A South African Christian doctor, Dr. Frans Cronjé, MBChB (UP), MSc, is the Principal Investigator of a three-year "physical, mental and spiritual health" study undertaken in collaboration with a ministry called Be in Health in Thomason, Georgia, under the auspices of Human Research Ethics Committee of the University of Stellenbosch (SUN).
Dr. Cronje presented the preliminary, pre-publication findings of this prospective, observational, cohort study at the 11th Annual World Christian Doctors Network (WCDN) Conference held at the Sofia Balkan Hotel (May 9-10, 2014).
After his presentation, Dr. Cronjé was asked by the ASSIST News Service (www.assistnews.net) to comment on the study and offered the following perspectives that we would like to share and he began by saying: "To appreciate the role and objective of this study, it must first be understood within the broader medical research landscape that WCDN is trying to address; the study is meant to serve as a prototype for future studies of this nature.
"Until this conference, the main focus of WCDN has been on reporting and celebrating supernatural and miraculous health outcomes in response to intercessory prayer, deliverance and other spiritual interventions. These cases glorify God, strengthen faith, and encourage spiritual conversions. However, they have limited impact on medicine as a whole: they might convince individual medical practitioners, but even the most convincing miraculous recovery does not address the underlying functional separation between the church and the broader medical profession. In this regard, there are several things to consider:
"Secular physicians are generally suspicious of faith and religion in matters of health; an individual's persuasion of faith may even be seen as a potential threat to medical compliance. As such, case reports containing statements like 'the patient decided to depend on God for their healing' are likely to be dismissed on principle by unbelieving physicians. Even if the outcome is good, it would be considered a 'fluke'; if it is bad, it would entrench their unbelief and engender further mistrust. It may even provoke subsequent scorn and ridicule of patients with spiritual views on health or - even worse - produce a state of censure of all religious interactions with patients. We must therefore be wise when matching evidence with the desired objective."
Dr. Cronjé with his wife on the Mount of Olives, Israel
He went on to say, "As believing physicians of the WCDN we also need to realize that there are two fundamentally different perspectives in healthcare: there is the individual perspective in which the most appropriate remedy is pursued, and there is the community perspective that attempts to offer a comprehensive health care delivery system. Secular health systems try - albeit imperfectly - to integrate the two as best they can. Miracles are part of the individual perspective; they are individual, personal and therefore - by definition - anecdotal. Even when they are verified scientifically and life-changing for the individuals in question, they are not the norm: they do not transfer necessarily to others in similar situations. As such, they do not meet the scientific and ethical criteria for becoming a standard of care. So, we must accept that, when viewing faith from a community health perspective, evidence for miraculous healing neither challenges nor guides health practices. So there is a missing piece in our puzzle.
"Then, for believing patients who become absorbed by the resident healthcare system, there may be a time - sooner or later - that they wish to pursue spiritual solutions or alternatives. Unless guided by wise and discerning physicians and pastors, these situations may become highly problematic. Frequently they force an ultimate 'either-or', God-or-medicine' decision. For the patient it often becomes a crisis of faith. For the medical practitioner - in lieu of any evidence or guidelines to follow - it may lead to a spiritual-ethical crisis, inappropriate coercion of the patient, or the immediate discharge from all care. The net result is often a fracture in the continuum of care and further alienation between ministry and medicine.
"Irrespective of the strength of our personal convictions, the difficulty remains that without the benefit of reproducibility, predictability, generalization or explanation, medical science is unable to fully embrace miraculous healings. It cannot extrapolate therapeutic principles from them and, as such, they are of limited benefit to medicine as a whole: Being exceptions, they are not the fabric of rules; and science pursues rules. So, apart from prayer, what is also necessary is a model for effective spiritual-medical partnership: discipleship, relational restoration and sanctification of the heart in combination with appropriate physical and medical care. The latter should serve as a bridge, i.e., as an extension of God's mercy, not as a license for immorality or refractory disobedience.
"Given all these challenges, research on faith and health has eventually split into two streams: (1) research attempting to prove the effectiveness of prayer and other spiritual interventions, and (2) studies attempting to identify principles and mediating factors that link faith and health:
"There have been various efforts to prove the 'reliability' of spiritual interventions on health outcomes. Apart from many case reports, there have also been several prospective post-surgical outcome studies employing intercessory prayer as the 'intervention'. Unfortunately such studies are intrinsically flawed through no fault of their own:
"Firstly, all spiritual interventions have a profound personal and relational dynamic. The bitter irony is that rigorous scientific enquiries, by their very nature, demand the exclusion of relational (including spiritual) factors. As such, the crucial role of the therapeutic relationship becomes isolated by means of placebo-controls; minimized through blinding; and evenly distributed by means of randomization. Given the fundamental requirements of a mechanistic approach to science, the most convincing methods would - by necessity - be the least suitable to record God's personal involvement in a given health outcome. As such, most studies on spiritual interventions are ultimately self-defeating: the typical finding is that the outcomes gradually become more inconsistent as the personal and relational variables are controlled. The secular conclusion, of course, is that the original results were either a random finding, fabricated or the result of some primitive superstition. This leaves believers stranded with feelings that range from doubt to righteous indignation. The problem is not the intervention, however: The problem lies in using methods of scientific inquiry that deliberately disable the principle dynamic of all transformative healing encounters - relationship.
"Secondly, it is impossible to completely control for participation vs. non-participation in spiritual interventions. For instance, an unbelieving individual who is randomized into a control group for prayer might have a devout family member who is praying behind the scenes.
"So, the point is this: It is mostly unproductive to study spiritual or religious interventions using conventional clinical research methods. Again, this does not mean that miracles are invalid or that spiritual interventions are not effective. The research failures are the result of using inappropriate research tools. There are specific applications for, and limitations to, any scientific method. Unfortunately, even though only a vast minority of health practices are truly held to this standard, the unrealistic scientific benchmark of randomized controlled trials still guards many of the boundaries of healthcare progress and practice. So, we need a different research strategy to move forward. These may include systematic outcome studies and the identification of mediating factors."
Cronjé then stated, "It may come as a surprise, but a vast number of assessment methods have already been developed and validated to facilitate systematic research on faith, religiosity and health. As a result, more than 15,000 studies have appeared over the past 30 years of which only a minority have been on spiritual interventions. The consistent findings have been that faith and religion play an important role in the prevention, treatment and perception of disease: they affect disease management practices and outcomes quite specifically, including the use of health care resources, compliance, choice of treatment, patient satisfaction and the effectiveness of treatment.
"The objective of these studies is not to substantiate spirituality or to manipulate the miraculous but simply to research correlations and mechanisms that link faith and health. Using these instruments - often in the form of simple self-assessment questionnaires - three factors have been identified that appear to mediate general health benefits related to faith and religiosity: mental health, social support, and a reduction in risk-behaviors. This is not really surprising. Conditions like anxiety, depression, addiction and social isolation have well-established associations with medical problems and poor health outcomes.
"As such, any intervention that changes these for the better - including faith and religion - would also be expected to improve physical health outcomes. And the actual scientific evidence bears this out. Therefore, in spite of any concerns about the exact mechanisms and even amidst frank denial of spiritual realities, there is great merit - and there are validated methods - for conducting systematic enquiries on measures of faith, spirituality and religion and their impact on mental and physical health. Such studies verify and quantify the health advantages of an active faith life and can even evaluate the pneuma-psycho-somatic (spirit-soul-body) dynamics within communities of faith.
"For instance, there are validated scales for forgiveness that could be invaluable for spiritual leaders in assessing the spiritual epidemiology of their congregations or to quantify changes in response to ministry. Having this perspective is important, and here are at least two reasons why:
"Firstly, under the inexorable pressure of escalating health care costs and dwindling health resources to support the growing, ageing populations of many affluent countries, there has been a gradual rise in deliberate, mutually beneficial partnerships between the secular health care sector and communities of faith. These include community wellness programs, parish nursing, as well as other health-oriented, behavior-modifying or health screening campaigns. Although these initiatives are predominantly charitable and primarily socially- and physically-oriented they offer an invaluable opportunity for relevance and influence on society - to be salt and light.
"Secondly, science has confirmed that religious interpretations of illness have a measurable effect on the ultimate health outcomes: Positive religious coping improves survival rates and quality of life. Conversely, negative religious coping, e.g., believing God is punishing you, is associated with poor health outcomes. However, whilst most doctors would not hesitate to ask a patient about smoking habits, they are unlikely to consider - and even less likely to assess - spiritual needs or negative religious coping as a risk factor. Yet, in light of mounting scientific evidence, it is actually medically negligent not to assess a patient's spiritual needs and perspectives towards their illness: They could either be a potential resource or an unrecognized liability for recovery. As such, there is now medical and ethical justification to assess a patient's spirituality from a patient-centered perspective.
"Thanks to the outcome of these studies, believing doctors now have an ethical and medical mandate to assess a patient's spirituality. This does not mean that they have the right to impose their personal faith or to offer e.g., prayer without appropriate consent. But it does mean that they are now actually required by evidence-based medical ethics to assess a patient's spiritual view of their illness. As such, they may therefore feel more at ease about doing so and there are many resources offering sound guidance on how to do it appropriately within the framework of ethical healthcare practice.
"So, as much as we should indeed continue documenting health-related miracles, there is also a need to demonstrate consistent, objective, physical, mental and spiritual (religious) health benefits in response to the teaching and the life-application of Biblical principles for love and life.
"This brings me to the point of explaining the actual material and methods employed in our study and the ministry called Be in Health Inc. (BiH) where the study was conducted."
He said that BiH is an international, NFP Christian Ministry founded in Thomaston Georgia, USA in 2005. It has become specialized in faith-based teaching on spiritual, psychological and physical health issues.
"Over the past 10 years BiH has reported consistent improvements in mental and physical health following attendance of a 5-day program called For My LifeTM (4ML)," he continued. "There have been sufficient anecdotal reports of good outcomes to justify formal scientific investigation and verification. It is estimated that approximately 30,000 people have attended the program since its inception.
"BiH has made an in depth study of the so-called 'spiritual roots' of disease and has developed a wide range of Biblically-based educational materials and programs aimed specifically at healing, health and disease prevention. The 40-hour 4ML program offers the initial, intensive, systematic teaching, ministry and discipleship components. Topics include Biblical perspectives on sickness and health; pathways of disease; 'spiritual roots' of disease; the effects of fear, stress and anxiety on health; the importance of forgiveness; and resolving negative religious coping in becoming reconciled with God, others and themselves.
"Over the years BiH has gained experience in ministering to a variety of minor and major mental and physical illnesses. Several chronic and 'incurable' diseases stand out as responding uniquely and often quite promptly to this method of ministry. These include: severe allergies, food sensitivities, auto-immune diseases, certain cardiovascular- and endocrine disorders as well as diverse mental health issues. Consistent improvements have also been reported in depression and anxiety. There have even been several documented cases of remission in paranoid schizophrenia.
"Although many faith-based organizations offer ministry or guidance on issues of health, few offer specific teaching on the potential associations between spiritual, psychological and biological problems. Even fewer address the potentially harmful effects of negative religious coping in a systematic way. To the PI's knowledge none have attempted to document the spiritual, mental and physical health outcomes of standardized faith-based education in a formal way. BiH in Georgia also has good infrastructure which also favored their selection for this observational study.
"The research protocol was developed with the assistance of Prof Harold Koenig of Duke University. His suggestions were supported and extended by Prof Kenneth Pargament of Bowling Green University, who also recommended the inclusion of the negative religious coping components. The result was a 91-question survey which BiH agreed to implement by inviting individuals registering on-line to take the survey before and after the 4ML program.
"Then, in January 2012, after the system had been running successfully for a year, we submitted a formal research protocol to the Institutional Review Board of the University of Stellenbosch. The study was registered under the title 'Effect of a faith-based education seminar on self-assessed physical, mental and spiritual (religious) health'. It has been nicknamed "PHYMSH" - the acronym for Physical, Mental & Spiritual Health. The goal was to create a generic research protocol that could then be replicated in different settings.
"The study design was a prospective observational cohort study. It ran over three years with a 21-month actual enrollment period. It was hosted entirely at BiH, Thomaston Georgia. IRB approval was provided by the University of Stellenbosch (SUN), Human Research Ethics Committee on Feb 3, 2012. The research team consisted of myself as PI; Dr. Rusty Turner from Medical University of South Carolina (MUSC) as Co-investigator; Levenda Sommers as the on-site BiH Research Coordinator; and Jim Faulkner, on BiH IT support. Biostatistical support was provided by Dr. WA (Jack) Meintjes from SUN. Dr Charles Van Wijk, from the Institute of Maritime Medicine, has extensive experience in self-assessment questionnaire research and provided guidance on the clinical psychological interpretation of the results.
"This was the first official report on this study prior to being submitted for publication. To my knowledge it is the first study of its kind to be presented at WCDN."
The study abstract follows. Note: Once it has been accepted for publication, readers will be directed to the journal reference:
Effect of a faith-based education seminar on self-assessed physical, mental and spiritual (religious) health -- Cronjé FJ, Sommers LS, Faulkner JK, Meintjes WAJ, Van Wijk CH, Turner RP.
Introduction: To determine the effect of a faith-based education program on self-assessed physical, mental and spiritual health parameters. Methods: Prospective cohort study of 211 individuals attending a 5-day, faith-based seminar. Over 21-months, previously unexposed on-line registrants were invited to complete a survey made up of: (1) Duke University Religion Index (DUREL); (2) Negative Religious Coping (N-RCOPE); (3) Perceived Stress Scale (PSS); (4) Centre for Epidemiology and Statistics - Depression Scale (CES-D); (5) Brief Illness Perception Questionnaire (BIPQ); and (6) State Trait Anxiety Inventory (STAI). Pre-attendance surveys (S1) were repeated post-attendance (S2), at 30 (S3), 90 (S4), and 393 to 1024 days (S5). Only 655 of 2650 registrants met initial inclusion criteria and received automated invitations: 139 (21%) declined; 242 (37%) did not complete; and 274 (42%) completed S1. Of the 274, 211 were eligible (Cases: 105?; 106?; ages: 18-84 yrs); 26 didn't attend (Controls: 5?; 21?; ages: 27-76 yrs); and 37 were excluded by on-site interview. Cases analyzed: 211 (S1); 192 (S2); 99 (S3); 52 (S4); 51 (S5). The Human Research Ethics Committee of the University of Stellenbosch (South Africa) approved the study. Results: All median values dropped significantly immediately post-seminar (STAI-State p<0.0001; STAI-Trait p<0.0001; PSS p<0.0001; BIPQ p<0.0001; CES-D p<0.0001). The 95% CI values did not overlap between S1 and S2 for any of these components and changes were sustained over 0.95-2.8 yrs. DUREL showed significant, sustained changes in organizational and intrinsic religiosity. N-RCOPE scores improved significantly.