1. SPRITUALITY AND MEDICINE Manoj Jain M.D. M.P.H.

2. Goals n Exploring Spirituality through science. n Is religion healthy? n If so - what mechanisms make religion healthy? n Evolving model n Our prayer study - Research

3. Resurgence of Spirituality in Medicine n Surveys n 1993 and 1998 Eisenberg study on Alternative Medicine n Medical School Curriculum n Research by Benson, Koenig, Larson, Matthews

4. Survey Results n 95% of Americans believe in God n 76% pray regularly n In 1990 25% used self-prayer for healing n In 1997 35% used self prayer (JAMA 98)

5. Spirituality vs. Religiosity n Spirituality is: Core of our belief- often individual n Religiosity is: broader, institutional, ritualistic n Spirituality more compatible with science

6. What evidence is there that Spirituality/Religiosity leads to good health? n Survival- 91,909 men attending church n Netherlands -SDA men 9 yrs. increase n Psychiatric illness n YET NO GOOD RCT--biased by behavior

7. What evidence is there that Spirituality/Religiosity leads to good health? n 3968 California residents age 64- 101 years old 6 year follow up- n 46% lower mortality rate if church going n After after correcting for behavior mortality rate 28% lower

8. Clinical Scenario n 1.Child falls “kiss the boo- boo” n 2.Patient with Shortness of Breath n 3.Patients with breast cancer go to social group n 4. Patients in CCU were prayed for

9. If religion is healthy then what is the mechanism? n Placebo effect n Psychological support n Social support n Religious practices i.e. dietary n Vibrational -- “devine” -- intercessory prayer

10. Placebo effect n Belief in Medicine n Belief in Doctor n Belied in Relationship n 30 percent effective (JAMA 1965)

11. Psychological/Social support n Clergy - priest n Forgiveness/Confession n Sunday Church visits n Church Socials

12. Relaxation Response n Prayer n Meditation n Chanting - repetition n Silence

13. Behavior modification n Less smoking, drinking or high risk activities n Better diet - Seventh Day Adventists

14. Vibrational or Devine intervention n ? By science n NTTE n Non-Tactile Transfer of Energy

15. Medical Perspective -50 yrs.ago Basic Needs: Food -Shelter

16. Medical Model - 20 yrs. ago Basic Needs Psychological Needs Social Support Needs Placebo effect Stress response Relaxation response

17. New Developing Medical Model Basic Needs Psychological Needs Social Needs Spiritual Needs Prayer- Intercessory prayer

18. Study on intercessory prayer: San Francisco - Byrd Study1988 Study Design: Randomized control CCU patients Sample: n=393, prayed group n=192, control group n=201 Results: CHF 8 vs. 20 p<.03 pneumonia 3 vs. 13... Conclusion: Pts. receiving prayer had favorable outcome

19. Study on the Therapeutic Effect of Prayer --1998-2001 Study Design: Randomized control CABG patients-multicenter Intervention: Intercessory prayer - knowledge if being prayed for Sample: n=2000 Three groups: Prayed for + certain if being prayed for Prayed for + uncertain if being prayed for Not prayed for + uncertain if being prayed for Outcomes: Complications - mortality -LOS

20. What kind of business are doctors in? n Healers or n Drug Dealers