Part 2 of 2. Read Part 1.
If researchers could only identify how religious acts like prayer affect the body, says Neal Krause of the University of Michigan, they might begin to explain why some spiritual practices seem to benefit health, while others—like intercessory prayer—do not. "If you're saying religion can change health, you need to show what it's doing very specifically," he says. That's why the scientists who study religion and health are increasingly examining quantifiable "hard measures" like stress hormone levels, white blood cells, and blood pressure, instead of self-reported health status, to track physical effects.
In a 2006 study of HIV patients, for example, Gail Ironson of the University of Miami measured patients' "viral load"—which shows the severity of the infection—and their levels of CD4 cells, the white blood cells attacked by HIV. She found that patients who reported becoming more spiritual since their diagnosis fought off the disease more effectively than those who did not. The more spiritual patients showed a higher number of CD4 cells and a lower viral load. That was true even for patients who had similar levels of social support, optimism, and compliance with medication. In an earlier study, Ironson had found that HIV patients who had become more spiritual had lower levels of the stress hormone cortisol than those who had not become more spiritual. Through studies like these, she says, "we're starting to get at the mechanisms" by which spirituality may affect the body.
Researchers are also looking to the brain to shed light on religion's physical impact. Using single photon emission computed tomography, or SPECT, brain imaging, which provides snapshots of brain function, Andrew Newberg of the University of Pennsylvania has found that religious experiences tend to involve many more areas of the brain than do more mundane activities. Brain images of nuns praying, for example, tend to show increased levels of activity in the frontal lobes, corresponding with concentration, as well as changes in brain regions relating to emotion, behavior, long-term memory, and the sense of self. Few tasks, he says, engage so many areas.
While critics have scoffed at brain-imaging studies as a misguided attempt to take photos of God, Newberg thinks a picture's worth a thousand words when it comes to demonstrating the physical effect of spiritual practices. "You could parade 100 people on a stage saying, 'Meditation helped me,' but a brain scan shows that this is what changes in the brain," he says. "That goes a long way to convince people in the scientific community that something is really happening."
Despite the increase in research into health and spirituality, some doctors feel religion simply has no place in the exam room. "There is nothing, nothing, nothing in this [scientific] literature that suggests there are any practical implications" for physicians, says Richard Sloan, professor of behavioral medicine at the New York-Presbyterian Hospital at the Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine .
Doctors hold a unique position of authority in a patient's life, Sloan argues, so suggesting patients pray or attend services would be an abuse of power. At worst, such suggestions might even damage patient health. "There are issues of manipulation and coercion, issues of invading privacy, and issues of actually causing harm by suggesting to people that their health is failing because of a failure of devotion," he says.
Many doctors seem to agree that discussing faith with patients is inappropriate: Although 84.5 percent of physicians think they should be aware of a patient's spiritual beliefs, only 31 percent say they would ask about them in the office, according to a 2003 survey published in the Archives of Internal Medicine .
In other ways, however, spirituality has assumed a larger role in healthcare. Since 2000, the Joint Commission, which accredits hospitals, has required hospitals to assess the spiritual needs and preferences of certain patients, including those receiving end-of-life care and those being treated for substance abuse or emotional and behavioral disorders. In part, this change reflects an industrywide shift toward more "patient centered" care, which emphasizes more than just symptoms—but it also indicates a growing acceptance for the idea that spirituality plays a role in good patient care.
At the same time, medical schools are teaching their students to talk about spiritual matters: Some 66 percent of medical schools now offer classes on spirituality and health, up from just 2 percent 15 years ago, according to internist Christina Puchalski of George Washington University, who administers a grant program for med schools developing courses. At 75 percent of the schools that offer these classes, such training is mandatory.
"We want our students to be prepared," says Kay Sandor, associate professor in the school of nursing at the University of Texas at Galveston and a course director for the Spirituality and Clinical Care course required of all its nursing and medical students. Patients, she says, "want more than their physical illness addressed. They want to be addressed in mind, body, and spirit."
Some veteran physicians have come to the same conclusion. Three years ago—and more than a decade after he started practicing medicine—Brad Moore, an internist and associate professor of medicine at George Washington University, began taking his patients' "spiritual histories," as well as their medical and family histories. He's found the process helps establish a better rapport with patients and, at times, sheds light on health practices. "I ask patients if there are any spiritual practices that are important to them. Most of the time, that's a nonthreatening question," says Moore. "If they say no, I don't usually push it."
His inquiries have helped reveal patients' dietary restrictions and use of alternative treatments. "It's important to understand how [patients'] faith beliefs are tied in to their health beliefs," he says. He even learned that one patient called herself a witch. "If you ask the question," he says, "you have to be ready to accept the answer you get."
When patients feel comfortable discussing their spiritual background with their doctors, it can help both parties tap into extra resources—internal and external—during a health crisis. When Puchalski found a tumor in Carrol Duggins-Diggs's breast, for instance, she was glad to know about her patient's strong faith. "I was able to ask, 'Where does your faith play a role in facing something like this?' That helped me convey the seriousness of the situation without taking away her hope."
More recently, when Duggins-Diggs has searched for strategies to help her control her weight, her doctor suggested she might read the Bible as a distraction instead of snacking. "I would never say, 'Focus on the Bible,' to someone I didn't know," says Puchalski. "But for her, it's a very obvious resource."
- Part 2 of 2. Read Part 1: 'Health Prayer: Religion ' s Role in Medicine.'