Richard Sloan: Medicine and Religion

We are now entering the last session in the Beyond Belief 2006 conference. Our first speaker is Richard Sloan. It is particularly fitting to have Sloan speak at this moment – after reading Dennett’s letters, since Sloan seeks to address the question, “Is religion good for your health?” Sloan wishes to argue that mixing medicine and religion is bad science, bad medicine, and bad religion.

Before getting into that, Sloan makes an interesting observation about the press dealing with the issue of religion and health.

I interviewed a number of journalists and actually startled to learn something that may be obvious to you that journalists and media conduct polls in just the way that politicians do and they want to determine what the issues are that will sell their product, and the biggest issue that sells the product is religion. The second biggest one is health and so there’s a very nice confluence of stories about religion and health for market purposes only.

I would like to add that this marketing, combined with the fact that people are more likely to buy something that tells people what they want to hear, means that there is market pressure in the press to promote the idea that religion benefits health independent of the idea having any merit. We live in a society that does not recognize that there is something morally problematic with misdirecting people (interfering with their ability to make rational choices concerning their own welfare) for the sake of money.

Sloan first tackled the subject of scientific investigation that purports to show that religion has a positive relationship on health. The main conclusion that one can draw from this presentation is that a great deal of the work done in this area represents bad science – or bad reporting.

For example, Sloan reports that he and a collegu, Emilia Bagiella, read the abstracts for all 266 papers that came up in a Medline search for articles dealing with religion published in the year 2000. They found that only 17 percent (45 papers) were relevant to the question of the health benefits of religion. The claim that there are thousands of papers covering the issue of medicine and religion is true, but most of those papers are irrelevant to the question of the health benefits of religion.

Of those that are relevant?

To answer this question, Sloan read all of the documents cited in two chapters of Harold Koenig's book Handbook of Religion and Health (those chapters dealing with cardiovascular disease and hypertension, which is Sloan’s area of medicine) to see how many of them were solid enough to ground claims about the health benefits of religion.

He found that only four papers out 89 were methodologically sound.

He gave an example of one of the papers which Koenig's Handbook claimed, “Meditation subjects had lower blood pressure at follow-up.” Sloan discovered that membership in each group was self-selected (students choose whether to be members of the control or study group), and members of the study group were cloistered in a Monestary where they had no activity other than walking a mile each day to receive food.

This was not a double-blind study and the study did not correct for possibly confounding influences (e.g., the fact that the members of the study group were not doing anything). Claiming that this study supported the idea that there were health effects of religion simply misrepresents the facts of the case.

A great many of the studies that are identified by proponents as supporting the claim that religious practices are good for the health suffer from significant methodological flaws like that. The failure to control for confounders and covariants, and . . . the failure to control for multiple comparisons.

This ‘failure to control for multiple comparisons’ is also known as ‘the sharpshooter’s fallacy’ – exemplified by a person who shoots a bullet at a wall then draw a bull’s eye around the bullet hole. The specific technique is to test for a long list of relationships at the same time. Inevitably, there will be some results far enough outside the statistical norm. The researcher then takes the one item and claims that this proves a relationship.

In the discussion that followed Sloan’s presentation, one person in the audience (who I could not identify) cited an article studying the effects of prayer on patients in a critical care unit. The paper reported that when the patient and the doctor were blinded as to whether the patient was being prayed for, the patient being prayed for had better outcomes.

In fact, this study measured a long list of potential outcomes such as total mortality and number of days in the critical care unit. The one area where the researchers found a benefit among those patients prayed for was the need for diuretics. This illustrates how, if you test for enough possible outcomes, simple random variation will give you one where you can claim to have discovered a benefit.

Another important question that came up in the discussion asked how all of these bad papers with flawed methodology (80 out of 89) ended up in published journals. This comes about because there are hundreds of journals having to do with medicine, and, as Sloan said, some journals were better than others.

A great deal of the papers that are supportive of the health benefits of religious practices are published in The International Journal of Psychiatry and Medicine. That is the 71st, according to the Institute for Scientific Information, the 71st most important psychiatry journal.

Reading this from the point of view of an ethicist, I have to ask, where is the condemnation that is deserved by people who do such poor work in a field as important as medicine?

This strikes me as another example of an issue that I have complained about in the past, where we have clear examples of intellectual recklessness, we explain what is wrong with the document, and yet we give the people who did the work a moral pass on their actions.

I have repeated the argument several times that intellectual recklessness has the same moral status as physical recklessness. A drunk driver is condemned because he shows such a low level of concern for the well-being of others that he feels free to take risks with their life, health, and well-being in driving a car. This is contemptible behavior, and we respond to it in a rational way. We use moral condemnation to promote desires that would reduce this carelessness, and even threaten criminal penalties against those who refuse to take reasonable care.

It is just as rational to demand reasonable care in what people say and write, particularly when they are saying and writing things that are used to determine medical practices. Now, we have a clear argument against using penalties against mere words. The benefits of freedom of speech tell us to limit the legitimate response to words with words and private actions. However, the condemnation and private actions against those who recklessly put our health at risk is mysteriously absent.

This ties in with a similar point that I tried to make in my recent essay on the moral nature of pornography. I pointed out how the issue of pornography was morally ambiguous (though a love of liberty argues for an assumption of legitimacy unless a case beyond a reasonable doubt, appealing to reasons for action that exist, can be made against it). However, in the discussion of the moral merits of pornography, we find a great deal of behavior that is not morally ambiguous. This is the morally objectionable behavior of those who use weak reasoning when discussing the moral quality of pornography.

On the issue of pornography, people claim that it an uncertain improvement in the quality of life in our society is sufficient reason to ban this type of content. Clearly, it would significantly improve the quality of life in our society if we could clear out – not the pornography, but the sloppy reasoning that appears in the discussion of pornography. We find equally sloppy thinking and writing, even in the 71st most important journal on the subject of psychiatry. In terms of its moral quality, this type of work should rightfully be considered as worse than pornography and its authors given a level of social standing below that of pornographers.

This is where our moral wrath should find its first target. Once we deal with the demagogues and sophists, then we can start to deal with questions of pornography and the effects of religious practices on medicine intelligently. Until that happens, it is foolish to expect decent people to wade in among all that filth and still have an intelligent conversation on the relevant subject matters.fs