Aug 05 2010

Proximal Intercessory Prayer

One of the core “pearls” of this blog is that not all scientific studies are created equal. It is common for the media and the public to cite the fact that “a study shows” some claim or other, but such appeals to evidence are worthless unless we can assess the quality of the study. We now have a gaggle of science bloggers – real scientists blogging about research – to help explain all the various ways to look at the quality of a study, and hopefully this is resulting in a more savvy population of science enthusiasts (the kind of people who read science blogs).

Let’s take the following hypothetical study: The study included 24 subjects who were all treated openly with the intervention in question. There was no blinding or control group – so everyone in the study, subjects and experimenters, knew that every subject was getting the treatment. The treatment involves active physical intervention with the subject. The protocol also calls for multiple interventions if initial treatments are not effective – essentially the subjects receive repeat treatments as long as possible until they report a response.

The outcome was either a change in vision or hearing. Subjects reported impaired vision or hearing at the beginning of the study and were tested with standard vision or audiology tests before and after treatment. All subjects demonstrated improvement from the intervention.

It should further be noted that the subjects in the study were not chosen from the random population but from a self-selected group that already believe in the efficacy of the treatment. Further, the authors admit, although they do not disclose the data, that previous attempts to document response to the treatment in other populations have failed.

At this point anyone with any reasonable familiarity with how to assess the quality of medical studies should see that this is a worthless study. This barely qualifies as a pilot study. It really doesn’t matter what the treatment is or how plausible it is – you simply cannot draw any meaningful conclusion from 24 self-selected subjects with no controls and no blinding.

Now, I know you can read headlines so you know this was a study of proximal intercessory prayer, but the point is – even if you assess the details of the study divorced from knowledge of what the intervention is, it should be obvious that this study tells us nothing.

The study took place in rural Mozambique among members of a Pentecostal church. The press release for the study says:

“We chose to investigate ‘proximal’ prayer because that is how a lot of prayer for healing is actually practiced by Pentecostal and Charismatic Christians around the world,” Brown said. “These constitute the fastest-growing Christian subgroups globally, with some 500 million adherents, and they are among those most likely to pray expectantly for healing.”

But there is another reason to study “proximal” prayer, which in this study meant physical laying on of hands, not just being near the subject. Studies of distant intercessory prayer have been essentially negative – we see the typical random scatter of results expected of an ineffective treatment, with no consistent pattern of positive results, and with the best studies being negative. A recent Cochrane review concluded:

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.

Interestingly, this review was sharply criticized for being wishy washy. The “positive” studies they included in their “equivocal” assessment had major flaws that were not discussed in the review. Most notably, they included a study described in the later criticism thusly:

We have not checked all ten included trials but noted that the largest one was published in BMJ’s Christmas issue. This trial seems to be meant to amuse rather than being a scientific study, in line with the tradition of this special issue, as the trial evaluated the effect of prayer taking place 4–10 years after the patients had either left the hospital alive, or had died from their bloodstream infection. Thus, the trial evaluated the effect of retroactive intercessory prayer using historical data and its author argued that we cannot assume “that God is limited by a linear time”. The authors of the Cochrane review did not mention anywhere in their review that the patients were randomised many years after their outcomes had occurred and did not discuss the likelihood that time can go backwards and that prayer can wake the dead.

Another review of the research concluded:

There is no scientifically discernable effect for IP as assessed in controlled studies. Given that the IP literature lacks a theoretical or theological base and has failed to produce significant findings in controlled trials, we recommend that further resources not be allocated to this line of research.

Bottom line – intercessory prayer does not work. Perhaps the studies are negative because they were properly blinded – it is easy to blind a subject to the fact that someone distant is praying for them. It is much more difficult to blind someone to the fact that someone is placing their hands over their eyes and asking God to heal them and banish any demons from them, over and over again until you tell them you are better.

I find that argument that a deity is better able to heal when the person asking them to do so is physically close to the person they are praying for absurd, lame, and convenient. It is a nice excuse to unblind the protocol, and nothing else –  a way of generating false-positive results.

The authors imply that improvements in sight and hearing are objective and cannot be explained by suggestion or hypnotism, but this is naive. Any visit to a faith healer’s performance clearly demonstrates the power of suggestion in a religious context. There is even good neuroscience to document this effect – belief in the healing power of a faith healer actually inhibited the critical thinking parts of the frontal lobes of the brain. This effect is tied to the perceived charisma of the healer. This might explain why the researchers had to go to rural Africa to find positive results – maybe they are just not charismatic enough to sway Western audiences.

I will also point out that hearing and vision are subjective – even when standard tests are used, subjective feedback from the subject is necessary. This allows for subjects to exaggerate their limitations prior to treatment and try hard to perform better after an intervention.


In my opinion this study represents a larger trend that I have discussed before – clinical research going backwards in quality after higher quality studies yield negative results. We have seen this with acupuncture – after well-controlled trials were negative, some proponents decided that “pragmatic” (i.e. unblinded) studies were better. We see this with homeopathy, where well-controlled studies are negative and then dismissed because treatments were not individualized.

Now we are seeing the same pattern with intercessory prayer. The research is clearly negative, so now some proponents are turning to “proximal” intercessory prayer, which just happens to require unblinding.

In the final analysis it is all an elaborate excuse to dismiss high quality negative studies in favor of low quality studies that are more likely to yield false positive results.

31 responses so far

31 thoughts on “Proximal Intercessory Prayer”

  1. On a recent Skeptoid, Brian Dunning discussed Hirsch Index and Impact factor, as metrics for peer reviewed journals. I was wondering if there is any similar metric that would help in assessing a study at first glance, I mean you can quickly look at the number of participants and sometimes it’s obvious how the study was or wasn’t blinded, but it almost seems like a 1-5 ranking site like politifact might be helpful in categorizing the general quality of studies. I know some people will chastise me for not always going to the source material, but aside from the 1 to 2 studies a day I find most interesting, I just don’t have time to investigate every single one thoroughly.

  2. HHC says:

    I prefer Dr. Dosa’s approach used in “Making Rounds With Oscar”. Regarding the usefulness of prayer, he quipped “God takes a message and he’ll get back to you.”

  3. Eric Thomson says:

    If they had grown new limbs I’d be impressed.

  4. Watcher says:

    We don’t need no stinkin’ laying of hands. I can do it with a jacket 😛

  5. bluedevilRA says:

    Is Southern Medical Journal a very legit journal? I can’t help but notice they also published a poorly done study from 1988 by Byrd et al.

    I tackled intercessory prayer also and I agree that most of the “positive” studies are small and horribly constructed. The large, controlled trials have pretty consistently come up negative.

  6. I recently commented (on SMB, I think) that if the words “In my experience…” are the three most dangerous words in medicine, then the words “One study showed…” probably aren’t too far behind.

    On another note: I am confused by the concept of a deity that will dole out healing to an individual based upon whether or not one or more other people request it to do so. Does the deity not know the person needs help unless someone tell it?

  7. SteveN says:

    It occurs to me that one way to have a controlled study blinded with regard to the subjects at least would be to have priests carry out proximal intercessory prayer on one group and to have actors carry out ‘sham’ PIP (reciting Shakespeare, perhaps?) on another group, both in a language not understood by the subjects. The outcome could then be evaluated by someone unaware of the group allocations.

  8. SARA says:

    I would think that most religions would have ethical problems with a double blind study and control groups. If someone asks for prayer and doesn’t get it, from their point of view that would be morally very bad. So ultimately, the catch 22 will protect their position that intercessory prayer works.

    On the subject of the rating system, I agree wholeheartedly that a rating system would have great benefits.
    a. It would make reliability an easy factor for the layman to understand.
    b. It would motivate the researchers to step up to the plate if they want their research to be publicized. Ultimately if you have a bad rating, Time Magazine won’t publish your results.
    c. Because Bad Ratings would make the results less believable, the media would be less likely to publish them as a result we would have fewer problems of scientific misconceptions.

  9. bluedevilRA says:

    Karl, one of the SBM bloggers said something regarding single studies. It went more or less like this: one study can be prospective and interesting but does not amount to much as evidence. Two studies is when he starts to take notice. And it takes at least 3 or 4 well done studies from different sources before he is ready to consider a change in scientific/clinical thinking.

    SteveN, that is a brilliant idea. I would suggest not using related languages (like Romance languages) because generally people know a few words, such as God, Jesus, etc., from neighboring countries/languages.

  10. bluedevilRA says:

    Hi SARA, you’d be surprised about people signing up for a controlled study where they might get no prayer. Both of these studies involved no prayer groups:

    They are the MANTRA II and STEP studies, if the links don’t work. Patients were randomized into prayer and no prayer groups. It didn’t mean that they couldn’t pray for themselves (can’t really prevent that) nor could they stop other people for praying for them. It just meant that the prayer group had a dedicated group of some unrelated people to pray for them.

  11. CivilUnrest says:

    I don’t really understand why the religious folks are interested in this line of research in the first place. If a god is super powerful and very secretive, it sure as hell isn’t going to get outed by some little study!

    Furthermore, I thought the whole point of faith was to believe in something that you CAN’T PROVE. As soon as a scientific study uncovers a miracle…doesn’t that really defeat the whole purpose of religion?

    Finally, what are they hoping to achieve by “proving” that prayer works? A medicare reimbursement? I don’t think anyone (especially a god) will look kindly on prayer-for-hire….

  12. @CivilUnrest
    Two reason the religous folks are interested:

    1 They’d love to have “proof” to throw out that we’re wrong.

    2 They’d love to get insurance companies to compensate for prayer related activities: rental of halls to pray in, rosaries, prayer shawls, candles, etc.

    Further, why couldn’t a church be compensated by an insurance company for providing prayer service for healing? Nobody said the prayer had to be purely altruistic in nature to work.

    I don’t think this is terribly far fetched.

  13. TheRedQueen says:

    @Karl Withakay and Civil Unrest

    The Affordable Care Act of 2010 originally contained a provision mandating that health insurance reimburse for “prayer”. Fortunately
    that provision was stripped out in committee.

  14. @CivilUnrest & Karl Withakay:

    You can’t think of religious people as a monolithic group who are entirely unshakable in their beliefs. Many of them are quite moderate, and some of them are, in fact, scientists. Most people with religious beliefs find no contradiction in also following empirical evidence, at least up until the point at which it directly challenges their belief system. And some (including myself before I left the church) can be swayed by evidence.

    But I don’t think that studying the effects (or lack thereof) of prayer, at least initially, should be thought of as only being in the interest of the religious. It is a legitimate scientific question, and anyone with an inquisitive mind should be interested in finding out if, in fact, there is something to the perceived phenomenon.

    That said, there is one qualification: once it has been adequately demonstrated that there is no effect (as I think it now has), the time, money and effort put into research should taper or end altogether.

    That’s also where the “true believers” feel they have to push back. As Dr. Novella mentioned, the trend has moved in the same direction as with acupuncture and homeopathy, where instead of accepting the rigorous research, poorly constructed studies are conducted to “counter” the results the results of real science.

    This is perfectly within the religious missionary’s interest. He/she recognizes that although those of moderate religious leanings generally believe what they hear about science, most do not have the ability to understand the nuances of research design or the cumulative nature of scientific evidence.

    A poor study is just as worthwhile as a good one in most peoples’ eyes. So if the high-quality research reflects negatively on your theology, it makes complete sense to retreat into low-quality research that reinforces your beliefs, then selectively present it to your flock. To most of them that’ll be good enough to keep them in the fold a while longer without too much doubt.

  15. eiskrystal says:

    -I don’t think anyone (especially a god) will look kindly on prayer-for-hire….-

    I can guarantee, someone is taking donations for this right now.

    Just a small donation of course.

  16. sonic says:

    1) The notion of a ratings system is interesting- the devil is in the details on that. Any specifics?
    2) There aren’t many perfect studies, but means of blinding (like earlier suggested from SteveN) can often be effective even in a situation as difficult as this.
    3) I don’t know how the deity works. I don’t know how the deity is supposed to act. I’m not sure that the nature of the creator of logic will be revealed by an exercise in logic.
    4) Sorry about that last…

  17. urodovic says:

    The Journal of Negative Results in Biomedicine?

    Here are the Peer Reviewers options for acceptance of manuscript:

    # Peer reviewers will have four possible options, for each article:

    * accept without revision
    * accept after revision without expecting to check those revisions
    * neither accept nor reject until author(s) make revisions
    * resubmit or reject because scientifically unsound.

    The last one at least gives me some hope…;-0

  18. elmer mccurdy says:

    First of all, a general comment: I think it’s important to distinguish between the goals of a research scientist (i.e. to contribute to the development of scientific knowledge) and the job of a working medical practitioner (i.e. to contribute to his patients’ health – of which the experience of pain is an important aspect).

    This particular post is directly concerned with the interests of the scientist, but this is not true of all the content on this blog, and at times I feel that these two different goals get conflated here (I myself am overwhelmingly interested in immediate practical concerns).

    I read the intended implications of this post as the following:

    a. Here is a treatment that all the readers will agree is absurd.

    b. Here are the deficiencies in the research.

    c. Therefore, any treatment for which the research displays these sorts of defficiencies is equivalent to this absurd treatment. In fact, “It really doesn’t matter what the treatment is or how plausible it is.”

    As an example of why this is a problem, let’s look at the Feldenkrais method (which was recommended to me for my chronic pain by a doctor some years ago). It is a method for teaching students to move with minimal pain. This is achieved by increasing body awareness – the more aware you are of the senations coming from your body, the more accurate your body image will be, and the better you will be able to control your movements. This is hard to explain through generalizations and abstractions, but much of the language reminds me of the sort of thing that my old sax teacher used to use in order to help me better coordinate my movements and breathing, albeit with very different goals.

    It is not, in other words, a “treatment,” in the sense of a pill or a strengthening exercise, and the emphasis on consciousness and control makes a double blind placebo controlled study out of the question. It also has little institutional support for research. The typical Feldenkrais teacher practices as an avocation, having first become interested for the benefit of his own health.

    I could go on (again, I’m partially responding to an older post that irked me, and resisting the temptation to digress with a point-by-point discussion of the post), but, unfortunately, pain, as opposed to, say, cancer, appears (from my vantage point as a pain sufferer) to be particularly responsive to the sort of hands-on protocols that don’t lend themselves to the preferred type of studies. The result of casually dismissing such tools on this basis can be a bias toward either a) easily placebo-controlled treatments such as pills or b) diagnostic methods and treatments that have the benefit of tradition behind them, regardless of the quality of research.

    None of which should be misconstrued as a defense of prayer therapy, homeopathy, etc. They are implausible, after all. It makes a difference.

  19. @elmer mccurdy:

    I’m not sure what specific points you’re responding to, so I hesitate to respond with many specifics of my own. The one thing I will mention is that there are research methods that can compare the efficacy of one treatment – even the kind you mention – with another. Most of these methods don’t meet quite the same standard as clinical RCTs, but they can at least remove some of the confounding variables and offer insight into a treatment’s or program’s relative worth.

    I agree with you that the plausibility makes a difference, too.

  20. Wholly Guacamole says:

    I am really bothered by the fact that I have have seen the results of this “study” reported in several newspapers with headlines like “Prayer for Healing Works at Close Range” (this was in the Chicago Tribune) as if this had been a legitimate study. Many people are very busy and only skim the headlines, since they don’t have time to read many articles in depth, so many, many people are being given a false impression. But perhaps that’s exactly what this religion professor was hoping for …

  21. Calli Arcale says:

    There’s gotta be a way to blind it. Pray to a deity who was invented on the spot, perhaps? Trouble is, as with stuff like reiki or acupuncture, if the blinded version appears to work, they’ll just say “oh, it works even then!” or, more particularly to the case of intercessory prayer, “God read their intent even if it wasn’t stated properly!”

    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.

  22. BillyJoe7 says:

    “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.

  23. @BillyJoe7:

    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” –

    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.

  24. John2 says:

    Brandon, your assertion is completely against my memory of what the research says. I seem to recall that intercessory prayer had a negative effect on health outcomes, and that the suggested mechanism was that stress associated with knowing that people’s expectations were resting on your health made things worse.

    Actually, after a little googling, I found this,

    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.

  25. I wasn’t equating it to prayer – I was pointing out that there is reason to suppose that the feeling of being supported by one’s social group often leads to more positive attitudes, and that those positive attitudes may in turn be associated with better health outcomes. That support may not come in the form of prayer – it can come in a variety of forms, as in the “box of chocolates” that Calli Arcale mentioned.

    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.

  26. Calli Arcale says:


    “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.

  27. Calli Arcale says:

    Brandon T. Bisceglia:

    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.

  28. Calli Arcale:

    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.

  29. ccbowers says:

    “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.”

    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

  30. Hi, ccbowers:

    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.”

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