Dr. Harvey Elder and a colleague at Loma Linda University Medical Center were puzzled. They could find no medical reason for a 37-year-old woman to have asthma so severe that she had suffered two heart attacks.
Elder finally asked the woman why she thought she had asthma.
"Because I had an abortion," the woman replied. Shocked by the implied belief of divine punishment, Elder blurted out, "My God's not like that."
A few hours later, the woman stopped wheezing.
In that moment 30 years ago, Elder began to realize the importance of religion in health care and how ill-prepared he was to deal with it.
"I became increasingly aware that there is within a patient a whole domain I had not learned about in medical school," he said. "I have seen so many patients where spiritual issues, guilt, loneliness are the root controls of behavior."
Since the late 1980s, the role of religion in a patient's health has been the subject of numerous studies. The National Institutes of Health has awarded millions of dollars to research religion, spirituality and meditation as they relate to health.
That interest in spirituality comes at a time when Americans are turning to religion in the face of rampant materialism, said William Cutter, director of the Kalsman Institute on Judaism and Health at Hebrew Union College in Los Angeles.
"I think we have a bit of a spiritual climate now," Cutter said by phone.
Researchers have found that people who attend religious services regularly tend to live longer, recover faster from serious illness and require fewer hospitalizations.
Although studies of prayer have been controversial, one report in 2001 found that heart patients who were prayed for or those who participated in stress-reduction, imagery or touch therapy suffered 25 percent fewer complications.
Religious belief can cause negative outcomes as well. A 2001 study at Duke University Medical Center found that patients who believe that God is punishing them or that they have been abandoned by God or their church were more likely to die within two years after being discharged from the hospital.
Although most spirituality research has focused on Christian patients, the findings appear to be similar for people of other faiths, said Dr. Harold Koenig, a psychiatrist at Duke University Medical Center in Durham, N.C., and a leading researcher of the relation between religion and health.
"People with devout religious faith who are active in a religious community appear to be generally healthier and happier," Koenig wrote in an e-mail.
Frequency of church attendance seems to have a significant effect on people's health, said Jim Walters, professor of Christian ethics at Loma Linda University.
Walters is completing a pilot study of Adventist religious beliefs and practices, and their effect on health. He hopes to secure funding this fall for his research.
"Church attendance is an indicator of a whole lifestyle," he said.
"Churchgoers tend to be less sexually promiscuous, eat better and drink less. There is an ethos conducive to health (that) you don't find in other groups."
The power of prayer
Four out of five Americans believe that personal prayer or religious practices can speed recovery, some polls show.
For Muslims, the physical act of lying prostrate to pray improves the flow of oxygen to the brain, said Dr. Mohammad Hossain, a pediatrician in Redlands and Riverside.
"Praying five times a day is like taking medicine five times a day," he said. "Prayers bring God in the heart. Prayer is nutrition of the mind and helps in healing."
Scott Rae, professor of Christian ethics at Biola University in La Mirada, believes that God answers prayers - but not always in the way people hope.
"I stay away from ideas of God as a cosmic Santa Claus that dispenses blessings upon request," Rae said.
"I believe that God heals everyone. He chooses to heal some after their death and some before their death. Ultimately, everyone is healed."
Cutter distinguishes between curing and healing, and between clinical health and spiritual health.
"When a person is sick and I offer a prayer, I don't believe God will heal because of that prayer," said Cutter, who supervises rabbinical students in a chaplaincy program at UCLA Medical Center.
"Prayer is a communal expression. It strengthens the ill person to know that others pray for them. It brings comfort. ... I don't think it's going to change God's will."
So far, research has not answered whether it matters how people pray, how many people pray, or what they pray for, Koenig said.
"It is the sincerity of the prayer and the extent to which prayer is integrated into a person's entire life and lifestyle that really matter, rather than the number of people praying or the specific technique used," he said.
For Alvaro Casas, praying with Elder during his appointments at a San Bernardino clinic comforts and strengthens him.
"I feel much better," said the 61-year-old AIDS patient. "He gives me faith in God. He gives me energy for life."
Lack of training
Many physicians are uncomfortable discussing matters of faith with their patients, even though polls show that a majority of Americans want their doctors to pray with them, Elder and Koenig said.
That discomfort results from a lack of training in spiritual care, concern about imposing beliefs on patients, or not understanding the benefits of addressing spiritual issues with patients, they said.
The situation is beginning to change, Koenig said. More than 70 of America's 126 medical schools now offer courses on religion, spirituality and medicine, he added.
"I think there will be an increasing trend, over time, for physicians and other health-care professionals to value, respect and try to understand the role that faith plays in the healing process," he said.
Physicians also would benefit by caring for the whole person, Elder said.
He remembered a patient who stopped talking when his hands became too crippled by arthritis to upholster the chairs he liked to give away. The surgeon who repaired the gnarled fingers focused on the hands, not the person, Elder said.
After surgery, the man could make the chairs again. He started talking.
"The surgeon didn't realize what a gift he had given this man," Elder said. "If you knew you had given him the ability to communicate, how much more joy would there be? That can get you past a hard day."