Inherent Dangers of Faith-Healing Studies
Author: Bruce L. Flamm, MD
It is often claimed that faith healing may not work but at least does no harm. However, as will be demonstrated in this article, reliance on faith healing can indirectly cause serious harm and even death. Therefore, there is an inherent danger in the publication of studies that advocate healing by faith. Nevertheless, dozens of studies claiming to have confirmed some therapeutic value of distant prayer and other "distant healing" methods have recently appeared in the medical literature. Although faith healing has been advocated by religious groups for millennia, the issue here is the propriety of making supernatural claims in medical journals. It is one thing to tell an audience at a religious revival that prayers yield miracle cures, but it is quite another thing to make the same such claims in a scientific journal.
This article is the third in a series that use the Cha et al. faith-healing study  as a model to demonstrate the problems that arise when faith-based studies are published in medical journals. The first article investigated methodological flaws in faith-based studies while the second article focused on paradoxical questions that arise in such publications. [2,3] This third article will evaluate several of the dangers inherent in the Cha study and all similar publications.
1. Faith healing can cause patients to shun effective medical
This is perhaps the greatest danger of any study that touts the efficacy of faith healing. In the Cha study, prayer appeared to double the in vitro fertilization (IVF) success rate. Since any method that can increase the success rate of IVF by even a few percent would be hailed as a major achievement, these results were astounding. The news media were quick to disseminate this seemingly favorable information to the public. [4-6] The apparent effects of prayer were so dramatic that it would not take a "leap of faith" for infertile women to conclude that prayer is more effective than medical intervention as a cure for infertility. This conclusion could cause some women to forgo medical care and thus miss out on the proven benefits of modern infertility treatments. In other specialties the consequences of avoiding medical care because of reliance on religious rituals and faith healing have been well documented.  A recent study identified 158 children who died due to reliance on faith healing and religion- motivated medical neglect. 
2. Doctors who accept faith-healing study results might diminish
their medical efforts.
Doctors as well as patients might change attitudes and practices in response to faith-healing studies published in medical journals. Why worry about proper clinical techniques and strict laboratory protocols that could at best potentially increase pregnancy success rates by a few percentage points when prayer is easy and far more efficacious? This may seem ridiculous, but if the Cha study results are to be taken seriously, it is not illogical. On the other hand, if the Cha study results are not to be taken seriously, why were they published in a peerreviewed, scientific medical journal?
3. Faith-healing studies could steer third-party payers toward
In the United States each IVF treatment cycle costs an average of $9,000, and several cycles are often required to achieve a viable pregnancy. For patients who require IVF, the cost of each live birth has been estimated at over more than $50000.  Since IVF is costly for health insurance companies, if the Cha study results were valid, it would be logical for these organizations to advocate the introduction of prayer into infertility programs. The claimed doubling of IVF success rates could save insurance companies an average of $25000 per patient. With millions of dollars at stake and with these compelling study results as evidence, insurance companies could insist that prayer be tried first.
4. Faith-healing studies raise informed consent issues.
The Cha study was conducted without informed consent. This is unethical, potentially dangerous, and possibly illegal. Placebo effect could have been avoided by first properly informing patients about the study and then, with their permission, blinding them to which group they were assigned. Lack of consent perhaps explains why none of the prayer recipients was located in the United States. Nevertheless, it is doubtful that the institutional review board of any university in the United States would waive the informed consent requirement simply because the patients to be experimented upon lived outside of the United States.
Using patients as research subjects without informed consent also violates both the Nuremberg Code and the Helsinki Declaration. Furthermore, it is not logical to claim that informed consent was unnecessary because the intervention was only prayer and then to claim that the same innocuous intervention actually had profound physical effects on study patients. This is especially true since numerous claims made in previously published papers by one of the study's authors indicate that at least some of the people involved with this study believed, from the project's inception, that the intervention could have very real effects on uninformed human subjects. [10-14] Furthermore, because the study was conducted in Korea, where the majority of the population is Buddhist, Shamanist, or nonreligious, many study patients might have objected to Christian prayers as unwanted, blasphemous, or antithetical to their personal beliefs. But since the study was conducted without their knowledge or permission, the study subjects had no way to voice their objections or to opt out of the study.
I recently learned that the United States Department of Health and Human Services Office for Human Research Protections (OHRP) was apparently alerted to the absence of informed consent by the flurry of newspaper articles and television news reports that announced the Cha study's results. OHRP officials read the report and confirmed the study's lack of informed consent. As a result of its participation in the Cha study, Columbia University was investigated by the U.S. Department of Health and Human Services and subsequently sanctioned by the OHRP. Columbia University acknowledged its noncompliance with its agreement to conduct human subject research through a Multiple Project Assurance (MPA) program of the OHRP. Columbia University also acknowledged noncompliance with its own policies and procedures. Some details of this investigation are in the public domain. A letter from Michael A. Carome, MD, director of the Division of Compliance Oversight of OHRP to the vice president for health sciences, Columbia University Health Sciences Division, concerning the prayer infertility study and remedial actions can be accessed at http://ohrp.osophs.dhhs.gov/detrm_letrs/ dec01f.pdf.
5. Faith-healing studies raise patient confidentiality issues.
In the Cha study, photographs of the study patients were obtained and circulated all over the world without the patients' knowledge or permission. Infertility is a personal issue for many women and circulation of their photos by fax and mail to strangers could cause emotional distress. Faith-healing researchers would be well advised to become familiar with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the penalties for violating this federal law.
6. Faith healing promotes guilt.
Many infertility patients believe that they are being punished by God for some "sin" that they may have previously committed. The implication that prayer can increase fertility would reinforce this belief. It could also undermine people's religious identity. Couples of other faiths who believe the study's results might conclude that their only hope of having a child would be to abandon their own faith and convert to Christianity. While this might be seen as a victory for the prayer-group participants in the Cha study, the converts would have been won under false pretenses if the study results were not valid and reproducible.
7. Faith healing studies encourage acceptance of magical and
The Cha study implies that some type of supernatural power had an effect on many of the study patients. Some readers might believe that God or some other deity was at work, while other readers might assume that some type of paranormal, psychic, or otherwise magical power worked without the need for a deity. In any case, something beyond the laws of physics is presumed to have occurred in this study. If the editors and reviewers of the journal believed that the results were supported by valid evidence, then it was appropriate to publish the study- but odd not to offer editorial comment. On the other hand, if the editors did not find the evidence convincing, then it is odd that they would choose to publish the study.
8. Faith-healing studies encourage the use of intercessory prayer,
a technique that is widely used for questionable purposes.
The intercessory prayer as described in the Cha study is similar to the intercessory prayer described in the book Operation World: The Day-by-Day Guide to Praying for the World.  This book, with more than 1 million copies in print, describes how intercessory prayer can and should be used to "take the kingdoms of this world for Jesus" and "challenge self-seeking sinners and bind or remove those who defy our God." Another popular book on prayer techniques, with hundreds of thousands of copies in print, explains that the fundamental purpose of intercessory prayer is to "hasten the day of total world evangelization" and thus complete the Great Commission of Jesus.  The same book also explains how thousands of Christian "prayer warriors" are using daily intercessory prayer in an effort to bring millions of unsaved souls in countries like China and Korea to Jesus. Can prayer for healing be divorced from prayer for salvation? For what reasons do the participants in the various Christian prayer groups in the Cha study generally use intercessory prayer when they are not taking part in an infertility study? One wonders if the Christian prayer group participants, with all the best intentions, were also praying for the salvation (conversion) of the Korean study subjects. Were they specifically instructed not to do so? In light of their strong Christian faith, could they ethically honor such a request even if it were made? Many of the prayer group participants may have sincerely believed that God would redeem or heal the Korean patients only if the patients accepted Jesus Christ as their savior.
Another book on intercessory prayer preaches that prayer is "the armor for every believer . . . the weapon of our warfare . . . for pulling down the strongholds of the enemy." [17(p15)] This same book also states that Christian intercessory prayers for both healing and fertility are intimately intertwined with prayers for salvation. To many evangelical Christians it might seem senseless or even sacrilegious to pray for the restoration of fertility to infidels or people with views heretical to the Christian faith, without first praying for their salvation. In his best-selling book Healing, Catholic priest Francis MacNutt states writes that "healing is simply the practical application of the basic Christian message of salvation."  He also explains that "the first condition, if we seek healing, is to cast out sin" and that "what I have come to see, though, is how intimately the forgiveness of sins is connected with bodily and emotional healing. They are not separate. In fact, physical sickness is a direct sign that we are not right with God." [18(p17)] Now that it has been published in a peer-reviewed medical journal, the Cha study is certain to be used by Operation World proponents and other Christian evangelists as a compelling testimonial to the efficacy and power of intercessory prayer.
9. Positive faith-healing studies could affect public policy.
President George W. Bush's stand in favor of faithbased initiatives has caused some Americans to believe that the Constitutional separation of church and state is in jeopardy. The conclusions of the Cha study may generate interest among policymakers who favor broadening the role of faith and prayer in the United States. In this regard, the Cha study results are now posted on the Web site of the National Center of Policy Analysis at http://www.ncpa.org/iss/soc/pd100901d.html.
10. Faith-healing studies could have emotional and psychological
consequences for infertility patients.
Emotional stress combined with fear of treatment failure can lead to serious depression in women with impaired fertility.  The psychological stress may become even more severe when all initial efforts to correct infertility fail and IVF is required. If this method of last resort fails, patients may lose hope and become despondent. Because of this, some experts recommend psychological counseling for patients who fail IVF.  If a patient were led to believe that God, rather than medical conditions, controlled the outcome of infertility treatments, then IVF failure could have severe emotional and psychological consequences. The already depressed woman would be burdened with the belief that her unworthiness and/or lack of faith had destroyed her chances for pregnancy and childbirth. The introduction to An Intercessor's Handbook of Scriptural Prayers states, "Prayer does not cause faith to work, but faith causes prayer to work. Therefore, any prayer problem is a problem of doubt- doubting the integrity of the Word and the ability of God to stand behind His promises or the statements of fact in the Word." [17(p18)] In his book on healing by prayer, Father MacNutt agrees that "lack of faith" is the number one reason why God does not heal people and that sin is a close runner-up. 
11. Faith-healing studies are self-perpetuating.
If a faith-healing study successfully makes its way into a medical journal, its results will be used to promote faith healing even if its methods are hopelessly flawed and the results are not reproducible. For example, I recently wrote a letter to the editor of Southern California Physiciancritical of their article "Prescription for Prayer" and the claim by Larry Dossey, MD, that some 1600 studies have revealed "something positive" about intercessory prayer. I commented that if there were, in fact, something positive, it certainly would not take 1600 studies to find it. Dr Dossey's published response to my letter included the following argument: "Controlled clinical trials and the peer-review process continue to serve us well. The most recent example of this process in action in the area of intercessory prayer is from Columbia Medical School-a positive, controlled clinical trail published in the respected, peer-reviewed Journal of Reproductive Medicine."  The flawed and possibly fraudulent Cha study has also been cited in other journals including the peerreviewed Journal of the American College of Surgeons as strrong evidence for the healing power of prayer. 
12. Birds of a feather flock together.
Many faith-healing researchers also conduct research on other supernatural or paranormal phenomena. Of the 3 authors of the Cha study, Kwang Cha, MD, is a doctor from Korea who also practices in the United States and Rogerio Lobo, MD, is chairman of Obstetrics and Gynecology at Columbia University. Dr Lobo now claims not to have been involved with the study until after its completion, stating that he provided only editorial assistance. The fact that 1 of the 3 authors now claims to have had nothing to do with the study is disturbing. Dr Cha and Dr Lobo both failed to respond to numerous telephone calls and letters requesting further information about their study. The remaining author, Daniel Wirth, MS, JD, has a long history of publishing studies on supernatural or paranormal phenomena, and his MS degree is in the dubious field of parapsychology. [10-14] While doing research for this manuscript I discovered that the Federal Bureau of Investigation had indicted Mr Wirth, claiming that he had conspired with ex-convict Joseph Horvath (AKA Joseph Hessler, AKA John Truelove, AKA John Doe) to defraud millions of dollars from the cable company Adelphia. Mr Wirth initially denied knowing Horvath.
An Associated Press article on the indictment includes the following statement: "The FBI, in the embezzlement indictment against Wirth and John Doe, said Wirth lied when he told agents in July that he didn't know Truelove by any other last name."  After reading this article I reviewed my file of publications authored by Mr Wirth. These publications deal with "paranormal" or apparently supernatural phenomena, including various topics such as "distant healing" and "prayer healing." I found an article from a little-known journal that claims to be devoted to "topics outside the established disciplines of mainstream science." The journal is the International Journal of Scientific Exploration. The article is "The Effect of Alternative Healing Therapy on the Regeneration Rate of Salamander Forelimbs." The coauthors are Daniel Wirth and Joseph Horvath.
In May 2004, both Wirth and Horvath pleaded guilty in federal court to criminal fraud and to using numerous phony identities to commit felonies. Only July 13, 2004, Horvath hanged himsel in his prison cell. On November 23, 2004, Daniel Wirth was sentenced to five years in federal prison to be followed by three years of parole. He is currently incarcerated in a federal penitentiary in California.
As demonstrated in this article, there are dangers in the publication of studies that advocate faith healing. Although the Cha study demonstrates many of these dangers, the purpose of this critique is not to imply that only scoundrels conduct such studies. Undoubtedly, many religious individuals conduct faith-based studies with the best of intentions. Nevertheless, the fact remains that extraordinary claims demand extraordinary evidence. Unless replicated under strictly controlled conditions, studies claiming to have demonstrated miracle cures belong in religious magazines, not medical journals. Editors of medical journals and doctors who review manuscripts for journals should remember this obvious fact. Physicians take an oath to respect the hard-won scientific gains of those physicians in whose footsteps we walk. This is the first premise of the modern version of the Hippocratic Oath.