Tuesday, November 3, 2009

Should Health Insurance Pay for Prayers for Healing?

If the Los Angeles Times is to be believed, the Senate health reform bill requires insurers to consider covering prayer "treatments" as medical expenses. The provision was inserted by Senator Hatch from Utah, with support from my own two Senators - Kennedy and Kerry! The Christian Science Church, which has substantial wealth, is based in Massachusetts. This probably explains why two ordinarily thoughtful liberal Senators supported such an absurdity.

In my clinical practice I often encouraged patients to use prayer as part of their "management strategy" for handling their conditions. And when patients with serious ailments asked me to remember them in my prayers I said I would, even though I do not do petitionary prayer. (I generally interpreted the request to be about concern for their well being and commitment to them, which is why I felt comfortable saying "yes" to the request.) But when prayer for patients by others has been subjected to experimental study it has not been effective. Mandating ineffective treatments is exactly what legislatures should not do.

The article quotes Erwin Chemerinsky, dean of the UC Irvine School of Law, as saying the provision raises serious questions about government support of religion: "I think when Congress mandates that health companies provide coverage for prayer, it has the effect of the government advancing religion." I disagree.

If prayer were shown to be effective in curing disease (and it hasn't been) it would seem just as reasonable for insurance to cover it as to cover acupuncture or hypnosis. For insurers to say "we will cover Christian prayer, but not Muslim prayer" or vice versa, would appear to be government endorsement of a particular religion. But endorsing a practice (prayer) doesn't require endorsing a belief (in a supreme being).

The reason for opposing the provision for covering prayer under insurance is that interventions that have been tested and found to be ineffective should not be paid for by communal funds. That should be a no-brainer in a rationally governed health system. But rational governance is not a covered benefit in the U.S. health "system"!


JohnLloydScharf said...

If health care is the problem, insurance is not the cause and government is not the answer.

Of those "50 million," that lack insurance there were 45,000 who died without health care.

WITH health care, 98,000 died FROM health care because of malpractice.

The question is do we want to trust that largest corporation in the world, the U.S. Government. Do not expect house calls anytime soon.

We have seen how well the government delivers on its promises and its bureaucracies pursue the money without giving us benefits on so many levels
Imagine another 111 bureacracies that only ultimately must listen to the Secretary of the Treasury - another "service" of which is the IRS.


That blog of mine above has several .pdf connections (HR. 3962 and two summaries, a few videos, and page references for new taxes and other mandates).

If you cannot use the link, google "Progressive Capitalist H.R. 3962."

If you believe the promises of this bill, you have to deal with the lie that it fosters competition with a government option called the "Public Option" and establishes the government as a monopoly making its own rules.
Don't worry. You'll run out of "rich" soon enough.

We have at least a $12 trillion economy of which at least $1.8 trillion is spent on health care.
If you read the bill, there are plenty of opportunities to soak the middle class, if you do not mind the 1.6 million made jobless.

REPUBLICAN Affordable Health Care For America Act
MAKING HEALTH Care Affordable For EVERY AmeriCAN


eric said...

Herbert Benson's spirituality and medicine conference included a discussion of intercessory prayer some years ago. The discussant posed the question, "If G-d could be proven with a randomized trial, what would that do to our belief in G-d?" He cited a randomized study which did show the effectiveness of intercessory prayer by complete strangers for hospitalized patients. The G-d that I believe in is bigger than a randomized study could "prove." My God is in another and more important realm. God may say as the poet said, don't tell me why you love me, as those reasons may disappear; love me for myself.
Moreover, the concept of paying for prayer is loathsome. Religious groups may pay for institutions in which to pray, and ritual objects to use in prayer. Holding a hand out for payment for prayer is the worst sort of begging. The prayers that my G-d listens to come from the heart.

Jim Sabin said...

Hi John and Eric -

Thank you for your comments!

John, the concerns you express about government are widespread, and are a major source of opposition to more government involvement in health care, whether through a public option or, more ambitiously, a single payer insurance program. My concern about the government is whether we have the stomach to set the needed expenditure limits. Medicare has been very successful in making lots of important and valuable treatment available to seniors. But it's been a flop at containing expenditures.

Eric - the only studies I'm familiar with have not shown a correlation between prayer by strangers and clinical improvement. And I agree with you that paying for prayer is not compatible with a sense that prayer comes from the heart.

It's an interesting thought experiment to consider how insurers should respond if it were proven that prayer by "prayer specialists" correlated with clinical improvement. There are many treatments which clinicians administer and insurers cover for which we have no understanding of the mechanism of effectiveness. In principle a case could be made that insurance should pay for the "prayer treatments." I have zero expectation that a correlation of this kind will be discovered. But reflecting whether an effective intervention of that kind should be covered and the rationale for our answer would be revealing about our presuppositions about what constitutes "real health care."



dcapurro said...

Hi Jim,

There is a study published by the British Medical Journal on 2001. This was a randomized controlled trial to test the effects of remote, retroactive intercessory prayer in patients with bloodstream infections. The study did not show differences in mortality but did show a decreased length of stay and decreased duration of fever. http://www.bmj.com/cgi/content/abstract/323/7327/1450



Jim Sabin said...

Hi Daniel -

Thank you for bringing the 2001 BMJ piece to my attention. It prompted me to look up the article and to nose around the web at bit.

In the 2001 study, prayer was done 4 - 10 years after patients had been at the hospital with bloodstream infections! I found a number of comments on the article. A 2008 article - "The need to reform our assessment of evidence from clinical trials" - had this especially interesting comment:

"...most, perhaps all, reasonable clinicians would reject the findings of a randomized trial of retroactive intercessory prayer compared with usual care showing a statistically significant decrease in the duration of hospital stay in patients with septicemia. Such a study completely lacks biological plausibility, along with rejecting the tenets of temporality and coherence. On the other hand, perhaps fewer physicians would have rejected the findings of the first interim analysis of the AML UK MRC study of 5 courses of chemotherapy compared to 4, where the investigators showed a 53% decrease in the odds of death. Yet the data safety and monitoring committee decided to continue the trial because these initial findings were considered too large to be clinically possible, and lacked biological plausibility and coherence. Accordingly, the committee recommended the trial be continued and the final results (no difference between the two therapies) vindicated this apparent chance finding at interim analysis. These examples both afford an opportunity to highlight how the results of randomized trials can be influenced by chance statistical findings, however improbable, and further deviate from the current and recognized knowledge of the day..."

The authors understand that some aberrant findings represent statistical artificats but others represent important (and real) new findings. It's not easy to make the distinction!

During my first year of college I was reading - with interest - a book on mysticism and meditation. I did some of the exercises. Then the author said I would soon notice that I was able to see through solid objects. To me this lacked "biological plausibility," and I stopped reading the book and doing the exercises.

Some years later I thought - "suppose I had continued...maybe I would have developed X-ray vision!"

In the semester-long required course in medical ethics at Harvard Medical School we have the students choose the topic for one of the seminar sessions. I'm going to suggest the issue you raised as a possibility.