Religious rituals in healthcare
Post Reply
 
Thread Rating:
  • 0 Votes - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
23-12-2016, 11:14 AM
RE: Religious rituals in healthcare
(23-12-2016 09:59 AM)Astreja Wrote:  Most hospitals seem to have a chapel and/or a "spiritual care" department. It's there already for people who find comfort and inspiration in such things.

While people already have access to whatever spiritual and religious practices they fancy I am advocating specifically targeting and recommending rituals as a part of some treatments - based on some kind of screening of patients to assess whether said ritual would produce a placebo effect.


Quote:I would leave things as status quo, rather than expecting doctors who favour evidence-based medicine to go romping down that rabbit hole.

Placebo is evidence-based though.
Find all posts by this user
Like Post Quote this message in a reply
23-12-2016, 11:25 AM
RE: Religious rituals in healthcare
(23-12-2016 10:41 AM)SYZ Wrote:  Slightly tangential, but...

I really, really object to Roman Catholic hospitals and/or doctors who refuse to carry out termination of pregnancies, or prescribe contraceptives and/or the so-called morning after pill RU-486. Believe it or not, this is totally legal where I live in Australia—providing the doctor or hospital immediately refers the patient to another consenting medical facility.

I note that this passage has been deleted from the original 5th century BCE Hippocratic Oath in its current 1964 format: "I will not give to a woman a pessary to cause abortion". So now there's nothing in the Oath that precludes any doctor carrying out these procedures.

In a scientifically-enlightened 21st century, there is NO place for religious intervention in any/all medical scenarios.

Unless people want it. If religion is an integral part of someone's life, it can be essential in their recovery. Pulling the rug out from under them when they are seriously ill, is the worst timing one could imagine. It's not the time or place. Forcing our values on others who aren't ready, isn't exactly a valid way to proceed.

Expecting Catholics to do terminations is unrealistic. If you need one, don't go to a Catholic. Doctors can't be forced to participate in what they consider "immoral'', and if the religious community that objects to certain procedures pays to keep the place open, they are free to determine what is or is not acceptable within their walls. Anyone going there (should) be fully aware of their policies.

Chaplains, where I come from are mostly a "comforting presence", and are someone to talk to. The medical staff doesn't really have the time or skills to do that. They get family members in touch with one another, and coordinate communication. They don't preach. They pray only if asked. There are exceptions, but the training programs weed out the wackos. But then I live in LaLa Land. Maybe it's different elsewhere.

Insufferable know-it-all.Einstein God has a plan for us. Please stop screwing it up with your prayers.
Find all posts by this user
Like Post Quote this message in a reply
23-12-2016, 11:29 AM
RE: Religious rituals in healthcare
(23-12-2016 11:14 AM)Gaest Wrote:  ...I am advocating specifically targeting and recommending rituals as a part of some treatments - based on some kind of screening of patients to assess whether said ritual would produce a placebo effect.

That I would not support. If somebody already believes in some kind of "spiritual" support then allowing them to do what comforts them is fine. I would not advocate promoting any kind of religious ritual on people who do not ask for it. Suggesting some forms of meditation or relaxation techniques could make sense but I would never encourage people to accept a belief that was not evidence based.

Atheism: it's not just for communists any more!
America July 4 1776 - November 8 2016 RIP
Find all posts by this user
Like Post Quote this message in a reply
23-12-2016, 11:43 AM
RE: Religious rituals in healthcare
I'd be interested in any links you have supporting this comment...

(23-12-2016 11:14 AM)Gaest Wrote:  Placebo is evidence-based though.

In May 2001, The New England Journal of Medicine published an article that called into question the validity of the placebo effect. "Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo with No Treatment" by Danish researchers Asbjørn Hróbjartsson and Peter C. Götzsche "found little evidence in general that placebos had powerful clinical effects."

Their meta-analysis of 114 studies found that "compared with no treatment, placebo had no significant effect on binary outcomes, regardless of whether these outcomes were subjective or objective. For the trials with continuous outcomes, placebo had a beneficial effect, but the effect decreased with increasing sample size, indicating a possible bias related to the effects of small trials." (Most of the studies evaluated by Hróbjartsson and Götzsche were small: for 82 of the studies the median size was 27 and for the other 32 studies the median was 51.)

The Skeptics Dictionary, Nov 2015.



Existing evidence strongly suggests that placebo effects are mostly comprised of bias in reporting and observation and non-specific effects. There is no measurable physiological benefit from placebo interventions for any objective outcome. There is a measured benefit for some subjective outcomes (mostly pain, nausea, asthma, and phobias), but the wide variation in effect size suggests this is due to trial design (and therefore bias) rather than a real effect.

In any case, any perceived benefit in subjective symptoms seems to be greater for physical interventions (perhaps a hands-on benefit) but is the same for mainstream vs novel treatments. Therefore, there is no justification to be found in the placebo effect for using unscientific or dubious interventions. Placebo medicine is a sham. And any potential placebo benefit worth having can be fully realized with science-based interventions.

Professor Steven Novella, Science-Based Medicine, March 2010.

I'm a creationist... I believe that man created God.
Find all posts by this user
Like Post Quote this message in a reply
[+] 1 user Likes SYZ's post
23-12-2016, 01:02 PM
RE: Religious rituals in healthcare
(23-12-2016 11:29 AM)unfogged Wrote:  
(23-12-2016 11:14 AM)Gaest Wrote:  ...I am advocating specifically targeting and recommending rituals as a part of some treatments - based on some kind of screening of patients to assess whether said ritual would produce a placebo effect.

That I would not support. If somebody already believes in some kind of "spiritual" support then allowing them to do what comforts them is fine. I would not advocate promoting any kind of religious ritual on people who do not ask for it. Suggesting some forms of meditation or relaxation techniques could make sense but I would never encourage people to accept a belief that was not evidence based.

I agree. The ritual doesn't have to be religious though. We go through rituals when we visit medical professionals all the time so maybe they could be optimized and formulated into non-religious rituals still capable of creating placebo effects.
Also I was thinking in terms of recommendations. Obviously it has to be a voluntary addition to the biomedical treatment Smile
Find all posts by this user
Like Post Quote this message in a reply
26-12-2016, 01:03 PM
RE: Religious rituals in healthcare
(23-12-2016 01:02 PM)Gaest Wrote:  We go through rituals when we visit medical professionals all the time so maybe they could be optimized and formulated into non-religious rituals still capable of creating placebo effects. [...]

I'm not sure that I'd agree with this (in my case). I note that Dictionary.com defines a ritual as: "a religious or solemn ceremony consisting of a series of actions performed according to a prescribed order" or "an established or prescribed procedure for a religious or other rite", or its synonyms "formality, procedure, or routine".

I guess—loosely speaking—my consultations with my doctors are procedural or routine, but they don't really qualify as "rites". That definition implies a much more formalised and rigid relationship. I know a lot of (particularly) older patients regard their doctors as demi-gods, but I'm not one of them. In fact I threatened one of our local GPs with a formal complaint to the controlling body for doctors late last year.

And I'm not certain that doctors—as a form of therapy—should be "optimiz[ing] and formulat[ing]" treatmemt into rituals still capable of "creating placebo effects". I much prefer my doctors to use accredited medicine and modes of intervention rather than potential pseudo-science that may hide a more serious cause for my illness..

I'm a creationist... I believe that man created God.
Find all posts by this user
Like Post Quote this message in a reply
27-12-2016, 11:32 AM
RE: Religious rituals in healthcare
I think people have a right to whatever rituals they want for themselves. However, they can't interfere with the welfare of any other patients. Also, I think the waters get muddier when kids are involved. Rituals that don't interfere with the practice of medicine are one thing, but things like refusing a blood transfusion for a child that needs one is completely another. Just as worshipers expect respect in their houses of worship, I think medical professionals can expect the same in their hospitals. So tough shit religious nut parents. Your kid gets the transfusion.

@DonaldTrump, Patriotism is not honoring your flag no matter what your country/leader does. It's doing whatever it takes to make your country the best it can be as long as its not violent.
Find all posts by this user
Like Post Quote this message in a reply
28-12-2016, 08:34 PM (This post was last modified: 28-12-2016 09:11 PM by Gaest.)
RE: Religious rituals in healthcare
Sorry for the late reply, its Christmas and figuring out the academic discussion on this took quite a bit of time… and Skeptics Dictionary didn’t really help to further a nuanced discussion.

(23-12-2016 11:43 AM)SYZ Wrote:  I'd be interested in any links you have supporting this comment...

(23-12-2016 11:14 AM)Gaest Wrote:  Placebo is evidence-based though.

Here ya go Smile

About the placebo effect in more general terms:

[1] Kaptchuk, T. J., & Miller, F. G. (2015). Placebo effects in medicine. N Engl J Med, 373(1), 8-9. doi:10.1056/NEJMp1504023 (http://www.nejm.org/doi/full/10.1056/NEJ...t=article)

[2] Finniss, D. G., Kaptchuk, T. J., Miller, F., & Benedetti, F. (2010). Biological, clinical, and ethical advances of placebo effects. The Lancet, 375(9715), 686-695. doi:10.1016/S0140-6736(09)61706-2

About the placebo effect relating to rituals and religion:

[3] T. J. K. (2011). Placebo studies and ritual theory: A comparative analysis of navajo, acupuncture and biomedical healing. Philosophical Transactions: Biological Sciences, 366(1572), 1849-1858. doi:10.1098/rstb.2010.0385 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130398/)

[4] Harrington, A. (2011). The placebo effect: What's interesting for scholars of religion? Zygon, 46(2), 265-280. doi:10.1111/j.1467-9744.2010.01188.x

Now on to the sources you posted:
(23-12-2016 11:43 AM)SYZ Wrote:  In May 2001, The New England Journal of Medicine published an article that called into question the validity of the placebo effect. "Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo with No Treatment" by Danish researchers Asbjørn Hróbjartsson and Peter C. Götzsche "found little evidence in general that placebos had powerful clinical effects."

Their meta-analysis of 114 studies found that "compared with no treatment, placebo had no significant effect on binary outcomes, regardless of whether these outcomes were subjective or objective. For the trials with continuous outcomes, placebo had a beneficial effect, but the effect decreased with increasing sample size, indicating a possible bias related to the effects of small trials." (Most of the studies evaluated by Hróbjartsson and Götzsche were small: for 82 of the studies the median size was 27 and for the other 32 studies the median was 51.)

—The Skeptics Dictionary, Nov 2015.

This is pretty dated. It’s a 15 year old study in a field that moves pretty rapidly. The newest version I could find of Hróbjartsson and Götzsches study is from 2010 [5] - It also happens to be the primary source in the blog post by Novella that you quoted from. They themselves indirectly call the 2001 study dated:

“The two previous versions of this review were published in 2001 and 2004. Both reviews found that placebo interventions in general do not have clinically important effects, but that there were possible beneficial effects on patient-reported outcomes, especially pain. Since then several relevant trials have been published.” ~ p. 4 [5]

One of the big differences is that there is a measured benefit in subjective outcomes.
Here summed up nicely in Hróbjartsson et al. from 2011:

“(…) but the latest update from 2010 reported more multifaceted results. Large analgesic effects of placebo interventions were found in several well conducted trials. Furthermore, a considerable variation in effect could in part be explained by differences in trial design, for example, effect of placebo was larger when the intervention was a device (as compared with pill placebo).” P. 1224 [6]

I will be dealing more with the newer study in my comments on the source you quoted from Science-Based Medicine:

(23-12-2016 11:43 AM)SYZ Wrote:  Existing evidence strongly suggests that placebo effects are mostly comprised of bias in reporting and observation and non-specific effects. There is no measurable physiological benefit from placebo interventions for any objective outcome. There is a measured benefit for some subjective outcomes (mostly pain, nausea, asthma, and phobias), but the wide variation in effect size suggests this is due to trial design (and therefore bias) rather than a real effect.

In any case, any perceived benefit in subjective symptoms seems to be greater for physical interventions (perhaps a hands-on benefit) but is the same for mainstream vs novel treatments. Therefore, there is no justification to be found in the placebo effect for using unscientific or dubious interventions. Placebo medicine is a sham. And any potential placebo benefit worth having can be fully realized with science-based interventions.

—Professor Steven Novella, Science-Based Medicine, March 2010.

I assume this is the blog post: https://sciencebasedmedicine.org/placebo...revisited/
While Novella in his blog post links to two papers he only quotes from the Hróbjartsson and Götzsche study, and since it also ties into the dictionary entry above I didn’t bother with the second paper… If it is important to anyone I can check up on it though.

Here are some of the key areas where I think Novella and I disagree.
-I disagree that there is “no measurable physiological benefit” when it comes to objective outcomes.
-I disagree that the “measured benefit for some subjective outcomes” can be dismissed as bias from trial design.
I would also argue that you can map the science of placebo to a point where utilizing certain rituals and interventions for the sake of causing placebo effects can be considered science-based interventions. So I guess that might eventually discard some novel treatments and mainstream others.

First of all it’s important to be aware that not only physiological benefits, but especially the subjective outcomes are fairly complicated to assess – which Hróbjartsson and Götzsche are aware of and probably why they pointed the limitations of their results:

“It is a question of definition whether our review evaluates the ‘placebo effect’. This term does not only imply the effect of a placebo intervention as compared with a no-treatment group, but is also used to describe various other aspects of the patient-provider interaction, such as psychologically-mediated effects in general, the effect of the patient-provider interaction, the effect of suggestion, the effect of expectancies, and the effect of patients’ experience of meaning. As patients in the no-treatment group also interact with treatment providers, a no-treatment group is only untreated in the sense that they do not receive a placebo intervention. Our result is therefore neutral to many of the meanings of the term ‘placebo effect’ cited above, and we do not exclude the possibility of important effects of other aspects of the patient-provider interaction (…)” ~ p. 14-15 [5]

Not sure if Novella read beyond the abstract, but this is a fairly important point regarding this study’s ability to handle subjective outcomes. Another important nuance in their study when it comes to subjective outcomes and trial design versus real effect:

“We found an effect on patient-reported outcomes, especially on pain. Several trials of low risk of bias reported large effects of placebo on pain, but other similar trials reported neglible effect of placebo, indicating the importance of background factors. (…) So, despite a general picture of low effects, and the risk of response bias and small sample size bias, it is likely that large effects of placebo interventions may occur in certain situations.

In other words, the study he quotes isn’t dismissive of subjective outcomes. [1], [2] and [3] all support subjective outcomes as being very real. Also a review and meta-analysis from 2013 by Howick et al. [7] found placebo effects to be pretty potent for a number of issues:

“The clinical usefulness of placebos requires comparison with treatments and we found that placebo effects are often similar to treatment effects. Trials involving such placebos must be adequately blinded [59], [76], and dichotomizing outcomes in trials with weaker interventions will lead to a loss of power to detect effects. Because the placebo effect is part of the overall treatment effect our findings do not imply that placebos – even powerful placebos – should replace treatments. Rather, this study shows that patients will benefit if doctors exploit relatively powerful placebos either alone or as part of a therapeutic regime. ” [7]

A later correction from 2016 [8] strengthened the result.

In terms of the physiological benefit (which can admittedly be slightly harder to measure) we know of several neurological mechanisms [1], [2], [9] and it is even hinted to in [5]. As one of the newest papers (2015) it’s probably best to quote Hall et al. [9] here:

“Recent innovative neuroimaging [4] and physiological experiments [5] have fostered the current viewpoint that placebo effects are biological responses to psychosocial environmental cues surrounding the administration of inactive (or active) treatments. Such placebo research has established that the placebo response is more than patient report bias, regression to the mean, or spontaneous remission 6, 7 and 8. As a result of these developments, placebo responses are emerging as a legitimate series of biological reactions that must be rigorously characterized to facilitate efficient pharmaceutical development and optimal clinical care.” P. 285 [9]

It also covers some interesting perspectives in terms of placebo and drugs as well as the possibility of tailoring placebo treatment to genetic profiles.
“This question of personalizing drug doses based on genetic placebo profiles is likely to be significant in conditions other than pain that are known to have high variability in both drug and placebo responses, such as functional urinary and bowel conditions, and symptoms of fatigue, nausea, hot flashes, depression, and anxiety. Furthermore, the usefulness of a recently proposed strategy of open-label honest placebo treatments in such conditions as IBS [89], acute episodic migraine attack [90], and depression [91] could prove more feasible with knowledge of a patient’s placebome.” P. 291 [9]

[5] Hróbjartsson, A., & Gøtzsche, P. C. Placebo interventions for all clinical conditions. Cochrane Database of Systematic Reviews, doi:10.1002/14651858.CD003974.pub3 (http://onlinelibrary.wiley.com/doi/10.10.../abstract)

[6] Hróbjartsson, A., Kaptchuk, T. J., & Miller, F. G. (2011). Placebo effect studies are susceptible to response bias and to other types of biases. Journal of Clinical Epidemiology, 64(11), 1223-1229.

[7] Howick J, Friedemann C, Tsakok M, Watson R, Tsakok T, et al. (2013) Are Treatments More Effective than Placebos? A Systematic Review and Meta-Analysis. PLOS ONE 8(5): e62599. doi: 10.1371/journal.pone.0062599 (http://journals.plos.org/plosone/article...e.0062599)

[8] Howick J, Friedemann C, Tsakok M, Watson R, Tsakok T, et al. (2016) Correction: Are Treatments More Effective than Placebos? A Systematic Review and Meta-Analysis. PLOS ONE 11(1): e0147354. doi: 10.1371/journal.pone.0147354 (http://journals.plos.org/plosone/article...e.0147354)

[9] Hall, K. T., Loscalzo, J., & Kaptchuk, T. J. (2015). Genetics and the placebo effect: The placebome. Trends in Molecular Medicine, 21(5), 285-294. doi:http://dx.doi.org.ez.statsbiblioteket.dk:2048/10.1016/j.molmed.2015.02.009

On a side not, it would be great if people would use phrases such as “it is 'just' a placebo” and “it is 'only' a placebo effect” less. Placebo and nocebo effects can be very potent in certain situations.

Edited for spelling stuff...
Find all posts by this user
Like Post Quote this message in a reply
28-12-2016, 09:31 PM
RE: Religious rituals in healthcare
(23-12-2016 07:47 AM)Gaest Wrote:  Hey everyone,

I considered calling this thread "the theater of healing" or something obscure along those lines, but I figured I would be a bit more direct:

Do religious rituals have a place in healthcare?

I would argue that they do to an extent. The reason I would argue they have a place along side traditional biomedical treatment is that rituals and - for religious people - religious rituals are pretty potent when it comes to unlocking the body's own medicinal cabinet through the placebo effect.

Obviously it is important to know the limits of placebo effects. You can't prayer-group yourself out of getting bitten by a snake, lacking insulin or having your appendix burst by an infection.
That being said the placebo effect can provide relief (fx by alleviating pain), have a therapeutic effect and enhance the effectiveness of pharmaceutical drugs.
They might also be able to stimulate and strengthen (?) immune responses, but I'm not sure how well established that is.

Of course more research is needed - partly because not everyone responds equally to placebo effects and partly to avoid nocebo effects - before you formally implement rituals (including religious ones) in healthcare practices, and you would need a special institution with medical professionals to vet rituals and the people performing them.

On another note the ritually induced placebo effect actually lends some credibility to the effectiveness of religious healing rituals historically and today...

Thoughts? Comments? Outbursts?

It would be utterly unethical for medical staff to divert their energy to religious ritual.
In fact, I'd sue their sorry asses if they even tried to do this.

If someone wants their witch doctor to attend them, that is their choice.

Skepticism is not a position; it is an approach to claims.
Science is not a subject, but a method.
[Image: flagstiny%206.gif]
Visit this user's website Find all posts by this user
Like Post Quote this message in a reply
[+] 1 user Likes Chas's post
28-12-2016, 09:40 PM
RE: Religious rituals in healthcare
I'd rather they just have cats roaming the hospital rooms.

'Murican Canadian
Find all posts by this user
Like Post Quote this message in a reply
[+] 1 user Likes yakherder's post
Post Reply
Forum Jump: