Review by Connor P. Wood, 2009
Blind Faith: The Unholy Alliance of Religion and Medicine. By Richard P. Sloan. St. Martin’s Griffin, 2006. 295 pages. $15.95.
In the past two decades academic journals in a variety of disciplines have published a veritable explosion of articles and studies relating to the intersection of religion, spirituality and health. In the context of what many see as mounting evidence that religious beliefs and practices are positively correlated with well-being, a number of voices within the medical world have begun calling, some quite loudly, for a greater integration of religion with health care practices. Utterly horrified by such chatter, Richard P. Sloan of Columbia University Medical Center has written a strongly worded counterargument in the form of a popular science book, Blind Faith. In no uncertain terms, the book challenges the validity of the studies claiming to link religious practices with better health, exhibiting throughout a passionate allegiance to a conception of religion and science as nonintersecting fields. Interestingly, because Sloan’s ideological commitments are fairly well on display, Blind Faith becomes in the course of reading a double argument. On one level, the book inveighs against undoubtedly radical and possibly overenthusiastic prescriptions for changes in health care practices, and on another, deeper level it serves as a blanket defense of empiricism, post-Enlightenment thought, and reductionist methodologies against what Sloan sees as a rising tide of irrationalism and unwarranted reverence for subjectivity.
Throughout the work, Sloan’s viewpoint is heavily informed by the idea that religion and science occupy totally separate spheres of human knowledge and use incompatible epistemological tools. Both are inherently valid, but only within their separate, mutually exclusive contexts, and only as appropriate according to the objectives and discursive locations of the persons using them. Most famously articulated by the evolutionary biologist Stephen Jay Gould, who termed religion and science “nonoverlapping magisteria” (Gould, 1997), this concept is widely admired among scientists who chafe at the intrusion of religious evaluative mechanisms into scientific discourse. Under this system (often abbreviated NOMA), religious and spiritual epistemologies belong to the realms of valuation, narrative construction, and existential inquiry, while empirical investigation and analytic inquiry are reserved for science. Science, therefore, has nothing to say about the claims of religion, nor religion about science, since they are intended to address different and completely separate sets of human needs. This is an important predicate for Sloan’s reasoning and, as I will suggest later, one that in its pristine and rather wishful assumptions about the nature of human inquiry and ways of knowing somewhat dampens the strength of his overall argument.
Nevertheless, in his more superficial goal--to raise doubts about the desirability of integrating religion or spiritual practices with formal health care--Sloan largely succeeds. His most stirring arguments arise when he points out the disturbing level to which religiously biased researchers, many pursuing agendas stemming from their credal commitments, are the driving forces behind much of the research in the field. In a section about the funding sources for studies in religion and health, Sloan quotes a disturbingly sectarian endorsement by Dr. William Wilson for the collected writings of David Larson, a major player in the field of spirituality and health. The fact that the collection was edited by Jeffrey Levin and Harold Koenig, two of the biggest names in the burgeoning field, makes Wilson’s quote that much more discomfiting: “Dave felt that the research he did would demonstrate the power of God in healing, and it has done just that. But mostly it has demonstrated the preventive medical aspects of a faith in the one true God” (63; emphasis mine).
Sloan goes on to point out that further funding for religion and health care research has been provided by the conservative Christian group Focus on the Family, as well as a variety of other organizations he finds suspect (63). Elsewhere, he outs Dr. William Harris, a perennial advocate of the integration of religion and medicine, as a member of the Intelligent Design Network. This revelation is especially damning; although their public statements may indicate otherwise, it is widely understood that virtually all proponents of intelligent design are motivated by strong, usually Christian, faith commitments. By revealing what appears to be the pervasive influence of religious apologetics in the dialogue surrounding spirituality and health, Sloan punctures a hole in the field’s public facade, which presents its research as unbiased and objective. Naturally, the religious allegiances of researchers need not by any means necessarily effect the quality of the research, and many good scientists who are religious regularly do high-quality, objective scientific work. However, the extent to which some of the research in religion and health appears to be driven by a sectarian agenda is disconcerting, particularly when there are indications that several important figures are willing to suspend judgment based on objective, well-established facts in favor of religious doctrines. The effect of Sloan’s argument here is persuasive.
Sloan’s arguments are not limited to ad hominem attacks, however, even if the revelations he brings to light about the researchers involved are relevant. The book is structured as a two-part critique of the claims that religion and health are linked and that spirituality ought to be integrated more fully into medical practice. A lengthy first part precedes these sections, presenting Sloan’s view of the history of medicine and religion, and Part Four presents a recap of his arguments and conclusions.
I will first examine Part Two. In this part, “Reading the Evidence,” Sloan deconstructs the research that suggests spiritual or religious practice is positively correlated with well-being. While the tone here often borders on condescending (discussing a study whose results he contests, Sloan writes (83), “To find out why, we need to consider how science operates,” leaving the reader with the eerie feeling of revisiting a fourth-grade biology textbook), the cumulative argument against the validity of the research is relatively weighty. Many of the seminal studies in the field, such as an influential 1977 report by George Comstock of Johns Hopkins University, fail to adequately control for confounding variables. Sloan pounces on this to suggest, with some justification, that much of the available data is contaminated. Sharpening his argument further, a disconcerting number of studies appear to discount the statistical problems associated with multiple comparisons. Other problems surface and are discussed, including data dredging, the conflating of anecdotes with evidence, and the sharpshooter’s fallacy, or collecting large amounts of data and then highlighting those results that support the researcher’s hypothesis. These chapters serve as both a good review of basic scientific methodologies and a fairly convincing critical analysis of the research published in medical journals on the effects of religion on physical health and mortality.
Strangely missing is a treatment of the numerous studies in the field that have examined the connection between religious participation and mental health, a subject in which a behavioral medicine professor could be expected to take interest. Also unaccounted for is the substantial spirituality-and-health literature published in the social sciences; Sloan appears to be familiar only with those articles on the topic of religion and health that have been published strictly in medical journals. A greater breadth of familiarity with the research, which despite Sloan’s skepticism is indeed voluminous, could have provided the opportunity for much sharper and more convincing arguments.
The section culminates with a chapter on the numerous studies of the effects of intercessory prayer. Easy targets, these studies make instant fodder for Sloan’s rhetorical cannon. One such study, codenamed MANTRA II, is especially egregious. Not only was no statistically significant correlation found between prayer and health outcomes, but despite this the authors barreled ahead with their conclusions, making conjectures about the mechanisms linking distant prayer to well-being as if the effects had been fully established. This generation of hypotheses required ignoring the results they reported only a few paragraphs earlier.
Part Three focuses on examining, and dismissing, the growing chorus of recommendations that physicians alter their practices in order to better integrate spirituality into health care and address patients’ spiritual needs. Four chapters focus on four separate aspects of the topic: the potential for doing harm, the impracticalities of integrating spirituality into medical practice, the presence (or absence) of an actual public demand for such integration, and the unpleasant possibility that greater admixture of religion and medicine will in fact damage religion.
Of these, the first is the most convincing. A lengthy section is dedicated to raising the frightening specter of examination-room conversion efforts--a blatant violation of medical ethics, but one unfortunately easily imagined should ideologically committed doctors gain greater influence within the medical community. This point by itself is powerful enough to anchor an argument against the implementation of spiritual questionnaires or related practices in health care settings. Sloan only makes the case more compelling by reporting on a revolting little book, The Saline Solution, whose aim is to guide physicians through the process of “cultivating,” “sowing,” and “harvesting” religious converts through their medical practices (198).
The other arguments in Part Three succeed less admirably. In Chapter 13, “Is It Practical to Bring Religion into Medicine?”, Sloan weakens his case by making questionable claims such as that “(g)ossip has relatively little redeeming value but is generally harmless” (209). By this he intends to show that personal behaviors--those typically modulated by religious injunctions--belong to a moral sphere and not to a scientific one, since the effects of these behaviors are, for good or ill, relatively inconsequential. Here he ignores the fact that a substantial amount of accumulated human wisdom as well as the discursive traditions of world religions suggest otherwise; individual behaviors such as malicious gossip can and indeed do have measurable impacts on, for example, the quality of social relationships, which then can easily be conjectured to be less reliable as resources during times of illness, stress, or economic difficulty. It seems self-evident that these lower-quality social relationships would tend to lead to less desirable health outcomes and lower levels of well-being. Whether it is the job of the physician to monitor and provide guidance for patients’ behavioral decisions is, I think, still an open question, but the interrelation of such decisions and patients’ objective well-being is not.
Indeed, while throughout the book Sloan makes compelling (if sometimes oversimplified) arguments against the redefinition of physicians’ roles to include the maintenance of patients’ spiritual well-being, on a more fundamental level his case against synthetic thinking and integrative epistemological methods fails. Sloan is a committed scion of the Enlightenment, and his admiration for reductive reasoning, analytical thought, and the identification of linear paths of causation is a dominant theme throughout the work. These things in themselves are not undesirable, but taken to an extreme they become, I think, sources of a certain blindness.
In numerous passages, for instance, Sloan makes clear that diseases are caused strictly by pathogens, plain and simple: “Infectious diseases are caused by infectious agents,” he insists in Chapter 11 (214), while in Chapter 5 he writes that “(t)he main cause of ulcers is an infectious agent, Helicobacter pylori” rather than stress, poor diet, or other factors (74). The latter quote provides an especially useful example of how stubborn Sloan is actually proving himself to be in relying on strictly reductive models of causality; while the role of H. pylori in causing peptic ulcers is certainly proved, a consensus that all ulcers are caused by the bacterium, implied by the above passage, is nonexistent. Writing in the gastroenterology journal GUT in 1993, for example, Reinbach et al. found a “lack of association of acute perforated duodenal ulcer and H pylori infection” and concluded that perforated duodenal ulcers arose from a different cause (Reinbach, et al. 1993). Smoking, stress, and other factors such as taking non-steroidal anti-inflammatory drugs probably do, in fact, affect development of ulcers (Wachirawat et al. 2003; Traversa et al. 1995). As in most lines of inquiry, the simple, mechanistic explanation is too simple and too mechanistic.
In a single page in the introduction, Sloan makes clear how dearly he wishes this were not the case, as the exasperation with nonreductionistic epistemologies that simmers throughout the work breaks momentarily to the surface. Sloan bitterly lambasts the growing “infatuation with subjectivity” that marks a building public discontent with a cultural Weltanschauung dominated by science: “Contemporary science is criticized for being excessively ‘linear’ and ‘reductionist.’ Preferable approaches to wisdom are spiritual, holistic, and nonlinear. That is, they don’t have to make sense” (49; emphasis mine).
This is a telling statement. Despite his persistent lip service to the value of religion as a source of comfort, it is difficult not to think that privately Sloan is flummoxed by popular adherence to religious traditions. Further down the same page, he bemoans the fact that more than 84 percent of Americans claim to believe in miracles, calling such findings indications of “pseudoscientific beliefs” (49), a statement that makes his declarations elsewhere that religion is valuable and should be respected seem somewhat disingenuous. Belief in miracles is a common element of many religious denominations, and to claim respect for those religions in principle while in practice dismissing the validity of their actual tenets points to a certain lack of cohesiveness in his overall perspective.
Indeed, in his insistence that religious doctrines and beliefs are based on pure faith without recourse to reason or evidence (251, 253), Sloan falls prey to an academic idealism that takes Gould’s nonoverlapping magisteria prescription one step too far. While certain Christian denominations, particularly those descended from Calvinism, do indeed downplay the role of searching for evidence God and instead emphasize pure personal faith, studies indicate that significant swaths of American society claim to have had religious experiences, from feeling the spirit in Pentecostal meetings to hearing the voices of angels (Baylor Survey, 2008). Irrespective of the objective validity of these experiences, religion is not a pristine or ideal construct, ensconced safely in the realm of the conceptual; it exists here and now, and for most people it is quite a real thing. Epistemological standards cannot, then, simply be divided cleanly down the middle, with one half neatly assigned to reason and the other to faith. In the common experience, they are necessarily intertwined. A greater familiarity with religious studies and the diversity of the American lived religion experience would have been useful in recasting Sloan’s arguments to take account of the fact that purely reductionist reasoning neither lends itself to provide meaning in (most) people’s lives nor corresponds to the typical lived experience.
However, all is not lost; despite his unwittingly condescending treatment of religion, Sloan understands that people are more than machines and have attendant needs. “We want to be treated like people, not cases with one disease or another, not collections of tissues and organ systems” he writes (57). The ongoing technological takeover of the medical establishment, with its overreliance on complicated and expensive tests, has “come at the cost of human relationships in clinical care, leading to a willingness to seek other ways to provide satisfying interpersonal interactions in medicine” (11), and because of this patients have begun swarming to dubious alternative treatments.
Although he is long on complaints and short on suggestions, Sloan has hit the nail on the head here, and despite his clumsy treatment of religious matters the book’s impact remains keenly felt after the last page is turned. The reader is left doubting that introducing religion per se into medical practice would have anywhere close to the beneficial impact of simply reemphasizing the human element in doctor-patient relations. His evidence suggesting that the majority of people do not, in fact, wish to discuss religion with their doctors, particularly if it means taking time away from other important matters during office visits (238), is convincing. In combination with the doubts he attempts, with broad success, to cast on the quality of the research in favor of religion-health connections, such revelations should serve to strongly temper the reader’s--and the public’s--enthusiasm for mixing spirituality with everyday medical practice. Sloan’s research is one-sided, yes, but in a way that rings a much-needed note of caution in an important public discourse. While Blind Faith is an imperfect work occasionally weighed down by its author’s ideological biases, it is to be recommended as a counterbalance to the sometimes sectarian cheerleading of many religion-and-health researchers and as a sober-minded voice in support of the repersonalization of medical care. Integrative thinking is not the bogeyman Sloan makes it out to be, but neither does it require the introduction of the pulpit into the hospital waiting room.
Baylor University Marketing and Communications. “Baylor Survey Finds New Perspectives on U.S. Religious Landscape.” Baylor University. http://www.baylor.edu/pr/news.php?action=story&story=52815 (accessed Oct. 15, 2009).
Gould, Stephen Jay. 1997. "Nonoverlapping Magisteria". Natural History 106: 16-22.
Reinbach, D.H., et al. 1993. “Acute perforated duodenal ulcer is not associated with Helicobacter pylori infection.” GUT 34 (10): 1344.
Traversa, G., et al. 1995. “Gastroduodenal toxicity of different nonsteroidal antiinflammatory drugs.” Epidemiology 6 (1): 49–54.
Wachirawat, W., S. Hanucharurnkul, P. Suriyawongpaisal, et al. 2003. “Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population.” J Med Assoc Thai 86 (7): 672–85.