It was my annual meeting with Tom, my insurance agent, to update my policies. In the middle of our session at a local coffee shop, Tom unexpectedly blurted out, “How do I keep from getting cancer?” I was stunned at what he said, though he said it with a smile. Was he kidding?

I knew Tom read the colorful pamphlets from his insurance company that recommended a number of healthy life-style recommendations that have been shown to prolong life by reducing the incidences of a wide ranging of illnesses including cancer. I also knew Tom followed a number of these recommendations including regular exercise, diet and weight control, avoidance of smoking and drinking of alcohol in moderation.

“Am I doing enough?” Tom asked. At first I nodded “yes.” Then I wondered if there could be another issue. Recent studies have been reported in the newspapers of the impact of friendship on health. What about Tom? Tom was a busy man with his firm. I knew he never spoke to me about any friends he had. Maybe friendship was something that could be relevant. So I asked him.

Tom replied to my query, “My last real friends were in the sixth grade. Once I got into junior high, I was too busy with my studies and sports to maintain any real friendships. That continued till after college. Then I became too busy with work. I’m still too busy. I guess I don’t have any friends.”

Four large national research studies published in the The Proceedings of the American Academy of Sciences have shown that after controlling for education, smoking, depression, alcohol consumption, diabetes and several other characteristics, friendship had a significant effect on health. Not only in the older population where social isolation is known to be a problem, but even starting in adolescence. In the elderly the lack of friends affected health as much as hypertension and diabetes. In teens the lack of friends affected health as much as physical inactivity.

Social integration, a scientific name for friendships, and the nature of social connections – in romantic relationships, with family and friends and by participation in religious and social organizations, have been shown to reduce the levels of measures of general inflammation (called C-reactive protein) that affects the immune system, blood pressure, body mass index, and waist circumference. Reductions in all these parameters lead to lower incidences of many diseases, including cancer.

The importance of friendship is recognized extensively throughout the Bible, and Scripture provides many examples of how friendship had major impacts on people’s lives. One of the notable stories concerning friendship in the Old Testament was the friendship of Jonathan (son of King Saul) and David (anointed by the prophet Samuel to be the next king of Israel). Though Jonathan understood that David, not he, would be the next king, it did not deter Jonathan from continuing his close friendship with David that was sustained over many years.

Jonathan’s friendship was exhibited in several ways: “He warned [David]” (1 Samuel 19:1) that King Saul intended to kill David; “He spoke well of David” (1 Samuel 19:4) when King Saul disparaged David; “[Jonathan] sounded out his father” (1 Samuel 20:12) to learn the threats to David’s life; ” He made a covenant with the house of David” (1 Samuel 20:16) pledging to aid David in times of threat; and “[Jonathan] helped David find strength in the Lord” (1 Samuel 23:16) when David was struggling in a fierce battle. Jonathan’s physical, emotional, and spiritual support indeed saved David’s life. David went on to become the next king of Israel and lived a long life.

This story of the friendship of David and Jonathan occurring 3000 years ago still has relevance for us today. Though our battles may be more internal than external, friendship offers much in impacting our lives for good.

Tom was doing many good things that would help him with his health, but he knew something was missing. Tom admitted to me he was lonely. Tom was missing not only the companionship of a friend, but someone who would be ultimately good for his health! He needed to meet people at Bard Coffee not just for business.

Dr. Delvyn C. Case Jr. is a hematologist/oncologist, playwright and director, columnist and consultant to the Department of Spiritual Care at Maine Medical Center in Portland.