Richard Sloan had an op-ed piece "Doctors aren't chaplains" in the LA Times today. Here's the gist of it:
The misguided effort to meld religion and medicine. By Richard P. Sloan
RICHARD P. SLOAN, director of the behavioral medical program at Columbia University Medical Center and the New York State Psychiatric Institute, is the author of "Blind Faith: The Unholy Alliance of Religion and Medicine
December 2, 2006
HOW WOULD you like your doctor, at your next examination, to ask not only about your diet and symptoms but about your spiritual life?
... A concerted effort is underway to make religious practices part of clinical medicine. About two-thirds of U.S. medical schools now offer some form of training on the role of religion and spirituality in medicine, according to Dr. Harold Koenig of Duke University....
But before organized medicine decides that religion has any value in physical healing, several things ought to be considered. First, the scientific evidence supposedly linking religious practices with better health is shockingly weak ...Most research studies that claim to show how religious involvement is associated with better health fail to rule out other factors that might account for the relationship.
We all agree, for instance, that there is a real connection between lung cancer and carrying a cigarette lighter in your pocket, but no one thinks that the lighter causes cancer. The lighter is a marker of another factor — smoking — that has been scientifically proved to cause the cancer.
In precisely the same way, religious practices are likely to be markers of some other factor — for example, social support from family, friends or the community or, perhaps, the absence of behavioral risk factors — that may lower the risk of disease...
The effort to link health and religion has other problems as well. For one thing, doctors already have so little time in their interactions with patients that they routinely fail to follow established guidelines for preventive care and for treatment of chronic disease. If, in the future, physicians spend their limited time with patients engaging in spiritual inquiries, they will have even less time to address depression, smoking cessation, weight control or diabetes self-care — factors that are demonstrably related to disease and an increased risk of mortality.
More problematic still is the actual effect on patients when physicians abuse the privileged authority ...
Perhaps most important of all, efforts to connect religion and medical practice are bad for religion itself. Bringing religion to the examining table subjects it to the laws of science, stripping away all elements of transcendence.
... These are matters for patients, their families and the ordained clergy.
Sloan has published a number of papers and op-ed pieces, in addition to his book. Here's a more recent one:
Religious attendance as a predictor of survival in the EPESE cohorts, Emilia Bagiella, Victor Hong, and Richard P. Sloan, Intl J of Epid 2005;34(2):443-451
Results Our analyses show that after controlling for important prognostic factors, frequent religious attendance was associated with increased survival in the entire cohort [risk ratio (RR) = 0.78, 95% Confidence interval (CI) 0.70–0.88]. However, stratified analyses show that this association exists for only two of the four sites.
Conclusions We conclude that the association between religious attendance and survival is not robust and may depend upon unknown confounders and covariates.
Commentary: Understanding religious involvement and mortality risk in the United States: comment on Bagiella, Hong and Sloan, Intl. J. of Epid 2005;34(2):452-3 , Robert A. Hummer
Population Research Center and Department of Sociology, University of Texas at Austin, TX, USA. E-mail: rhummer@prc.utexas.eduThere are a number of excellent classic and contemporary works conceptualizing religious attendance as a social phenomena, detailing measures of religion and what they mean, and laying out the behavioural, psychological, social, and health mechanisms by which religious involvement might work to influence mortality.5–10 None of this literature is referenced, nor did it have any impact on what BHS apparently thought about religious attendance, the religion-mortality relationship, or the possible confounders or mediators of this relationship. As a result, their interpretation of the findings and conclusions can be seriously questioned.
What must be remembered here is that religious attendance should, indeed, display no association with mortality if the complete set of confounding and mediating variables that drive the overall relationship are included in the statistical models...
Third, if the intent of the BHS study is to aid in their well-publicized efforts to keep religious influences out of the practice of medicine, at least based on findings like their own or well-received studies in the religion–mortality area, I am in agreement. A recently published review by myself and several of my colleagues reflects such sentiment.11 Based on findings in the religious attendance–mortality literature, implications for the practice of health care and medicine are limited. Other portions of the religion–health literature—that deal much more directly with religion's possible impacts within clinical settings and with which I am much less involved or an expert on—would seem to be much more relevant in terms of possible implications for health care and medical practice. At the same time, the work by BHS in this issue, as well as related religion–mortality studies within this literature, absolutely beg for a greater understanding of the population-based relationship between religious involvement and mortality for a number of reasons, most importantly including: (i) the development of better social and epidemiological theories of health and mortality; (ii) the better understanding of how demographic and social contexts have impacts on health and mortality patterns.
In conclusion, the BHS article is interesting because it comes from outspoken critics in this area of study, but includes interpretations of the data and conclusions that seem to be based on: (i) a lack of understanding of religious attendance as a social phenomena in the United States; (ii) no theoretical guidance; (iii) questionable interpretations of what their regression coefficients might mean; (iv) little concern for how contexts are important for mortality patterns at the population level; and (v) an agenda that seems to be based on keeping religion out of medicine and health care but is trying to do so using social science and social epidemiology research findings that do not really touch upon religion as an aspect of medical or health care. This fascinating area of scientific inquiry deserves better treatment. It is time to put aside other agendas and work towards scientifically better understanding, with appropriate theoretical guidance, why religious involvement seems to have a beneficial association with mortality risk in the United States. [emphasis added]
5 Durkheim E. Suicide: A Study in Sociology. New York: Free Press, [1897] 1951.
6 Ellison CE, Levin JS. The religion-health connection: evidence, theory and future directions. Health Educ Behav 1998; 25:700–20.[Abstract]
8 Idler EL, Musick MA, Ellison CG et al. Measuring multiple dimensions of religion and spirituality for health research. Res Aging 2003; 25:327–65.[Abstract]
9 Waite LJ, Lehrer EL. The benefits from marriage and religion in the United States: a comparative analysis. Popul Dev Rev 2003; 29:255–76.[CrossRef][ISI]
10 Musick MA, House JS, Williams DR. Attendance at religious services and mortality in a national sample. J Health Soc Behav 2004; 45:198–213.[ISI][Medline]
11 Hummer RA, Ellison CG, Rogers RG, Moulton BE, Romero RR. Religious involvement and adult mortality in the United States: review and perspective. Sout Med J 2004; 97:1223–30.[CrossRef][ISI]
I agree with Robert Hummer's critique on this issue. When we have religious groups, such as the Church of Jesus Christ of Latter Day Saints (mormons) with an undisputed well-document life expectancy almost 10 years longer than the average US resident, it's both hard and irresponsible to not investigate this question further.
Is Sloan correct that religious attendance is really just a proxy for something deeper? Sure. Is the fact that smoking and alcohol are prohibited by that religion related to this mortality rate? Certainly. Is that's all that's going on? Science doesn't actually know yet.
But if we're spending $100,000 to keep people alive another month in hospitals, you'd think we, collectively, would find it a good investment to put a billion dollars into studying this question correctly, instead of simply complaining that prior studies had weaknesses. After all, it was only a decade ago that organized medicine was willing to recognize that there was a "mind-body" connection, and then only when they could see it on the MRI images.
So, yes, there are many ill-conceived, anecdotal, poorly done "studies" out there. Let's fix that situation by having some much better studies, not by dismissing the question.
Unfortunately, rationality is not what determines how money is spent in the health care arena. If it were, "prevention" would be getting much more than its current 2% of the $1.2 trillion health care bill in the USA today. Prevention is far more cost-effective than heroic repair, but far less glamorous, and far less profitable to the "provider" industry.
It is somewhat paradoxical, but while physicians as individuals are striving to repair and heal patients and maintain good health, the health-care industry as a whole would shut down and die if every person suddenly got well and stayed well. Perhaps that has something to do with why preventive care is so low on the national agenda. Still, it's like not wanting to pay to fix the roof, but being perfectly willing to pay to replace the ceiling and rain-soaked furniture every year.
There are unstated assumptions and broken mental models in the "organized medicine" community regarding the whole area of "public health." It is as important to address these "religiously" held misconceptions and biases and mental models among scientists and doctors as it is to address misconceptions among the various religious groups.
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