Impact of Religious Attendance on Life Expectancy

To the Editor: We read with great interest the recent article by Hall, “Religious Attendance: More Cost-effective than Lipitor?” regarding the real-world, practical significance of regular religious attendance on life expectancy.1 Evidence is steadily accumulating regarding the associations between a wide variety of religious or spiritual factors and both mental and physical health outcomes and has been systematically reviewed by many others.2–5 Whereas we applaud the author’s contribution to knowledge concerning the impact of religious attendance on life expectancy, his conclusions regarding the inappropriateness of religious attendance as a therapeutic intervention may be worthy of additional discussion because others have come to different conclusions.6,7

Dr. Hall mentions 5 reasons why religious attendance should be viewed as an inert predictor of health (like nationality) rather than as a potential intervention. First, he states plainly: “religious attendance is not a therapy… .” Of course in the absence of a compelling rationale for the assertion, this statement is begging the question—it assumes that the answer to the debate has already been decided in favor of his position. Rather, it is precisely the appropriateness of religious attendance as therapy that is in question. Further, we would argue that in many ways, therapy is precisely what religion is for many people. In a world that can at times be overwhelmingly painful, many pursue religious knowledge and activities as a way to cope and make sense of it all. Others seek healing from medical conditions through faith healers or spiritualists, and many more ask for prayer from clergy and fellow members of their religious communities. In the view of all these people, religion does appear to be at least partly therapeutic.

Second, Dr Hall supports his view that religious attendance should not be considered as a medical intervention because “… [T]here is no evidence that changing attendance causes a change in health outcomes.” This is a valid observation, and the question of whether increased attendance for the sake of better health actually results in improved health has yet to be determined. However, lack of proof of an effect should not be wrongly interpreted as proof that there is no effect. To evaluate the health effects of a change in religious behaviors, prospective research would need to be done. The ideal approach of this research would be a randomized intervention trial—something that will never occur if researchers (and funders) take the a priori position that religious activities can never be used as a health-promoting intervention.

The third reason cited for not promoting religious attendance as a therapeutic (or health-promoting) intervention is: “from a theological perspective, such instrumental use of religion is idolatrous.” To us, this argument seems to fail on 2 accounts. First, it is not the place of the medical community to determine what is or is not idolatrous or to work toward reducing the amount of idolatry practiced by our patients. Rather, it is incumbent on us to provide treatment and information to help individuals improve their health. Second, there are many instances in the Christian Bible in which people came to Jesus specifically for healing. In almost all these cases, these people received the healing they sought, and rather than rebuking them for their self-interest, Jesus often praised them for their displays of faith. So from the Christian perspective at least, it is debatable that seeking Christ for the purpose of physical healing must necessarily be considered idolatrous.

Fourth, Dr Hall states: “… [I]t is not at all clear that “instrumental faith” is sufficiently genuine to accrue the observed reduction in mortality.” Again, while this observation appears to be true, it does not necessarily mean that “instrumental faith” is not efficacious; only that more study is needed to answer the question.

Finally, he refers to “the ethical quagmire engendered by any medical recommendation to attend religious services.” It is true that there are many ethical questions to be addressed when it comes to physician recommendations regarding religious or spiritual participation or interventions. Considerations such as patient autonomy, physician respect for diversity, and avoidance of offending a patient or creating barriers in the physician-patient relationship are vital. However, the fact that a topic is ethically difficult need not preclude its discussion in the clinical environment. If that were the case, discussions about abortion, end of life concerns, domestic violence, alcohol and drug abuse, and many other issues would be taboo for the physician. Obviously, when controversial issues impact a patient’s health, it is incumbent on the physician to address them with his or her patients, even if the patient’s choices are ultimately different from those the physician would prefer or recommend.

In short, research increasingly demonstrates that religious or spiritual behaviors and beliefs are associated with real, measurable, and clinically significant impacts on people’s health. Most patients desire to be offered basic spiritual care by their clinicians and censure our professions for ignoring their spiritual needs. In addition, professional associations and educational institutions are beginning to provide learners and clinicians information on how to incorporate spirituality and practice. Furthermore, anecdotal evidence indicates that clinicians having received training in providing spiritual or religious interventions in clinical care find it immediately helpful and do apply it to their practice without self-reported evidence of harm.8

Therefore, the medical community has an obligation to take the observed relationships seriously and to carefully consider their implications for clinical practice and public health. Our view of the evidence to date is that trained or experienced clinicians should encourage positive spiritual interventions to interested patients (easily determined with any of several simple spiritual assessments) and that there is no evidence that such interventions are, in general, harmful.

Further, unless or until there is evidence of harm from a clinician’s provision of either basic spiritual care or a spiritually sensitive practice, interested clinicians and systems should learn to assess their patients’ spiritual health and to provide indicated and desired spiritual intervention. Clinicians and health care systems should not, without compelling data to the contrary, deprive their patients of the spiritual support and comfort on which their hope, health, and well-being may hinge.

The possibility of integrating religious/spiritual interventions into medical practice should not be dismissed without a thorough and open discussion about all the issues involved, and without more rigorous research about the potential benefits and/or harms of such interventions.