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Am Fam Physician. 2006;74(10):1684-1685

to the editor: The editorial by Drs. Weaver and Koenig in the April 15, 2006, issue of American Family Physician provides a helpful synopsis of recent studies regarding the relationship between religion and health.1 However, other literature suggests that this relationship is more nuanced than can be described by even high-quality studies.

Religious practice is heterogeneous. The beliefs, practices, and lifestyle of a Seventh-Day Adventist, for example, are different from those of a devout Muslim or orthodox Jew; yet, much of the medical literature on religion and health presumes a Christian context.2 Physicians generally lack the training to engage in in-depth conversations with patients about spiritual concerns.2 Differences in religious content become especially problematic when family physicians are urged to encourage and support their patients in religious activities.3 Despite the growing body of research linking religion to better health, certain religious practices may have negative health effects, as demonstrated by the ascetics and martyrs from the world's religions. If evidence eventually were to suggest that some religious denominations offer better health than others, should physicians guide patients toward those religions?

Attempts to quantify the effects of religion upon health may misrepresent religious practice. An instrumental approach to religion—that is, viewing religion as an intervention similar to antibiotics or surgery—may be deeply offensive to some people.2 Shuman and Meador assert that a utilitarian understanding of religion distorts the very nature of religion.4 A person who prays regularly solely because of purported health benefits may be involved in a substantively different activity from that of a person who follows the tenets of a particular religion out of faithfulness and humility. They further suggest that religious faith is not a commodity that can be exchanged for health.4

Physicians should have a basic knowledge of existing research on religion and health. Religious practice, however, is qualitatively different from other health behaviors such as quitting smoking5; research findings should be applied cautiously, if at all, to clinical practice.

in reply: Dr. Garrison addresses some important points about the relationship between religion and health and the potential applications of this relationship to clinical practice. Most of the current research does occur in a Christian context, mainly because approximately 80 percent of the population of the United States is Christian; however, a handful of studies in other religions have reported similar findings related to the effects of religion on health. Although physicians generally lack training on how to address spiritual issues in clinical practice, more than 85 of the 126 medical schools in the United States now offer elective or required training regarding these issues. Medical students are not being trained to “engage in in-depth conversations with patients regarding spiritual concerns,” but rather to take a brief spiritual history and refer patients to chaplains or pastoral counselors if appropriate. Supporting a patient's religious beliefs is straightforward and does not depend on concordance between the beliefs of the patient and physician. However, the physician should not feel required to do so.

In general, prescribing which religion to belong to or whether to be religious at all for health reasons is ethically out of bounds for physicians, and we do not encourage this practice. On the other hand, understanding the role that a patient's religious beliefs plays in coping with illness, medical decision making, and medical outcomes (i.e., taking a spiritual history), and supporting healthy coping behaviors falls squarely within the scope of what good whole-person medical care is all about.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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