According to a lawsuit recently filed by his children, country music songwriter Wayne Perry died because his sister, Darlene Bishop, a television preacher and co-minister of the Solid Rock Church of Monroe, Ohio, convinced him to rely on religion instead of seeking standard medical care for his cancer. He did and he died.

Although Bishop had claimed in her book Your Life Follows Your Words to have cured her own breast cancer through faith and prayer, her deposition in the case made it clear that she never had received a breast cancer diagnosis from a physician. The controversy over Perry’s death is only one episode in the longstanding fascination, persisting centuries after the scientific revolution, with the use of religious ritual to treat disease, either alone or supplemented by conventional medical care.

 

In 2004, CBS News reported on a Colorado orthopedic surgeon who “requests” that patients pray with him while they are gowned and supine on the gurney, ready to be wheeled into surgery. In a 2007 report in the Archives of Internal Medicine, 54 percent of 1,144 physicians surveyed indicated they believed that God or another supernatural being intervenes in the health of their patients. The Christian Medical and Dental Association, a professional society half as large as the American College of Cardiology, publishes a handbook that instructs physicians on how to use their practices to evangelize. According to an article published this summer in the Des Moines Register, staff members at the Iowa City VA Medical Center repeatedly attempted to convert a Jewish veteran to Christianity during hospitalizations over a two-year period. 

 

The intrusion of religion into medicine is not limited to the Corn Belt or the Bible Belt. More than half of U.S. medical schools now offer some kind of training in religion and health. Each December, Harvard Medical School offers a continuing medical education course on religion and medicine. George Washington University has established an institute on spirituality and health. Duke University sponsors a Center for Spirituality, Theology and Health. Even the U.S. National Institutes of Health established a commission to generate papers on this matter without any effort to include skeptical perspectives. In a 2001 issue of Hospital Physician, doctors were encouraged to take a “spiritual history,” in much the same way that they take a medical history.

 

Proponents of bringing religion into medicine cite research showing that religious devotion is associated with better health outcomes. But overwhelmingly, the evidence is weak and inconclusive, marred by serious flaws in research methods. Even the best review article in the field, published by Lynda Powell in the American Psychologist in 2003, found that in all but 43 of the hundreds of studies examined, the research methods were so flawed that they couldn’t definitively determine that religion and not other factors, including chance, was responsible for the outcomes.

 

Of all the studies that attempt to establish a connection between religion and health, those finding an association between attendance at religious services and life expectancy are, without question, the strongest. In one of the best studies, a survey of more than 21,000 subjects, R. A. Hummer and colleagues found that frequency of religious attendance was inversely associated with mortality. However, the protective effect was entirely absent for patients with cancer, and only marginally significant for patients with heart disease, the two leading causes of death in the United States.

 

A report published in the American Journal of Public Health in 1998 showed that, in a community sample of 2,023 affluent, largely white adults over age 55 in Marin County, California, religious attendance was associated with reduced mortality. However, the magnitude and significance of the effect varied depending upon the definition of attendance, and whether the model included other indices of social engagement. So while the data suggest some health benefits from social engagement, they are anything but a ringing endorsement of the health benefits of religion or religious faith, per se. 

 

It would appear that many people want less God in medicine, not more. A study that appeared in the Journal of Family Practice in 1994 is often cited as indicating patient interest in bringing religion into clinical medicine because it reports that 37 percent of the respondents to a survey indicated that they wanted their physicians to discuss religious matters more than they generally do. But what is generally overlooked is that 47 percent of the patients reported that they wanted no discussion at all, and another 3 percent reported that they wanted less discussion. 

 

Whether patients are really that eager for doctors to inquire about religion is unclear. The Archives of Internal Medicine published another report in 1999 which found that about two-thirds of the patients questioned approved of physician inquiries into religious and spiritual matters. However, patients were not asked about this matter in general but specifically whether such physician inquiries would be acceptable to them if they became gravely ill. Patients’ responses to this narrower query are by no means a general endorsement of physicians taking time away from clinical matters to act as spiritual counselors. 

 

The attitudes don’t seem to be all that different in more religious parts of the country. In 2002, the journal Social Science and Medicine published the results of a survey of 1,033 randomly selected adults in eastern North Carolina, a part of the country in which religious observance is especially high. More than two-thirds of the respondents reported that they probably would or definitely would want to talk to someone about spiritual concerns if they were seriously ill or injured badly enough to be hospitalized. But even in eastern North Carolina, only 2 percent said that their first choice for such a person to speak to would be a physician. 

 

Wider surveys show that patients mostly want doctors to concentrate on providing medical care. In a much more geographically representative study published in the Journal of General Internal Medicine in 2003, 456 patients from primary care clinics in six academic medical centers from North Carolina, Florida, and Vermont were surveyed about a variety of topics including their preferences for religious/spiritual involvement in their own medical encounters. Only 19 percent believed it appropriate during a conventional office visit.

 

When asked whether they would want their doctor to discuss spiritual issues, even if it meant spending less time on their medical problems, the number of patients who wanted spiritual discussions as part of their medical care dropped to only 10 percent. Numerous surveys document that in preventive medicine and treatment of patients with chronic disease, many physicians lack the time to follow evidence-based guidelines.

 

If physicians are distracted by a religious agenda, they are less likely to attend as fully to the conditions and needs of their patients. Spending time engaged in spiritual or religious inquiries comes at the expense of not pursuing matters of much greater medical significance.

 

Beyond the evidence of patient preference, efforts to bring religious matters into clinical medicine rarely consider the serious ethical problems. The most obvious concern is religious manipulation or outright coercion that can occur when patients made vulnerable by fear, discomfort, and pain confront the authority figure of the doctor who has a religious agenda.

 

In the same survey, which showed that a majority of physicians believe in supernatural interventions in healing, 14 percent claimed that their personal religious beliefs justify withholding from their patients information about a perfectly legal procedure, such as abortion, let alone referring them to a doctor who would perform the procedure.

 

Forty-six legislatures have enacted conscience clauses to permit such religiously motivated malpractice (often the same legislatures that have prohibited the use of embryonic stem cells in research or treatment). Thus in many regions, government colludes to deprive citizens of evidence-based medical treatment on religious grounds. And because of geographic location or health plan limitation, many patients have no alternative to physicians who think that their primary obligation is to honor their religious convictions rather than act in the best interests of their patients.

 

No one disputes that for a great many people, religion provides comfort in times of difficulty, including illness. But allowing religion to become a part of clinical medicine is another matter entirely.

 

Richard Sloan is Professor of Behavioral Medicine at Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine.