The woman is enmeshed in the wondrous gadgetry of modern medicine. A rotating X-ray machine swings around her on a C-shaped arm. Video monitors show images of her heart as well as her vital signs. Doctors and nurses, clad in lead-lined vests, look like clinical RoboCops. The room is filled with beeps and flashes and growls from assorted high-tech instruments.
Mitchell Krucoff, a cardiologist at Duke University Medical Center, and Suzanne Crater, a nurse practitioner, are in a control room overlooking the scene. Very soon Dr. Krucoff will insert a wire into the woman’s heart and guide it to a clogged artery, where he will inflate a small balloon to clear the blockage. The procedure, known as an angioplasty, has become routine in recent years, but no heart surgery is free of risk.
Before they begin the procedure, Krucoff and Crater do something that few medical textbooks advise: They pray. As they do before every operation they perform. They typically try to do it in a quiet place, in an office or a lounge. But the elderly woman is ready for her angioplasty, so they’ve got no choice but to hold forth in the control room-amid the clutter and hubbub of 21st-century medicine, which includes, in a corner, a computer clicked onto Yahoo!’s personal finance page (someone had been checking a stock portfolio).
“Now?” Krucoff says, glancing at Crater.
“Yes,” she nods.
Krucoff looks at me.
“This is an 80-year-old woman who just had a heart attack, so we need all the help we can get.”
Crater looks at a monitor that shows an X-ray image of the woman’s heart-a dark splotch of muscle and arteries. She stares intensely at the heart, as though in dialogue with it.
Krucoff leans back in his chair and closes his eyes. A smile appears on his face-the kind of smile you see when someone is imagining a sunny beach, waves lapping at his toes, everything tranquil and good. Krucoff is far away.
Within a minute he opens his eyes and rises from his chair. Crater ends her communion with the woman’s heart. Their prayer session, or whatever you wish to call this interlude, is over. They are ready to take control of another person’s destiny.
Krucoff and Crater believe in the power of prayer. They are inclined to believe it works even if the person being prayed for is half a world away, unaware that prayers are being said. In the medical and scientific worlds, this is known as intercessory prayer.
Its efficacy is an article of faith in religious communities, but doctors and scientists, bearers of sobering news from the ramparts of medical research, tend to note that concrete proof is hard to find.
“Most people believe prayer works,” Krucoff says. “It’s just that where, when, how, whom-there’s simply no data to test that belief, prove that belief, or even characterize the implications of that belief.”
Krucoff and Crater would like to change that. They are conducting a remarkable study in which 14 groups are praying for angioplasty patients at five hospitals across the country. (Six more hospitals are expected to join the study in the next few months.) When the study, which is to involve 1,500 patients, is finished next year, the health of patients who received prayer will be compared to that of a control group that did not. If the patients who received prayer are in significantly better shape, the explanation will be startling: The prayers did it.
“How wild is it?” muses Krucoff, who looks like Al Gore with a mustache. “It’s wild. But there was a time when if you suggested that taking two aspirin would prevent heart attacks, people would think you were nuts. Can intercessory prayer do anything for a person 200 miles away having a heart attack? I don’t think that’s inconceivable.”
The prayer groups represent a rainbow coalition of religions across the globe. One group consists of about 150 monks at a Buddhist monastery on a hilltop outside Kathmandu. The monks, who are from Nepal, India, Tibet, and other Himalayan countries, face each other in rows at the Kopan Monastery and listen, during morning prayers, as their chantmaster calls out the names of the heart patients. Clad in traditional maroon robes, the monks silently pray for the patients’ good health. A similar scene takes place at a Buddhist monastery near Toulouse, France.
On the outskirts of Baltimore a group of 18 nuns at a Carmelite convent files into their chapel during vespers, adding the heart patients to those they beseech God to watch over. In Jerusalem the patients’ names are printed on slips of paper and placed in the Western Wall, following a Jewish tradition for bringing prayers to the attention of God; this is done by e-mailing the prayers to a popular website, VirtualJerusalem.com, which prints out and places in the wall missives sent from anyone, anywhere. In North Carolina, where Duke University is located, a number of groups-Pentecostal, Baptist, Moravian, Sufi Muslim, even an assemblage of Christian soccer moms-pray for the patients.
The door to Dr. Krucoff’s office bears a one-word notice: “Breathe.” Take a breath, relax; okay, come in. The office has a split personality. One wall is covered with medical diplomas and certificates, and the bookshelves groan with tomes that do not bother with cute, please-read-me titles. Interventional Cardiovascular Medicine, says one. Heart Disease, says another. But alongside them are books about prayer and health, and scattered about are religious and spiritual totems: Buddhas, an obelisk, an Orthodox icon, a figurine of a man doing tai chi, a plastic Disney dwarf. The office reflects the stress of a surgeon’s life and, at the same time, is a refuge from it.
Krucoff’s life is similarly divided. He has performed thousands of angioplasties and conducts cutting-edge research. But he prefaces his working day with a spell of meditation, and he is editor-in-chief of the journal Alternative Therapies in Health and Medicine. (Crater is an associate editor.) He will go almost anywhere, and speak to anyone, about noetic medicine-a catchphrase for spiritual and mind/body therapies. He even appeared at a meeting of construction contractors, taking the podium after a guy who lectured about new types of asphalt surfaces.
The prayer study that Krucoff and Crater are overseeing is known formally as the MANTRA Study Project, which is shorthand for Monitoring and Actualization of Noetic Trainings.
When the study is completed next year, they plan to assemble the data and learn whether patients who were prayed for had fewer complications-such as heart attacks, angina, or the need for additional surgery, like angioplasty or coronary bypass. They are also tracking the length of a patient’s hospital stay and incidents of stroke, shock, or death.
The study is double blind, which means neither the patients nor the medical personnel treating them know who is being prayed for and who isn’t. Once a patient agrees to join the study, he (or she) is randomly assigned by a computer at Duke to receive prayer or be in the control group. Off-site administrators e-mail leaders of the prayer groups or call them on the phone, providing them with the name of the patient who is to be prayed for, the patient’s age, the type of operation, and the location of the hospital where the patient is being operated on.
In typical medical trials the control group does not receive the drug or treatment that is being tested. But the control group in a prayer study is harder to control; family and friends might pray, as well as laypeople and religious leaders. “Prayer is already there,” Krucoff notes. “We are measuring whether or not a systematic addition of more prayer has a measurable effect.”
The study is being funded by several benefactors and philanthropic organizations. Krucoff and Crater intended to seek funding from the government but backed off after being told by an official at the National Institutes of Health that the agency would have nothing to do with prayer. (A spokesperson for the NIH’s National Center for Complementary and Alternative Medicine told me there is no policy against funding prayer studies, but only one study involving prayer has so far been funded, several years ago, and it didn’t involve much money.) Krucoff describes his own project as “sorely underfunded,” but that does not disappoint some members of his profession.
“Intercessory prayer is magic,” says Dr. Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering Cancer Center in Manhattan. Cassileth oversees a variety of treatments that used to be considered off-limits at mainstream hospitals, including acupuncture, hypnosis, and biofeedback. But she draws the line at intercessory prayer. “It suggests that people at long distance can influence the health outcome of someone they don’t know and are praying for. People have done this for millennia, but there really is no convincing evidence to suggest it is beneficial…. I would never put any intellectual or financial resources into a study of this kind. It is like studying whether the earth is round or flat.”
The Rev. Jerry Falwell also sounds a bit skeptical, in a here-we-go-again way. “I am not sure that God responds to so many of these surveys,” he says. “God wants us to believe and to trust based upon the promises in the Bible, not upon scientific surveys.” He noted that prayers do not tend to function in the manner of a popularity contest, in which the person who is prayed for the most lives the longest-which, if it were the case, would mean Mother Teresa would still be alive, as would Joe DiMaggio. Falwell pronounced himself “ambivalent” about prayer studies, although he said with a chuckle that if he were one of Krucoff’s patients, “I would want to be in that segment of guinea pigs who were being prayed for.”
The question of prayer’s impact has been pondered for some time. In a widely noted 1872 study titled “Statistical Inquiries into the Efficacy of Prayer,” Sir Francis Galton, a cousin of Charles Darwin, posed a direct question: “Are prayers answered, or are they not?” Galton, a brilliant scientist in his own right who became known, for better or worse, as the father of eugenics, compared morbidity rates of eminent lawyers, doctors, and priests. He found that the priests, who presumably prayed more than others and were prayed for by their congregations, lived shorter lives. He found no difference between the rate of stillbirths among churchgoers and nonchurchgoers, nor did he find a difference between the health of financial institutions led by devout bankers and those led by nondevout bankers.
For a century the issue was left for theologians and atheists to debate, not for respected doctors and scientists to test. But now treatments once deemed beyond the realm of serious inquiry are being investigated by the medical establishment. There is a boom in alternative and complementary medicine, from hypnosis and herbal supplements to aromatherapy and tai chi. The NIH is even paying for a study into the value of shark cartilage as a cure for cancer. These things reflect a widespread belief that modern medicine, as wonderful as it might be, does not have all the answers.
The modern era of credible prayer studies began in 1988, when Dr. Randolph C. Byrd, a cardiologist at San Francisco General Medical Center, published the results of an experiment in which he divided 393 patients in his hospital’s coronary care unit into two sections. One section received prayer from a Christian group, while the other section received no prayer at all. Byrd tracked 29 different indicators of health and found that on six of them those patients who had received prayers had better results, including fewer cases of newly diagnosed heart failure, fewer cases of pneumonia, and lower levels of prescribed antibiotics.
That study is not viewed as conclusive, however. Richard P. Sloan, director of the behavioral medicine program at Columbia Presbyterian Medical Center, noted in a recent article in The Lancet, the British medical journal, that “the groups did not differ in days in the coronary care unit, length of stay in hospital, and number of discharge medications.” In other words, even if prayer works it doesn’t work particularly well-to which prayer advocates respond that a slight improvement is better than none at all.
The torch was picked up by a team of researchers led by Dr. William S. Harris, a cardiologist at the Mid-America Heart Institute at Saint Luke’s Hospital in Kansas City. Harris tracked 990 patients in Saint Luke’s coronary care unit. Half were prayed for every day over 28 days by a five-person prayer group, and half were not prayed for at all. The patients who received prayer had 10 percent fewer complications, such as cardiac arrest and chest pain. But, as in the Byrd study, there was no difference in the length of time in the coronary care unit or in the hospital.
“We have not proven that God answers prayer or that God even exists,” Harris wrote in the Archives of Internal Medicine, a respected, peer-reviewed journal that published his findings last year. “It was intercessory prayer, not the existence of God, that was tested here. All we have observed is that when individuals outside of the hospital speak (or think) the first names of hospitalized patients with an attitude of prayer, the latter appear to have a ‘better’ CCU experience…. Chance still remains a possible explanation of our results.”
The journal received a cascade of responses, according to its editor, Dr. Richard Liebowitz, who is also director of education at the University of Arizona’s Program in Integrative Medicine-which is run by Dr. Andrew Weil. Liebowitz describes the reaction as “very polarized…. It goes from people criticizing the article without having read it, saying there couldn’t be any effect, it’s hogwash, to people accepting it without reading it, saying they always knew it would work, it’s just common sense. So there’s extremism on both ends.”
Sloan, the critic from Columbia Presbyterian, believes that even if the results are reliable-and he doesn’t think they are-some doctors might push religion on their patients; some patients, in response, might blame themselves for their illness, attributing it to insufficient piety. “Scientists can do all sorts of things that aren’t necessarily good ideas,” he told me. “Where’s this research going to go? Would you be tempted to contrast the capacity of Muslim prayers to Jewish prayers to Catholic prayers? Would you want to do that? It seems to me it’s very dangerous.”
All the researchers I interviewed stressed that they do not plan to test the efficacy of one faith against another. But-as the debate over cloning indicates-science can, on occasion, trot a few paces ahead of society. “I have had it proposed to me by a physician who was devout that we have an experimental contest between different religions,” recalls Dr. Larry Dossey, who wrote Healing Words, a 1993 best-seller that became a bible on the subject of spirituality and health. “You would have a Super Bowl of prayer. He had no doubt that his religion would beat the others hands down. I think it is a fairly dreadful proposal…. Leave it to human beings to figure out a way to screw this up.”
Much will be determined this year. In addition to the study at Duke, Dr. Herbert Benson, a well-known professor at Harvard Medical School and president of the Harvard-affiliated Mind/Body Medical Institute, is overseeing a study that involves at least 1,200 patients undergoing bypass surgery at several medical centers across the country. Results of the study are to be published in 2002.
Krucoff, who is 45 years old, was destined to cause a ruckus in the medical world. The son of a doctor, he grew up in Washington, D.C., and was in high school during the waning days of the Vietnam War, when the police were teargassing protesters. He remembers making impromptu gas masks out of women’s sanitary napkins soaked in water. “Excellent protection,” he told me.
The political climate had quieted by the time he entered Yale University, where he studied religion and philosophy, letting his mind wander a bit before medical school. Even then he sensed there was more to treating patients than science might know.
Krucoff didn’t begin focusing on the intersection between prayer and health until he began performing trial angioplasties on seriously ill patients at Duke in the early 1990s. Patients were required to sign consent forms that made it crystal clear that there was a one-in-three chance they might die during surgery. To Krucoff’s surprise, the mortality rate plummeted from 33 percent to three percent. Krucoff says he would have liked to attribute all of this to his own skills and the development of better techniques. But looking back now, he realizes there must have been something more at work. He has concluded that by warning his patients of the high risk of death, he inadvertently encouraged them to pray like they had never prayed before.
“It was not unusual-we’re right in the middle of the Bible Belt-to find the family, when we came to the room, saying a prayer together, just as the patient went into the cath lab,” Krucoff recalls. “We had focused, not by design but by the way we connected with the families, on a spiritual dimension…. We certainly believe that (prayer) was as much a part as the high tech in giving us a tenfold lower rate of mortality than we expected.”
In the middle of this, Krucoff and Crater were invited to visit an unusual hospital in Puttaparthi, India. The modern hospital, built with funding from a foundation controlled by Hard Rock Cafe cofounder Isaac Tigrett, was unofficially presided over by an Indian guru, Sai Baba, whose followers believe he has special spiritual powers. Sai Baba often visited the hospital. Krucoff and Crater were surprised to find an atmosphere in which staff and patients were remarkably calm and confident; there was no fear. “What was clear to us,” Krucoff recalled, “was that everybody did believe that God was making the rounds.”
On the plane back to Durham, Krucoff and Crater worked out, on a laptop, a proposal to conduct a study to track the Puttaparthi patients’ long-term health. The idea was to figure out whether the boost of being around Sai Baba had more than a short-term effect. Once they returned to Duke they decided to test the waters by conducting an informal and slightly wacky survey of dozens of colleagues: If Jesus accompanied cardiologists on their rounds, would patients recover faster? Almost everyone responded in the affirmative.
Krucoff and Crater were marching into one of the hottest areas of medical research-the nexus between spirituality and health. Duke, which is home to the Center for the Study of Religion/Spirituality and Health and has a special branch devoted to integrative medicine, has embraced these notions. Then again, the school played host decades ago to J.B. Rhine’s trailblazing and controversial research on extrasensory perception (ESP), so Duke is accustomed to shaking things up.
The proposal that Krucoff and Crater created in the jet stream between Puttaparthi and Durham had taken on a different shape by the time they presented it to their colleagues. Instead of studying the Puttaparthi patients, Krucoff and Crater decided to focus on the effects, if any, of prayer and other noetic therapies, such as healing touch. They completed a pilot study in 1998, but because the number of patients receiving prayer was small-just 30-the results, which suggested that intercessory prayer worked, were statistically insignificant. A full-blown study was needed, one that would involve 1,500 patients at hospitals across the country. That’s what Krucoff and Crater are overseeing right now.
The heart monitor next to the bed shows a regular beat. That is good news for Donald, a frequent visitor to the coronary care unit at Durham’s Veterans Affairs Hospital. Donald, who asked that his last name not be used, is a MANTRA patient. He doesn’t know whether he was prayed for before his angioplasty, but he hopes so. “I’m 100 percent for that,” he tells me. “Jesus is 100 percent in my life. I believe in the power of prayer.”
But Donald, a self-described “country boy” with the twang to prove it, does not believe in all types of prayer, and his view points up one of the incongruities of the study. “Not all prayers are answered,” he says. “If you don’t believe in Jesus, your prayers aren’t heard.” He shakes his head from side to side when I ask whether the Buddhists in Nepal could do him any good: No, they cannot. I don’t bother asking about the bits of paper in the Western Wall.
If the point of scientific inquiry is to answer unresolved questions, there is much to be answered in the realm of prayer. It’s not just a matter of figuring out, if you are tempted to do so, whether one faith’s prayer is more effective than another’s, or whether 10 minutes of prayer from a priest is more effective than 10 minutes from a nun or an hour from a divinity student-in medical parlance, these are questions of “dosage control”-or whether it’s possible to hurt people by praying for them to meet with ill fortune (a real possibility, some enthusiasts fear).
Researchers have tried for decades to establish whether prayer is a “distant healing”-a phenomenon in which one person transfers therapeutic energy to another. An oft-cited study on this was performed in the 1960s by Bernard Grad, a biologist at McGill University in Montreal. He made small skin wounds on the backs of 300 mice and divided them into three groups of 100 each. The cage of one group was held, twice daily, by a faith healer, Oscar Estebany, who was told to focus healing energy on the wounds. Another cage was held, twice daily, by medical students; the third cage wasn’t held by anyone. After two weeks, Estebany’s mice had healed faster than the other mice, according to Grad’s report, which was published in the decidedly nonmainstream Journal of the American Society for Psychical Research.
That was more than 30 years ago. Follow-up studies have been fragmentary and carried out on the margins of the medical establishment, though that could change as the stigma lifts on once-taboo areas of research. Though the NIH remains reluctant to dabble in prayer, it is backing a range of studies on alternative therapies that would have been unimaginable just a few years ago. Private funding sources are more available too. The prayer study at Harvard is being financed by the well-endowed John Templeton Foundation.
One of the ironies of this new activity is that the coalition of religious and spiritual activists who have pushed things forward could end up-if prayer is proved to have an effect-dividing along stark lines between those who believe prayer works through God and those who believe it works through innate human powers.
“It’s an argument that doesn’t have to happen but probably will,” Dossey told me. “There are people who are claiming this is a ‘mind over matter’ sort of thing and nothing more, and other people who say that God did it, or Allah.”
Krucoff professes neutrality when I inquire about the mechanism through which he believes prayer works. “I think it’s a great conversation piece, and I guess it’s silly to say we’ll never know,” he explains in his office, as John Coltrane pours forth from the stereo. “Speculating, experimenting, pretending that you know the mechanisms is fun and it can make academic careers. But the important part of healing, to the patient, is the outcome.”