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A growing chorus in the United States is exhorting the medical profession to tear down the wall of separation between medicine and religion and is claiming the future of medicine is prayer. Recent articles in major newspapers report religion is good for your health. According to one study, 48 percent of hospitalized patients wanted their physicians to pray with them. The medical community is getting into the act, too. More than half of the U.S. medical schools now include in their curricula courses on religion, spirituality, and health. Advocates assert that linking religion to health is both good medical practice and has a solid factual basis.

Neither is true.

While no one would dispute that for a great many people, religion provides comfort in times of difficulty, whether medicine can add to this is another matter entirely. Attempts to introduce religion into medicine represent weak science, poor quality medical care, and questionable ethics.

Studies of religion and health are almost exclusively epidemiologic investigations of subjects who self-select for different degrees of religious involvement. While some studies are well conducted, a great many contain significant methodological flaws that render their conclusions suspect. For example, in studying the health impact of a religious practice, such as church attendance, researchers must be certain that it is religious activity and no other factor that is responsible for the association to health. Such studies require methodological control of potentially confounding variables and a great many studies lack this stringency.

Consider a 1972 study demonstrating an association between church attendance and reduced mortality, often cited by proponents of religious-based medical interventions. Even the author of this study later pointed out the association between church attendance and decreased mortality probably was due to the fact that people in poor health were unable to go to church. Thus, church attendance was influenced by poor health, not the other way around. While some more recently conducted studies control for the confounding variables, a great many of the studies in the literature do not.

But even if they did, these studies are about pre-existing associations between religious activities and health outcomes. They tell us nothing about introducing religious activities in clinical medicine. There are no data whatsoever about whether physician recommendations to engage in one form or another of religious activity will be followed, let alone whether following them will lead to better health outcomes.

Even if there were substantial evidence of efficacy of religious activity in relation to health, significant ethical problems are raised by introducing religion into medical practice. First and foremost is the issue of coercion. Even in these days of consumer advocacy, health professionals retain influence over their patients by virtue of their medical expertise. When doctors depart from areas of established expertise to promote a non-medical agenda, they abuse their status as professionals. Is it really appropriate, as some recommend, for a physician to ask a patient to support the doctor's faith or religious commitment?

A second ethical concern is privacy. Consider the case of marriage. Solid evidence indicates people who are married live longer than those who are single. But we would consider it outrageous if a doctor recommended marriage to patients who were single because of such evidence. This is because we regard marriage as a personal and private matter, even if it has health implications. The same should be true for religious activity.

Further, suggestions that religious activity is associated with health can harm those patients who conclude their illness is due to insufficient faith. Attempts to link religious and spiritual activities to health are reminiscent of the now discredited research suggesting that different ethnic groups show differing levels of moral probity, intelligence, or other measures of social worth.

All of us, devout or non-religious, ultimately will succumb to illness. We wish to avoid adding the burden of moral failure to those whose physical health fails before our own. No one can object to respectful support for patients who draw upon religious faith for comfort in times of illness. However, in the absence of solid empirical support and until these ethical issues are resolved, claims that religious activity will promote health or, conversely, that illness is the result of insufficient faith, are unwarranted. There is no basis for introducing religious activity into medical practice and there are many good reasons not to. Patients should be free to express their religious interests in any way they see fit and require no assistance from physicians to do so.

Dr. Richard P. Sloan is professor of behavioral medicine in psychiatry.

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