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Spiritual Healing: More Than Meets the Eye

      To the Editor:
      Spiritual healing, sometimes also called intercessory prayer or distant, faith or psychic healing, is an intriguing subject. It is immensely popular: in the UK, for instance, there are currently about 14,000 registered spiritual healers (about half the number of primary care physicians!) and in the United States, faith healing is among the fastest growing “alternative” treatments.
      • Eisenberg D.
      • David R.B.
      • Ettner S.L.
      • et al.
      Trends in alternative medicine use in the United States; 1990-1997.
      At the same time, it is one of the most implausible of all therapeutic methods. Healers believe that they channel “energy” into their client's body, which, in turn, promotes healing. Some healers claim that the “energy” is divine. There are, of course, numerous problems with this concept. For instance the healing “energy” seems to defy qualification, and even if it existed, it is unclear how nonspecific “energy” can enhance specific self-healing processes within the body.
      Not surprisingly then, the clinical evidence does not suggest that spiritual healing is an effective means of symptom management. A systematic review of 23 randomized clinical trials (RCTs) of spiritual healing for any type of condition initially documented that the majority of these studies were positive but stated that “the methodological limitations of several studies make it difficult to draw definitive conclusions.”
      • Astin J.A.
      • Harkness E.F.
      • Ernst E.
      The efficacy of “distant healing”: a systematic review of randomized trials.
      An update of this systematic review found 17 further studies, including 9 RCTs, and concluded that “the majority of the rigorous trials do not support the hypothesis that distant healing has specific therapeutic effects.”
      • Ernst E.
      Distant healing—an “update” of a systematic review.
      Recent studies have been more rigorous and failed to demonstrate significant effects.
      • Krucoff M.W.
      • Crater S.W.
      • Gallup D.
      • et al.
      Music, imagery, touch, and prayer as adjuncts to interventional cardiac care: the Monitoring and Actualisation of Noetic Trainings (MANTRA) II randomised study.
      • Cleland J.A.
      • Price D.B.
      • Lee A.J.
      • Gerard S.
      • Sharma A.
      A pragmatic, three-arm randomised controlled trial of spiritual healing for asthma in primary care.
      • Lyvers M.
      • Barling N.
      • Harding-Clark J.
      Effect of belief in “psychic healing” on self-reported pain in chronic pain sufferers.
      In one such trial,
      • Benson H.
      • Dusek J.A.
      • Sherwood J.B.
      • et al.
      Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer.
      patients certain of receiving intercessory prayer experienced a higher complication rate after bypass surgery.
      Regardless of the increasingly negative evidence, healing continues to be promoted. Several UK government-sponsored documents published by the Prince of Wales's Foundation for Integrated Health support spiritual healing:

      Thomson A. A healthy partnership, integrating complementary healthcare into primary care. The Prince of Wales's Foundation for Integrated Healthcare, London, UK 2000.

      Pinder M. ed. Complementary healthcare: A guide for patients. The Prince of Wale's Foundation for Integrated Healthcare, London, UK 2006

      Department of Health UK. Complementary medicine, information pack for primary care groups, Richmond House, Whitehall, London, UK 2000.

      “The laying on of hands is used for a wide variety of conditions, including reducing side-effects of chemotherapy and radiotherapy for people with cancer.”

      Pinder M. ed. Complementary healthcare: A guide for patients. The Prince of Wale's Foundation for Integrated Healthcare, London, UK 2006

      There is a multitude of reasons why such promotion could be detrimental to patients and health care systems.
      • Ernst E.
      Complementary treatment: who cares how it works, as long as it does?.
      Healing can be expensive and might divert patients from effective treatments. If it helps some patients through the power of belief, we should remember that treatments that are effective beyond placebo also come with the “free bonus” of a placebo response—we do not need a placebo treatment for generating a placebo response. Most important, spiritual healing might promote the belief in a supernatural healing “energy,” which undermines rationality in general. In turn, this has the potential to boost pseudoscience, creationism, or worse.
      • Ernst E.
      Complementary treatment: who cares how it works, as long as it does?.
      But there is more—recent reports have raised serious concerns about the validity of some of the primary data on spiritual healing. In several cases, the published evidence seems to be less than reliable. One trial reporting positive effects of healing in acquired immune deficiency syndrome patients
      • Sicher F.
      • Targ E.
      • Moore D.
      • Smith H.S.
      A randomized double-blind study of the effect of distant healing in a population with advanced AIDS Report of a small scale study.
      has come under suspicion. When its primary findings failed to generate a positive result, the impression of a positive result was apparently created through “data dredging,” a fact which was not disclosed in the original article.

      Bronson P. A prayer before dying. Wired Magazine, December, 2002.

      More serious concerns have arisen relating to an entire series of trials. Daniel P. Wirth has authored at least 20 healing studies,
      • Solfvin J.
      • Leskowitz E.
      • Benor D.J.
      Questions concerning the scientific credibility of wound healing studies authored by Daniel P. Wirth.
      more than any other researcher in this field. We and others have repeatedly attempted to contact Wirth—invariably without success. An “absence of adequate documentation that the healing studies took place as described” was recently noted in relation to Wirth's research by his former supervisor.
      • Solfvin J.
      • Leskowitz E.
      • Benor D.J.
      Questions concerning the work of Daniel P. Wirth.
      Moreover “numerous unanswered questions regarding the actual nature of the listed co-authors' involvement in these studies” and “the possibility that these foundational studies are without scientific basis” were noted.
      • Solfvin J.
      • Leskowitz E.
      • Benor D.J.
      Questions concerning the work of Daniel P. Wirth.
      Meanwhile, Wirth has been convicted of an unrelated crime; in 2004 he pleaded guilty to mail and bank fraud.
      • Solfvin J.
      • Leskowitz E.
      • Benor D.J.
      Questions concerning the work of Daniel P. Wirth.
      Wirth's coauthor and long-time collaborator (J.S. Horvath) was charged in relation to his research for practicing medicine without a license and convicted of identity theft and other crimes.
      • Solfvin J.
      • Leskowitz E.
      • Benor D.J.
      Questions concerning the scientific credibility of wound healing studies authored by Daniel P. Wirth.
      Solfvin et al. described in detail how some of Wirth's and Horvath's activities imply that at least some of these data are fabricated.
      • Solfvin J.
      • Leskowitz E.
      • Benor D.J.
      Questions concerning the scientific credibility of wound healing studies authored by Daniel P. Wirth.
      The results of a multicenter healing study (Wirth acted as its second author) have recently suggested that distant healing increases the success rate of fertility treatment.
      • Cha K.Y.
      • Wirth D.P.
      • Lobo R.A.
      Does prayer influence the success of in vitro fertilization—embryo transfer?.
      This trial is now suspected to be the product of scientific misconduct.

      Carey B. Can prayer heal? New York Times, December 10, 2004.

      Jaroff L. More questions on healing prayer. Time, December 10, 2004.

      One of its authors (R.A. Lobo) withdrew his name after the article was published.
      • Solfvin J.
      • Leskowitz E.
      • Benor D.J.
      Questions concerning the scientific credibility of wound healing studies authored by Daniel P. Wirth.
      So far, none of the journals that published Wirth's research has withdrawn his articles,
      • Van Haselen R.
      Misconduct in CAM research: does it occur?.
      and the affair has been called “a major scandal in the history of science.”
      Spiritual healing continues to be promoted despite the absence of biological plausibility or convincing clinical evidence, and the presence of considerable risks. Several apparently positive studies have come under suspicion. Given these circumstances, it seems time to turn a page and state clearly that there is no good evidence to show that these methods work therapeutically and plenty to demonstrate that they do not.

      References

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        Wien Klin Wochenschr. 2003; 115: 241-245
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        • Crater S.W.
        • Gallup D.
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        Lancet. 2005; 366: 211-217
        • Cleland J.A.
        • Price D.B.
        • Lee A.J.
        • Gerard S.
        • Sharma A.
        A pragmatic, three-arm randomised controlled trial of spiritual healing for asthma in primary care.
        Br J Gen Pract. 2006; 56: 444-449
        • Lyvers M.
        • Barling N.
        • Harding-Clark J.
        Effect of belief in “psychic healing” on self-reported pain in chronic pain sufferers.
        J Psychosom Res. 2006; 60: 59-91
        • Benson H.
        • Dusek J.A.
        • Sherwood J.B.
        • et al.
        Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer.
        Am Heart J. 2006; 151: 934-942
      1. Thomson A. A healthy partnership, integrating complementary healthcare into primary care. The Prince of Wales's Foundation for Integrated Healthcare, London, UK 2000.

      2. Pinder M. ed. Complementary healthcare: A guide for patients. The Prince of Wale's Foundation for Integrated Healthcare, London, UK 2006

      3. Department of Health UK. Complementary medicine, information pack for primary care groups, Richmond House, Whitehall, London, UK 2000.

        • Ernst E.
        Complementary treatment: who cares how it works, as long as it does?.
        Lancet Oncol. 2005; 6: 131-132
        • Sicher F.
        • Targ E.
        • Moore D.
        • Smith H.S.
        A randomized double-blind study of the effect of distant healing in a population with advanced AIDS Report of a small scale study.
        West J Med. 1998; 169: 356-363
      4. Bronson P. A prayer before dying. Wired Magazine, December, 2002.

        • Solfvin J.
        • Leskowitz E.
        • Benor D.J.
        Questions concerning the scientific credibility of wound healing studies authored by Daniel P. Wirth.
        (Available from) (Accessed February 8, 2006)
        • Solfvin J.
        • Leskowitz E.
        • Benor D.J.
        Questions concerning the work of Daniel P. Wirth.
        J Altern Complement Med. 2005; 11: 949-950
        • Cha K.Y.
        • Wirth D.P.
        • Lobo R.A.
        Does prayer influence the success of in vitro fertilization—embryo transfer?.
        J Reprod Med. 2001; 46: 781-787
      5. Carey B. Can prayer heal? New York Times, December 10, 2004.

      6. Jaroff L. More questions on healing prayer. Time, December 10, 2004.

        • Van Haselen R.
        Misconduct in CAM research: does it occur?.
        Compl Ther Med. 2006; 14: 89-90
        • Randi J.
        We repeat.
        (Available from) (Accessed April 4, 2006. Swift, the online newsletter of the James Randi Educational Foundation)