Effect of Spiritist “passe” (Spiritual healing) on growth of bacterial cultures

Effect of Spiritist “passe” (Spiritual healing) on growth of bacterial cultures

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Complementary Therapies in Medicine (2013) xxx, xxx—xxx

Available online at www.sciencedirect.com

ScienceDirect journal homepage: www.elsevierhealth.com/journals/ctim

Effect of Spiritist ‘‘passe’’ (Spiritual healing) on growth of bacterial cultures Giancarlo Lucchetti a,b,c,d,∗, Renata Ferreira de Oliveira b, ¸alves b, Juliane Piasseschi de Bernardin Gonc Suely Mitoi Ykko Ueda c, Lycia Mara Jenne Mimica c, Alessandra Lamas Granero Lucchetti b,d a

Federal University of Juiz de Fora, Brazil São Paulo Medical Spiritist Association, Brazil c Santa Casa of São Paulo, Brazil d João Evangelista Hospital, Brazil b

KEYWORDS Biofield therapies; Spiritism; Passe; Bacteria; Therapeutic touch



Summary Background: Biofield therapies are approaches that harness energy fields to influence the human body. These therapies encompass Reiki, Qigong, Therapeutic Touch, Johrei and Spiritist ‘‘passe’’, among others. The aim of this study was to evaluate bacterial growth in two groups of cultures subjected to biofield therapy (Spiritist ‘‘passe’’ and laying on of hands (LOH)) in four situations (no intention, intention to inhibit bacterial growth, intention to promote growth, and influence of a negative factor) and compare them with a ‘‘no LOH/no treatment’’ group. Methods: Bacterial cultures (Escherichia coli ATCC) were randomized and allocated into three groups: Spiritist ‘‘passe’’, ‘‘LOH’’, and ‘‘no LOH’’. Bacterial growth was assessed using the McFarland Nephelometer Scale. A One-way ANOVA was performed to determine group differences in bacterial growth at 48 h, and at 1 week after each situation. Results: A total of 11 Spiritist ‘‘passe’’ healers, 10 LOH laymen and ‘‘no LOH’’ tubes were assessed. Under the intention to inhibit bacterial growth condition, statistically significant differences were found between the Spiritist ‘‘passe’’ and ‘‘no LOH’’ Groups (p = 0.002 after 48 h, and p = 0.008 after one week) and also between the Spiritist ‘‘passe’’ and ‘‘LOH’’ Groups (p = 0.005 after 48 h, and p = 0.009 after one week). No statistically significant difference was detected for the other situations tested (no intention, intention to promote growth and influence of a negative factor). Conclusions: We concluded that Spiritist ‘‘passe’’ effectively inhibited growth in bacterial cultures compared to LOH with intention or no LOH. Further studies comparing different intentions and types of LOH in cultures of cells and microorganisms are warranted. © 2013 Elsevier Ltd. All rights reserved.

Corresponding author at: Av. Juriti, 367 apto 131, Moema, São Paulo, SP, Brazil. Tel.: +55 11 981199001. E-mail addresses: [email protected], [email protected] (G. Lucchetti).

0965-2299/$ — see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ctim.2013.08.012

Please cite this article in press as: Lucchetti G, et al. Effect of Spiritist ‘‘passe’’ (Spiritual healing) on growth of bacterial cultures. Complement Ther Med (2013), http://dx.doi.org/10.1016/j.ctim.2013.08.012

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Introduction Complementary medicine has grown significantly in recent decades. An estimated 40% of patients in the United State use some type of complementary therapy1 where at least 13% use spiritual healing or prayer, and 1% energy therapies.2 Biofield modalities3 are defined as those ‘‘therapies intended to affect energy fields that purportedly surround and interpenetrate the human body. These therapies involve touch or placement of the hands in or through biofields, the existence of which have not yet been scientifically proven’’. These therapies include Reiki, Qigong, Therapeutic Touch, Johrei and Spiritist ‘‘passe’’, among others. This latter approach numbers among the therapies employed by Spiritism, the third most prominent religion in Brazil that adopts a dualistic concept of human beings. It postulates that we are essentially immortal spirits that temporarily inhabit physical bodies for several necessary incarnations to attain moral and intellectual improvement. It also implies a possible beneficent or maleficent influence of the spirits over incarnate humans.4 With Spiritism emerged Complementary Spiritist Therapy,5 based on a range of therapeutic resources including prayer, fluidotherapy (fluidic or magnetized water), charity, spirit education, disobsession (spirit release therapy) and the Spiritist ‘‘passe’’ (a kind of laying on of hands (LOH) which, according to Spiritism, results in an exchange of fluids and energies derived from the healer, from good spirits or a combination of both). Spiritist therapy, although not yet fully understood or extensively studied, has shown promising indirect results such as those reported in a recent systematic review.6 Several studies involving biofield therapies have shown positive results, in some cases showing differences between LOH with intention versus the same approach without a defined intention.6 However, in the last decades, numerous systematic reviews in this field showed controversial results and heterogeneous evidence.7—9 Other studies have shown the effect of biofield therapies on human cells and bacteria.10,11 It is well established that several physical factors can influence bacterial growth such as temperature, pH and salinity.12 Nevertheless, few studies have been conducted aimed at elucidating the relationship between behavioral factors and bacterial growth. In 2006, a study assessing the influence of Reiki in bacterial cultures was published. According to the study results, ‘‘no overall difference was found between the Reiki and control plates in the non-healing context. In the healing context however, the Reiki treated cultures exhibited significantly more bacteria overall than did controls’’.11 Nevertheless, one of the current knowledge gaps in this field of research is whether differences exist between two different types of LOH with intention (a therapy deemed ‘‘spiritual’’ versus a ‘‘non-spiritual’’ therapy). Similarly, it is not clear if different intentions such as that of promoting or inhibiting growth can in fact positively or negatively influence the proliferation of bacterial cultures. Against this background, the aim of this study was to evaluate bacterial growth in two groups of cultures subjected to biofield therapy (Spiritist ‘‘passe’’ and laying on of hands (LOH)) in four situations (no intention, intention to inhibit bacterial growth, intention to promote growth, and

influence of a negative factor) and compare them with a ‘‘no LOH/no treatment’’ group.

Methods An experimental study was conducted at the Microbiology Laboratory of the Medical Sciences Faculty of the Santa Casa de Misericórdia of São Paulo between April and June 2011. This laboratory is one of the references for microbiological analysis in São Paulo, Brazil. It has a controlled environment and it follows the procedures from the ‘Manual of Clinical Microbiology’12 which sets the standard for state-of-the-science laboratory practice. The main hypothesis was that bacterial growth in cultures submitted to different types of LOH varies according to the type of intention and faith of the participants. Three different groups were employed to test this theory: • Spiritist ‘‘passe’’ (spiritual healing) group: according to Spiritism,6 ‘‘passe’’ is defined as a ‘‘transfusion of energy which changes the cellular field’’ and ‘‘a transfusion of psychic energy’’. Spiritist healers undergo a course of three years in which they learn the fundamentals of the application of ‘‘passes’’ with the aim of curing individuals through practical classes. Having completed this course they are authorized to act in the capacity of healers within Spiritist Centers. For the present study, healers affiliated to the Spiritist Federation of São Paulo State (one of the most renowned Spiritist institutions in Brazil) were recruited. Inclusion criteria for healers was having at least 2 years of experience, aged older than 18 years, and having taken part in courses accredited by the institution. • Laying on of hands (LOH) laymen group: the group was randomly selected from among groups of friends of relatives of the researchers, staff or trainees at the Santa Casa de São Paulo Hospital. Inclusion criteria for this group was adults (older than 18 years of age), not belonging to the Spiritist religion, and no prior knowledge of LOH techniques such as Reiki, Johrei or Therapeutic Touch. • No LOH/No treatment group: Analysis of bacterial culture growth without LOH, in other words by ‘‘natural course’’.

Experimental procedures Bacterial cultures were randomized and allocated into the three groups: Spiritist ‘‘passes’’, LOH, and no LOH. The tubes were numbered consecutively and a computerized random-number generator was used to create a random sequence. Then, the first tube in the random sequence was included in the ‘Spiritist passe’ group, the second tube was included in the ‘LOH’ group, the third tube was included in the ‘No LOH’ group and so on. The bacterial samples were placed in identical tubes with culture medium and presented uncovered in metal test tube racks to the volunteers. A notebook device with headphones was used to enable participants to watch and listen to the videos (see below). The Spiritist healers were allowed to previously prepare the setting through 5 (five) min of prayer and relaxation. The ‘‘passe’’ or LOH was carried out continuously for 10 min (witnessed by two research assistants) at a distance of 10—15 cm from the tubes containing the bacterial cultures

Please cite this article in press as: Lucchetti G, et al. Effect of Spiritist ‘‘passe’’ (Spiritual healing) on growth of bacterial cultures. Complement Ther Med (2013), http://dx.doi.org/10.1016/j.ctim.2013.08.012

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Spiritist ‘‘passe’’ (spiritual healing) on growth of bacterial cultures (this distance was chosen because the Spiritist healers are trained to apply the ‘passe’ within this distance). The experimental sessions were performed between 8 a.m. and 3 p.m. for three consecutive days. Participants were submitted to a well-being scale (10 cmlong line, numbered from zero to ten), containing questions on general well-being, peace, happiness, spiritual wellbeing, nervousness and irritability. Both groups applied ‘‘passe’’ or ‘‘LOH’’ with lights out (to increase concentration) for 10 min and under four different conditions: (1) LOH with no intention for 10 min: in this experiment the participants (Spiritist ‘‘passe’’ and ‘‘LOH’’) watched a video about the industrial production of ethanol fuel, describing the process of obtaining, storing and manufacturing the product (in order to distract their attention). Healers were instructed to place their hands over the cultures while paying attention to the video with no intention requested. (2) LOH with the intention of inhibiting bacterial growth for 10 min: participants were instructed to ‘‘kill the bacteria’’ (prevent growth) since they were the ‘‘cause of infection and were harmful to humans’’. At this point, participants watched a video of aspects of nature and relaxing sounds with no religious connotation. (3) LOH with the intention of promoting growth: participants were instructed to ‘‘promote growth of the cells’’. At this point, participants watched the same video of aspects of nature and relaxing sounds with no religious connotation. (4) LOH with a negative impact: In this experiment, participants watched the first 10 min of the film ‘‘Saving Private Ryan’’ showing scenes of violent combat on Dday during the Second World War. Participants were instructed to place their hands over the cultures while paying attention to the video with no intention requested.

Bacterial culture The agent Escherichia coli ATCC was used in all experiments, based on a previous study which investigated the effects of Reiki treatments on E. coli bacteria.11 The agent was chosen inoculated into screw-capped tubes containing aliquots of 5 mL of TSB (Tryptic Soy Broth; Probac do BrasilTM ) medium where density corresponding to the 0.5 standard on the McFarland scale. For each condition investigated, it was decided to use 3 tubes in a bid to improve reliability and increase the sample count. Cultures were stored in an incubator at 37 ◦ C. Inoculums were assessed at 48 h and again at one week, post experimentally. The McFarland Nephelometer Scale (NefelobacTM , Probac do Brasil),13 was used to determine the intensity of multiplication in liquid culture medium. This multiplication manifests in liquid media via an increase in particles (bacteria) which in turn block the free passage of light, causing turbidity or opacity of the medium. The higher the bacteria count, the greater the opacity of the culture medium. NefelobacTM was prepared according to the nephelometric McFarland standard formula.12,14 Briefly, this consists of a series of 11 tubes

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numbered from 0.5 to 10, containing different amounts of barium chloride and sulfuric acid. The different concentrations of barium chloride and sulfuric acid determine the bacterial counts. Thus, tube number 0.5 corresponds to 150 million bacteria, tube number 5—1.5 billion, and tube number 10—3 billion bacteria, per mL of medium. To increase reliability of the results, tubes were withdrawn randomly (precluding identification) and analyses of growth were performed in triplicate by three independent examiners. In the event of no consensus, examiners convened to reach a decision on the final result. Results analysis was carried out as per manufacturer’s instructions (Probac do Brasil) by comparing tubes containing NefelobacTM against those containing bacterial culture, side by side with the naked eye. The tubes used to hold NefelobacTM and bacterial culture were homogenized to produce a uniform suspension (turbidity). Printed texts and a Wickerham card15 were placed to carry out comparative readings of the tubes, where lesser or greater clarity of the letters and lines seen through the tubes indicated higher and lower turbidity, respectively. The outcome assessment took place by an assessor blind to treatment allocation. After the analysis at one week, cultures were seeded onto blood Agar medium to test the viability of the strains. Bacterial samples not viable after one week were excluded from the study (7 tubes from the LOH group were excluded).

Statistical analysis The data collected were input to the SPSS 17.0 (SPSS Inc.) statistics package. Demographic data for the groups was compared using the t test (continuous variables) and Chisquare test (categorical variables). A one-way ANOVA was performed to determine group differences (‘‘Passe’’, ‘‘LOH’ and ‘‘no LOH’’) in bacterial growth/counts at 48 h, and at 1 week after each situation. Then, a Tukey—Kramer post hoc analysis was performed. To increase homogeneity and to approach normality of the data, the variables used in the analysis were transformed to Z-scores before analysis. A p value <0.05 was considered statistically significant and the confidence interval was set at 95%. All statistical analyses were conducted under blind circumstances by an independent statistician.

Ethical issues The study was evaluated and approved by the Santa Casa of São Paulo Institutional Review Board and all participants signed a consent form.

Results Characteristics of participants A total of 12 Spiritist healers and 12 individuals for the LOH group was selected. Due to personal problems, one of the Spiritist healers and two from the LOH group were unable to

Please cite this article in press as: Lucchetti G, et al. Effect of Spiritist ‘‘passe’’ (Spiritual healing) on growth of bacterial cultures. Complement Ther Med (2013), http://dx.doi.org/10.1016/j.ctim.2013.08.012

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take part, giving a final sample of 11 and 10 participants in the Spiritist ‘‘passe’’ and LOH groups, respectively. Three tubes per participant were used for each experimental condition, i.e. each participant performed laying on of hands on three tubes at a time (3 tubes with no intention, 3 tubes inhibiting growth, 3 tubes promoting growth and 3 tubes with negative influence). Thus, a total of 132 tubes were used for the 11 Spiritist healers (33 per condition), 113 for the 10 subjects in the LOH group (28.2 per situation — excluding 7 tubes due to non-viability of the sample after one week) plus 33 tubes to serve as no LOH group. The mean age of subjects in the Spiritist healer group was 51.8 (SD: 10.8) years, with subjects being predominantly females (72.7%) with a mean experience of 16.2 (SD: 11.4) years applying ‘‘passes’’ at Spiritist centers. The mean age of subjects in the LOH group (non-Spiritist healers) was 35.1 (SD: 16.9) years (p = 0.016 compared to Spiritist healers) and subjects were predominantly females (80.0%), with no significant difference to the Spiritist passes group in terms of gender (p = 0.55).

Bacterial growth after 48 h The assumptions for performing the ANOVA parametric test were met. Z-scores were used for dependent variables (bacterial growth/counts in each situation: no intention, increase, decrease and negative) in order to reduce the effect of non-normality of this variable. On the analysis of bacterial growth after 48 h (Graph 1), the one-way ANOVA test showed differences for the inhibition of bacterial growth condition (F = 7.932, p = 0.001, eta squared: 0.148) but not for the other situations: promoting bacterial growth (F = 2.015, p = 0.139), no intention (F = 2.093, p = 0.129) and negative impact (F = 2.467, p = 0.091). The Tukey—Kramer post hoc test was used given the lack of homogeneity among the groups. For the inhibition of bacterial growth situation, statistically significant differences were found between the ‘‘no LOH’’ and the ‘‘passe’’ groups (p = 0.002) and likewise between the ‘‘LOH’’ and the ‘‘passe’’ groups (p = 0.005).

Bacterial growth after one week General well-being of participants A difference in participants’ well-being was noted among the groups. Mean physical well-being of the Spiritist ‘‘passe’’ and LOH groups was 8.82 vs. 7.30 (p = 0.006), 9.36 vs. 7.20 (p = 0.017) for inner peace, 8.73 vs. 7.20 (p = 0.151) for happiness, 9.36 vs. 7.70 (p = 0.111) for spiritual well-being, 0.45 vs. 3.90 (p = 0.000) for nerves, 0.55 vs. 3.80 (p = 0.011) for irritability, and 2.55 vs. 4.50 (p = 0.0155) for worries. No statistically significant difference was found (p = 0.256) for response to the question on whether subjects had experienced a bad time during the week.

Graph 1

The analysis of bacterial growth after one week can be seen in Graph 1. The one-way ANOVA test showed differences for the inhibition of bacterial growth situation (F = 6.210, p = 0.003, eta squared: 0.118) but not for the other situations: promoting bacterial growth (F = 0.090, p = 0.914), no intention (F = 0.578, p = 0.563) and negative impact (F = 2.080, p = 0.131). The Tukey—Kramer post hoc test was used given the lack of homogeneity among the groups. For the decrease in bacterial growth situation, statistically significant differences were found between the ‘‘no LOH’’ and the ‘‘passe’’ groups (p = 0.008) groups and likewise between the ‘‘LOH’’ and the ‘‘passe’’ groups (p = 0.009) groups.

Bacterial growth 48 h, and one week, after experiment by group (mean, SE).

Please cite this article in press as: Lucchetti G, et al. Effect of Spiritist ‘‘passe’’ (Spiritual healing) on growth of bacterial cultures. Complement Ther Med (2013), http://dx.doi.org/10.1016/j.ctim.2013.08.012

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Spiritist ‘‘passe’’ (spiritual healing) on growth of bacterial cultures

Discussion In the present study, a difference was noted between the ‘‘Spiritist healer’’ group and the other groups for ‘‘inhibiting growth’’ in bacterial cultures. These results were maintained even one week after the ‘‘passe’’ intervention. The possibility of humans exerting change in infectious agents is a subject little studied in the medical literature, with few reports available on the theme. The present study revisits the discussion as to whether humans are capable of not only influencing their own organism but influencing other cell types such as bacteria and fibroblasts. In addition, these data raise the possibility of there being a difference between only having good or bad intentions in LOH and actually making a ‘‘spiritual connection’’. This theory is supported by the fact that, for all of the situations studied, the LOH group showed no significant improvement on results found in the Control group, suggesting that intention alone was unable to impact bacteria in the experiment. Given that all biofield therapies (Reiki, Qigong, Therapeutic Touch, Johrei and Spiritist ‘‘passe’’) involve some kind of ritual or systematization, it could be inferred that this element shall be a prerequisite for the approach to effectively influence outcomes. The influence of biofield therapies on the growth of different cell types has been a constant focus of research and reports in the medical literature.16 Studies based on therapeutic touch have confirmed increased proliferation of human cells in cultures,10 DNA synthesis and mineralization of human osteoblasts17 as well as increased blood hemoglobin and hematocrit level.18 However, studies in bacterial cultures remain scarce in the literature. In a recent study, Rubik et al.11 assessed the influence of Reiki on bacterial cultures and reported ‘‘no overall difference was found between the Reiki and control plates in the non-healing context. In the healing context, the Reiki treated cultures overall exhibited significantly more bacteria than control’’. Some studies conducted in China19 have shown that external qi emitted from the hands of qigong masters can either increase or decrease counts of bacteria, normal and cancer cells, demonstrating two forms of external qi: positive qi, with beneficial effects; and negative qi, with deleterious effects on cells. Recently, Morse and Beem20 reported a 54-year-old severely ill man who had hepatitis C who was treated with experimental high-dose interferon/ribavirin therapy with resultant profound anemia and neutropenia. Spiritist passe and Reiki were used for complementary treatment and he found statistically significant relationships between these therapies, a quieting of the electronically created white noise of the RNG during healing sessions, and improvement in the patient’s absolute neutrophil count. Nevertheless, to date, no experimental studies have assessed Spiritist ‘‘passe’’ as a modality in biofield therapies. Noteworthy, the present study presents some strengths that should be mentioned: (a) the investigation of several different intentions and the comparison between healers and laymen, weakening the possibility that these results could be justified by the imposition of hands alone; (b) the measurement of some psychological aspects of participants through well-being scales which, in accordance with some

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authors, should be assessed by this type of study21 and, (c) the use of nonhuman populations (such as animals or bacteria) which, could solve some methodological problems in such research.7 However, our results should also be interpreted with caution. Firstly, this was an experimental study in which it was not possible to determine whether the influence seen in bacterial growth also occurs in vivo. Secondly, a clear difference in age and well-being between participants from the Spiritist ‘‘passe’’ and LOH groups was observed, pointing to a possible role of other factors influencing these results. Thirdly, a larger sample may yield other statistical differences not observed in the present study. Fourthly, the results were obtained from only one center. A future multiple center trial is warranted in order to enhance the validation of our results. Comparing to other studies, we found some remarkable differences. For instance, Rubik et al.11 found that Reiki was capable of promoting bacterial growth. On the other hand, our study found that the Spiritist passe was capable of inhibiting bacterial growth. This apparent contradiction could be explained by the intentions involved in both studies. In the first study, healers were asked to help the bacteria recover and grow. In the latter, healers were instructed to inhibit growth. Interestingly, when Spiritist healers were asked to promote growth, they failed to replicate Rubik findings. This finding, not yet fully understood, leads us to speculate that Spiritist healers’ motivation and concentration may have been greater when asked to ‘‘kill’’ bacteria ‘‘harmful to humans and the cause of diseases’’ than under other conditions. Moreover, when Spiritist healers have no defined intention, bacteria were found to exhibit similar growth to control samples. This result lends further weight to the hypothesis that intention to inhibit growth was able to influence bacteria, as shown in Graph 1. Although, at present, there are only very tenuous theoretical foundations underlying the mechanism responsible for healing, authors believe that an energy (undetected by normal scientific methods) is activated during the process of healing and transferred to the patient.22 In Spiritism,6 laying on of hands is defined as ‘‘an energy transfusion, changing the cellular field’’ and ‘‘a psychic energy transfusion’’, denoting the influence of the spiritual energy on physical health. According to Hodges and Scofield,22 ‘‘the purpose of the healer is to channel the energy from what is usually termed a ‘‘higher’’ source into the patient where, firstly, it increases the energy levels and flows, and re-establishes a balance; secondly, it activates the natural healing force within patients, helping them to heal themselves and to return toward a state of normality’’. Our findings have also some implications for clinicians. The role of ‘‘spiritual healing’’ on the growth of bacterial cultures in two studies (the present one and Rubik et al. [11]) could foster the discussion on whether these therapies could have the same impact in clinical samples such as patients with sepsis or treated with antibiotics. In addition, although spiritual treatments are frequently used by patients, there is little evidence available. Increasing evidence regarding these issues could help health professionals in recommending or not these practices to their patients.

Please cite this article in press as: Lucchetti G, et al. Effect of Spiritist ‘‘passe’’ (Spiritual healing) on growth of bacterial cultures. Complement Ther Med (2013), http://dx.doi.org/10.1016/j.ctim.2013.08.012

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In our opinion, future studies should focus on the differences among techniques such as therapeutic touch, Spiritist ‘‘passe,’’ Johrei and Reiki in clinical outcomes. Another aspect that should be more evaluated is the comparison of intentional laying on of hands and healing techniques based on a ‘‘high healing’’ power, such as attempted in the present study. Furthermore, another future direction is focusing on the identification of which types of energies were irradiated from the imposition of hands. We conclude that LOH by Spiritist ‘‘passe’’ was able to effectively inhibit the growth of bacterial cultures compared to LOH with intention and no laying on of hands. Further studies comparing different intentions and types of laying on of hands in cultures of cells, other microorganisms and other bacterial species are warranted.

Authors’ contributions GL has made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; has been involved in drafting the manuscript; and has given final approval of the version to be published. RFO has made substantial contributions to acquisition of data; has been involved in revising the manuscript critically for important intellectual content; and has given final approval of the version to be published. JPBG has made substantial contributions to acquisition of data; has been involved in revising the manuscript critically for important intellectual content; and has given final approval of the version to be published. SMYU has made substantial contributions to conception and design; has been involved in revising the manuscript critically for important intellectual content; and has given final approval of the version to be published. LMJM has made substantial contributions to conception and design; has been involved in revising the manuscript critically for important intellectual content; and has given final approval of the version to be published. ALGL has made substantial contributions to conception and design, analysis and interpretation of data; has been involved in revising the manuscript critically for important intellectual content; and has given final approval of the version to be published.

Conflict of interest statement The authors declare that there is no conflict of interest.

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Acknowledgement The authors would like to extend their thanks to the volunteers who took part in this study.

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Please cite this article in press as: Lucchetti G, et al. Effect of Spiritist ‘‘passe’’ (Spiritual healing) on growth of bacterial cultures. Complement Ther Med (2013), http://dx.doi.org/10.1016/j.ctim.2013.08.012