What is prayer, exactly? Prayer is most commonly understood to be a conversation between a human being and a Deity. In their book entitled Prayer, Carol and Philip Zaleski more eloquently define it as “action that communicates between human and divine realms…[prayer] entails a multitude of forms and a multiplicity of aims.”⁶ Some of the recognized forms of prayer include: intercession (praying for someone else), meditation, praise, thanksgiving, petition, and even sacrifice. Prayers for healing may include any assortment of these forms and are sometimes accompanied by an anointing ritual or laying-on-of-hands by clergymen or other religious leaders.^7,8 Most Christian anointing rituals practiced in the United States are based on the biblical instruction that one who is sick should call for the elders of the church, “and let them pray over him, anointing him with oil in the name of the Lord: and the prayer of faith shall save him that is sick…and if he have committed sins, they shall be forgiven him.”⁹

A patient’s choice to pray for healing is often informed by his religious or spiritual beliefs. The Holy Bible, which is central to the Christian faith, speaks extensively of God’s restoring power and gives examples of certain individuals who received healing at His hand (such as King Hezekiah whose life was extended after he prayed to God on his deathbed¹⁰). It is a traditional Christian belief that God is a mighty healer, but that His healing of an individual is not always synonymous with eradication of disease. In Christianity, spiritual healing of the soul is viewed as paramount to physical restoration. In Judaism, there is a similar belief in God alone as healer.¹¹ In addition, some Jewish traditions hold that God is the lone source of both health and illness. Historically, sickness was regarded as a sign of either individual or collective punishment, and healing was considered a sign of individual or collective forgiveness. The focal point of contemporary Jewish beliefs is the idea that healing is not about alleviating symptoms, but rather it is about developing courage and a positive identity.¹² Two common elements of Jewish healing services are meditation and prayer. Similar healing strategies are found in Buddhism, Hinduism, and Islam. In Islam, faith is believed to protect against ill health and allows one to manage health problems when they do occur (by the will of Allah). The ritual prayer, zikr, is an act of worship and is sometimes used to promote physical and mental wellness.¹³

One of the first empirical studies on prayer was done at the San Francisco General Hospital by Dr. Randolph C. Byrd.¹⁴ In a paper published in 1988, Dr. Byrd summarized the results of his 10-month study. In a randomized, double-blind protocol, 393 patients admitted to the coronary care unit were assigned to either an intercessory prayer (IP) group or a control group. The IP group received prayer by Christians outside the hospital; the control group did not. It was found that control patients not receiving any prayer required ventilatory assistance, antibiotics, and diuretics more frequently than patients in the IP 
group.

In a similar study of adults recovering from coronary artery bypass graft surgery, information about post-surgery depression and general distress was gathered from a sample of 151 patients. It was found that 85% of these patients practiced complementary therapies. Two of these therapies, prayer and exercise, were associated with better psychological recoveries.¹⁵A 2002 study by the University of Texas expanded on the notion that prayer improves patients’ coping regimens. In this study, prayer activities of 32 patients with cancer were monitored. Increased prayer activity was associated with decreased physical responses to cancer. Moreover, prayer (for oneself) was found to influence a patient’s perception of cancer and lessen some of its psychological effects.¹⁶

However, not every study has found positive outcomes associated with prayer. In a 2006 investigation involving cardiac bypass patients, intercessory prayer was found to have no effect on complication-free recovery, and conversely was associated with a higher incidence of complications.¹⁷ Some point out that the inconsistency of empirical studies on prayer is due to the fact that God cannot and should not be tested; they believe He is a supernatural being and His works are scientifically unknowable.

In his theoretical model on prayer,18 Dr. Jeffrey Levin proposes several possible mechanisms by which prayer evokes healing. He discusses the possibility that prayer works by naturalistic mechanisms: perhaps by optimizing the efficacy of a force present within the universe or strengthening the reign of mind over body. Toward the end of his proposal, he admits that none of these theories really matter to the one who prays. For that individual, the only mechanism by which prayer works is a supernatural one, and the only explanation needed for how prayer heals is the existence of a transcendent Creator-God, a supernatural Being, who is able to heal.

The belief in a God who heals has a profound effect on the physician-patient relationship. For some patients, it means that the physician is not autonomous, but rather is assisting God, and may even be an instrument in His hands.¹⁹ It means that they trust in God’s will and their clinical decisions are influenced by that trust. Consequently, there are some patients who desire to include their physicians in spiritual discussions. Ehman et al. found that 94% of patients who considered spirituality important wanted physicians to ask about their spiritual beliefs, and nearly half of those who did not consider spirituality important still felt physicians should ask.²⁰ Another study found that some patients desire to pray with their physicians but feel embarrassed to make the request.²¹ These studies suggest that some patients would benefit from physicians who are sensitive and responsive to spiritual issues.

Traditionally, medical practitioners have avoided matters of spirituality in the medical interview, but recently, steps have been taken to address the spiritual needs of patients. The Handbook of Religion and Health encourages physicians and other healthcare professionals to consider taking a spiritual history, to cautiously use spiritual interventions (such as prayer), and to encourage the spiritual and/or religious beliefs of patients.²² In addition, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has published guidelines for taking a spiritual assessment.²³

At Mayo Medical School in Rochester, Minnesota, we have already discussed in our first year how to initiate a conversation with patients about their religious or spiritual beliefs and how to respond to patients’ requests to pray. Training on spiritual history taking is being integrated into medical education nationwide. Nearly two-thirds of medical schools now incorporate this type of coursework into their curricula.²⁴

The integration of spirituality and medicine represents a new frontier in health science. It is likely that our generation will be better prepared than previous ones to appropriately handle issues of religion and spirituality in the healthcare setting. America is a religiously diverse nation, perhaps the most diverse in the world. Thus, as we continue maturing into physicians, it is my sincere hope that we also continue to develop sensitivity for beliefs and practices that may not be agreeable to our own. I conclude that we will.

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