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Participation and membership in the Christian Science Church has been declining steadily for many years: Between 1971 and 2009 the number of U.S. practitioners and teachers listed in the Christian Science Journal fell from about 5,000 to about 1,160. The number of churches fell from about 1,800 to about 900. The current number of Christian Science "nurses" in the United States is only 20. Subscriptions to the Christian Science Sentinel fell from about 175,000 in 1988 to 24,130 in 2009, and the church does not disclose how many members it has, but the current subscription figure suggests there are fewer than 50,000 members worldwide. Christian Science contends that illness is an illusion caused by faulty beliefs, and that prayer heals by replacing bad thoughts with good ones. Christian Science practitioners work by trying to argue the sick thoughts out of the patient's mind. Consultations can take place in person, by telephone, or even by mail. Individuals may also be able to attain correct beliefs by themselves through prayer or concentration. The steady membership decline is not surprising because the church's doctrines have little appeal to modern youth. The church's efforts to include coverage of services by practitioners in proposed health care reform bills have been thwarted so far, but lobbying to gain inclusion continues. Stephen Barrett MD, Quackwatch (18th December 2009)