I’m writing a review essay on religion in medicine and make a nod toward a distinctive literature that exemplifies key aspects of the interrelationships of religion and science. The issues are ably represented in a “systematic” review by the Cochrane Collaboration inspecting the utility of “intercessory prayer for the alleviation of ill health.” After merging several pre-existing studies with the techniques of systematic review (also called “meta-analysis”), the authors conclude that “We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.” While I think this systematic review is irredeemably obtuse, I agree with their conclusion. Of course the fun, and the distinction, is in arriving at the conclusion.
I have two main problems with the review. First, the scientific methodology of the literature they are reviewing is incredibly sloppy. Second, the religious methodology is flawed and distracting. This feels to me like a caricature of science investigating a caricature of religion.
Systematic reviews are a strange entity within science, a technique for summarizing the results of several independent studies on a single topic. Those who practice them tend to believe in such reviews strongly, arguing that the scientists performing the actual experiments are too far from the truth, that it is only the repetition, in diverse populations and experimental conditions, of the scientific findings that should influence policy or practice. Those who reject these reviews see them as barely a step above scientific journalism, competing for space in scientific journals with actual experiments. The critics emphasize the fundamental heterogeneity among summarized studies that resists any attempt to combine them meaningfully. Most of us are somewhere in between–we believe that systematic reviews have a place in scientific discourse but they are generally not the final word on a subject. To be of any use, systematic reviews have to be summarizing something of reasonable clarity and integrity. In this case, the outcome is “alleviation of ill health.” Outcomes that broad are generally reserved for snake oils and nutraceuticals, therapies with claims so uncertain that they are generally untestable. Both the types and causes of ill health are myriad; the idea that any single intervention will have such wide-ranging effects has no real face validity.
The authors chose “intercessory” rather than “petitionary” prayer to describe the intervention, a choice that emphasizes the poor religious methodology underlying this entire scholarly literature. The notion of interceding to change the will of God represents the vending machine theology in which God does precisely what humans tell him to do. A generation or so ago anthropologists would have called this “magic” (Douglas Davies calls this “manipulationist theology” with regard to Mormonism). Although truth be told many of us are at least occasionally tempted to see prayer as a way to change God’s mind, in the honesty that lurks deep in our hearts we know that is not true.
There are experiments that could start to get at this question, but they are unethical. One might randomize ailing patients whose friends and family assure them that they are being prayed over to the actual act of praying (at random, friends and family would be required either to pray or not to pray–they would all assure the patient that the prayer had occurred). I hope it’s immediately apparent how unethical and morally fraught such a study might be, but this is an example of the kind of methodology that would be required if one were actually interested scientifically in evaluating intercessory prayer.
Of course most believers when pressed will admit that they endorse a petitionary model, I believe, that humans cannot alter the mind of God but can only plead with him for mercy. What is to be is ultimately, as they say, to be. And they know that when they pray they feel closer to God. And divine intimacy, an awareness that makes life tolerable and that calls us to greater action as God’s hands in the world, makes prayer worth whatever lengths we can take to experience it. If you have ever been a part of that sacred transaction, knowing that people who love you are pleading with God on your behalf, you know at once how sacred and unpredictable that access to divine light and love can be.
In any case, enough of the caricatures of science scowling at caricatures of religion. That money and time would be better spent praying for and serving those who suffer.
 I once thought this image came from my mother, but I later discovered that she was channeling Marvin Hinten.
 Of course even that methodology would suffer from the ill effects of moral discomfort on the part of loved ones randomized to lie about praying.