Draped in embroidered cloth, laden with candles, redolent with roses and incense, the altar at the Santa Fe, New Mexico, home of Eetla Soracco seems an unlikely site for cutting-edge medical research. Yet every day for 10 weeks, ending last October, Soracco spent an hour or more there as part of a controlled study in the treatment of AIDS. Her assignment: to pray for five seriously ill patients in San Francisco.
Soracco, an Estonian-born "healer" who draws on Christian, Buddhist and Native American traditions, did not know the people for whom she was praying. All she had were their photographs, first names and, in some cases, T-cell counts. Picturing a patient in her mind, she would ask for "permission to heal" and then start to explore his body in her mind: "I looked at all the organs as though it is an anatomy book. I could see where things were distressed. These areas are usually dark and murky. I go in there like a white shower and wash it all out." Soracco was instructed to spend one hour a day in prayer, but the sessions often lasted twice as long. "For that time," she says, "it's as if I know the person."
Soracco is one of 20 faith healers recruited for the study by Dr. Elisabeth Targ, clinical director of psychosocial oncology research at California Pacific Medical Center in San Francisco. In the experiment, 20 severely ill AIDS patients were randomly selected; half were prayed for, half were not. None were told to which group they had been assigned. Though Targ has not yet published her results, she describes them as sufficiently "encouraging" to warrant a larger, follow-up study with 100 AIDS patients.
Twenty years ago, no self-respecting M.D. would have dared to propose a double-blind, controlled study of something as intangible as prayer. Western medicine has spent the past 100 years trying to rid itself of remnants of mysticism. Targ's own field, psychiatry, couldn't be more hostile to spirituality: Sigmund Freud dismissed religious mysticism as "infantile helplessness" and "regression to primary narcissism." Today, while Targ's experiment is not exactly mainstream, it does exemplify a shift among doctors toward the view that there may be more to health than blood-cell counts and ekgs and more to healing than pills and scalpels.
"People, a growing number of them, want to examine the connection between healing and spirituality," says Jeffrey Levin, a gerontologist and epidemiologist at Eastern Virginia Medical School in Norfolk. To do such research, he adds, "is no longer professional death." Indeed, more and more medical schools are adding courses on holistic and alternative medicine with titles like Caring for the Soul. "The majority, 10 to 1, present the material uncritically," reports Dr. Wallace Sampson of Stanford University, who recently surveyed the offerings of every U.S. medical school.
This change in doctors' attitudes reflects a broader yearning among their patients for a more personal, more spiritual approach to health and healing. As the 20th century draws to an end, there is growing disenchantment with one of its greatest achievements: modern, high-tech medicine. Western medicine is at its best in a crisis--battling acute infection, repairing the wounds of war, replacing a broken-down kidney or heart. But increasingly, what ails America and other prosperous societies are chronic illnesses, such as high blood pressure, backaches, cardiovascular disease, arthritis, depression and acute illnesses that become chronic, such as cancer and AIDS. In most of these, stress and life-style play a part.
"Anywhere from 60% to 90% of visits to doctors are in the mind-body, stress-related realm," asserts Dr. Herbert Benson, president of the Mind/Body Medical Institute of Boston's Deaconess Hospital and Harvard Medical School. It is a triumph of medicine that so many of us live long enough to develop these chronic woes, but, notes Benson, "traditional modes of therapy--pharmaceutical and surgical--don't work well against them."
Not only do patients with chronic health problems fail to find relief in a doctor's office, but the endless high-tech scans and tests of modern medicine also often leave them feeling alienated and uncared for. Many seek solace in the offices of alternative therapists and faith healers--to the tune of $30 billion a year, by some estimates. Millions more is spent on best-selling books and tapes by New Age doctors such as Deepak Chopra, Andrew Weil and Larry Dossey, who offer an appealing blend of medicine and Eastern-flavored spirituality (see following story).
Some scientists are beginning to look seriously at just what benefits patients may derive from spirituality. To their surprise, they are finding plenty of relevant data buried in the medical literature. More than 200 studies that touch directly or indirectly on the role of religion have been ferreted out by Levin of Eastern Virginia and Dr. David Larson, a research psychiatrist formerly at the National Institutes of Health and now at the privately funded National Institute for Healthcare Research. Most of these studies offer evidence that religion is good for one's health. Some highlights:
--A 1995 study at Dartmouth-Hitchcock Medical Center found that one of the best predictors of survival among 232 heart-surgery patients was the degree to which the patients said they drew comfort and strength from religious faith. Those who did not had more than three times the death rate of those who did.
--A survey of 30 years of research on blood pressure showed that churchgoers have lower blood pressure than nonchurchgoers--5 mm lower, according to Larson, even when adjusted to account for smoking and other risk factors.
--Other studies have shown that men and women who attend church regularly have half the risk of dying from coronary-artery disease as those who rarely go to church. Again, smoking and socioeconomic factors were taken into account.
--A 1996 National Institute on Aging study of 4,000 elderly living at home in North Carolina found that those who attend religious services are less depressed and physically healthier than those who don't attend or who worship at home.
--In a study of 30 female patients recovering from hip fractures, those who regarded God as a source of strength and comfort and who attended religious services were able to walk farther upon discharge and had lower rates of depression than those who had little faith.
--Numerous studies have found lower rates of depression and anxiety-related illness among the religiously committed. Nonchurchgoers have been found to have a suicide rate four times higher than church regulars.
There are many possible explanations for such findings. Since churchgoers are more apt than nonattendees to respect religious injunctions against drinking, drug abuse, smoking and other excesses, it's possible that their better health merely reflects these healthier habits.
Some of the studies, however, took pains to correct for this possibility by making statistical adjustments for life-style differences. Larson likes to point out that in his own study the benefits of religion hold up strongly, even for those who indulge in cigarette smoking. Smokers who rated religion as being very important to them were one-seventh as likely to have an abnormal blood-pressure reading as smokers who did not value religion.
Churchgoing also offers social support--which numerous studies have shown to have a salutary effect on well-being. (Even owning a pet has been shown to improve the health of the lonesome.) The Dartmouth heart-surgery study is one of the few that attempts to tease apart the effects of social support and religious conviction. Patients were asked separate sets of questions about their participation in social groups and the comfort they drew from faith. The two factors appeared to have distinct benefits that made for a powerful combination. Those who were both religious and socially involved had a 14-fold advantage over those who were isolated or lacked faith.
Could it be that religious faith has some direct influence on physiology and health? Harvard's Herbert Benson is probably the most persuasive proponent of this view. Benson won international fame in 1975 with his best-selling book, The Relaxation Response. In it he showed that patients can successfully battle a number of stress-related ills by practicing a simple form of meditation. The act of focusing the mind on a single sound or image brings about a set of physiological changes that are the opposite of the "fight-or-flight response." With meditation, heart rate, respiration and brain waves slow down, muscles relax and the effects of epinephrine and other stress-related hormones diminish. Studies have shown that by routinely eliciting this "relaxation response," 75% of insomniacs begin to sleep normally, 35% of infertile women become pregnant and 34% of chronic-pain sufferers reduce their use of painkilling drugs.
In his latest book, Timeless Healing (Scribner; $24), Benson moves beyond the purely pragmatic use of meditation into the realm of spirituality. He ventures to say humans are actually engineered for religious faith. Benson bases this contention on his work with a subgroup of patients who report that they sense a closeness to God while meditating. In a five-year study of patients using meditation to battle chronic illnesses, Benson found that those who claim to feel the intimate presence of a higher power had better health and more rapid recoveries.
"Our genetic blueprint has made believing in an Infinite Absolute part of our nature," writes Benson. Evolution has so equipped us, he believes, in order to offset our uniquely human ability to ponder our own mortality: "To counter this fundamental angst, humans are also wired for God."
In Benson's view, prayer operates along the same biochemical pathways as the relaxation response. In other words, praying affects epinephrine and other corticosteroid messengers or "stress hormones," leading to lower blood pressure, more relaxed heart rate and respiration and other benefits.
Recent research demonstrates that these stress hormones also have a direct impact on the body's immunological defenses against disease. "Anything involved with meditation and controlling the state of mind that alters hormone activity has the potential to have an impact on the immune system," says David Felten, chairman of the Department of Neurobiology at the University of Rochester.
It is probably no coincidence that the relaxation response and religious experience share headquarters in the brain. Studies show that the relaxation response is controlled by the amygdala, a small, almond-shaped structure in the brain that together with the hippocampus and hypothalamus makes up the limbic system. The limbic system, which is found in all primates, plays a key role in emotions, sexual pleasure, deep-felt memories and, it seems, spirituality. When either the amygdala or the hippocampus is electrically stimulated during surgery, some patients have visions of angels and devils. Patients whose limbic systems are chronically stimulated by drug abuse or a tumor often become religious fanatics. "The ability to have religious experiences has a neuro-anatomical basis," concludes Rhawn Joseph, a neuroscientist at the Palo Alto VA Medical Center in California.
Many researchers believe these same neuronal and hormonal pathways are the basis for the renowned and powerful "placebo effect." Decades of research show that if a patient truly believes a therapy is useful--even if it is a sugar pill or snake oil--that belief has the power to heal. In one classic 1950 study, for instance, pregnant women suffering from severe morning sickness were given syrup of ipecac, which induces vomiting, and told it was a powerful new cure for nausea. Amazingly, the women ceased vomiting. "Most of the history of medicine is the history of the placebo effect," observes Benson in Timeless Healing.
Though Benson devotes much of his book to documenting the power of the placebo effect--which he prefers to call "remembered wellness"--he has come to believe the benefits of religious faith are even greater. "Faith in the medical treatment," he writes, "[is] wonderfully therapeutic, successful in treating 60% to 90% of the most common medical problems. But if you so believe, faith in an invincible and infallible force carries even more healing power...It is a supremely potent belief."
Do the faithful actually have God on their side? Are their prayers answered? Benson doesn't say. But a true scientist, insists Jeffrey Levin, cannot dismiss this possibility: "I can't directly study that, but as an honest scholar, I can't rule it out."
A handful of scientists have attempted to study the possibility that praying works through some supernatural factor. One of the most cited examples is a 1988 study by cardiologist Randolph Byrd at San Francisco General Hospital. Byrd took 393 patients in the coronary-care unit and randomly assigned half to be prayed for by born-again Christians. To eliminate the placebo effect, the patients were not told of the experiment. Remarkably, Byrd found that the control group was five times as likely to need antibiotics and three times as likely to develop complications as those who were prayed for.
Byrd's experiment has never been replicated and has come under some criticism for design flaws. A more recent study of intercessory prayer with alcoholics found no benefit, while Elisabeth Targ's study of AIDS patients is still too small to produce significant results.
Science may never be able to pin down the benefits of spirituality. Attempts by Benson and others to do so are like "trying to nail Jell-O to the wall," complains William Jarvis, a public-health professor at California's Loma Linda University and the president of the National Council Against Health Fraud. But it may not be necessary to understand how prayer works to put it to use for patients. "We often know something works before we know why," observes Santa Fe internist Larry Dossey, the author of the 1993 best seller Healing Words.
A TIME/CNN poll of 1,004 Americans conducted last week by Yankelovich Partners found that 82% believed in the healing power of prayer and 64% thought doctors should pray with those patients who request it. Yet even today few doctors are comfortable with that role. "We physicians are culturally insensitive about the role of religion," says David Larson, noting that fewer than two-thirds of doctors say they believe in God. "It is very important to many of our patients and not important to lots of doctors."
Larson would like physicians to be trained to ask a few simple questions of their seriously or chronically ill patients: Is religion important to you? Is it important in how you cope with your illness? If the answers are yes, doctors might ask whether the patient would like to discuss his or her faith with the hospital chaplain or another member of the clergy. "You can be an atheist and say this," Larson insists. Not doing so, he argues, is a disservice to the patient.
Even skeptics such as Jarvis believe meditation and prayer are part of "good patient management." But he worries, as do many doctors, that patients may become "so convinced of the power of mind over body that they may decide to rely on that, instead of doing the hard things, like chemotherapy."
In the long run, it may be that most secular of forces--economics--that pushes doctors to become more sensitive to the spiritual needs of their patients. Increasingly, American medicine is a business, run by large hmos and managed-care groups with a keen eye on the bottom line. Medical businessmen are more likely than are scientifically trained doctors to view prayer and spirituality as low-cost treatments that clients say they want. "The combination of these forces--consumer demand and the economic collapse of medicine--are very powerful influences that are making medicine suddenly open to this direction," observes Andrew Weil, a Harvard-trained doctor and author of Spontaneous Healing.
Cynics point out that there is an even more practical reason for doctors to embrace spirituality even if they don't believe. The high cost of malpractice insurance gives physicians an incentive to attend to their patients' spiritual needs--and, if necessary, get on their knees and pray with them. Not only might it help restore their image as infallible caregivers, but if something does go wrong, patients who associate their doctors with a higher power might be less likely to sue.
--Reported by Jeanne McDowell/Los Angeles, Alice Park/ New York and Lisa H. Towle/Raleigh
http://www.time.com/time/magazine/article/0,9171,984737,00.html
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