Abortion and mental health: Christian Medical Fellowship changes its argument

In the face of the now overwhelming evidence that abortion has no effect on a woman's mental health, the Christian Medical Fellowship has been forced to change their argument in order to maintain their faith-based, pro-life position that abortion is a very bad thing.

The recent report by the National Collaborating Centre for Mental Health for the Academy of Medical Royal Colleges makes clear that any previous findings of adverse mental health outcomes of women having abortion were in fact due to the initial poorer mental health of women with unwanted pregnancies, and that women who choose to have an abortion have the same level of mental health problems as those who choose to carry their pregnancies to term. Indeed, such is the knockout blow inflicted on the myth that abortion has a negative effect on mental health (perpetuated by unsound studies and religious politicians) that the researchers who authored the new report state it would now not be fruitful to perform any more research on the matter.

This has prompted a major change in tack in the argument of the Christian Medical Fellowship. Dr. Peter Saunders, head of the CMF went on Radio 4's Today programme to air what he clearly feels is a clever new argument. He reiterates it here on his blog: he believes that the findings of the report now make 98% of abortions illegal in the UK. This is because 98% of abortion in the UK are carried out on mental health grounds (for which provision is made in the 1967 Abortion Act), specifically that continuation of the pregnancy would risk injury to the mental health of the woman.

Now that the new study has shown that the risk to the mental health of women having abortions is the same as women continuing with the pregnancy, doctors authorising abortions cannot do so on the grounds of mental health, and therefore by signing papers authorising abortion are acting illegally. Dr. Saunders states "If they continue to authorise abortions on mental health grounds from now on they will then be knowingly making false statements on legal documents". Their penalty? Dr. Saunders becomes even more hyperbolic here. Under the Offences Against the Person Act 1961, doctors could face life imprisonment as "making false statements on an abortion authorisation certificate is a form of perjury".

I'm sure most high school or university students with any training in critical thinking could spot the basic flaw in Dr. Saunders' new argument, which suggests he's either being disingenuous or doesn't understand some basic principles of logic: specifically, which comparison groups would enable us to make an evidence-based statement. It's pleasing, however, to see that he now accepts there is no link between mental health and abortion. Anyway, back to the fatal flaw in this shiny new argument; it's simply that those continuing with unwanted pregnancies (the comparison group in the new report) are a self-selecting group, of which a woman asking for an abortion is not a member. Let's imagine one such woman requesting an abortion; let's call her Julie. Dr. Saunders says I shouldn't sign the papers as it's now shown that there would be no damage to Julie's mental health if I failed to do so. He infers this from the report as it shows that giving birth to an 'unwanted pregancy' has the same effect on mental health as having an abortion.

Really? Would denying Julie an abortion and forcing her to have a child that she doesn't want not be prejudicial to her mental health? If I wanted to cause someone severe mental health problems, then high up my list of methods would be to force someone to carry a pregnancy and give birth to a child that they don't want. No studies have been carried out which compare the prospective mental health outcomes of those forced to have unwanted pregnancies versus those having abortion (because such studies would be highly unethical as commonsense tells us that they would be highly damaging to the women forced to carry unwanted pregnancies). Dr. Saunders' argument (that I am not doing Julie any harm by not signing the papers) could only be supported if we had such evidence. By asking for an abortion, Julie has placed herself in a different group to those women choosing to carry their pregnancies to term; she wishes to terminate her pregnancy.

Therefore, the new report tells us that by signing the documents, thereby authorising an abortion, I am not prejudicing Julie's mental health. The report (or any evidence) can never say that by failing to sign the documents I would not prejudice Julie's mental health, as Julie is by definition not a women choosing to continue with unwanted pregnancy (i.e. she is not part of the comparison group in the new report which provides the comparison group in Dr. Saunders' argument). The new report therefore does not tell me how I should behave when faced with a patient asking for an abortion (no report ever could, as to get a comparison group to answer the question, we would have to do a randomised trial of denying some women an abortion whilst allowing others to have one). I don't think anyone, even those opposed to abortion, would suggest we try that.

As the new report has nothing to say about the mental health effects of not signing the papers, doctors can of course continue to sign papers "in good faith" (as Dr. Saunders puts it) and could never be convicted under the Offences Against the Person Act. To reiterate: there is no evidence in this report or any other to suggest that refusal to authorise an abortion results in the same mental health outcome for the woman as if the abortion was authorised. To suggest doctors could thus receive life imprisonment for signing abortion requests is either obscurantist bunkum or a result of failure to understand basic logic and set theory. But logical argument never was a strong point amongst those of faith.

The Lords Spiritual, Exorcism, and the NHS

The UK's selection of some of its legislators by their religious beliefs (the 26 Lords Spiritual - senior Bishops - in the House of Lords) puts it in the same club as Iran. Bringing this incredible practice into the spotlight are the frankly bizarre utterances of the Archbishop of York who, in supporting a motion by the crossbench peer Baroness Hollins, explained how the NHS should be bound to take care of the spiritual health of people, not just their mental and physical health.

The Archbishop of York, who thinks that exorcism has relevance to the debate on the Health Bill

He illustrated his point by a wonderful story (from "Archbishop calls for NHS Bill to cover spiritual health" at BBC News):

...when he first became a vicar in south London, he was invited to a home where there was "a presence ", a phrase he said he did not understand at the time. At the home, he said, he found a young girl who had been unable to move for nearly three weeks and would shout out in the middle of the night. He was told the family had been to a witches' coven where a goat had been sacrificed. The young girl was petrified she would be next. Visits from a GP, psychiatrist and psychologist did little to help, he said, but then he said a prayer, anointed the girl and lit a candle on his visit. Shortly after, he received a phone call saying the girl was no longer terrified and was talking again. "That was not mental or physical illness; there was something in her spirit that needed to be set free" he told his peers.

The Archbishop's utterances are not much more bizarre than the motion by Baroness Hollins, who is a psychiatrist. Psychiatrists seem to get themselves into all sorts of problems with matters spiritual. The new Recommendations for Psychiatrists on Spirituality and Religion (PDF Link) is authored by Professor Christopher Cook (Chair of the Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group) who believes that mental disorder can be caused by demonic possession (published and presumably endorsed by the Christian Medical Fellowship). Here's the astonished response to his beliefs by me and by the medical ethicist Iain Brassington at the BMJ Medical Ethics Blog. Baroness Hollins's motion is equally bizarre, but with supporters like the Archbishop, you don't need me to tell you that. Time for the UK to exorcise the Lords Spiritual from its legislature.

British Medical Journal's 'Lobbywatch' puts the UK Islamic Medical Association under the microscope.

Last month the BMJ ran a rather damning expose of the Christian Medical Fellowship (an organisation which appears to have been hijacked by conservative Christians and used as a vehicle for pushing their increasingly extreme points of view on medical matters). This month it targets the UK's Islamic Medical Association who have equally wacky ideas on issues like vaccination. Their spokesman states:

...that he wants to promote a debate on the practice of vaccination in general. He has also urged British Muslims not to give their children vaccines such as that for measles, mumps, and rubella (MMR), because they contain substances that make them un-Islamic. He alleged that almost all vaccines contain “haraam” (forbidden) derivatives of animal or human tissue and that Muslim parents were better off letting children’s immune systems develop on their own.

Other medical practices are apparently not to be encouraged by Muslim doctors, such as giving condoms to unmarried persons, and the organisation sees its mandates as "joining actively the Pro-life campaign in Britain" and "Joining the campaign against the adding of Fluoride to our drinking water" (see http://www.islamicmedicine.org/imaUK.doc). 

The article notes that the British Medical Association and GMC have learned of Muslim students who are refusing to learn about alcohol related illness or sexually transmitted disease as it offends their religious beliefs and that "A small number were also reported to be refusing to treat patients of the opposite sex."

I guess that would at least shorten ward rounds by about half. Makes the Christian Medical Fellowship look almost moderate in its views. (OK, not really).

Where next for the anti-abortion brigade?

With the defeat of Nadine Dorries' abortion amendment in the House of Commons by 368 votes to 118, where can the UK anti-abortion lobby go now? The amendment had attempted to get 'independent' (read: 'faith-based') groups into pre-abortion counselling, with the aim of increasing the wait to abortion and applying pressure on those with unwanted pregnancies.

Well, the anti-choice lobby can take some comfort in the comments by the Under-Secretary for public health, Anne Milton, who was said that the Government was:

...supportive of the spirit of these amendments and we intend to bring forward proposals for regulations accordingly, but after consultation. Primary legislation is not only unnecessary but would deprive parliament of the opportunity to consider the detail of how this service would develop and evolve.

Ann Milton, Parliamentary Under Secretary of State for Public Health, and a supporter of 'the spirit' of Nadine Dorries' amendments

Milton has fallen for Dorries' trap, that there is a problem here that somehow needs correcting; that counselling services for women considering abortion are somehow currently skewed or inadequate (a contention for which not one jot of evidence exists). Dorries' (or 'Mad Nad' as Private Eye magazine now dub her) amendment was described by Diane Abbot (the shadow public health minister) as "a shoddy, ill-conceived attempt to promote non-facts to make a non-case".

That, however, is precisely the kind of strategy the anti-abortion lobby must now pursue. With no case to make for a comprehensive review of abortion law, they must concentrate on building up straw men using anecdotes, irrelevant facts, and presuming causation where there exists only correlation. Oh, and getting funding from US anti-abortion campaigners, who are suspected of bankrolling the 'Right to Know' campaign spearheaded by Dorries and her parliamentary colleague Frank Field. The anti-abortion campaigners must concentrate on peripheral or nonsensical arguments, such as the supposed mental health consequences of abortion, or the tiny proportion of late term abortions, in order to chip away steadily at the notion that universal access to abortion in the UK represents a huge advance in healthcare and reproductive ethics. Or, a new favourite, is to play the victim card: that people are conspiring against you (or even blackmailing others) or that you are the victim of censorship. And whatever happens, rule number one is always to use smokescreen arguments and to NEVER mention that you really object to abortion because you believe there exists a text which is actually the transcribed thoughts of a deity who wasn't too keen on female reproductive choice. And you think that this deity's writings should be forced upon other people who don't hold that belief.

Find out how your MP voted on the amendment here.

"Independent" abortion counselling: a solution in search of a problem

Rules designed to restrict abortion choice look set to be introduced by the coalition Government in the UK. The rules, proposed as an amendment to the Health and Social Care Bill by Labour MP Frank Field and Conservative MP Nadine Dorries (both devout Christians), will remove the role of abortion providers such as BPAS and Marie Stopes in providing pre-abortion advice. Ms. Dorries and Mr. Field state that there is a financial conflict of interest of abortion providers in providing pre-abortion counselling. It is of course a ridiculous idea, effectively accusing medics and nurses working for such organisations of failing to obtain informed consent (the cornerstone of medical ethics) for abortion procedures. There is not one study or piece of evidence to support their claim. Imagine if you are thinking of having your gallbladder removed due to gallstones. The very idea that a surgeon could not tell you about the procedure or alternative options because he/she has a financial stake in carrying out the operation (is paid by the NHS to carry out such operations) is a ludicrous one. But that is the logic of Ms. Dorries.

The amendment is supported by the secretive 'Right to Know' campaign, which rebuts all questions about its funding. It is widely suspected that it is financed by US evangelical conservative Christian groups (see interview with Dr. Evan Harris here), and is part of the 'chipping away' strategy that Ms. Dorries is adopting at UK abortion law.

Whilst this is only tinkering (reducing the gestation limit at which abortion is available was roundly rejected by MPs in 2008), Ms. Dorries has admitted to being advised by Dr. Peter Saunders, who is CEO of the Christian Medical Fellowship (which appears to be an increasingly extreme organisation peddling increasingly wacky ideas). A look at the powerpoint slides of Dr. Saunders here lays bare the 'chipping away' strategy. Ms. Dorries has indeed concentrated on the potential reduction in numbers of abortions her amendment might produce (she states up to 60,000) a year). More pragmatic commentators have stated that numbers will probably not be reduced a great deal, but that referral to the 'independent' counsellors will cause delays in abortion meaning later term abortions, which will be a matter of regret not only to Christian and secular organisations, but particularly for patients.

Pre-abortion advice provided by non-mainstream organisations has been found severely wanting. As The Guardian reported this month:

A survey of 10 centres operated by Christian and anti-abortion organisations found evidence in most of them of poor practice and factually incorrect advice, while the quality of counselling differs widely. Advice ranged from scaremongering – linking abortion with breast cancer, for example – to actions apparently designed to steer women away from abortion, such as showing them baby clothes and talking about "the child"...At a Life centre in Covent Garden, London, the undercover researcher was given a leaflet entitled Abortions – How they're Done, which said incorrectly that 85% of abortions are carried out using vacuum aspiration. It stated that "the unborn child is sucked down the tube" and that "the woman should wear some protection. She has to dispose of the corpse [in the case of chemically induced abortion]."

Finally, Ms. Dorries cites support for her campaign from BACP, the British Association of Counselling and Psychotherapy. This rather conflicts with the reply from BACP to a question about its supposed support to which the answer came "BACP has never suggested or implied that organisations like BPAS and Marie Stopes International should stop providing abortion advice or any of their other ancillary services."

It's good to know that the Government is, in straightened times, thinking of introducing complex, unfeasible, unceccessary, and expensive legislation for which there is no need, merely at the whim of a couple of backbench MPs. The amendments will also use up valuable time for debating the major aspects of the Bill - most notably, that GPs will be given the majority of the NHS budget to commission services, and the stealth privatisation of the NHS. I urge you to lobby your MP about this issue before the 6th Sept (when the amendment is likely to be debated), which can be done easily at this link:

http://www.abortionrights.org.uk/component/option,com_frontpage/Itemid,1/

The British Medical Journal's Lobbywatch targets the Christian Medical Fellowship

The British Medical Journal has got the right take on the Christian Medical Fellowship (CMF) in its "Lobbywatch" column of 20th July 2011. It notes that the evangelical Christian GP Richard Scott, currently having problems with the GMC for proselytising during consultations, has stated in the CMF's magazine that, for him, “saving the soul was ultimately far more important than mending the body”, and that:

“Evangelism is a job for all Christians, at all times and in all places, and Christian GPs are in a unique position to reach the lost in their local area. Sharing the gospel with patients is not an abuse of trust because God himself gives us the authority and salvation is their greatest need.”

The  CMF continues its attempt to legitimise proselytising to vulnerable patients by importing the notorious US 'Saline Course' which aims to equip doctors with the skills needed for "drawing patients in a natural way one step closer to God".

From the website of the cryptically named International Health Services which runs the Saline Course. "International Health Services teaches Christian medical professionals how to share Christ's love at the time of need, patient by patient"

GPs who consider our spiritual needs a higher priority than our medical treatment may think their authority comes from God, but their medical licensing comes from a higher power: the General Medical Council. Let's hope it protects us from doctors who see their patients as vehicles for their wacky beliefs.

Religion & medicine as seen by WG Sebald

I came across the following in 'Vertigo' by the late WG Sebald, who I think one of the greatest post-war writers. It speaks to the ridiculousness of juxtaposing religion and medicine.

"On one occasion, the two of them, the priest and Dr Piazolo, mistook each other's rucksacks when they were sitting side by side at the Adlerwirt, and Dr Piazolo drove off to his next patient equipped for the last rites while Father Wurmser brought the doctor's instruments to the next member of his congregation who was about to expire"

Radio 4 on male circumcision

Antony Lempert, head of the Secular Medical Forum, spoke on Broadcasting House this morning on Radio 4 (listen right at end of programme). The programme broadcast the cries of a 8 day old infant being circumcised (under anaesthetic).  

A Muslim boy cries as a doctor performs a circumcision on him. Photograph: Stoyan Nenov/Reuters. Picture from guardian.co.uk detailing the charity Norm-UK who, addressing a conference on the physical and psychological consequences of male circumcision at Keele University, encouraged parents to wait to circumcise their children until they were old enough to give consent.

Over 30,000 male circumcisions are performed in the UK each year (in a ritual ceremony 8 days after birth for children of Jewish parents, and at approximately 7 years of age for children of Muslim parents) with complications ranging from severe bleeding, urethral scarring, infection, and in rare cases, death (see Williams, N & Kapila L. Complications of circumcision British Journal of Surgery Volume 80, Issue 10, pages 1231–1236, October 1993 DOI: 10.1002/bjs.1800801005).

Dr. Lempert spoke on the programme about this study in the BJU International which shows that 'circumcision ablates the most sensitive parts of the penis'; indeed, in circumcised males, the circumcision scar is the most sensitive part left of the penis.

The programme noted that the procedure does not have to be carried out by a doctor, or indeed with any anaesthetic. I blog here about a research paper in the Journal of Public Health which found that 13 of 32 genital mutilations ('circumcisions') carried out for religious reasons on teenage boys by the Oxford Islamic community led to complications, including infections, urethral scarring and severe bleeding. They were conducted by non-doctors (local religious leaders and others) in the library of a faith school.

The BMA still refuses to tackle this issue. There is going to be a demonstration Monday 27th June 2011 outside the BMA Annual Representatives Meeting who refuse to debate Motion 310 and encourage representatives to choose it as one of five additional motions for debate. Motion 310 asks the BMA to endorse the 2010 position of the Royal Dutch Medical Association which calls non-therapeutic genital surgery on male minors a violation of the boy's rights to autonomy and to physical integrity.

I find our differential attitudes to male circumcision and female genital mutilation peculiar, as if the less severe injury to males somehow makes us ignore the fact we are still cutting a child's genitals. Mutilating the genitals of non-consenting children as a result of their parent's faith is not something with which doctors should collude.

Some thoughts on assisted dying and the 'argumentum ad Hitlerum'

The argumentum ad Hitlerum or reductio ad nazium is a form of argument that was given its dog latin appellation in 1953 by the political philosopher Leo Strauss. It is an informal fallacy, suggesting that X is bad because it has been associated with Y, with Y being something Hitler or the third Reich did or espoused. It is easily shown to be a fallacy because X might be playing competitive sport, something which the Nazis promoted as a way of proving the superiority of the Aryan race. It does not follow that playing competitive sport is bad.

Dr. Peter Saunders, head of the Christian Medical Fellowship, has written a blogpost entitled ‘Twenty facts we did not learn from Terry Pratchett’s BBC ‘documentary’ on assisted suicide in Europe’. His fact number 20:

The Nazi holocaust began in 1939 with the killing of 6,000 disabled children and 70,000 patients in geriatric and psychiatric institutions. Leo Alexander, a psychiatrist who gave evidence at Nuremberg in 1949 said that ‘its beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the attitude, basic in the euthanasia movement that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.

Firstly, the killing of disabled children and geriatric/mentally disordered patients is not assisted suicide. It is involuntary euthanasia, more commonly known as murder. Does Leo Alexander’s claim that this extermination was born from the notion that there is such a thing as a life not worthy to be lived make assisted suicide wrong? No, once again, the shift in attitude by physicians that Alexander mentions was not a precursor to assisted suicide. It was a precursor to murder and systematic extermination of classes of persons on an unimaginable scale. 

A Nazi propaganda slide depicting portraits of mentally ill people. From the Holocaust Education and Research Archive Team www.holocaustresearchproject.org

Dr. Saunders denies having made the argument in the face of replies to his blogpost. For example, in reply to one post: “Wow, I read this assuming credibility until you likened it to Nazi Germany”, Dr. Saunders states “The article simply lists twenty facts the programme did not tell us about assisted suicide and euthanasia in Europe - of which the 20th is undoubtedly one…what you conclude from it is up to you.” This defence is given short shrift by another commenter on the blog: “Dr Saunders - you definitely have undermined the credibility of your argument by bringing up Nazi Germany… and in response to your assertion that you're factually correct, you could write an endless list of irrelevant facts if you wanted, but that wouldn't make your argument more convincing.” 

This article on the use of the argumentum ad Hitlerum shows how the Nazi card is easily played by implication:

In a debate about the Republican contract, US congressman John Lewis first read out Martin Niemoller's speech about the Nazi takeover ('They came first for the Communists, and I didn't speak up because I wasn't a Communist. Then they came for the Jews…'), then said, with gravity: 'Read the Republican contract. They are coming for the children. They are coming for the poor. They are coming for the sick, the elderly, and the disabled.’

It seems to me that there's something more complex and morally pernicious about the reductio ad nazium than it being a simple fallacy. It attempts to recruit a particular tragedy, in this case the systematic murder of thousands of patients, in (spurious) support of a particular viewpoint. The class of persons so recruited has no voice to indicate whether they object or assent to the viewpoint. As an example, I could say “All religion is bad because of the Catholic abuse scandal” (see Sam Harris here on why he’s tried to steer clear of the abuse scandal). But all religion cannot be bad because of the bad acts of some members of one religious group. By saying this, I would exploit the suffering of thousands of victims of abuse as a smokescreen for a viewpoint that I might hold for reasons totally unrelated to the abuse scandal.

In summary, to object to an issue by invoking the suffering of a group of persons (whose suffering is entirely irrelevant to the point being made and being used a smokescreen for deeper beliefs) seems to me to be a more grievous act than the mere commission of a fallacious argument.

Health benefits of religious involvement? The flawed evidence quoted by Dr. Peter Saunders and the Christian Medical Fellowship.

Dr. Peter Saunders, advocating that doctors should proselytise to patients in consultations, trotted out on Radio 4 last week the rather exhausted canard that there is a huge evidence base to suggest a positive relationship between religion and health. Dr. Saunders states: “We are talking about in the vicinity of 1,200 research studies and 400 reviews in peer-reviewed medical journals. 81% show a positive correlation between faith and health; 4% a negative correlation and 15% sit on the fence.” This astonishing number of papers was mentioned by Dr. Harold Koenig in his “Handbook of Religion and Health”, and trotted out again in a (no doubt impartial) report by the Christian Medical Fellowship (CMF).

Over a thousand studies? Really? Others don’t see the statistics in quite this way. The researcher Richard Sloan (Professor of Behavioral Medicine at Columbia University Medical Center) analysed 266 papers identified as relevant to religion and health by the healthcare literature database Medline that appeared over the course of one year. However, only 42 of 266 (17%) were relevant to claims about the effects of religious involvement on health.

Sloan continues: “So proponents of a connection between religion and health are technically correct when they write that there are a great many studies on the topic. But they are wrong when they report that the vast majority demonstrate positive relationships between religious involvement and better health. In fact, the vast majority of these studies have nothing whatsoever to do with the health benefits of religious involvement”.

Let’s have a look at some of these papers supposedly demonstrating the effects of religious faith on health. Of 89 studies on cardiovascular health cited by Koenig and the Christian Medical Fellowship report, 33 were studies on denominational differences in health or compared groups whose religiosity was unknown e.g. comparing cholesterol levels in Seventh day Adventists to age-matched New York city residents. Such studies show us nothing about the effect of religious involvement and health. Eleven studies were reviews of other studies, case reports or “mere descriptions of projects”. Three were published only in abstract form and cannot therefore be critically appraised. This leaves 34 of the original 89 papers that Koenig and the CMF claim to be the basis of the relationship between religious involvement and healthcare. Sloan reviewed these and found 30 had serious methodological flaws or were “so misinterpreted or misrepresented that they cannot possibly be used as evidence for an effect of religion on health”. 

That leaves 4 studies out of the original 89. Extrapolating this to the 1200 cited by Dr. Saunders, only in the region of 50 are likely to actually be about the effect of religious involvement in health, and we don’t know whether they show positive or negative effects.

The quality of many of the papers cited is also dubious in the least. In one of the 81% of 'positive' studies cited by Koenig, the CMF, and Dr. Saunders, eight ‘remote healers’ prayed for patients with high blood pressure, who did indeed have a reduction in systolic blood pressure greater than the control group. No patient details are given. The eight remote healers were four “Science of Mind Practitioners”, one was a Presbyterian Institute Minister, another was a Church of Christ Minister, one was “Director of the Seventh Sense Institute” and another was “a gifted individual whose healing abilities have been verified by both doctors and scientists”. Data was presented only for the patients of four healers who “had the highest number of returned patients”. It is a wonder that the authors managed to publish a study that drops patients from its analysis who are likely to have a negative outcome.

Whilst the Christian Medical Fellowship and Dr. Peter Saunders might consider this a study that supports the discussion of religion with patients, I would hope most doctors would look at such studies and consider that proselytising to patients on the basis of such nonsense would be a serious breach of their duty to treat patients on the basis of evidence (not to mention a breach of General Medical Council guidelines).

References

Sloan R. Blind Faith. New York: St. Martin’s Griffin.

Koenig H, McCullough M, Larson D. Handbook of Religion and Health. New York: OUP.

Bunn A & Randall D. cmf file 44 (2011) - health benefits of Christian faith. Available at http://admin.cmf.org.uk/pdf/cmffiles/44_faith_benefits.pdf