THE UNEXPECTED THERAPEUTIC ADVANTAGE

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THE UNEXPECTED THERAPEUTIC ADVANTAGE

• Mark A. Snyder, M.D.
• Wellington Orthopaedics
• Cincinnati, Ohio

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(No Transcript)
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WHO EXPECTS RELIGIOUS COMMITMENT TO BE MEDICALLY
ADVANTAGEOUS?
YES

• Patients
• Doctors

NO
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BELIEFS OF THE AMERICAN PEOPLE

• 94 of the general public believes in God
• 85 believe religion is important in their lives
• 76 report that prayer is an important part of
  their lives
• 64 of Americans thought doctors should pray
  with those patients who request it.

Gallup, 1990
Wallis,1996
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PATIENT ATTITUDES

• Combined surveys conclude that greater than
  90 of Americans pray and a common focus of
  prayer is health.

Bearon, 1990 Gallup, 1989 Greeley, 1989 Woodward,
1992 Barna, 1999
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PATIENT ATTITUDES

• In a survey of 200 hospitalized patients
• 77 of patients wanted their doctor to consider
  their spiritual needs.
• 48 wanted their doctor to pray with them.

King, 1994
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PATIENT ATTITUDES

• In a survey of 100 consecutive adult
• orthopaedic patients in an outpatient
• setting
• 83 wanted their doctor to consider their
  religious commitment to better understand how
  they cope with their health problems
• 95 wanted their doctor to pray with them during
  treatment events such as surgery
• 89 reported rare or absent physician prayer
  support throughout their medical history

Snyder, 2000
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PHYSICIAN ATTITUDES

• Most physicians do not recognize or value the
  central role that religious faith (and prayer)
  can play in helping patients deal with serious
  illnesses.
• When surveyed, the vast majority of physicians do
  not believe that patients faith is their most
  important coping mechanism.

Maugans, 1991
Koenig, 1991
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PHYSICIAN ATTITUDES

• Most physicians view religious faith as
  unscientific and distracting to their clinical
  decision-making.
• Although over ½ of medical schools now include
  spirituality curricula, most practicing
  physicians have never received this type of
  instruction.

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SUMMARY OF FINDINGS

• Americans are highly religious and esteem
  spiritual practices (i.e., prayer) as
  advantageous to their health.
• Health professionals are less religious than the
  general public.
• Religious factors are often neglected in the
  practice of medicine, despite patients desires
  to have them included.

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CHARACTERISTICS OF RELIGIOUS COMMITMENT

• Prayer
• Worship
• Intimacy with God
• Bible and devotional reading

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CHARACTERISTICS OF RELIGIOUS COMMITMENT

• Financial support of ministry
• Personal involvement in religious and volunteer
  activities
• Preference of religious art, entertainment and
  education

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BENEFITS OF RELIGIOUS COMMITMENT

• Overall benefits from 212 studies
• All examined the effects of religious commitment
  on health care outcomes
• 75 (160) demonstrated a positive benefit of
  religious commitment
• 17 (37) with mixed or no benefit
• 7 (15) demonstrated a negative effect

Matthews, 1995
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ALCOHOL AND DRUG ABUSE
Therapeutic Benefit

• The strongest predictor during medical school of
  subsequent alcoholism was a lack of religious
  affiliation. From a study of 1014 males entering
  Johns Hopkins Medical School between 1948 and
  1964. Moore, 1990
• There is a 71 risk reduction of alcoholism for
  those who attend church weekly compared with
  those who attend less frequently. From a study of
  2969 participants in the NIMH Epidemiologic
  Catchment Area study in N.C.
• Koenig, 1994

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ALCOHOL AND DRUG ABUSE
Therapeutic Benefit

• The rate of opiate recidivism was 95 vs. 55 in
  a Public Health Service program vs. a long-term
  religious-based program. 248 male patients
  examined between 1964 and 1967.
• Desmond 1981

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PSYCHOPATHOLOGY
Therapeutic Benefit

• Frequent church attenders have almost ½ the rate
  of psychopathology than infrequent attenders.
  2,679 participants in the NIMH Epidemiologic
  Catchment Area study in N.C.
• Koenig, 1994

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PSYCHOPATHOLOGY
Therapeutic Benefit

• Religious beliefs and behaviors used by depressed
  older adults to cope with medical problems helped
  them recover faster from depression.
• Intrinsic religious commitment was measured in 87
  depressed elderly patients hospitalized for
  medical illness.
• Hoges 10-item scale was used to measure
  religious commitment. For every 10 point increase
  in score, there was a 70 increase in the speed
  of remission.
• Koenig, 1998

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MORTALITY STUDIES
Therapeutic Benefit

• 192 of 393 patients in a San Francisco CCU who
  received intercessory prayer support had a more
  favorable overall outcome than the control group
  of 201 patients.
• CHF 8 vs. 20 plt.03
• Intubation 0 vs. 12 plt.002
• Cardiac arrest 3 vs. 14 plt.02
• Byrd, 1988

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MORTALITY STUDIES
Therapeutic Benefit

• Religious commitment and social involvement were
  associated with a 14-fold decrease in the death
  rate following cardiac surgery. Religious
  commitment was as important as lifestyle habits
  in reducing the death rate in a Dartmouth study
  of 232 elderly patients.
• Oxman, 1995
• People who attended church once a week were more
  than 25 less likely to die than those who
  attended infrequently. This study of 5286
  individuals followed for 28 years was controlled
  for demographic, social and health factors.
• Strawbridge, 1997

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MORTALITY STUDIES
Therapeutic Benefit

• Mortality rates are lower for Orthodox vs.
  non-Orthodox Jews in a 23 year cohort study
• Goldbourt, 1993
• In a 16-year follow-up study, members of Orthodox
  kibbutzim had 50 lower mortality rates than
  non-Orthodox kibbutzim members.
• Kark, 1996
• Controlling for socioeconomic, health and
  lifestyle factors, 21,000 U.S. adults tracked
  over 9 years were found to have longer life
  expectancy if they attended church on a weekly
  basis. The life-expectancy gap was gt7 years
  overall. Amongst blacks, the gap was 14
  years. Hummer, 1999

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LONGEVITY
Therapeutic Benefit

• Attending religious services was the most
  important factor contributing to longevity for
  senior citizens 55 years or older. A 5-year
  follow-up study of 2,025 residents of Marin
  County, Calif.
• Six classes of confounding factors were
  considered
• Age, sex, race, ethnic group, body fat , income
  level, education and employment
• Chronic diseases
• Physical functioning and driving status
• Health habits
• Social participation
• Psychological status

Oman, 1998
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INTERCESSORY PRAYER
Therapeutic Benefit

• In-person intercessory prayer was a useful
  adjunct to standard medical care in the treatment
  of patients with rheumatoid arthritis.
• Multivariate analysis of arthritis-specific
  outcome measures demonstrated significant overall
  improvement in prayer-interceded patients
  compared with a baseline cohort.
• Matthews 2000

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AN ORTHOPAEDIC SURVEY

• 100 consecutive patients
• 8 questions
• 61 females 39 males
• Avg. age 60.2 with range of 18 to 82
• Survey administered by a non M.D.

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THE QUESTIONS

• 1) Is your religious commitment advantageous
  to your health? Yes ___ No ___
• 2) Do you want your doctor to understand how
  your religious commitment (if you have any) helps
  you cope with your health problems? Yes___
  No___
• 3) Do you want your doctor to pray for you
  during treatment events (i.e., surgery)? Yes___
  No___
• 4) How often has a doctor offered to pray for
  you?
• Never ___ Rarely ___ Occasionally ___ Often
  ___

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THE QUESTIONS

• 5) Do you expect prayer to assist you in your
  recovery?
• Yes ___ No __
• 6) Do you expect prayer will improve the
  outcomes (results) of treatment? Yes
  ___ No___
• 7) Would a doctors prayer for you increase
  your confidence in his/her treatment? Yes___
  No___
• 8) Do you think the doctor-patient
  relationship is improved by a doctors prayer for
  you?
• Yes ___ No___

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THE RESULTS

• 1 Faith advantageous?
• 87 yes
• 2 MD connects faith with coping
• 83 yes
• 3 Pt wants MD to pray for them
• 95 yes

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THE RESULTS

• How often MD prays?
• Never 39
• Rarely 50
• Occasionally 7
• Often 4

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THE RESULTS

• 5 Prayer assists?
• 96
• 6 Prayer improves results?
• 90
• 7 Prayer increases confidence?
• 89
• 8 Prayer improves MD-pt relationship?
• 98

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OBSERVATIONS

• Most patients in this survey highly valued prayer
  in the doctor-patient relationship.
• The doctor is clearly welcomed by most patients
  to assess spiritual needs and share in prayer.
• Even patients who did not personally embrace
  religious commitment would likely welcome a
  physicians offer to pray for them.

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RECOMMENDATIONS

• Learn how to obtain a spiritual history
• Ask how they cope
• Ask about spiritual habits
• Ask about support systems
• Ask about their anger and fear
• Always ask permission to go further with more
  penetrating questions and spiritual intervention
  such as intercessory prayer.

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RECOMMENDATIONS

• If you are comfortable with religious commitment,
  offer prayer support for your patients,
  particularly if they request it.
• If you do not possess religious commitment, at
  least recognize that the majority of patients
  consider it to be pivotally important in their
  lives. Refer patients to faith-specific
  pastors/counselors.
• Consider reviewing the studies included in the
  list of references, as well as future research
  reviews from the NIH (key authors Matthews,
  Larson, Koenig, McCullough).

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Even Friedrich Nietzsche acknowledged that Men
and women can endure any amount of suffering so
long as they know the why to their
existence. Religious faith provides the wider
context of meaning and purpose to both life and
death. In the very least, it gives us an eternal
perspective.
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Religious commitment might well help transform
mere medical technique into medical care.
Thank You