Anastasios P. Bouras, M.D. Assistant Professor of Medicine Mayo Clinic School of Medicine

1. Cancer – Power of Faith & Prayer The Medical Perspective Anastasios P. Bouras, M.D. Assistant Professor of Medicine Mayo Clinic School of Medicine

2. Cancer – Power of Faith & Prayer The Medical Perspective • Definitions • Associations between religion, spirituality and health • Studies in cancer • Intercessory prayer • Comments on studying prayer and religion • Biology of Hope • Recognizing spirituality • Conclusions

3. 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

4. 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

5. Spirituality • Broader concept of religion that is primarily dynamic, personal and experiential • Features include quest for meaning and purpose, transcendence, connectedness and values

6. 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) Prayer

7. 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

8. 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

9. 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

10. Clinical Outcome 5 Placebo Drug A 4 * Drug B 3 * 2 1 0 Variable 1 Variable 2 Evidence-Based Medicine • The practice of medicine based on the scientific evidence or data revealed during studies using specific outcome measures to test specific therapies • Making recommendations for treatment based on proven therapies – usually based on randomized, controlled trials

11. 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

12. 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

13. Associations between religion, spirituality and health Theme #1

14. Prayer and Health Percent Finding 90 • Believe in a Higher Being • Spiritual and physical health are equally important • Pray for health concerns • Believe prayer helps recover from disease • Believe doctors should discuss religious beliefs with the seriously ill • Think doctors should pray with those who request it 94 13-84 79-82 70-94 64

15. 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

16. Lower mortality rates Cardiovascular disease Hypertension Depression Anxiety Substance abuse Suicide Overall healthy lifestyle Functioning among disabled Coping skills Quality of life End of life issues – depth of religiousness/spirituality, death anxiety, acceptance of death Health Benefits

17. 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 • Most want their spiritual needs assessed and addressed • Relationship between religion and better health outcomes • Spirituality appears to enhance coping and recovery • Religious people don’t get sick • Illness is due to a lack of religious faith • Spirituality is the most important factor in health • Doctors should prescribe religious activities

18. Religion, Spirituality and Cancer Theme #2

19. 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

20. Use of Prayer among Cancer Patients Taylor EJ. Holist Nurs Pract 2002;16:46-60. • 30 adults of various religions • Differences in . . . • definition of prayer 4. relation to illness • how to pray 5. expectations • for what to pray 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.”

21. 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

22. Research on Religion & Spirituality National Center for Complimentary and Alternative Medicine $2.2 million on studies of distant healing and intercessory prayer since 2000

23. Studies of Intercessory Prayer Theme #3

24. 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

25. Studies of Intercessory Prayer • 13 studies identified from 1965-2005 with following criteria: (1) random assignment of study patients • (2) placebo, sham or otherwise blinded or adequate control • (3) publication in a peer-reviewed journal • (4) clinical investigation of humans • No standardization of prayers or intercessors among various trials • Heterogeneous diseases and outcome variables

26. 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

27. 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.

28. 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

29. Cancer – Power of Faith & Prayer The Medical Perspective • Definitions • Associations between religion, spirituality and health • Studies in cancer • Intercessory prayer • Comments on studying prayer and religion • Biology of Hope • Recognizing spirituality • Conclusions

30. Hope • Belief that one’s desires may be obtained • Different types of hope • Hope as part of one’s spirituality

31. Alosetron and Relief from D-IBS Camilleri, et al. Lancet 2000;355:1035-40. * * * * * * * * * * * * 80 *p<0.05 Alosetron 1mg bid 70 60 50 % with relief 40 Placebo bid 30 Hope and Faith 20 10 Treatment Period Follow-Up 0 1 2 3 4 5 6 7 8 9 10 11 12 +1 +2 +3 +4 Weeks • Placebo response rates up to 84% • Physiologic changes • Hope and faith

32. 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.

33. 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.

34. ‘Mechanism’ of Religion and Prayer Is There a Biology of Hope? Decreased activation of sympathetic nervous system and hypothalamic-pituitary-adrenal axis Psychological effects (less anxiety) Physiological effects (lower BP, HR, oxygen consumption) Better health Positive emotions

35. Cancer – Power of Faith & Prayer The Medical Perspective • Definitions • Associations between religion, spirituality and health • Studies in cancer • Intercessory prayer • Comments on studying prayer and religion • Biology of Hope • Recognizing spirituality • Conclusions

36. 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

37. Barriers to Dealing with Spirituality • Ethical issues • Fewer physicians maintain religious or spiritual ties • Biomedical model of care • Outcomes of spirituality not taught in medical school • Some patients having daunting spiritual needs • Time constraints, lack of training and uncertainty Mueller 2001

38. Reasons to Acknowledge Spirituality • Patients regard physical and spiritual health equally • Spirituality enhances coping skills and QOL and mitigates uncertainties during an illness • Acknowledgement may enhance cultural sensitivity • May enrich the patient-physician relationship • Goal of medicine is to cure disease when possible, but we must always alleviate suffering Mueller 2001

39. 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

40. 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