I think that, to some extent, pessimistic people are usually “that way for a reason.” There may be neuro-chemical reasons. There may be personal history reasons. There may be any number of reasons working in tandem.

I also agree that the difference between a positive and negative outlook may influence lifestyle choices, which probably have a more direct impact on health than the outlook itself.

I’m not sure how either of these things contradicts what I was saying. If anything, they echo my own comments.

You say, “Also, this information is really only helpful if a person can change their outcome by changing their outlook on life, and there is no study that comes close to being able to say this.”

I agree with that wholeheartedly. Again, this echoes several of my own comments, such as the following: “it is unclear whether a shift in attitudes that began as negative and turned to positive would be enough to make any significant difference in outcomes.” If you go for ten years with a negative outlook, changing it in the last two might not do anything worthwhile.”

I’m a little perplexed about how you conclude that any of what I said implies that a person could be held responsible for their health outcomes as they resulted from attitude (or the choices that those attitudes led to). In order for that to be true, we would first have to establish that a person was entirely responsible for their outlook on life. That is expressly NOT my argument. My understanding of most of the research (as well as experience) is that personality and outlook are primarily products of things over which people have little control. If you look back at the examples I gave as contributors to outlook (most of them about whether or not a person grew up with or has a strong support network), you will see that at no point did I place the responsibility for a person’s outlook in his or her hands.

Where changes to attitude can be made, they are often only incremental and excruciatingly slow to develop.

But even if there’s no clinical applicability in trying to modify a patient’s outlook, that doesn’t mean that the outlook has no effect at all or is entirely useless as a predictor. That’s where I think some knowledge can be gleaned.

It is horrible that some people do believe that disease outcomes are entirely the responsibility of the patient’s attitude. As Stephen Colbert once said (satirically, of course): “If my airbag didn’t deploy, it’s because I didn’t believe in it hard enough.”

There are very few disease states in which this statement is true. Most of the studies (particularly cancers) show no relationship at all. I think some cardiovascular event studies show a relationship, but these studies are nearly impossible to evaluate for cause and effect. First of all, pessimistic people are likely very different than optimistic people in many ways, such a the choices that they make, and it may be certain life choices that impact the outcome. Pessimistic people may be that way for a reason (e.g. poor health, fewer close relationships, etc) and it may be a bit selecting the less healthy group.

Also, this information is really only helpful if a person can change their outcome by changing their outlook on life, and there is no study that comes close to being able to say this. There is a danger in implying (without good evidence) what you are implying: a person may be partially to blame for their health outcome. If a positive outlook increases surivival with cancer (which it does not), then a person died because of their negative attitude. This is a horrible implication and is completely untrue. The problem is that some people believe this

I agree entirely that the effect of the prayer (or other token) depends highly upon how it’s received. I noted this in my original response:

“Of course, there are lots of caveats here: not everyone reacts to support in the same manner (some, for instance, view it as paternalistic or as an affront to their independence)…”

I thought I had been clear enough there, but I suppose now that I must not have been.

What I was saying was that a token or gesture of support might produce a beneficial effect equal to (but probably not greater than) placebo if the person receiving it welcomes it as a genuine indication thereof, and that the chances that the person will welcome it are greater if it comes from a member of one’s preexisting chosen support network (i.e. friends and family).

If one does not have such a preexisting network, then the chances of welcoming the tokens are lower (as are the chances that the person will have a rosy take on life generally).

Obviously, if the token comes from a stranger, or an enemy, or it comes in a form that the person does not recognize as a viable token, then the effect will be lessened, or perhaps even become a liability.

I further qualified this by mentioning that “it is unclear whether a shift in attitudes that began as negative and turned to positive would be enough to make any significant difference in outcomes.” If you go for ten years with a negative outlook, changing it in the last two might not do anything worthwhile.

But yes, all of this is definitely a sticky soup. Relationships develop over time, and involve complex interchanges of personality and circumstance. And attitude patterns tend to be self-reinforcing; a person’s past experiences will to some extent determine their reactions to new encounters. Since everyone comes to the table with a unique suite of past experiences, forecasting the attitudinal reaction of a given individual to something as highly personalized as prayer (or chocolates, or a personal visit) is, to say the least, troublesome.

Certainly you’re well aware that people who have loved ones to support them tend to live healthier, happier lives.

That might actually be a confounding factor for unblinded studies of intercessory prayer (or other tokens of concern) — different people have different levels of social support, and different behaviors within their social networks. Is it a tight-knit but demanding family? Or a loose-knit but very easygoing and accepting one? John2 makes a good point with the study he cited showing a *worse* outcome in one study, perhaps because of people feeling they can’t live up to the expectations.

The nature of the token would be significant, as would the context in which it is given, and it occurs to me that that makes this harder to study. It’s not just one question; it’s a lot of questions. After all, prayers and gifts all mean more than just what they are, and family dynamics will affect how the recipient interprets these tokens.

Another thought: people aren’t stupid, and they’ll be able to read between the lines of an intercessory prayer — or, because they’re all drugged and hurting and tired, they may be irritable and take offense more easily. If the prayer makes it clear (to them) that the person praying has only a dim awareness of what the patient is really going through, yet also conveys a powerful assertion that the praying person feels they understand and know exactly what the patient needs, that could insult the patient, or convince him/her that nobody really understands or cares or that there are unrealistic expectations. And, of course, if the patient is atheist or a member of a different religion, it could be like punching them in the metaphorical nose. Prayer can backfire spectacularly, and it would be possible (though perhaps not ethical, since it involves being nasty to people) to test that.

“Intercessory prayer works — when the subject knows about it. It works the same way as sending a person a box of chocolates; it lets them know you care about them, and that helps them hang in there until the worst is over. ”

I’d like to see a study that supports that statement.
I doubt very much that it is accurate.
For example, it has been shown that a positive attitude improves the quality of life but not the quantity of life.

Read my post again; you’ve misunderstood if you think I’m saying that sending someone a box of chocolates will make them live longer.

All prayer does is make people feel better about themselves. Generally. Sometimes it doesn’t even do that.

Certainly you’re well aware that people who have loved ones to support them tend to live healthier, happier lives. Multiple lines of evidence support this, from early nurturing and involvement by parents to the health benefits of constructive marriages to the fact that people seek out friendships because it makes them feel good about themselves and their lives. The tokens of validation and support that our social groups provide us have very real consequences for our long-term survival, including our attitudes about the world we live in.

That was my point, not that being prayed for per se leads to health benefits. I certainly would garner no personal benefit from knowing I was being prayed for. But I might get some benifit if I knew that my family and friends would be there for me in my time of need, especially since they would be able to help keep me from sinking into the kind of malaise that would lead to the cynical outlook characterized in the Women’s Health Initiative study I quoted.

But maybe not. I didn’t say that any of that was definite – just that it made sense, and that some lines of evidence seemed to suggest the possibility.

I’d appreciate if you didn’t insult me in making your own arguments, which I notice have their own problematic spots. For instance, the increased risk you mention comes from a critique of a review of the study you cite. I could not gain access to the full text of original Cochrane Review article, so I am not sure what the protocols of the cited study actually were. Neither the critique nor the Cochrane abstract mention whether the people in question were being prayed for by loved ones, strangers, or some mix thereof. That’s one factor out of a few that might make a major difference in response – and could potentially undercut it as a refutation of the “box of chocolates” phenomenon.

Actually, after a little googling, I found this,

http://www.jnrbm.com/content/8/1/7

which contains the following line

“The authors found one study that reported an increased risk of surgical complications due to prayer, but only if the patients were aware that people prayed for them.”

You really can’t take a study on optimism, as you have, and then extrapolate from that to another area. This, I’m afraid, is pure quackery, every bit as much as extrapolating from in vitro to in vivo results would be.

Even if feeling that you are cared for doesn’t itself do anything, knowing that you’re being prayed for and believing that works certainly produces the same set of conditions sufficient for the placebo effect.

As far as being cared about goes, I think there is some evidence to suggest that a person’s attitudes (positive or negative) can play a role in health outcomes. Here is one example of a study that looked at these differences: “Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s Health Initiative” – http://www.ncbi.nlm.nih.gov/pubmed/19667234.

They found that “Optimists (top versus bottom quartile ["pessimists"]) had lower age-adjusted rates (per 10 000) of CHD (43 versus 60) and total mortality (46 versus 63). The most cynical, hostile women (top versus bottom quartile) had higher rates of CHD (56 versus 44) and total mortality (63 versus 46). Optimists (versus pessimists) had a lower hazard of CHD (AHR 0.91, 95% CI 0.83 to 0.99), CHD-related mortality (AHR 0.70, 95% CI 0.55 to 0.90), cancer-related mortality (blacks only; AHR 0.56, 95% CI 0.35 to 0.88), and total mortality (AHR 0.86, 95% CI 0.79 to 0.93). Most (versus least) cynical, hostile women had a higher hazard of cancer-related mortality (AHR 1.23, 95% CI 1.09 to 1.40) and total mortality (AHR 1.16, 95% CI 1.07 to 1.27; this effect was pronounced in blacks). ”

The researchers concluded that “optimism and cynical hostility are independently associated with important health outcomes in black and white women.”

Of course, this is a correlation, and the authors note that “Future research should examine whether interventions designed to change attitudes would lead to altered risk.” In this case, although attitudes were associated with differences in outcomes, the study doesn’t explore whether the attitudes themselves were the product of a supportive environment.

It makes sense that being in a supportive environment would generally lead to more optimistic attitudes. Of course, there are lots of caveats here: not everyone reacts to support in the same manner (some, for instance, view it as paternalistic or as an affront to their independence); it is unclear whether a shift in attitudes that began as negative and turned to positive would be enough to make any significant difference in outcomes; and it is unclear whether the person must believe that a positive attitude will yield better outcomes (a version of placebo), or if feeling positive on its own, without any additional expectation, would have any impact. Some of these problems are, I expect, extremely difficult to disentangle.

All that aside, I do think that improving quality of life (even sometimes at the expense of quantity) can be a desirable thing on its own. Personally, I’m much less concerned with the number of years I survive than I am with whether or not those years are fruitful and enjoyable.

I’d like to see a study that supports that statement.
I doubt very much that it is accurate.
For example, it has been shown that a positive attitude improves the quality of life but not the quantity of life.

Y’know, one method might be to use a fictitious language or perhaps a real language with which the subject is unfamiliar and speak the prayer using that language. God would presumably know what is said, but the recipient would not. This would constitute a blinded test of whether or not the words are important. Praying to a freshly-invented God and getting a positive result would prove it doesn’t matter who you pray to. But of course, there’s always an “out” for the creative religious mind, namely, “God knows what the subject wants and answered that prayer”.

Intercessory prayer works — when the subject knows about it. It works the same way as sending a person a box of chocolates; it lets them know you care about them, and that helps them hang in there until the worst is over. There’s nothing magic in that, and it saddens me that many Christians (and people of other faiths as well) feel threatened by that knowledge. Why do they *need* a God who grants boons? Wouldn’t that imply that the same God mostly refuses them, judging by how frequently people have terrible things happen to them? Crappy way to feel about God, in my opinion.