Prayer, surgery, and separating doctoring from dogma

Over the years, I’ve learned that a lot of surgeons are very religious. Actually, a lot of doctors are quite religious. Indeed, long ago in the history of this blog, back when I used to write about evolution a lot more than I do these days, I’ve pointed out that at least as many physicians as the general public accept “intelligent design” creationism as a valid description of the origin of life. Indeed, 15% of physicians believe that states should be required to teach ID and 50% believe that states should be permitted to teach it. In other words, approximately 65% of physicians are in favor of or neutral to teaching ID in the science classroom, a problem that has at times resulted in some bad biology finding its way even into surgical meetings. I have witnessed it myself. Moreover, there are a lot of doctors out there who even advocate for promoting religious beliefs as part of their treatment of patients.

At major surgical meetings, there is always the presidential address. It is usually, but not always, relatively early in the meeting and represents an opportunity for the outgoing president to reflect on his or her tenure leading the surgical organization and provide a vision for the future. It is not particularly uncommon that the outgoing president of a surgical organization will wax philosophical, and frequently the philosophical wax applied to the presidential address is religious. Indeed, I remember one presidential address at a Society of Surgical Oncology meeting a few years back that was a veritable swamp of religiosity, to the point that I remember being particularly annoyed. What did any of this have to do with surgery, science, or medicine? Nothing. Yet there it was.

As annoying as that address was, though, at least the then-president of the SSO didn’t try to justify his religious beliefs using science. Unfortunately, via Pharyngula, I learned the other day that the outgoing president of the Midwest Surgical Association, Dr. Donn M. Schroder, was unable to resist the temptation to do just that in his presidential address, which was just published in American Surgeon last month under the title Can prayer help surgery? The religion flows right from the very beginning:

Surgeons use chemotherapy and radiation as adjuvant therapies to surgery, working synergistically to cure cancers. We believe that neoadjuvant therapy can help our surgical outcomes. Despite the good results we have achieved, our patients want better. There has been a plethora of Internet searches by our patients looking for ways to improve their surgical results. Like other alternative therapies to aid surgery, prayer has become increasingly popular among patients in the United States.

There’s a huge difference between using chemotherapy and radiation therapy as adjuvant therapies after cancer surgery in order to reduce the risk of recurrence. We know what they are. Science can demonstrate that they work, how they work, and how effective they are for various clinical situations. This is in marked contrast to intercessory prayer, which has never been shown to work. Of course, I’d ask Dr. Schroder what his opinion of “alternative” therapies is. does he think science supports them? If so, how? And, if so, what science supports his assertion that prayer can help surgery? No, wait. Stop. I bet that he probably does, at least if the reasoning he uses to evaluate alternative medical therapies is anywhere near a sloppy as his reasoning in arguing for surgeons to use prayer as an adjunct to surgery.

Unfortunately, that’s what Dr. Schroder’s speech is all about, and he makes what can only be described as a highly embarrassing case. Worse, I consider it inappropriate in the extreme for a president of a major surgical or scientific organization to abuse his position to regale the membership of his organization with his sectarian religious beliefs disguised as science. Yet that’s exactly what Dr. Schroder does ad nauseam. For instance, after pointing out how the “historical foundation for prayer to aid in healing is replete in the Torah, the Bible, and the Qur’an,” that there are “42 accounts of healing by Jesus in the Gospels alone,” and that Gospel writer Luke was a physician, in order to be ecumenical (apparently), Dr. Schroder then points out that healing through prayer is integral in Islam as well. No doubt Dr. Schroder is a Christian; so his invoking Islamic beliefs fools no one. One wonders why he doesn’t invoke Buddhist, Hindu, or other major religious traditions. He does, however, use the standard ploy used by religious physicians to justify using prayer, namely using it alongside science-based medicine. He also can’t resist the “bandwagon” argument, or argumentum ad populum, lamenting how during the Renaissance, prayer and healing started to diverge, but rejoicing over how now the “pendulum is swinging back”:

Articles in Time and Newsweek reflect the explosion of manuscripts published in the medical and surgical literature. A MEDLINE search from 1950 to 1995 revealed only 212 articles published about prayer aiding healing, compared with 855 in just the past 15 years. There are 46 prospective randomized series on prayer aiding medicine and surgery in the Cochrane database. Studies that show benefit to prayer and healing do not favor one religion over another. Equal healing benefit has been demonstrated whether the prayer is Hindu or Buddhist, Catholic or Protestant, Jewish or Muslim.

I suppose that’s one way of putting it. All forms of prayer do work equally–equally poorly (as in not at all) when tested in rigorous trials. In fact, Dr. Schroder even admits as much:

Can medical science prove the benefit of prayer to im- prove the result of an operation? I refer you to the latest Cochrane review on this topic.5 This 69-page manuscript is a meta-analysis of 10 prospective randomized studies on intercessory prayer to help the efforts of modern medicine involving over 7,000 patients. Some studies in this meta- analysis showed benefit, while others did not. The conclusion of the authors was that there is no indisputable proof that intercessory prayer lowers surgical complications or improves mortality rates.

Not quite, actually. What the Cochrane Review actually says is:

The authors conclude that due to various limitations in the trials included in this review (such as unclear randomising procedures and the reporting of many different outcomes and illnesses) it is only possible to state that intercessory prayer is neither significantly beneficial nor harmful for those who are sick. Further studies which are better designed and reported would be necessary to draw firmer conclusions.

And what it concludes is:

These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.

Do you realize how incredibly rare it is for a Cochrane review ever to conclude with a recommendation that no further studies be done? Seriously! Even in the Cochrane Review of homeopathy and laetrile, the authors recommend more studies. Yet in the case of intercessory prayer, the authors recommend exactly that, arguing in essence that it would be a waste of resources. And so it would be. Whether he realizes it or not, Dr. Schroder has said exactly the same thing, although he tries desperately to try to spin it otherwise, deemphasizing how many studies were negative and how few were positive. So instead of asking the right question (why were the vast majority of the studies negative?) and getting the right answer (because intercessory prayer doesn’t work), Dr. Schroder asks, “Why is it that not all studies demonstrate prayer benefit?” and gives a wildly off-base answer:

Unfortunately, most of these studies have flaws in their methods. The investigators as- sume that while the “prayed-for patients” receive distant intercessory prayer from assigned prayers, their “control groups” are not prayed for by anyone. Wait a minute. Do patients not pray for themselves? How can researchers re- ally think that a patient undergoing open-heart surgery is not going to pray for his or her health before and after the operation? Do the investigators think that the patients’ mothers and fathers, sisters and brothers, and their children or friends are all struck spiritually mute during this time of need? The point is that there is no control group. Somebody prayed for all of these patients. Thus, there can be no valid scientific comparison of so-called prayed-for and not- prayed-for surgical patients. Furthermore, are there factors that, as humans, we may never understand about prayer that affected the results of these prayer studies? For instance, does the religious devotion of the prayer intercessor or the holiness of the patient have any bearing on how God re- sponds to prayer? Does God take into account the worthiness of the cause? What happens when the outcome being prayed for is not in accord with the will of God? If it’s the time for a person to die, does prayer defer destiny? Reli- gious scholars are still wrestling with these questions. So where does this leave us? The scientific foundation for prayer is not solid. There is no indisputable proof that prayer can aid in healing. Those who believe do so by faith alone.

All of which has to be the most tortuous way I’ve ever seen anyone try to justify intercessory prayer through science and end up coming to the conclusion that there is no evidence and that those who use prayer do so by faith alone, which is a trivial conclusion larded with Dr. Schroder’s tortured justification for why science doesn’t support the contention that pray has health benefits.

Being utterly unable to demonstrate scientifically that prayer heals, Dr. Schroder falls back into more argumentum ad populum by citing studies that show that large numbers of neurosurgeons believe in it, as well as large numbers of the general public. Well, duh! When the vast majority of Americans are religious, most of them Christian, I would be shocked if surveys didn’t show that most surgeons and most patients believe in prayer. None of this stops Dr. Schroder from offering up anecdotes, cherry picked fMRI studies about the salutary effects of prayer on various neurological functions, and a description of his own practice when it comes to praying with his patients. One of these is a study Dr. Schroder himself did in which he purported to study his prayer practice, which is:

It is my practice to say a silent preoperative prayer for my patient at the scrub sink. I do extend an offer to pray with my patients in the preoperative area as well. After discussing the operation and answering any questions the patient may have, I say, “I know that some patients like to pray before surgery. If you would like me to pray with you, just ask.” If they ask to pray, then I respond, “Would you like to lead?” I hope not to be coercive and realize that prayer in this instance must benefit the patient more than the surgeon. We then pray together in whatever manner the patient chooses.

Does Dr. Schroder really believe he’s being non-coercive? I mean, seriously. Think about it. Let’s say you’re an atheist. You’re about to go under the knife for, let’s say, a cholecystectomy. Your surgeon, after explaining once again the risks and benefits of surgery, asks you if you want to pray with him? Do you refuse? Or are you intimidated because you don’t want to piss off the man who is about to cut into your body in order to forcibly rearrange your anatomy for therapeutic effect? Whenever I hear surgeons like Dr. Schroder claim they are not being coercive, I can’t help but ask, “Oh, really?” In reality, Dr. Schroder probably really does believe he’s being noncoercive, and he even has his very own survey that showed that few none of his patients felt coerced. He did note that, out of 186 patients, 10 did refuse and that of these two were agnostics and six were atheists, with two of this group being atheists. Among the comments was, “”I don’t pray and it made me think it was really bad going into surgery.”

Indeed.

Of course, the vast majority of Dr. Schroder’s patients were Christian, and the response among them was overwhelmingly positive. Does that mean it’s OK? Personally, as a surgeon myself, I have a real problem with Dr. Schroder’s approach. It is coercive, whether he realizes it or not, whether he admits it or not. It’s one thing if the patient asks the surgeon if he wants to pray with him, completely unprompted. In that case, I don’t see a problem. In fact, even I would probably join in (after trying to beg off once perhaps), because in the end to me it’s all about the patient and I’m not about to do anything that makes the patient feel uncomfortable or lose confidence in me, my heathen tendencies notwithstanding. But that’s not what Dr. Schroder is talking about. When the surgeon asks the patient about prayer, he makes it more about him than the patient, no matter how much he tries to tell himself otherwise. If it were truly about the patient, Dr. Schroder would not in any way try to advertise his religion or to make himself feel better by using his religion to bond with his patients before surgery. Indeed, a physician should not even be mentioning this to his patients, because there is a power differential that makes it incredibly difficult, if not outright impossible, for such a request to leave the most patients truly free to decline it.

Rather like the way the members attending the annual meeting of the Midwest Surgical Association weren’t free to decline Dr. Schroder’s pontifications about the power of prayer used right before surgery. I hope the chairs in the lecture hall were comfortable; snoozing would have been mandatory.