Review: Blind Faith

Blind_FaithRichard P. Sloan's book Blind Faith: The Unholy Alliance of Religion and Medicine begins with a description of patients who are asked to pray with their doctor as he prepares to perform surgery on them. With this and other examples of ethical and practical concerns, the book examines “the brave new world of religion and health, where science, medicine, faith, and ethics exist in a potentially explosive mixture” (p. 3). In this book, the author, a professor of behavioral medicine at Columbia University, expands on issues he’d raised previously in medical journals, claiming that in contrast to headlines, “evidence about the health benefits of religious involvement is much more questionable that the popular media suggest, and there are many other problems associated with bringing religion into clinical practice” (p. 4).

The author describes this book as a critical examination of the science, ethics, and health care policy associated with the study of religion and health, and states that it proposes to answer three questions:

  • Do the efforts to link religion and health represent good science?
  • Do they represent good medicine?
  • Do they represent good religion?

In Part 1: Religion and Health, Yesterday and Today, Sloan explains that we now “confront a deluge of interest in connecting religion to medicine” (p. 4), and gives an overview of types of research and concerns. He also provides historical perspectives on the relation of religion and medicine, tracing back from ancient times to trends in modern America, where a post-Sputnik emphasis on science has been muted by disenchantment, including a backlash against impersonal modern medicine. He gives reasons for recent interest in scientific study of health and religion, including funding from the Templeton Foundation and other advocacy organizations, an uncritical media, and active popular interest in religion. Intermixed in this, Sloan describes the scientific method and the importance of a control group, sample size, and other elements that contribute to well-designed studies.

In Part 2: Reading the Evidence, Sloan gives an overview of claims that have been made based on studies of health and religion, with critical analysis of conclusions and methods. He begins by looking at claims that hundreds of studies have examined the relationship between religious involvement and health, and that the majority “have found that religious involvement and spirituality are associated with better health outcomes” (p. 74). With a close look at selected parts of the body of studies cited as evidence, Sloan shows that many are peripherally or not related to health outcomes, and many others are designed so poorly that no conclusions can be made. Then, after whittling large numbers of claimed supportive studies down to a handful that can legitimately be considered, he identifies limits and flaws and he uses quotes from books and papers to show how, despite these, investigators (who should presumably know better) make claims that exceed what is warranted by the data. He identifies Harold Koenig (lead investigator of several studies, and author of prominent books that summarize findings) as a notable offender who often neglects to mention qualifiers that had been included in published papers. In addition to flaws in studies and claims, Sloan assigns blame to uninformed and profit-driven media for touting headlines based on questionable findings.

Sloan spends much of this section informing readers of what to look for as signs of strength or weakness in data and explaining confounds, data dredging, the sharpshooter’s fallacy, and the difference between association and cause. He also explains how the quality of publication and mode of announcing findings (via peer-reviewed journal vs. media announcement) can give perspectives on the strength or weakness of claims. To illustrate and provide examples of these points, Sloan takes a close look at some prominent studies and areas of research, including the reported connection between longevity and attendance at religious services and the potential health benefits of intercessory prayer. In his review of available evidence, he makes a case that data, overall, are weak and claims of benefit are overstated. And, in the few solid studies where apparent benefit was seen, he points to confounders and limits in study design that would require follow-up studies to confirm what was observed.

In Part 3: Religion and the Practice of Medicine, the book shifts from examination of evidence to the implications of connecting religion in health research. Sloan identifies a number of ethical problems, including issues pertaining to privacy and coercion. He gives examples of cautionary tales, in which some doctors actively proselytize, and he feels that, despite presumed good intentions, inclusion of religion into medical practice may violate the mandate to “do no harm”.

Beyond this, he also sees practical problems in what to do in cases where clear support for medical benefit may be found. For example, should doctors advise patients, as Koenig and others have suggested, to go to church more often? And, if this suggestion were to be adopted, why not advise patients to engage in other behaviors associated with longevity, like getting married? Among additional logistical issues, would just attending church be enough, or might some minimum frequency or demonstration of real faith be required? All in all, this is tricky business with some important concerns, and an area Sloan suggests should be avoided. He feels that advocacy of religion is not a doctor’s job, and that, with little or no training in this area, doctors are not qualified to serve patients’ spiritual needs. Also, with limited time available to spend with patients, why spend part of this on unproven methods?

Beyond these practical medical issues, Sloan examines a separate concern, in which science might “trivialize the transcendent” (p. 241). He describes religion as multifaceted and feels that the reductionism in neurologic studies, which attempt to correlate religious experiences with brain activity, have little bearing on the benefits of religion. He is also concerned about potential “dumbing down”, where in touting health benefits, religion may be reduced to a behavioral method, like exercise, and he notes that potential conflict that may come from examining comparative effects from different faiths or denominations. He states, “Religion and science are fundamentally different, with the former relying on faith as a source of wisdom and the latter demanding evidence. . . For these reasons, attempts to understand experience by scientific means can never be satisfying to religion. They can satisfy only science” (p. 253-254).

In the final section, Sloan re-examines questions posed at the beginning and concludes that efforts to link religion and health (1) are not good science, (2) they are not good medicine, and (3) they do not represent good religion. He concludes by distinguishing the different focus and methods of science and religion, and highlights the value of religion in the unmeasurable realm of hope.

With this book, Sloan performs a valuable service. With critical analysis of published evidence relating religion to health benefits, he identifies weaknesses and limits and exposes exaggerated claims. He supports the contention that much of what’s presented may be seen more as advocacy than science and, in explaining methods used in studies and communication of findings, he prepares readers to read critically, as well.

As he does this, though, it’s questionable who the main readers of this book will be. For health professionals, he gives limited hard data. And while discussions of study methods are clear and to the point, they are often more lengthy or complex than may appeal to the general public.

It is interesting to note that, breaking with otherwise well-documented support for claims, Sloan at times exhibits flaws he criticizes in Koenig and others, when he himself makes some unfounded or exaggerated claims. For example, when discussing brain imaging studies, he states that “neurotheology offers us nothing at all” (p. 252) and after describing benefits of religious ritual in times of trouble he states, with no apparent evidence, “There is no doubt that in this way, religious ritual provides comfort and hope to many” (p. 265).

It is also interesting to note that, while he considers and generally debunks the findings of studies on religion and health, overall, Sloan does not consider studies that examine the relation of religion to more specific outcomes, such as blood pressure and markers of immune function or stress. This may be related to the concern he describes at the end of Section 3, of reducing religion to parts. One aspect of his concern is that “By implementing the approach of scientific reductionism, the transcendent aspects of religious experience are diminished if not lost altogether” (p. 241). He puts this in stronger terms with the statement that “the measurement requirements of science reduce religion and spirituality to something that does not represent them fully and as a result does violence to them” (p. 243).

Sloan seems to respect and care about religion and, beyond criticism of data and the ethical and practical implications of studying potential health benefits, he is concerned about the potential impact of this type of study on religion itself. Sloan appreciates religion as a multifaceted realm. But, as he sounds warnings regarding reductionism, he also recognizes that this is how science is conducted. With a need to consider confounders, well-constructed studies will focus not on vague and unworkable attempts to relate “religion” and health. Instead, they will use more focused analysis - to observe in what situations, with what frequency, and for which populations specific aspects of religion may have particular measurable effects.

From the perspective of religion, this is in fact “dangerous ground” (p. 259) that could potentially prompt questions or reconsideration of practices. But, from the perspective of science, this area of study can be great fun and potentially important. For reasons both noble and questionable, ongoing study in this area seems irresistible. Due to voices like Sloan, future studies may be better constructed and unsupported claims may receive more active challenge. So, bring it on. Let the study and debate continue, and let’s all see what it shows.