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Should Medicare Subsidise Your High Holidays Seat?

December 27, 2009 – 6:38 pm8 Comments
Will Dr Moses' tablets improve your health?

Will Dr Moses' tablets improve your health?

By Liz Paratz

This is the final instalment in the ‘Judaism Under the Microscope’ series, applying evidence-based medicine to 6000 years of Jewish practice. Here, Liz takes a look at whether religious people are healthier overall.

The question of whether being religious equates with being healthier is a hot one. Now, evidence-based medicine has come to the party to weigh in on whether a religious lifestyle results in medical benefits ; and if so, whether ‘religion’ should be an approved therapy in the medical landscape. After all, if religious attendance shows medical benefits, shouldn’t High Holiday seats be reimbursable on Medicare just like any doctor’s appointment?

Well firstly, there are many studies on the issue of increased life-expectancy in religious people.

A US national study of 21 000 adults documented a strong association between religious attendance and mortality. People who had never attended services had a 19 times higher risk of death over an 8-year period than those who attended more than once a week. Striking differences in life expectancy were also evident, with life expectancy at age 20 for religious people who attended services being, on average, seven and a half years longer than for the non-religious.

Another study specifically examining Israeli Jews used 16 years of mortality data comparing secular kibbutzim to religious kibbutzim. Overall, they found that mortality was significantly higher in the secular kibbutzim, associated with higher intake of meat, dairy products and coffee, less fish and much more smoking and reported stress.

Another article was provocatively titled ‘Religious Attendance :  More Cost-Effective Than Lipitor?’ (Lipitor is a widely-used cholesterol-lowering agent). It compared the increase in life expectancy noted in people who regularly attended religious services to the increase gained from statins, and then predicted cost-effectiveness. Cost was based on price of statins and the assumption that people would contribute 10% of their income to their religious community. The authors’ conclusion was that ‘the real-world, practical significance of regular religious attendance is comparable to commonly recommended therapies, and rough estimates even suggest that religious attendance may be more cost-effective than statins.’ So perhaps in this post-Marx age religion has become the poor person’s statin, rather than the opiate of the masses.

Other studies have focused on more short-term parameters. For example, being religious might improve life expectancy, but does it affect the course of your diabetes? Or your recovery from surgery or your risk of a heart attack? At this point, it would seem that the answer may be yes.

C-reactive protein (usually abbreviated to CRP) is a marker of inflammation in the body, and a raised CRP is usually not a good thing. In the context of diabetes, a raised CRP has been shown to be associated with increased risk of vascular complications like heart attack and peripheral arterial disease. The researchers in ‘C-Reactive Protein, Diabetes + Attendance At Religious Services’ examined a group of diabetics who were regular religious service attenders versus diabetics who did not attend religious services.

Impressively, even after adjusting for demographic variables, health status, smoking, social support, mobility, and body mass index, the diabetics who did not attend any religious services were still more than two times more likely to have a raised CRP compared to the religious diabetics. The researchers’ conclusion was thus that, ‘attendance at religious services has been linked epidemiologically to improved morbidity and mortality from cardiovascular causes’.

Religiousness has also been documented to be associated with shorter hospital stays in patients undergoing coronary artery bypass grafting, and longer walking distances at discharge in patients undergoing hip surgery.

However, the exact mechanism by which a religious lifestyle brings about an increase in life-expectancy and general health is still debated. In 2007, the Medical Journal of Australia dedicated a supplementary issue to the inter-relationship of religion and medicine, trying to elucidate how religiousness might bring health benefits and whether religion could even be recommended as another therapy.

Many of the researchers contended that most studies still fail to adequately control for confounding factors that differentiate a ‘religious’ group from a ‘non-religious’ group. Such oversights can be as basic as failing to consider, when examining the link between church attendance and mortality, the fact that healthy people are more likely to be capable of attending church while very sick people will be confined to a hospital bed.

Finally, a study published in 2000 in the New England Journal of Medicine neatly encapsulates the issues that come with considering religion as just another therapy. The authors point out that religion is a personal choice. As such, it falls into the category of several other activities that may yield health benefits, but may not be appropriate to prescribe as therapy.

For example, several studies have linked being married to better health status. Yet doctors don’t promote JDate the same way they do Quitline. Likewise, having babies at a younger age is now thought to decrease the risk of breast cancer. But again, it would be extremely out-of-place for doctors to push young female patients into having babies before they’re personally ready. It’s just definitely in a different category to encouraging regular exercise.

But ultimately, perhaps the best reason for not prescribing religion as therapy may be that to do so demeans religion itself. While religious people appear to be obtaining benefit from their choice of lifestyle, there’s no evidence suggesting benefit to atheists who adopt the accoutrements of a frum life.

Radically changing your chosen lifestyle in the hope of maybe increasing your post-op walking distance is a big move to make. And, when there are so many other simpler ways of improving your health – more exercise, better diet, drinking less, quitting smoking – becoming religious only for the health benefits looks a bit like climbing Mt Everest for a breath of fresh air.

* Image from http://img.dailymail.co.uk/i/pix/2008/03_01/mosesHeston2703_468x611.jpg

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8 Comments »

  • frosh says:

    I know this is slightly off the topic, but since the title of the article relates to health economics, I do wonder if there is a false economy with some health promotion.

     

    Allow me to play devil’s advocate:

     

    On one hand we are told to exercise, abstain from smoking (and yes, I do exercise, and I have never smoked) and eat a balanced diet etc.  We are told these things will make us live longer and healthier.  I have no reason to believe this to be untrue.

     

    However, we are also told that this will save the public health system considerable money.   Meanwhile, we are also told that the public health system is struggling under the weight of population that is living longer, and thus there is a far higher incidence of gerontological illnesses.

     

    So, when it comes to keeping people healthier and living longer, is it a case of save money now, but pay money later?

     

    Let me add a couple of caveats to this.

    1)      I have no expertise in health economics – only posing a question.

          2) I am not questioning the moral and social imperative of keeping healthy and living longer – I’m just questioning whether there is really a significant economic benefit to the health system.

  • Liz says:

    Frosh,
    You have to watch Yes, Minister….you would love I am sure.
    At any rate, you’ve just come up with one of their exact plots….
    http://en.wikipedia.org/wiki/The_Smoke_Screen_(Yes,_Prime_Minister)
    cheers
    Liz
     

  • Chaim says:

    Frosh:
     
    It is the difference in cost between the treatment of the chronic illnesses over decades (Diabetes, hypertension, heart disease, strokes, emphysema) which in most cases do not kill you right away but cause extensive morbidity and treatment costs at an earlier age and the increased chances of dying at 85 suddenly from an heart attack  or cancer (very expensive but in most cases shorter duration of treatment) – if you lead a healthier lifestyle.
     
    Especially when we also have lower expectations of outcomes and more chance of just making people “comfortable” at older ages – “Grandpa had a good long life and he is tired and wants to die” i.e. less heroic effort at treatment s and more cheaper palliative care..
     
    Also productive work years are increased if most of your life is healthy plus less sick pay etc
     

  • Sam says:

    Hi Frosh

    Difficult to determine whether it is less costly for governments for people to allow poor lifestyle choices to shorten their lifespans or vice versa.
    It has been ascertained that a disproportionately large expenditure is made on a patient that has been very ill in the last 6 months of life. 

    I know that you are expert in stats, but the design of an analysis to answer the question might be too complex (taking into account all the variables) to produce a meaningful result. What do you think?

    I do work in the health industry and don’t know the answer, but I suspect that it is costly for governments either way. Nowadays people live a long time with high blood pressure, diabetes and arthritis all of which probably require multiple medications and regular doctor visits.

  • frosh says:

    Hi Sam,

    Such an analysis falls outside my area of expertise.

    At any rate, I think such policy decisions should probably not primarily be made on economic grounds, but rather on moral grounds.   But even this throws up some questions.

    For example, I think it is morally correct that the government has publcised the health dangers of smoking.  But surely everyone in our society has now been adequately informed of these dangers.  Is the argument for continuing to spend large sums of money on advertsing the dangers of smoking an economic or a moral one?

    If it is moral, I’d counter that the tax payer only needs to do so much to inform people of now obvious health issues.  It has long since passed that point. If people still wish to take up smoking now, well…

    If it is economic, then maybe there is an economic benefit from this advertsing, but as we’ve discussed, there is some question over this too.

     

     

  • Rachsd says:

    Something that I am interested in is the theological / philosophical implication of religion being good for you: on the one hand, it is clear that this does not lend any additional credibility to the truth or otherwise of any particular religion given that the health benefits do not vary by creed.
    Nonetheless, there is an interesting question of whether, if religion is good for you this demeans religion (as Liz suggests in her final paragraph) – if being religious is rational (in that it is good for your health), this might explain why humans are attracted to religion and thereby undermine divinity / transcendence. On the other hand, perhaps the benefits of religion demonstrate the compassionate nature of religious tradition, which would support the idea of a compassionate divinity.

  • frosh says:

    Hi Liz,

    I can’t recall seeing that episode – but I am a little disconcerted at having had the same thought as Sir Humphrey :-)

  • Chaim says:

    Most preventative medical programs are not cost effective – see here
     
    Smoking cessation is – here, here, here
    Exercise is free (nearly) and clearly cost effective..
     
    The point is that obesity and  smoking usually cause a slow death over many years with much morbidity and loss of productivity… Society does not have the benefit a “quick death”. It is not moral but economic..
     
    Widespread screening by mammograms, prostate screening are clearly political causes….

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