The Fevers of Reason

by Gerald Weissmann

  The world of Holmes and the black-bag doctors whom he addressed seems far away, viewed from our privileged decade of molecular medicine, of sono- and angiograms, of cyclo- and cephalosporins, of liposomes and liposuction. The day-to-day medicine from the 1830s to the 1930s appears to have been futile, groping—let’s face it, quackish. All that laying on of hands, thumping of the chest, calomel, glycerine, cautery, compresses! Nevertheless, Holmes gave the young Bellevue physicians a meliorist vision of the medical profession that transcends the fashionable diagnoses and drugs of the day; it will remain true when colonoscopy will have gone the way of cautery, and cortisone the way of calomel, when he said:

  If the cinchona trees all died out . . . and the arsenic mines were exhausted, and the sulphur regions were burned up, if every drug from the vegetable, animal, and mineral kingdom were to disappear from the market, a body of enlightened men, organized as a distinct profession, would be required just as much as now, and respected and trusted as now, whose province should be to guard against the causes of disease, to eliminate them if possible when still present, to order all the conditions of the patient so as to favor the efforts of the system to right itself, and to give those predictions of the course of disease which only experience can warrant, and which in so many cases relieve the exaggerated fears of sufferers and their friends, or warn them in season of impending danger. Great as the loss would be if certain active remedies could no longer be obtained, it would leave the medical profession the most essential part of its duties, and all, and more than all, its present share of honor.

  11.

  Galton’s Prayer

  What a tremendous stir-up your excellent article on prayer has made in England and America!

  —Charles Darwin to Francis Galton (November 8, 1872)

  AS THE EARTH WARMS, hurricanes, typhoons, and tsunamis happen. After each such calamity, be it in the land of Muslim, Jew, or Gentile, our leaders launch worldwide appeals for material aid and urge public prayer for the injured. New research shows that they needn’t bother with prayer.

  Well over a century ago, Sir Francis Galton, Fellow of the Royal Society, a cousin of Charles Darwin and the founder of modern biostatistics, called for a prospective, controlled study of whether those for whom prayers were offered would heal faster than those unaided by distant appeals to the deity. Writing in the Fortnightly Review of August 1, 1872, Galton proposed the comparison of two groups of traumatically injured patients,

  The one consisting of markedly religious, piously-befriended individuals, the other of those who were remarkably cold-hearted and neglected [since] an honest comparison of their respective periods of treatment and the results would manifest a distinct proof of the efficacy of prayer.

  In 2006, 134 years later, his call was answered in a definitive, double-blind study published in the American Heart Journal, fetchingly named “The Study of Therapeutic Effects of Intercessory Prayer (STEP).” Both its scope and cost were greater than the trial proposed in 1872.

  Herbert Benson of Harvard and a brigade of faithful collaborators assigned three Christian prayer groups to pray for 1,800 patients undergoing coronary artery bypass graft (CABG) surgery in six medical centers throughout the United States. Funded mainly by the John Templeton Foundation, which supports research at the interface of religion and science, the $2.4 million study was described in the New York Times as “the most scientifically rigorous investigation of whether prayer can heal illness.” It found that patients undergoing CABG surgery did no better when prayed for by strangers at a distance to them (“intercessory prayer”) than those who received no prayers. But 59 percent of those patients who were told they were definitely being prayed for developed complications compared with 52 percent of those who had been told it was just a possibility, a statistically significant, if theologically disappointing, result. Benson et al. came to the objective conclusion that “Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.”

  American advocates of intercessory prayer immediately raised objections to the study. “‘God Factor’ Defended; Prayer Study Flawed,” headlined the Worcester Telegram & Gazette. Brother Dennis Anthony Wyrzykowski told the newspaper, “The study was not a ploy to make God look bad. . . . Dr. Benson is interested in the God factor. He’s not out to disprove anything. We were disappointed. I was sure it would show that prayer works. . . .” “Area Residents Challenging Prayer Study,” headlined the Richmond Times-Dispatch. The Rev. Robert Friend of All Saints Episcopal Church in Richmond told the paper, “That’s not the way prayer works. When we pray we are aligning ourselves the best we can with God’s will for us. I think God’s will for us is that we be whole and healthy.” All Saints would continue its weekly prayer service for healing.

  Newspapers in less devout corners of the earth drew different conclusions: “Healing Power of Prayer Debunked” cried the Gazette of Montreal, while Le Monde warned from Paris that “La prière serait dangereuse pour la santé” [“Prayer Could be Dangerous to Your Health”]. Britain’s Guardian called attention to the most unexpected result of the STEP study: “If You Want to Get Better—Don’t Say a Little Prayer.” The Guardian’s Oliver Burkeman wrote, “If a religious person offers to pray for you next time you fall ill, you may wish politely to ask them not to bother. The largest scientific study into the health effects of prayer seems to suggest it may make matters worse.”

  THE Guardian DIDN’T NEED BENSON’S STUDY to draw its conclusions. Indeed, the STEP trial had been scooped by an older, irrefutable, and far less expensive analysis, Galton’s essay of 1872. Galton suggested that in place of any prospective study of intercessory prayer in traumatic injury, a more rigorous test of the effect of prayer would require life or death as an endpoint. He proposed an inquiry

  into the longevity of persons whose lives are prayed for; also that of the praying classes generally; and in both those cases we can easily obtain statistical facts.

  He noted that, for hundreds of years, public prayer each Sunday had been offered from the Book of Common Prayer for the long life of the monarch of England, as in “Grant him [her] in health long to live.” He asked, “Now, as a simple matter of fact, has this prayer any efficacy?” Fetching data from the records of over 6,500 biographies assembled by a colleague, Galton found that intercessory prayer offered on behalf of those who knew they were prayed for was bad for one’s health.

  It turned out that members of royal houses had a mean life expectancy of 64.0 years, significantly less than that of other aristocrats (67.3 years) or of other gentry (70.2 years). Since the royals knew they were being prayed for—we might say that each Sunday they were on the same page as their subjects—they were as much at risk for a worse outcome from prayer as were Benson’s CABG patients. While Benson et al. downplayed the possible side effects of prayer as a possible chance finding, Galton had reached a similar conclusion from a neater endpoint.

  Worse yet! The life expectancy of eminent clergymen (66.4 years) was no higher than that of their peers among lawyers (66.5 years) or medical men (67.0 years), and Galton concluded that, in keeping with the results of the STEP trial,

  prayers of the clergy for protection against the perils and dangers of the night, for protection during the day, and for recovery from sickness, appear to be futile in result.

  In an editorial in the American Heart Journal that accompanied the STEP trial paper, William Krucoff and colleagues at Duke sounded concern over the higher incidence of complications in the group that knew it was being prayed for. They asked: “If the results had shown benefit rather than harm, would we have read the investigators’ conclusion that this effect ‘may have been a chance finding,’ with absolutely no other comments, insight, or even speculation?” Supported by a foundation committed to the “God factor” at work in health and disease, Benson et al. must have been taken aback by the harmful consequences of intercesso
ry prayer. Perhaps that’s why it took almost five years to analyze data obtained on patients enrolled in the trial from January 1998 to November 2000! Undaunted, Dr. Charles Bethea, one of STEP’s coauthors, insisted to the New York Times in 2006 that “One conclusion from this is that the role of awareness of prayer should be studied further.” While the final STEP publication was impartial in its presentation and low-keyed in interpretation, it aroused the anger of believers and skeptics alike. The credulous contended that STEP was flawed, that it represented bad medical care and trivialized religion. Skeptics argued against the study, convinced that there is no place in the realm of science for supernatural intervention.

  NOW IT IS CERTAINLY WITHIN THE PREROGATIVE of objective clinicians to engage in statistical analyses of long-range prayer for others, especially when a foundation devoted to such notions picks up the tab. On the other hand, not only skeptics will wonder why the National Institutes of Health would encourage or support inquiries into the supernatural. Newspaper accounts of the STEP trial carried the remarkable news that our government has spent more than $2.3 million of public money on prayer research since 2000. Some of these studies overlap the published results of Galton and Benson et al., including, for example, “Distant Healing Efforts for AIDS by Nurses and ‘Healers’” (Elisabeth F. Targ, Principal Investigator California Pacific Medical Center, 1-R01-AT-485-1), a three-year grant totaling approximately $663,000, and “Efficacy of Distant Healing in Glioblastoma Treatment” (Elisabeth F. Targ, Principal Investigator, 1-R01-AT-644-1), a four-year grant totaling approximately $823,000. Sadly, the results of these studies remain largely unpublished: Dr. Targ died of glioblastoma in 2002. In April 2000, she had reported:

  Of more than 135 studies of distant healing on biological organisms . . . about two-thirds reported significant results. One fascinating study . . . concerned remote healing of tumors on mice. The study showed that the healers who were farthest from the mice had the greatest influence in shrinking the tumors.

  To be fair, when conducting controlled trials, Dr. Targ had been as professional and objective as Dr. Benson and his colleagues in their STEP study. Reporting on an $800,000 trial funded by the Department of Defense (Grant No. 17-96-1-6260) of Complementary and Alternative Methodologies (CAM) in breast cancer, “The Efficacy of a Mind-Body-Spirit Group for Women with Breast Cancer,” she concluded that “The study found equivalence on most psychosocial outcomes between the two interventions” (CAM versus control). And that’s not even at a distance.

  This year, the chances of being funded on any given grant application to the NIH are around 15% percent. It is in this context that one questions whether the NIH, and especially the National Center for Complementary and Alternative Medicine, NCCAM (now the National Center for Complementary and Integrative Health, NCCIH), has any business encouraging further grant applications and/or research into prayer. Those of us who engage in experimental biology are generally uninterested in enlarging the norms of our realm into the spiritual, artistic, or ethical life of our time. But believers in “noetic,” spiritual, or supernatural explanations for the vast territory of the unknown in science seem to have no such qualms. They’ve persuaded a credulous citizenry that there is spiritual gold to be mined by applying the methods of science to the study of religious practice. By confusing credulity with piety, they’ve also cleared the way to belief in “intelligent design.” While such notions discredit both rigorous science and true beliefs, they are part and parcel of the new Endarkenment.

  NCCAM was undeterred. In 2005 Catherine Stoney, PhD, of its Division of Extramural Research and Training, insisted that “There is already some preliminary evidence for a connection between prayer and related practices and health outcomes. For example, we’ve seen some evidence that religious affiliation and religious practices are associated with health and mortality—in other words, with better health and longer life.” She is unlikely to have consulted Galton’s statistics in the Fortnightly Review.

  Galton, who shared a grandfather—Erasmus Darwin—with Charles Darwin (all three were Fellows of the Royal Society), was far more modest in his peroration, as he offered the skeptical equivalent of prayer:

  Neither does anything I have said profess to throw light on the question of how far it is possible for man to commune in his heart with God . . . and it is equally certain that similar benefits are not excluded from those who on conscientious grounds are skeptical as to the reality of a power of communion. . . . They know that they are descended from an endless past, that they have a brotherhood with all that is, and have each his own share of responsibility in the parentage of an endless future. The effort to familiarize the imagination with this great idea has much in common with the effort of communing with a God, and its reaction on the mind of the thinker is in many important respects the same. It may not equally rejoice the heart, but it is quite as powerful in ennobling the resolves, and it is found to give serenity during life and in the shadow of approaching death.

  12.

  Dr. Doyle and the Case of the Guilty Gene

  The importance of the infinitely little is incalculable. Poison a well at Mecca with the cholera bacillus, and the holy water which the pilgrims carry off in their bottles will infect a continent, and the rags of the victims of the plague will terrify every seaport in Christendom.

  —Dr. Joseph Bell (1892)

  EDGAR ALLAN POE MAY HAVE WRITTEN the first mystery, but Dr. Arthur Conan Doyle put the genre on the map for keeps. Those ever-popular stories written by Doyle and Poe share a pattern: the hero is an omniscient, eccentric detective; the narrator is his obtuse roommate; the police are severely befuddled; the solution hinges on recourse to natural history or the pharmacopoeia. Most of all they celebrate what Poe called “the mental features discoursed of as the analytical.” However, despite the similarities in their fictions, Poe and Doyle were very unlike with respect to fortune, temperament, and career. They differed as much from each other as, let us say, doctor and patient. Doyle went as a medic to the Boer War, while “poor Edgar” died in a hospital of drink and tuberculosis. They’re also as different as checkers and chess.

  The Murders in the Rue Morgue begins with a curious introduction, a mini-essay in which Poe contrasts the “analytic powers” needed for chess and checkers. He argues that the mental features required in “the elaborate frivolity of chess” rank on a lower scale than those wanted to solve the “unostentatious” game of draughts (checkers). In chess, he claims, “the attention is here called powerfully into play . . . it is the more concentrative rather than the more acute player who conquers,” whereas in the simpler game of checkers, “what advantages are obtained by either party are obtained by superior acumen . . . by some recherché movement.” Reading Poe’s argument in the context of his rejection by the literary lions of his day, we have a hint of what he was up to when he proposed:

  Between ingenuity and the analytic ability there exists a difference far greater indeed than between the fancy and the imagination but of a character very strictly analogous. It will be found, in fact, that the ingenious are always fanciful, and the truly imaginative never otherwise than analytic.

  Since Poe accused the Boston literati, and especially the transcendentalists, of excess fancy and limited imaginations, we might read his homage to the “truly imaginative” as an advertisement for himself. Poe, champion of the recherché in his tales of terror and the imagination, seems to anticipate how critics of the future might distinguish his work from that of his disciple, Sir Arthur Conan Doyle. It’s the difference between England and France, chess and checkers. The good doctor’s very Anglo-Saxon hero, Sherlock Holmes, excels in the attentive power of a chess player. On the other hand, Poe’s Auguste Dupin shows the acumen of a Gallic champion at checkers with his recherché move into Cuvier. “King me!” the story seems to be saying: “The ape did it!”

  Poe’s quest for whodunit, in which the murderer ranks among the highest of apes, suggests that the detective story had other ove
rtones from its beginning. The murders in the rue Morgue were committed in those critical years for natural history between the theories of Jean-Baptiste Lamarck (1809) and those of Charles Darwin (1859). Baron Georges Cuvier’s original encyclopedia of the animal kingdom showed European man standing first in the Great Chain of Being, followed closely by the great apes. As one might expect, a very Gallic man was depicted at the head of the human pack, with the other specimens (Asian, Semitic, African) trailing backward to the beasts. The apes were described as “almost human, but with distinctly violent and bestial features.”

  With Cuvier as a template, it may not be too fanciful to suggest that the murder mystery began as a search for the ape beneath the skin, the biology of social guilt. And so, notwithstanding the differences between attention and acumen, checkers and chess, that Poe used to explain why he invented the genre, one has a hunch that the detective story is out not only to find whodunit but also to search for the guilty gene.

  More than a century ago, in December 1892, there appeared in the Bookman a review of Dr. Arthur Conan Doyle’s recently published The Adventures of Sherlock Holmes. The piece was written by Dr. Joseph Bell, a professor of surgery at the University of Edinburgh. Readers of the Bookman, a popular literary magazine, knew that the Scottish surgeon was the real-life prototype of Dr. Doyle’s detective—Doyle had been Bell’s student and assistant—and could fancy that they were reading a review of Sherlock Holmes’s adventures written by Sherlock Holmes himself. Bell wrote:

  The greatest stride that has been made of late years in preventive and diagnostic medicine is the recognition and differentiation by bacteriological research of those minute organisms which disseminate cholera and fever, tubercle and anthrax. The importance of the infinitely little is incalculable. Poison a well at Mecca with the cholera bacillus, and the holy water which the pilgrims carry off in their bottles will infect a continent, and the rags of the victims of the plague will terrify every seaport in Christendom. Trained as he has been to appreciate minute detail, Dr. Doyle saw how he could interest his intelligent readers by taking them into his confidence, and showing his mode of working. He created a shrewd, quick-sighted, inquisitive man, half doctor, half virtuoso, with plenty of spare time, a retentive memory for whom the petty results of environment, the sign-manuals of labor, the stains of trade, the incidents of travel, have living interest, as they tend to satisfy an insatiable, almost inhuman, because impersonal curiosity.