from the National Institutes of Health, researchers are now studying the effect of third-party prayer on cancer patients. Research on the connection between religious activity and cardiac health was published in the Lancet, one of the top peer-reviewed medical journals. The John Templeton Foundation, whose annual prize on spiritual discoveries exceeds the amount of the Nobel Prize in medicine, has funded dozens of medical researchers, some at top-tier institutions, who claim an association between religious devotion and better health.

Some prominent physicians are calling for the wall of separation between religion and medicine to be torn down. They declare that the future of medicine is prayer and Prozac, and they recommend that doctors take a “spiritual history” during a patient’s initial visit and annually thereafter. Walter Larimore, an award-winning physician, for instance, has declared that excluding God from a consultation should be grounds for malpractice.

Of course, religion is not utterly irrelevant to patients. If it were, hospitals would not have chaplains and chapels. But before organized medicine decides that religion has any value in physical healing, several things ought to be considered. First, the scientific evidence supposedly linking religious practices with better health is shockingly weak — so bad, in fact, that if we were discussing drugs, the Food and Drug Administration would have to find them unsafe and ineffective. Most research studies that claim to show how religious involvement is associated with better health fail to rule out other factors that might account for the relationship.

We all agree, for instance, that there is a real connection between lung cancer and carrying a cigarette lighter in your pocket, but no one thinks that the lighter causes cancer. The lighter is a marker of another factor — smoking — that has been scientifically proved to cause the cancer.

In precisely the same way, religious practices are likely to be markers of some other factor — for example, social support from family, friends or the community or, perhaps, the absence of behavioral risk factors — that may lower the risk of disease.

Studies that show, for example, the health benefits of attending worship services or reading the Bible often make this mistake. A study of residents of Washington County, Md. — the largest study ever to demonstrate that church attendance was associated with reduced mortality — made precisely this error; it failed to recognize that attendance itself was a marker for good health.

The effort to link health and religion has other problems as well. For one thing, doctors already have so little time in their interactions with patients that they routinely fail to follow established guidelines for preventive care and for treatment of chronic disease. If, in the future, physicians spend their limited time with patients engaging in spiritual inquiries, they will have even less time to address depression, smoking cessation, weight control or diabetes self-care — factors that are demonstrably related to disease and an increased risk of mortality.

More problematic still is the actual effect on patients when physicians abuse the privileged authority inherent in the role of the doctor by manipulating the religious sentiments of frightened and vulnerable patients. Physicians risk transgressing other ethical boundaries when they tell their patients that religious practices can improve their health. Asserting that prayer can promote recovery can lead patients who fare poorly to question their spiritual devotion and to experience guilt and remorse over their supposed religious failures.

Perhaps most important of all, efforts to connect religion and medical practice are bad for religion itself. Bringing religion to the examining table subjects it to the laws of science, stripping away all elements of transcendence.

A recent report, for instance, suggesting that religious experience is based on the neurochemistry of the serotonin system in the brain is a perfect example of how religion is trivialized by studying it scientifically.

The same goes for efforts to use modern neuroimaging techniques to take a “photograph of God,” as proposed by University of Pennsylvania neurologist Andrew Newberg, the author of a recent book on “neurotheology.” That represents precisely the false idolatry that many religions caution us to avoid.

All of us, sooner or later, will succumb to illness and death. Some will die prematurely. Others will live longer than expected. For many, illness will raise important religious and spiritual concerns, providing comfort to some and anxiety to others.

No one disputes the significance of these concerns, but recognizing that they arise in times of illness doesn’t mean that doctors should take them on as part of their responsibility. These are matters for patients, their families and the ordained clergy.