An Unholy Alliance of Religion and Medicine

GUEST: Richard P. Sloan
VTR: 10/01/2007

I’m Richard Heffner, your host on The Open Mind.

And in Blind Faith – his recently published St. Martin’s Press study of what he describes as an “unholy alliance of religion and medicine” – my guest today introduces us with sometimes shocking chapter and verse to what he describes as “the brave new world of religion and health, where science, medicine, faith and ethics exist together in a potentially explosive mixture”.

Richard P. Sloan is professor of behavioral medicine at Columbia University. And, as usual, my friend Vartan Gregorian probably has put it best: that Dr. Sloan’s Blind Faith is “a provocative yet judicious and timely book based on meticulous scholarship … [coming] at a moment when there is vigorous, ongoing national debate and widespread concern about the growing influence of religion and religiosity and their impact on science, medicine, health, and patient care…[and providing] an in-depth examination of key questions, including how to preserve the coexistence of faith and science without violating the sacred domain of religion and the necessary autonomy of science and medicine”.

Of course, I now want to ask Dr. Sloan both how we got to this point and whether – given the unholy alliance of religion and medicine he so well documents in Blind Faith – whether we CAN any longer hope to return the holy and the healing to their traditional roles in our national life. What do you think? Optimistic? Pessimistic?

SLOAN: I’m not optimistic, at least not for the near term. I think that the trend to link religion and medicine is something that is likely to increase over the next decade or two. Eventually I think it will pass and will, some years from now, be regarded as a fad. And a bad one. But not for a while.

HEFFNER: Interesting, you use that word “a fad. A bad one, but a fad”. What did happen? How did this come about?

SLOAN: There are … there are a number of reasons, I think why the embrace of religion and medicine have arisen since the, I guess the mid-nineties. One is that there’s been a rise in irrationalism in the United States for about thirty or forty years.

And the best evidence can be found in, in bookstores. If you go to the bestsellers on Amazon, a great many of them are about angels and crystals and other kinds of healing that bear no relationship to conventional medicine. And they’re enormous best sellers. It, it’s ironic that we’re about to celebrate the 50th anniversary of Sputnik which led to a huge increase in funding for science research and science education that lasted for about 10 years and then started to flatten off. And about that time there began this rise in an interest in subjectivity over rationalism. And it’s continued ever since. So that’s one reason.

There’s a cyclical waxing and waning of religious sentiment that’s characterized the history of the United States for hundreds of years. And we’re in a period of ascendancy now. So that’s another reason.

A third reason is the uncritical media. I was astonished. I interviewed a number of journalists for the, for the book and I was astonished to learn that journalists like grocers and hardware stores, poll the general public to, to determine what stories sell. And the stories that sell the most are stories about religion and medicine. So the combination of the two is just irresistible to broadcast and print journalism.

HEFFNER: Why does that surprise you, by the way?

SLOAN: I was surprised that they polled, actually. I just assumed, naively that journalism is a, a field that looks for stories that, that are newsworthy, not necessarily of interest in the same way that corn flakes are of interest. So …

HEFFNER: You think then that if you take the media and you take what you call a cyclical phenomenon in America and I, I question that because you seem to feel … yes, indeed, the extremes are cyclical. But don’t you feel that that element of irrationality has run through America, America’s history?

SLOAN: Yes, it has, but I think it’s waxed and waned as well. Then … in the immediate post-Sputnik period, for ten years there was a real reverence for science. After all, Sputnik …

HEFFNER: Reverence? You’re choosing your words …

SLOAN: Yes. I think reverence …

HEFFNER: … carefully?

SLOAN: … I think reverence is the right word. Science was really esteemed in the post-Sputnik period. And remember that science also … just a few years earlier brought us the cure to polio … cure for polio which was the scourge of, of America in the forties and fifties. And I’m old enough … sorry to say, to remember the, the iron lungs and other characteristics of polio that terrorized all of us. And so when science brought us a vaccine that cured polio, that prevented polio, it was enormous as a … as a … it was an enormous leap for science. Shortly followed by the rise in funding for science education and science research that brought us a whole series of other technological benefits. So, in that period I think there was less of an interest in irrationalism.

HEFFNER: What’s your sense of the present situation? And of the near future?

SLOAN: We’re awash in irrationalism. And it’s, it’s frightening because all of the benefits of our modern technological society depend upon science and engineering and technology. And the rise of … or the prominence of irrationalism and of religious influence on public policy and science broadly and then in medicine more specifically are a real concern.

HEFFNER: Now, is, is it a concern on your part that in the long run, or generally a nation that is … puts its emphasis upon the irrational can’t possibly be good for medicine, let’s say. Or are you aware of real inroads that that irrationality has made and is making upon medical practice?

SLOAN: Oh, I think that there are real … it’s made real inroads. There are estimates now suggest that two thirds of US medical schools offer some form of training in religion and spirituality. It’s unclear what that means. But, that’s … that’s a lot of medical schools. We now know that the … there are lots of anecdotes that are frightening.

I’ve often spoken about a CBS news program about a Colorado orthopedic surgeon who prays with his patients while they are gowned and supine on the gurney about to be wheeled into the operating room. And he stands over then and says, “Mind if we say a prayer?”

“Mind if we say a prayer?”, he’s practically got a scalpel to their throat and he says, “Mind if we say a prayer?” Just a few months ago the …

HEFFNER: Now, wait a minute … let me ask you something. Because that’s the first … that’s the very beginning of your book …

SLOAN: Yeah.

HEFFNER: You, you tell this anecdote off of CBS. Do you feel that, or might someone legitimately ask you … Dr. Sloan was the patient harmed by … was the operation less successful because of this religiosity?

SLOAN: I have no idea. And it’s a legitimate question. But the, the … you have to keep in mind, that especially, but more generally in other situations … patients when they see physicians are often fearful, in pain and as a result vulnerable to religious manipulation or coercion. And that’s a violation of everything that we stand for about religious freedom in the United States.

We … it’s one of the fundamental founding principles of American democracy that we are free to choose how we express or don’t express our religious sentiment. And so when a physician uses his or her power in the physician/patient relationship to manipulate or even coerce religious activities on the part of patients, it’s a real violation of, of our concern for religious freedom

HEFFNER: Well, when I began to read your book, I, I was thinking … now, Richard Sloan, I’ve met him once … am I going to find that he and I are soul mates, that we come from the same kind of intellectual background and that that’s the nature of the book.

First Amendment considerations … considerations perhaps of whether one is a believer or not. Those loom larger than the question of this … of is this bad for … has this been bad for the practice of good medicine?

SLOAN: Oh, I think it has. There are other, less anecdotal accounts of the role that religion now plays in, in contemporary American medicine. There’s an organization called the Christian Medical and Dental Association. And while they do many laudable things, they publish a handbook accompanied by CDs and videos that instructs physicians on how to use their practices to evangelize … to convert their patients to Christianity. And that is simply an intolerable kind of manipulation, again, of potentially vulnerable patients.

And it, it’s quite dramatic because it provides instructions on how to cultivate and sew and ultimately reap converts … over long periods of time, so if the patient doesn’t consent initially, you come back to it and come back to it and come back to it.

HEFFNER: But that’s why I wonder whether … what we would agree upon or what we’re talking about are First Amendment concerns? Or near First Amendment concerns? This isn’t a matter yet of government involvement, which would make it a First Amendment concern.

But separation of church and state … not on a Constitutional level, but on a social level … is that your concern or is your concern medicine and the medical well being of Americans?

SLOAN: Well, ultimately, I’m interested in both. And there are other issues, apart from these ethical considerations that, that we’ve been discussing. There’s the issue of, of just bad science. Most of the scientific reports that make claims about the relationship between religious devotion and better health are methodologically flawed, so flawed that they really render the conclusions invalid. The evidence is extremely weak despite what proponents say. Proponents have argued that there are hundreds, thousands of studies about the connection between religion and medicine with 50%, 60%, 70% showing a favorable association. But those are so … those assertions are simply wrong. And the evidence is extraordinarily weak. So, the, the scientific basis for this connection is, is invalid.

HEFFNER: Still … press you again.

SLOAN: Okay.

HEFFNER: Does it do damage and where does it do damage. I know from reading the book that you feel that it does do damage and I’m trying to squeeze it out of you for our audience’s sake. You feel that it does do damage to the practice of medicine?

SLOAN: Sure. There are, there are several ways … very tangible ways in which it does damage. Some proponents of religion could bring religious practices into medicine … urge physicians to conduct the spiritual history, just the way you would conduct a social history or a medical history.

And estimates are that the spiritual history takes four minutes. Four minutes to ask the questions and then get the answers. That may not seem like a lot of time, but when you consider that the typical physician visit now is estimated to range anywhere between seven and 19 minutes, that’s it. Seven to 19 minutes is how much time on average patients spend with their physicians … a four minute spiritual inquiry is at least 20% of that physician/patient interaction. So what won’t the doctor have time to discuss with the patient? Will he or she not be able to ask about depression or exercise or smoking. What will be crowded out by a spiritual disposition in the, in the physician/patient interaction?

HEFFNER: Well, of course, I couldn’t help but think of my old friend, the late Norman Cousins who was a great person in my estimate, who put his emphasis upon something other than tangible feeling … feeling is a bad word, touchable medical practice and thinking about the curative value of laughter, of humor, of good feeling. I, I find this very much the same, that what you’re talking about is people who are saying “you will feel better and if you feel better we know some things about the way the mind works and the body works in relationship to it … believe that there will be benefits from feeling better.” Having religious faith … that you will feel better in certain situations. Can you give some credence to that notion?

SLOAN: I, I don’t … I don’t think anybody disputes that religion provides comfort in times of difficulty, whether it’s illness related or otherwise. I certainly don’t dispute that.

The question is whether that contributes to better health and whether it’s the physician’s business to promote it. I, I think actually, the answer to both is “no”.

You know, nobody really takes Cousins’ assertion seriously any more. There’s very little evidence about the health benefits of laughter. And whether it’s … whether there’s a health benefit to being optimistic or pessimistic is nowhere near as clear as the public likes to believe. So I’m not sure that merely feeling better is enough to swing the balance toward better health.

HEFFNER: But would you say, Richard Sloan, god bless you if somebody said, “I feel better because I think this or I believe that.

SLOAN: I think it’s great if you feel better, but that’s not a substitute for adequate medical care.

HEFFNER: MmmHmm. And that’s your concern then …

SLOAN: Yes.

HEFFNER: … that we will use that as a substitute for what it is that the doctor will be inquiring about in those very few minutes.

SLOAN: Yes. Physicians have an astonishing array of things to ask about and tasks to accomplish in the very brief interaction they have with patients. And to be diverted from that by some spiritual inquiry … is to take away from the very valuable time that they have with patients.

They’re all ready loads of estimates that physicians don’t do enough as far as prevention is concerned and have at least half their day, according to recent estimates consumed by treating stable chronic disease. And so there’s very little time in the day to do anything other than evidence based medical practice.

HEFFNER: So what you set this in the context of is evidence-based versus faith-based decisions about medicine, science and I am sure you would say political matters, too.

SLOAN: Oh, yes. Yes. And you know, there’s another dimension of this that I think your viewers need to recognize and that is, it’s not only bad science to try to link religion and medicine because the evidence is extremely weak … and it’s bad medicine because of the practical considerations and the ethical considerations we’ve been discussing.

It’s actually bad religion as well. There have been a number of studies recently that have essentially tried to reduce the religious experience to the activity of neuro-chemicals in the brain.

So, for example, a study that was conducted by scientists at the Karolinski Institute in Stockholm and published a few years ago, linked the sense of religious transcendence to dis-regulation of the serotonin system in the brain. Serotonin is a neuro-chemical … a neuro-transmitter that’s implicated in may different biological functions. And it turns out that this disregulation associated with the sense of transcendence is the same dis-regulation that characterizes panic disorder.

Now those findings may be perfectly satisfying to the scientist, but they ought to be viewed with great skepticism, even concern by theologians, the religiously devout and I would suggest even people who aren’t religious at all.

Because what it suggests is our religious experience is merely reducible to the activity of neuro-chemicals in the brain. And if that’s so, we can “fix” that; we can turn it on, or we can turn it off with electrical stimuli or magnetic stimuli or drugs. And so, I think that people who want to connect religion and medicine ought to think very carefully about the implications of studies like that.

HEFFNER: Have there been theologians or those who were primarily interested professionally in religion who have been making that point?

SLOAN: Yes, and for precisely the same reason. Because the …this kind of research suggests that you can put religious tenants to the test of science. And religion and science operate according to different rules.

Science operates according to evidence. And religion according to faith. And principles of religion since they are faith based do not require scientific documentation. It’s really a corruption of the religious sentiment to suggest that they should be tested scientifically.

HEFFNER: But that, of course, isn’t your primary concern.

SLOAN: No. No. My primary concern is how religion influences medicine.

HEFFNER: And again … chapter and verse. You talk about it in terms of time … the time that should be devoted, when very little time, generally, is devoted to the relationship between the physician and his patients … takes time away when the inquiry is made as to, “what is your religious history?”

Are there examples, and I believe your book touches upon them … that you would care to set forth … of real damage done by the mixture.

SLOAN: Well, the, the … all I can … I don’t have any particular case studies of real damage because it’s hard to … it’s hard to know. But if you, as a physician, don’t spend time on evidence based procedures and instead spend time discussing religious and spiritual matters that have the most tangential relationship …

Now I don’t suggest … let me, let me divert for just a moment. I don’t suggest that these concerns aren’t real on the parts of patients. They’re absolutely real. The question is whether physicians are the best people to deal with them. And my contention is that physicians are not and the people to deal with them are the professional clergy … health care chaplains who are well trained in religion and spirituality … have lots of experience and also have the time to address these very complex religious and spiritual matters.

HEFFNER: But I feel comfortable assuming with proof, in terms of what we know about each other … I feel more comfortable with my sense that my intellectual positions are close to your intellectual positions on these matters. Wouldn’t the … a patient feel that way, too? And some exchange between patient and physician help a patient have a better sense of a better relationship with her physician?

SLOAN: I think physicians are duty bound to, to know everything that’s important about their patients. And that includes religion and spirituality. But it doesn’t privilege religion and spirituality over other aspects of patient’s lives. Their work, their hobbies, their social relationships, all of those things are important … physicians need to know all of those things in order to treat them well.

There’s a difference though between knowing about those things and taking them on as the objects of an intervention. That’s very different.

HEFFNER: What’s your bet as to what’s going to happen in the short term future in this relationship between faith and medicine, science.

SLOAN: I’m afraid, unfortunately, that there will be greater incursions into the medical intervention by religious and spiritual concerns, that’s likely to last for some time. And while it will abate eventually, not for a while, I don’t think.

HEFFNER: What feeds that? 9/11? Fear?

SLOAN: I don’t think it’s 9/11. I think it’s a, a, a deep religiosity that the United States experiences that distinguishes it from all other Westernized democracies.

HEFFNER: And how do you account for that?

SLOAN: I’m tempted … I don’t really know … I’m not a historian of religion … somebody commented, I think, during the Clinton impeachment hearings that he …an Australian commented that they were fortunate to get criminals while we got the Puritans. I, I … it’s been … this has been a religious country since its inception and it continues to be so with, with estimates of all the indices of religiosity are greater in this country than they are in other Westernized democracies.

HEFFNER: Do you think that indicates a different kind of practice of medicine in other countries?

SLOAN: Well, ah … yes, in the sense that other countries … the practice of medicine in other countries is, is uninformed by this. They don’t know what we’re talking about, they don’t know why it’s a concern. I’ve given talks on this in Europe and the response has been one of astonishment. They have no idea why this is an issue in the United States.

HEFFNER: I guess the question I’m asking is whether the practice of medicine is safer, better … whether you think of it as wiser or less so abroad because there is no tradition, or their isn’t the intensity of our tradition of involvement with religion.

SLOAN: I think it is, for that reason, yes.

HEFFNER: And your sense now is one of pessimism, I gather.

SLOAN: Yes. I’m not optimistic that this is going to end in the near future. And I think it can continue to cause damage.

HEFFNER: Is there any movement, though, are there any focal points aside from your book on Blind Faith?

SLOAN: There are some people who have expressed the kind of concern that I’ve expressed in the book. But not as many as who are fascinated with the possibility that there may be health benefits to religious devotion.

HEFFNER: Is there any parallel in your concern about this unholy alliance? Any parallel to a possible concern you might have to alternative medicine?

SLOAN: Yeah, there is. Alternative medicine also is … has arisen because … one of the other reasons why interest in religion and medicine has arisen is related …

HEFFNER: In the half minute we have left.

SLOAN: The … people are dissatisfied with the way medicine is practiced … contemporary, technological medicine is practiced. It’s, it’s impersonal and off-putting and religion and medicine … alternative practices are much more personal and more appealing for that reason.

HEFFNER: Ahaa, I would say. As we near the end of our program. That’s a point that, that really doesn’t surface in the book, that there’s a fault, perhaps dear Brutus … in what we do in the practice of medicine.

SLOAN: There, there definitely is. And … but, as, as H. L. Menken put it … for every complex problem, there’s a solution that’s simple, neat and wrong.

HEFFNER: And I get the sign … very simple, neat, but not wrong … I must say good-bye and thank you for joining me on The Open Mind, Dr. Sloan.

SLOAN: Thanks for having me.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. For transcripts of today’s program, please send $4.00 in check or money order to The Open Mind, P. O. Box 7977, FDR Station, New York, New York 10150.

Meanwhile, as an old friend used to say, “Good night and good luck.”

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.