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News of interest from the Journal of the
American Medical Association
May 1995
SHOULD PHYSICIANS write "prayer"
or "more frequent participation in
religious observances" when prescribing for their patients? Some physicians,
chaplains, pastoral workers, and sociologists would answer affirmatively.
"There is at work an integration
of medicine with religion, of spirituality with
medical practice, the twin guardians of healing through the ages,"
said Dale
Matthews, MD, associate professor of medicine, Georgetown University School
of Medicine, Washington, DC, at a meeting presented as "the first conference
on Spiritual Dimensions in Clinical Research."
The meeting, meant to "explore
the current body of knowledge and emerging
trends in the area of spirituality and health," was held in Leesburg,
Va. by the
National Institute for Healthcare Research, a private organization devoted
to
examining the role of religious commitment in improving patient care and
well-being. The agenda concentrated on three general areas: alcohol and
other
drug abuse, mental health, and physical health. Conferees reviewed the current
status of the role of prayer and religious observance in maintaining health
and
outlined future research needs.
That there is considerable interest
in this topic is illustrated by the fact that,
apart from the Leesburg meeting, there have been three recent national
conferences on the spiritual aspects of health. One was called Methodological
Approaches to the Study of Aging, Health, and Religion and held by the
National Institute on Aging (part of the National Institutes of Health,
Bethesda,
Md); another, held by hospital chaplains, was entitled Spiritual Assessments
in
Health Care Settings; the third meeting, The Roles of Religiosity and Spirituality
in Medical Rehabilitation and the Lives of Persons With Disabilities, was
held
early this month by the National Center for Medical Rehabilitation Research.
Respect the Religious
"There is a need for primary care
physicians to consider and respect the
religious and spiritual beliefs of patients. To do otherwise might be considered
unethical or even negligent," said speaker Stephen Post, PhD, associate
professor, Center for Biomedical Ethics, Case Western Reserve University
School of Medicine, Cleveland, Ohio. The evidence suggests that spirituality
is an important medical tool that should be considered when developing a
therapeutic regimen for the patient, he said.
Authoritative surveys have confirmed
that Americans are highly religious.
Gallup polls conducted in 1944 and again in 1981 showed consistently that
around 95% believe in God, and 42% attend worship services weekly.
George Gallup, Jr, who also spoke at
the meeting, reviewed a number of the
surveys his organization has done since the 1930s that have sought to measure
the religious beliefs of people in the United States. During a 35-year period,
the Gallup Poll has surveyed Americans 12 times about their belief in God.
"We find that large majorities
of Americans say that prayer is an important
part of their lives, that they believe that miracles are performed by the
power
of God, and that they are sometimes conscious of the presence of God,"
Gallup
said. Most of those surveyed named religious practices such as prayer,
meditation, and reading the Bible as their way to deal with depression,
said
Gallup.
"Psychiatrists no longer dismiss
out of hand the importance of religious faith
in recovery from emotional illness and the healing power of forgiveness;
there
is a recognition of the connection between prayer and healing. A strong
faith
can have a profound effect on our lifestyles and outlook in terms of health,"
he added.
However, these earlier surveys did not
probe deeply, Gallup said. "Many
studies that link religious practices to health do not go far enough. We
have
been negligent about exploring this spiritual area of life. But this is
changing
rapidly. The public is being increasingly drawn to the nonmaterial aspects
of
existence."
Some psychiatrists may indeed no longer
dismiss the importance of religion,
as Gallup maintains, but by and large the profession remains skeptical.
A
survey by the American Psychiatric Association showed that only 43% of
respondents said they believed in God--half that of the general population
--and in a review of the published studies in four major psychiatric journals,
only between 2.5% and 1.5% included a religious commitment variable, said
David B. Larson, MD, president of the National Institute for Healthcare
Research. In the primary care and family practice literature, the figure
was
even less-- 1%.
Religion as a Variable
In a review of 115 articles that included
religion as a variable, 37 showed a
positive effect on health, 47 showed a negative effect, and 31 had no positive
relationship. However, Georgetown's Matthews pointed out that the measures
of religiousness used in these studies were limited to noting such factors
as
attendance at worship. "Such single-item religiosity measures are not
very
effective; religious factors are multidimensional," he said.
If religion is not important to physicians,
it is probably not a particularly
influential factor in the health and well-being of others, said another
speaker
at the meeting, Jeffrey S. Levin, PhD, associate professor of family and
community medicine, Eastern Virginia Medical School, Norfolk. Even if
physicians acknowledge the importance of religion to patients, they may
not
regard it as a phenomenon that could promote healing and health, he said.
But for the most part. the speakers
were positive regarding the influence of
religion on health. Levin has made a study of the epidemiology of religion
and health. He reviewed data on the effects of religion on outcomes in a
number of conditions, including heart disease, cancer, tuberculosis, and
suicide.
"Out of 27 studies that included
a religious variable, such as church affiliation
or regular religious involvement, 22 reported a significant, positive effect,
and
four had a positive effect, although the studies were not large enough to
be
statistically significant. This suggests, although it doesn't prove, that
lack of
religious involvement seems to be a risk factor [for poorer health],"
he said.
Another example of the beneficial effect
of religious commitment came from
studies among the elderly reported by Harold G. Koenig, MD, assistant
professor of psychiatry and internal medicine, Duke University Medical Center,
Durham, NC. Many surveys have shown, Koenig said, that older people are
by
and large more religious than younger persons. "Belief in God increases
as
people get older. Bible reading and worship attendance increases with age,"
he said.
He pointed out that 50% of older adults
attend church at least weekly. "That's
an astounding figure," he said. "It means that every Sunday half
the population
of the entire United States over 65 is in church. One investigator figured
out
that the number of people attending church on one Sunday was equal to the
number attending sports events during the entire year in the United States."
At the same time, Koenig noted that it is not clear whether this is because
people
do in fact become more religious as they get older, or simply that the studies
are
identifying an older cohort that is more religious.
Koenig has done a study of these older
people that suggests that despite the
presence of chronic disabling disorders, such as heart disease and diabetes,
they are less likely to become depressed if they score high in religious
coping.
He defined ''coping" as the use of religion to adapt to stress, such
as prayer,
faith in God, and Bible reading--"typical types of Judeo-Christian
behavior,"
he said.
"One of the strongest predictors
of depression is disability. In our study, we
showed that those with the most severe disabilities, such as heart disease
or
diabetes, and who scored high in religious coping, were less likely to become
depressed compared with those who scored low in religious coping,"
Koenig
said.
"There is an inverse relationship
between religious coping and depression that
was strongest among the most disabled persons. It did not necessarily prevent
the disability, but it did prevent or reduce the depression that accompanies
disability," he said.
There also seems to be a dynamic effect.
In a 6 month follow-up study of
200 people, those who scored high in religious coping suffered less depression.
"This finding is probably more important than the cross-sectional finding,"
Koenig said. "Over time, those who were good religious copers became
less
depressed."
There have been similar studies elsewhere.
"This is not an isolated
phenomenon," he said. "It has been demonstrated by at least 50
different studies in many parts of the United States."
Call for Collaboration
Koenig called for steps to educate health
care providers concerning the
effects of religion and for a collaboration between religious institutions
and social service agencies to screen for health problems and to demonstrate
that governmental agencies and religious bodies can work together.
"Spirituality and religion have
important health benefits and more detailed
studies using more accurate measures of this are warranted," said Larson.
"The question today is not whether there are health benefits, it is
how these
benefits can be obtained. We can no longer afford to neglect this important
clinical variable."
--by Charles Marwick
Journal of the American Medical Association
Medical News & Perspectives, pp. 1561, 1562
JAMA, May 24/31, 1995--Vol 273. No 20
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