The day of publication of the July 1988 issue of the Southern Medical
Journal must have been one Hell of a busy news day, literally. Apparently
none of the major media in the world could manage to find room to include
this little item: a scientific study, published that day in that journal,
indicates that God exists, and that he had interceded in the recovery of a
group of coronary care unit patients! Both Paul Harvey and Charles Osgood
publicized this study in their radio commentaries in early 1989, so
despite the delay, word of this startling development has by now reached
the heartland of America.
In his article
entitled "Positive Therapeutic Effects of Intercessory
Prayer in a Coronary Care Unit Population," Randolph C. Byrd, M.D., a San
Francisco cardiologist, endeavored to answer these questions: (1) Does
intercessory prayer (IP) to the Judeo-Christian God have any effect on a
CCU patient's medical condition and recovery? (2) How are these effects
manifested, if present?
The study took place between August 1982 and May 1983, when 393 patients
signed informed consent papers upon admission to the San Francisco General
Hospital CCU, and were entered into a prospective, double-blind,
randomized study. (The remaining fifty-seven patients admitted during this
period cited various reasons for refusing to participate.) A
computer-generated list randomly assigned patients to either the IP or the
control group, and neither they, nor the CCU doctors and staff, nor
Randolph Byrd were aware of which patients were assigned to which group.
Intercessors chosen to pray for the IP-group patients were "'born again'
Christians (according to the Gospel of John 3:3) with an active Christian
life as manifested by daily devotional prayer and active Christian
fellowship with a local church." Each IP patient "was assigned to three to
seven intercessors. . . . The [IP] was done outside of the hospital daily
until the patient was discharged . . . each intercessor was asked to pray
daily for a rapid recovery and for prevention of complications and death."
The IP group consisted of 192 patients, and the control group of 201.
Analyses revealed no significant statistical differences between the
health of the two groups upon admission. "Thus it was concluded that the
two groups were statistically inseparable and that results from the
analysis of the effects of [IP] would be valid." The mean age of the IP
patients was two years younger than that of the control patients, a
difference deemed statistically insignificant.
Each patient's hospital course was given a severity score of "good,"
"intermediate," or "bad," based upon the degree of morbidity experienced
by the patient. In addition, twenty-six categories of "New Problems,
Diagnoses, and Therapeutic Events After Entry" were measured, and tested
for statistical significance between the groups. These included such
things as congestive heart failure, diuretics, hypotension,
intubation/ventilation, pneumonia, and so on.
The results of the study, as reported by Byrd, employing "multivariant
[sic] analysis of the data using [these twenty-six] variables . . .
revealed a significant difference (P less than .0001) between the two
groups based on events that occurred after entry into the study. Fewer
patients in the prayer group required ventilatory support, antibiotics, or
diuretics." (1) In addition, using the "good/intermediate/bad" severity
score, "A bad hospital course was observed in 14% of the prayer group vs.
22% of the controls. . . .chi-square analysis of these data gave a P
value of less than .01" (that is, a less than 1 percent probability that
chance alone could account for the difference).
In his introductory abstract, which was also reproduced in the "Domestic
Abstracts" section of the Journal of the American Medical Association on
January 20, 1989, Byrd concludes that the "data suggest that [IP] . . .
has a beneficial therapeutic effect in patients admitted to a CCU." In the
final paragraph of his article, Byrd says, "Based on these data there
seemed to be an effect [from IP], and that effect was presumed to be
beneficial" (emphasis added).
But what are those of lesser faith -- or of other faiths -- to make of
this miraculous claim for the efficacy of prayer? Has the Judeo-Christian
God been shown to exist, and to intervene in the hospital course of
patients?
The most striking flaw in this study's methodology is one forthrightly
acknowledged by Byrd. "It was assumed that some of the patients in both
groups would be prayed for by people not associated with the study; this
was not controlled for. . . . Therefore, 'pure' groups were not attained
in this study." In other words, the focus of the study -- prayer -- was "not
controlled for," except that three to seven intercessors were assigned to
pray daily for each patient in the IP group, and none was assigned to the
controls. Thus, although unlikely, it is nevertheless theoretically
possible that the control group received as many prayers as did the IP
group, if not more.
If "intercessory prayer" was not controlled, except that each IP patient
was assumed to have received somewhere between X+3 and X+7 prayers daily,
as opposed to X+0 for the control patients, what are we to conclude? That
God is conditioned in a Pavlovian manner to automatically respond to the
side with the greater number of troops, even though the assigned
intercessors had no emotional ties to their patients, and even though the
IP patients were otherwise no more worthy of healing as a group than were
the controls? Does God not know that the side with fewer troops is in just
as much need of assistance? Where is the evidence of his omnicience and
compassion?
And what can be said about the evidence for God's omnipotence? It is
true, assuming that Byrd's data are valid, that in the IP group, 5 percent
fewer patients needed diuretics, 7 percent fewer needed antibiotics, 6
percent fewer needed respiratory intubation and/or ventilation, 6 percent
fewer developed congestive heart failure, 5 percent fewer developed
pneumonia, and 5 percent fewer suffered cardiopulmonary arrest. But no
significant differences were found among the other twenty categories,
including mortality, despite explicit prayers "for prevention of . . .
death." And, reports Byrd, "Even though for [the six seemingly
significant] variables the P values were less than .05, they could not be
considered statistically significant because of the large number of
variables examined. I used two methods to overcome this statistical
limitation . . . [the] severity score, and multivariant [sic] analysis"
(emphasis added).
But was this lack of significance truly "overcome"? One must note the
interrelationships among these six categories: for instance, the
development of congestive heart failure automatically leads to the need
for diuretics; the development of pneumonia automatically requires the use
of antibiotics; and the development of either would likely increase the
risk of developing the other, of requiring intubation or ventilation, and
of suffering cardiopulmonary arrest. Thus, the development of any single
complication may automatically lead to a cascade of other complications
and therapeutic interventions that cannot be considered independent
events, rendering the significance of Byrd's data highly doubtful.
In addition to the twenty-six categories previously described, three
further variables were tracked during the study and tested for
significance: "Days in CCU after entry," "Days in hospital after entry,"
and "Number of discharge medications." No significant differences
between the prayer and control groups were found, despite explicit prayers
for "a rapid recovery." Are we thus to conclude from all of the data
derived in this study that although God may reflexively respond to the
will of the majority, his manifestations are so marginal as to approach
insignificance?
Consider a hypothetical study (containing similarly flawed methodology)
allegedly demonstrating the beneficial effects of reading periodicals on
the course of CCU patients: Patients in the test group are given anywhere
from three to seven periodicals daily by people associated with the study;
patients in the control group are given none. (OK so far.) Patients in
both groups are allowed to have family and friends bring them periodicals,
in a manner "not controlled for." Differences of several percent in six
interrelated categories are noted (comparable to the "significance" of
Byrd's data), with no significance found in twenty-three other variables
measured. I cannot imagine such an article surviving the rigorous
screening process of any authoritative medical journal.
The religious nature of Byrd's hypothesis may have been the attraction
for the Southern Medical Journal, which is published in Birmingham,
Alabama, in the heart of the Bible Belt. I assumed that the five-year gap
between his study's conclusion (1983), and its publication indicates that
a number of other journals had been approached prior to SMJ, but had
failed to appreciate the historic nature of Byrd's alleged findings. Byrd
graciously responded to my inquiry on this point, informing me that he had
received two prior rejections, which he called "the academic average."
Perhaps the other two journals subscribe to the generally accepted axiom
of science that extraordinary claims (particularly miraculous ones)
require proportionately extraordinary proof. This is not to say that
studies purporting to demonstrate evidence of supernatural events ought
not to be published, as long as a journal's minimum standards of
acceptability are met. Nature has published several such studies, but has
historically accompanied them with statements expressing editorial
reservations. (2) In contrast, Byrd's SMJ article was accompanied by a
"Commentary" entitled "Religion in Healing," whose author
says, "The paper by Dr. Byrd answers a question that has long been
asked: Does prayer make a difference? His data say that it does." (3)
Three previous scientific/medical studies on the efficacy of prayer were
briefly reviewed in Byrd's paper. We are informed that Galton's 1872
article, one of the first on record, on "the effects of prayer in the
clergy, found no salutory effects." (4) In Joyce and Welldon's 1965 study
of rheumatics, the prayer group fared better in the first half, "but in
the second half the control group did better" (emphasis added). (5) And
in 1969, Collipp's findings regarding prayer and leukemia "did not reach
significance." (6)
Byrd obviously believes that his study has succeeded where others have
failed. But are the data obtained in his study -- in which prayer was
admittedly "not controlled for" -- sufficient to suggest the existence of
the omnicient, omnipotent Judeo-Christian God, and the efficacy of
intercessory prayer on CCU patients? Or is it much more likely that what
we have here is akin to the findings of the Shroud of Turin Research
Project (STURP), in which scientists blinded by faith concluded,
erroneously, that the shroud was authentic? In his report, Byrd notes that
"How God acted in this situation is unknown." But I suspect it was with
smoke and mirrors.
Notes:
(1) The correct term is "multivariate." (2) See, for instance, Targ and Puthoff's paper on "remote viewing,"
251:602-7, 1974, and Benveniste et al. on "high dilution," 333:816-818,
1988. (3) The author of the commentary also cited several books and articles
that have reported positive effects of faith and personal prayer (as
distinguished from intercessory prayer) upon conditions that clearly have
large psychosomatic components. Also appearing in the same issue was a
study of the beneficial effects of faith in dealing with stress of
traumatic injury. (4) Galton, F. "Statistical inquiries into the efficacy of prayer,"
Fortnightly Review, 12:125-135, 1872. (5) Joyce, C.R.B., and R.M.C. Welldon "The efficacy of prayer: A
double-blind clinical trial," Journal of Chronic Disease, 18:367-377,
1965. (6) Collipp, P.J. "The efficacy of prayer: A triple blind study," Medical
Times, 97:201-204, 1969.
Return to Posner's Medically Related Articles Page
Return to Posner's Prayer-Related Articles Page
Listen to my 35-minute presentation on prayer and healing at a national conference
in 2001, in which this study was one of my principal topics