Angela was dying; everybody knew that. She was out of medical options when she first met Puchalski—a specialist in end-of-life care—11 months earlier. At the time, Angela’s surgeon had given her 2 months, and objectively, Puchalski agreed. The only help medicine could offer was some pain relief. “I was really trying to get Angela to understand that this disease would kill her—soon,” she says. But Angela wanted to make it through one last holiday season with her family. So Angela prayed. She loved the rosary; she loved hymns. Her parish priest and another old friend in the clergy visited regularly. Each month, Angela grew weaker, but she held on. In November, shortly after her husband died, Angela didn’t open her eyes for 2 days. When she finally awoke, family members were gathered around, telling her it was okay to let go. “What are you talking about?” she asked with typical spunk. “I’m not going anywhere.” But with Christmas only 2 days away, Puchalski stood at the doorway filled with concern for her patient. Then Angela’s family came trooping in and the gloom vanished. Puchalski was drawn into Christmas revelry, Italian-American style. Music played; a small nativity scene sat near the tree, along with a picture of Mary and a rosary. Angela’s exuberant 7-year-old granddaughter presented the doctor with a gift. And Angela started laughing. She made it through that Christmas, and New Year’s to boot. In February, a year after she’d been given 2 months to live, she died. Could prayer account for Angela’s remarkable endurance? Many Americans would say yes. According to a recent CDC survey of more than 31,000 adults, 43% had prayed for their own health, 24% were prayed for by others, and 10% had prayed as part of a group on behalf of others—what’s called intercessory prayer. The survey found that prayer was by far the most commonly used method among complementary and alternative therapies. And the National Institutes of Health has sponsored at least $3.1 million in research over the past few years to study prayer’s effect on heart disease, cancer, and AIDS, among other conditions. But despite all the money and effort, it’s still tough to pinpoint what prayer can do for the ailing. Almost as soon as promising results on prayer’s powers are released, they’re marred by controversy or questions about the data. For a true believer like Puchalski, a Catholic and director of the George Washington Institute for Spirituality and Health, the desperate chase for proof that prayer works smacks of “testing God.” “I believe in God because of faith,” she says. “I’m not waiting for an experiment to prove his or her existence.” She doesn’t need data to tell her that a spiritual life matters to her patients and helps keep them healthy. It’s that faith that has led her on a mission to get doctors to recognize patients’ beliefs—to make room for spirituality in treatment. [pagebreak] The Case for Prayer For thousands of years, spiritual leaders and healers were one and the same. Religious orders founded the first hospitals, and it wasn’t until the 1800s that medical science finally broke free of faith. But the separation of body and spirit was pursued vigorously by medical science as it advanced. Sigmund Freud went so far as to compare religion to a neurosis. Now the pendulum is swinging back…a bit. Scientific evidence that prayer and faith can protect health has been building slowly over the past few decades. This controversial inquiry divides into two major questions: Can a person’s spiritual faith and practice affect his or her health? And can religious or spiritual practice—particularly intercessory prayer—affect the health of those being prayed for? The first is a complicated puzzle; scientists must try to tease out the benefits of religious participation from other health factors such as diet, exercise, and family history. As for the second, intercessory prayer suggests divine intervention at work, and there’s no lab test for that. To make a case for the health benefits of faith, prayer would have to activate a healing mechanism in the body. Herbert Benson, MD, of the Mind/Body Medical Institute in Boston and Harvard Medical School, has discovered one possible mechanism. In 1970, Benson and colleagues at Harvard described the relaxation response, a simple technique where, through rest, repetition of a word or phrase, and deep breathing, people can change their physical and emotional reactions to stress—reactions that can lead to high blood pressure, heart trouble, and insomnia. He also found that prayer could elicit the relaxation response. “Over 60% of visits to health care professionals are in the mind/body, stress-related realm,” says Benson. These ailments generally don’t respond to drugs or surgery. “We can effectively treat any disorder—to the extent that stress is contributing to it—by a once or twice daily elicitation of the relaxation response,” he says. But this isn’t strictly a religious phenomenon. Recent research shows that stress management tools, exercise, or transcendental meditation can have similar heart benefits. “It doesn’t matter where the relaxation comes from. The mechanism is within us,” says Benson. “Your own belief system will determine whether you believe it’s God given or whether it’s evolution derived.” Harold G. Koenig, MD, agrees, but he also believes that church offers benefits beyond those of meditation and exercise. As codirector of the Center for Spirituality, Theology, and Health at Duke University, Koenig has produced dozens of journal articles on spirituality’s role in healing and has edited the Handbook of Religion and Health, a scholarly volume that makes the case that religious people live longer, healthier lives. Koenig has been searching for biological evidence that prayer or religious practice tacks on years. In 1997, he found that regular church-goers had low levels of a protein called interleukin-6, which is linked to inflammation. Previous research has demonstrated that chronically high levels of the protein can indicate increased risk of many types of disease, such as cancer, heart disease, and diabetes. The research reinforced something Koenig first noticed as a young doctor during a residency in geriatrics. “If you ask older patients in the hospital ‘What enables you to cope?’ they say ‘Prayer, my religious faith.’” Religious people are less depressed, he says, a finding replicated in scores of studies. “People who are depressed experience worse medical outcomes,” he concludes. “They have more heart attacks, more recurrences of hospitalization, weaker immune functioning. They don’t do as well.” [pagebreak] Trouble in Paradise Koenig’s assertions seem logical, but generalizations like these drive critics like Richard Sloan, MD, to distraction. There’s an association between religion and health, says the chief of behavioral medicine at Columbia University, but no proven cause and effect. As he points out, it’s probably true that if you carry a lighter you’re more likely to die of lung cancer. But lighters don’t cause cancer. The research problems grow thornier in the study of intercessory prayer. In 1999, when the Archives of Internal Medicine published a study suggesting that praying for cardiac patients helped them recover, it generated a maelstrom of protest from doctors and a published correction (though the major findings did hold up to scrutiny). In 2004, the Journal of Reproductive Medicinewithdrew a 2001 study that claimed Christian intercessory prayer doubled the success rate of in vitro fertilization. The reasons: There were problems with the way the study was conducted, and Daniel Wirth, a coauthor on the paper, had pled guilty to unrelated fraud of $1.2 million. The journal investigated and ultimately reposted the study. Wirth is now in federal prison, and a coauthor asked that his name be withdrawn. Another widely reported study suggested that prayer could protect AIDS patients from complications, but that, too, is now mired in reports of methodological problems. The California Pacific Medical Center in San Francisco, where the work was done, stands by it. John Astin, PhD, a research scientist—who participated in the hospital’s review—says the real problem is that the findings from intercessory prayer studies “are all over the map.” Case in point: In July, The Lancet reported no effects from a large trial of prayer for 700 cardiac patients. Koenig distances himself from this research. “I think the study of intercessory prayer is worthless,” he says. “It seeks to prove that God exists, but God isn’t part of the natural world—he isn’t mechanistic. No scientific model exists to examine this phenomenon.” Sloan disputes the scientific validity of all the claims regarding spirituality and health. Often they’re not original research but reviews that reinterpret—and commonly misinterpret—older studies. Sloan calls it “torturing the data until it confesses.” In 2003, research from Rush University Medical Center in Chicago reappraised the strongest studies linking religion and longevity, finding a 25% reduction in the risk of death in service attendees. Still, the authors concluded that “more methodologically sound studies are needed.” Puchalski is unimpressed by the whole body of work on prayer and healing. “There’s no cause and effect,” she says, echoing Sloan. She also worries about the ethical dimensions of potential treatments. What would Baptists do if a Buddhist practice turned out to be best at preventing heart disease? “Referring a patient to a chaplain, or prescribing a secular practice such as meditation, may be fine,” she says. “But to prescribe going to church or temple or mosque? I would actively fight against that.” [pagebreak] Between Spirit & Science Puchalski’s background has prepared her well to straddle the divide between faith and medicine. She has always been a spiritual seeker, always wanted to be a doctor, and has always seen the two as connected. “I think of medicine as one of my spiritual practices,” she says. In college and graduate school she studied meditation in a Tibetan Buddhist temple. And she took the long road to medicine, spending 10 years as a biochemist at the National Institutes of Health studying rare genetic diseases. When Puchalski enrolled in medical school at George Washington University in 1990, she discovered that there was no course on spirituality and health—so she set out as a student to develop one. In 2001, she founded the university’s institute for spirituality and health, and she’s been involved in developing dozens of similar courses for the more than two-thirds of American medical schools that now include such classes in their curriculums. These courses focus on building compassion in medicine. “The health care system is forcing doctors to practice in a mode that does not value the doctor-patient relationship,” she says. “We’re forcing doctors to see patients in 10- to 15-minute blocks, bang bang, get ’em in, get ’em out. Patients aren’t cars. We’re not mechanics.” An increasing number of health professionals have advocated, at minimum, more spiritual awareness among practitioners. It’s a simple recognition that if spirituality matters to the patient, that ought to matter to the physician. “It’s good to respect people, to treat them with dignity,” says Puchalski. “You don’t need data for that.” She has developed a protocol for doctors to get the spiritual history of their patients. And patients can easily incorporate Puchalski’s plan: Let your doctor know if you have religious beliefs that help you cope with stress or difficult times. Convey the importanc eof spirituality in your life. Indicate the influence it has on how you care for yourself. Explain your spiritual community to your doctor. Is it church-based, for example? Ask your physician to take action—can she refer you to spiritual services such as a chaplain, meditation, yoga classes, or another spiritual resource? [pagebreak] How Prayer Really Heals Puchalski’s vision of spirituality and health is not about waiting for miracles. “Spirituality is that aspect of humans that seeks to heal or be whole,” she argues. “It helps people find hope in the midst of despair.” And whether people locate that hope in Sunday morning chapel or on a rocky outcrop overlooking a verdant landscape, the spiritual power is the same. Her best teachers are patients, inspired survivors like her colleague and patient Cornelius Bennhold. A theoretical physicist, Bennhold has been fighting synovial sarcoma, a rare cancer of the joints and tendons, for 13 years. As a physicist, you might expect him to put his faith in the marvels of modern medicine—chemo, radiation, surgery—and he does. But he also credits a rich and far-reaching spiritual life with helping him rebound from each new finding of the cancer, followed by the brutal invasions of surgery and treatment. “I don’t need to prejudge something just because it doesn’t fit into my theory of the universe,” he says of the tenuous scientific proof that faith heals. “I was probing and exploring the kind of tools that work for me to find my spiritual center and my access to God.” During his last round of hospitalization, he prayed and practiced meditation. He got support from his church and from a spiritual group. One day, Puchalski found him depressed by the hospital food, craving Brie, good wine, French bread. So she went out and got them—substituting sparkling cider for the wine—and they talked into the night. “That to me is very much a part of spiritual care,” she says, but in this case she was the beneficiary. “I walked away inspired. I didn’t think he’d walk again and nor did anyone else. But he is. I think all of that attention either gave him the inner strength to get better, or maybe it was a miracle. I don’t know. “Science can’t measure the influence of spiritual grace,” says Puchalski. “Much of what happens to our patients has no explanation. Illness causes us to ask questions that are deeply spiritual and unanswerable scientifically: Why am I suffering? What is the meaning of my illness and suffering? Illness, in and of itself, is a spiritual journey, which may include emptiness, joy, despair, hope, and mystical experiences. As physicians and caregivers, our job is to assist our patients through this journey.” If you pray, no study will alter your faith. If you don’t, the established benefits of Benson’s relaxation response are still there for the taking. But whether you’re Baptist, Buddhist, or agnostic, knowing that there is room for your beliefs in your medical care may provide all the spiritual healing you need.
