Transcript IBS

Cancer – Power of Faith & Prayer
The Medical Perspective
Anastasios P. Bouras, M.D.
Assistant Professor of Medicine
Mayo Clinic School of Medicine
Cancer – Power of Faith & Prayer
The Medical Perspective
A. Definitions
E. Comments on studying prayer
and religion
B. Associations between religion,
spirituality and health
F. Biology of Hope
C. Studies in cancer
G. Recognizing spirituality
D. Intercessory prayer
H. Conclusions
Healing and the Patient
The greatest mistake physicians make is
that they attempt to cure the body without
attempting to cure the mind; yet the mind
and body are one and should not be
treated separately.
Plato
Religion
• The organization of the collective
spiritual experiences of a group
of people into a system of beliefs
and practices
• The service and worship of God
or the supernatural
Spirituality
• Broader concept of religion that is
primarily dynamic, personal and
experiential
• Features include quest for meaning
and purpose, transcendence,
connectedness and values
Prayer
• A solemn and humble request to
God, or to an object of worship
• A supplication, petition, or
thanksgiving, usually expressed
in words (and based on faith)
Faith
• Belief and trust in and loyalty to God
• Belief in the traditional doctrines of a
religion
• Firm belief in something for which
there is no proof
Science
• The state of knowing, as distinguished
from ignorance or misunderstanding
(based on evidence and proof)
• Knowledge covering general truths or
the operation of general laws especially
as obtained and tested through the
scientific method
Medicine
• The science and art dealing with the
maintenance of health and the
prevention, alleviation, or cure of
disease
• Involves the systematic observation
and classification of facts related to
the causes, prevention, and
treatment of disease
Evidence-Based Medicine
Clinical Outcome
5
4
Placebo
Drug A
Drug B
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3
2
*
1
0
• The practice of medicine based on the
scientific evidence or data revealed
during studies using specific outcome
measures to test specific therapies
Variable 1
Variable 2
• Making recommendations for
treatment based on proven therapies –
usually based on randomized,
controlled trials
Can or should we study prayer?
• What are the outcomes of prayer?
• What ‘dose’ of prayer do we use and how do we test it?
• How do we define healing?
• Is studying prayer and religion consistent with our faith?
Jesus said to him . . .
“It is written again. Thou shalt not test the Lord thy God.”
Matthew 4:7
Are there data on prayer in medicine?
• Medline search 1966-2005
• Prayer, religion, faith, spirituality, health, cancer
• Over 1,000 articles
• Three major themes . . .
(1) Associations between religion, spirituality and health
(2) Religion, spirituality and cancer
(3) Studies of intercessory prayer
Associations between
religion, spirituality and health
Theme #1
Prayer and Health
Percent
Finding
90
• Believe in a Higher Being
94
• Spiritual and physical health are equally important
13-84
• Pray for health concerns
79-82
• Believe prayer helps recover from disease
70-94
• Believe doctors should discuss religious beliefs with
the seriously ill
64
• Think doctors should pray with those who request it
Religion, Spirituality and Medicine
Mueller PS. Mayo Clinic Proc 2001;76:1225-35.
• Associations between religion and spirituality with physical
health, mental health and quality of life
• 350 studies of physical health
• 850 studies of mental health
• Various outcomes were examined
Health Benefits
• Lower mortality rates
• Overall healthy lifestyle
• Cardiovascular disease
• Functioning among disabled
• Hypertension
• Coping skills
• Depression
• Quality of life
• Anxiety
• Substance abuse
• Suicide
• End of life issues – depth of
religiousness/spirituality, death
anxiety, acceptance of death
Religion, Spirituality and Medicine
Mueller PS. Mayo Clinic Proc 2001;76:1225-35.
Studies Do Show
Studies Do Not Show
• Most have a spiritual life
• Religious people don’t get sick
• Most want their spiritual needs
assessed and addressed
• Illness is due to a lack of
religious faith
• Relationship between religion
and better health outcomes
• Spirituality is the most important
factor in health
• Spirituality appears to enhance
coping and recovery
• Doctors should prescribe
religious activities
Religion, Spirituality and Cancer
Theme #2
Religion, Spirituality and Cancer
Stefanek M, et al. Psycho-Oncology 2005;14:450-63.
•
8 studies found no significant relation of religion and spirituality
with morbidity or mortality
•
Numerous studies show that religion and spirituality are
important in coping, adjustment and QOL
•
Importance of spirituality in caregivers as well
•
Prayer as a coping strategy – help find comfort, decrease anxiety,
facilitate hope and adjustment to illness
Use of Prayer among Cancer Patients
Taylor EJ. Holist Nurs Pract 2002;16:46-60.
•
•
30 adults of various religions
Differences in . . .
1.
2.
3.
•
definition of prayer
how to pray
for what to pray
4. relation to illness
5. expectations
6. how prayer made them feel
“I struggle with praying for my own healing. Instead, I pray to
be able to live this experience fully . . . And that it be used
someway for God’s purpose.”
Scientific Research on Spirituality
National Institute for Health Care Research, 1997
• Evaluated the scientific evidence for an association
between spirituality and religious practices and health
• Concluded that spirituality/religious involvement has
been shown to be consistently related to positive health
outcomes across a variety of health domains
Research on Religion & Spirituality
National Center for Complimentary and Alternative Medicine
$2.2 million on studies of distant healing and
intercessory prayer since 2000
Studies of Intercessory Prayer
Theme #3
It is asserted by some, that men possess the faculty of
obtaining results over which they have little or no direct
personal control, by means of devout earnest prayer, while
others doubt the truth of that assertion. The question regards
a matter of fact that has to be determined by observation and
not by authority: and it is one that appears to be a very
suitable topic for statistical inquiry . . . Are prayers answered
or are they not? . . . Do sick persons who are prayed for
recover, on the average, more rapidly than others?
Francis Galton, 1883
Studies of Intercessory Prayer
• 13 studies identified from 1965-2005 with following criteria:
(1)
(2)
(3)
(4)
random assignment of study patients
placebo, sham or otherwise blinded or adequate control
publication in a peer-reviewed journal
clinical investigation of humans
• No standardization of prayers or intercessors among various trials
• Heterogeneous diseases and outcome variables
Intercessory Prayer – The Results
• 6/13 showed a benefit in primary outcomes
• 9/13 showed some benefit in some secondary outcomes or showed
trends in improvement in health or coping
• One study suggested that patients who believed the problem could
be solved (i.e., had faith) had reduced levels of concern
• One study identified an effect of retroactive prayer
Comments on Studying Prayer and Religion
• Numerous methodological problems
• Studies suggest that God must respond positively to prayers based
on what outcome is chosen; but prayer is more than receiving what
is requested, and we aren’t sure how God answers our prayers
• If distant prayer studies can make the results of prayer consistent,
predictable, and replicable, then faith has become a science
• There is no scientific or theoretical way to answer questions about
prayer and religion. These are personal relationships with God and
are answered only by moral, theological, philosophical or spiritual
methods that go beyond mechanisms of causality.
Comments on Studying Prayer and Religion
An attempt at scientific proof of the existence of God is an effort . . .
“to create a situation in which God must show Himself and perform
a miracle – something that God may do only rarely. Even more
rarely does He perform on demand. If God feels the need to give us
a sign – He tends to choose the time, place, and form; not us.
Simply put, I am sure that such tests are hideously arrogant at best
and certainly blasphemous.”
Modified from its original form in
Targ and Thompson. Alt Ther Health Med 1997;3:92-105
Cancer – Power of Faith & Prayer
The Medical Perspective
A. Definitions
E. Comments on studying prayer
and religion
B. Associations between religion,
spirituality and health
F. Biology of Hope
C. Studies in cancer
G. Recognizing spirituality
D. Intercessory prayer
H. Conclusions
Hope
1. Belief that one’s desires may be obtained
2. Different types of hope
3. Hope as part of one’s spirituality
Alosetron and Relief from D-IBS
Camilleri, et al. Lancet 2000;355:1035-40.
80
*p<0.05
Alosetron 1mg bid
70
* * * * * * *
60
*
* * *
50 *
40
30
• Physiologic
changes
Placebo bid
20
Hope and Faith
10
Treatment Period
0
• Placebo response
rates up to 84%
• Hope and faith
Follow-Up
1 2 3 4 5 6 7 8 9 10 11 12 +1 +2 +3 +4
Weeks
Comments on Hope
• “I was most intrigued by the sense that I may have felt
physical changes caused by hope.”
Patient on placebo medication
• “Hope helps us overcome hurdles that we otherwise
could not scale, and it moves us forward to a place where
healing may occur.”
James Groopman, M.D.
The ‘Mechanism’ of Religion and Prayer
Is There a Biology of Hope?
• Adoption of healthy behaviors, shared ancestry, strong social
support systems
• Encourages hope, love, contentment, forgiveness and limits
negative emotions
• Religious people have enhanced immune function
Koenig HG. Handbook of Religion and Health, 2001.
‘Mechanism’ of Religion and Prayer
Is There a Biology of Hope?
Positive emotions
Decreased activation of sympathetic nervous system and
hypothalamic-pituitary-adrenal axis
Psychological effects (less anxiety)
Physiological effects (lower BP, HR, oxygen consumption)
Better health
Cancer – Power of Faith & Prayer
The Medical Perspective
A. Definitions
E. Comments on studying prayer
and religion
B. Associations between religion,
spirituality and health
F. Biology of Hope
C. Studies in cancer
G. Recognizing spirituality
D. Intercessory prayer
H. Conclusions
Recognizing Spirituality
There is a spiritual as well as a material quality in
the care of sick people, and too great efficiency in
material details may hamper progress.
William Mayo
Faculty meeting minutes
November 21, 1932
Barriers to Dealing with Spirituality
1.
Ethical issues
2.
Fewer physicians maintain religious or spiritual ties
3.
Biomedical model of care
4.
Outcomes of spirituality not taught in medical school
5.
Some patients having daunting spiritual needs
6.
Time constraints, lack of training and uncertainty
Mueller 2001
Reasons to Acknowledge Spirituality
1.
Patients regard physical and spiritual health equally
2.
Spirituality enhances coping skills and QOL and mitigates
uncertainties during an illness
3.
Acknowledgement may enhance cultural sensitivity
4.
May enrich the patient-physician relationship
5.
Goal of medicine is to cure disease when possible, but we must
always alleviate suffering
Mueller 2001
Cancer – Power of Faith & Prayer
Conclusions
• Prayer has been shown to help people with various physical and
mental ailments in several ways
• Religion and spirituality are dynamic interactions of complex
variables involving cognitive, behavioral, interpersonal and
physiological dimensions – some of which we have a minor
understanding – and the supernatural, which we do not
understand
Cancer – Power of Faith & Prayer
Conclusions
• Science and medical research are ineffective and probably
improper ways of trying to understand the power of faith and
prayer
• How God answers our prayers is unknown
• God’s grace is greater than our skills and is immeasurable by
our tools