This Tuesday, His Holiness the 14th Dalai Lama is expected to join about 50 neuroscientists and biologists in a gleaming auditorium at Beth Israel Medical Centers Institute for Neurology and Neurosurgery (INN) for what has been billed as a landmark medical conference on meditation and healing. His Holiness will listen to various esteemed neuroscientists comments on the still mostly mysterious interplay between brain and body; hell then hold forth with the Eastern perspective on such inviting subjects as Bliss, Learning, and Perfect Stage Meditation. Already, Matthew Fink, president and CEO of Beth Israel, predicts this meeting will be the most unusual intellectual discourse that I have been involved in in 25 years of medical education and training. But Fink, a neurologist, is aspiring to another first beyond the unusual discourse: It is his fond hope that the Dalai Lama -- a technology enthusiast who fixes watches in his spare time -- will allow neuroscientists to monitor his brain waves as he enters a state of deep meditation. As Fink puts it simply, We want to hook him up. The monitoring device -- pet scan, functional MRI, or quantitative EEG -- has yet to be firmly established, as has, for that matter, His Holinesss receptiveness to the idea.
Although the New York medical community has been tentatively experimenting with so-called alternative medical approaches at its hospitals, this carefully orchestrated apotheosis of mind-body medicine may mark a dramatic turning point. Three of the citys most prestigious institutions -- Beth Israel Medical Center, Columbia-Presbyterian Medical Center, and Memorial Sloan-Kettering Cancer Center -- have announced ambitious plans for integrative or complementary programs that promise to feature mind-body medicine, all of which have been jump-started with funding from either one benefactor or a handful of impassioned donors. These hospitals are staking millions of dollars, not to mention their reputations, on the proposition that patients heal more quickly and less traumatically with the use of support groups, meditation, and a variety of relaxation techniques and cognitive therapy. Although some doctors on staff are actively skeptical about lending both resources and credibility to complementary services, an increasing number seem to be asking a different question altogether: What took so long?
Only one of the New York hospitals fledgling programs is running at full steam -- Columbia-Presbyterians Department of Complementary Care Services. By contrast, programs have been flourishing for years at major centers around the country. Why has New York, medical and psychiatric capital of the world, been so slow to adapt? New York has always been the citadel of the medical Establishment, observes Reed Moskowitz, head of New York University Medical Centers Stress Disorders Services. Of course, the citadel is often the last place where a new wave begins to have an effect.
As the patient lies unconscious, the heart-bypass team plucks rubbery veins from his calves and cracks open his chest, readying him for the needlework of his surgeon. The surgeon, Mehmet Oz, who arrives as soon as the heart/lung machine kicks in, begins sewing vein grafts onto the surface of the still heart. Oz does not comment much as he works, but he does muse to a member of his team, I wonder what Ed is thinking right now.
Oz is convinced that during much of the four-hour procedure, save perhaps the hour when his heart his stopped, Ed is not bereft of consciousness. Even more heretically, Oz believes that what his patient is thinking could influence his healing process, which explains why he is hooked up to a Walkman, listening to quietly spoken suggestions that his wounds heal quickly, and that his recovery be smooth.
The 72-year-old patient had engaged the services of the Complementary Care Center at Columbia-Presbyterian Medical Center, three rooms adjacent to the cardiac unit that offer individual sessions in visualization, hypnosis, meditation, yoga, massage, and therapeutic touch. The center, founded and directed by Oz and his colleague Jery Whitworth, is the most evolved mind-body program currently operating at one of the big six institutions. Many patients who engage its services do so before surgery. As part of the preparation for a triple bypass, a typical patient spends a week listening to audiotapes with relaxing instructions and a custom-tailored hypnosis session.
Even at the most superficial level, complementary medicine can empower the patient, says Oz, 37, a cardiothoracic surgeon with suave good looks. The fundamental argument I have always made is that to a certain extent, we can augment our own ability to heal.
Even among Columbia physicians who consider Oz a brilliant, innovative surgeon, skepticism reigns about some of the services he champions. Those tapes tell you youre going to feel wonderful and when you wake up, youre going to want apple juice, says one breast surgeon. That never worked. They never wanted apple juice when they woke up. So obviously the subliminal thing didnt work, she continues matter-of-factly. Its not going to kill me if they use the tapes; its not like its a waste of my energy. It just seems like a very weird thing to do.
Thus, the divide on complementary care: There are those who think its a very weird thing to do and those who have faith in the growing body of research suggesting that many mind-body applications actually help. If you dont help patients to harness their own healing capacities, you are putting them at a significant disadvantage, says Woodson Merrell, assistant medical professor at Columbia Medical School. There are certainly dozens and now probably hundreds of studies showing the effect of mind or emotion on the immune system. In 1989, professor of psychiatry David Spiegel, director of Stanford Medical Schools Psychosocial Treatment Laboratory, published a landmark study that found women with metastatic breast cancer who participated in psychotherapy groups lived eighteen months longer than those in a control group. (After four years, all of the 36 control patients had died, whereas a third of the 50 group members remained alive.) And two years ago, psychologist Wolfgang Linden of the University of British Columbia published an overview of 23 clinical trials evaluating psychosocial treatments, mainly supportive counseling and relaxation techniques, for heart-attack patients. Linden, whose results were published in the well-respected Archives of Internal Medicine, found that the addition of these treatments to standard cardiac rehabilitation cut the post-heart-attack death rate by 41 percent.
Skeptics, of course, are not unique to New York, but more than elsewhere, the power elite here has viewed mind-body medicine with disinterest or outright disdain. Jan Breslow, a professor at Rockefeller University and past president of the American Heart Association, maintains that its too early to broadly recommend mind-body treatments for heart patients. The six main risk factors for heart disease are smoking, cholesterol, physical inactivity, obesity, blood pressure, and diabetes, says Breslow. This whole relaxation business is more controversial.
Spiegels study on breast cancer also has its detractors. Its a scam, says Victor Herbert, professor of medicine at Mt. Sinai Medical Center and a leading critic of alternative medicine who is taken seriously by many mainstream physicians. The researchers are doing it to make money. That was a totally worthless study. He speculates that patients in the treatment group probably had less advanced disease but later acknowledges he has not read the study. Send it to me, and I will show you where it is revealed that the study is worthless. Spiegel, in fact, did perform statistical analyses to rule out meaningful differences between the two groups in disease severity.
Moments later, Herbert, in a fit of moderation, tempers his earlier characterization of Spiegel. Im not saying these guys are crooks, he concedes. Im just saying they are delusional. The self-styled G. Gordon Liddy of medical quack-busting, hes so sure about the fallacy of mind-body science that he doesnt even need to see the numbers.
There is a third camp that falls between Herberts vehement dismissal and Merrells firm commitment. Some doctors still think the science isnt strong enough or needs to be replicated but take a pro-mind-body-medicine stance, if only because its popular with patients. Craig Smith, chief of the cardiothoracic-surgery division at Columbia-Presbyterian, whose own division provided critical early funding for the hospitals Complementary Care Center, falls neatly into that category. I dont buy into the effectiveness of all these techniques, and I dont go out of my way to encourage my patients to partake, says Smith. But he has high regard for Mehmet Oz and is particularly pleased that the center is now a department independent of the cardiac division: I thought I might be stuck with this for a number of years, funding-wise.
When Ann Webster graduated from Albert Einstein Medical School with a Ph.D. in health psychology twelve years ago, she found that none of New Yorks major medical institutions would hire her to do what she had trained to do: offer mind-body medicine to cancer patients. To this day, the Upper West Sider commutes every Monday morning to Boston, where she was snapped up by Harvard Medical Schools Dr. Herbert Benson, a leader in mind-body medicine, shortly after completing her degree. When patients join a mind-body program at Bensons fifteen-year-old Mind/Body Clinic at Beth Israel Deaconess, they spend two hours each week for ten weeks in a treatment room with a dozen fellow patients, learning to sink into states of relaxation so profound as to change their physiology -- decreasing oxygen consumption and heart rate, even altering brain waves. Webster might take patients through a progressive muscle relaxation, quietly directing them to release the tension in muscles from their forehead to their eyelids down to their toes; she offers yoga, cognitive restructuring, and meditation, guiding them through the correct breathing, encouraging them to focus, as Webster puts it, on a word -- you know, peace, or whatever works, to quiet the mind.
And Bostons program is far from unique: Duke, Stanford, the University of Massachusetts, and the University of Miami all offer comprehensive plans and attract substantial funding for research on these mind-oriented healing methods.
Certainly, mind-body practitioners themselves are not in short supply in New York -- the names of biofeedback practitioners alone take up a column in the Yellow Pages. But advocates argue that to be most effective, the programs need affiliation with major hospitals, to assure patients of the therapists skills, to facilitate studies, and, most practically, to increase the odds of collaboration among the therapists and physicians.
Mehmet Oz and Jery Whitworth, the pair who have championed mind-body medicine most aggressively at Columbia-Presbyterian, discovered their mutual interest in the subject in the middle of a complicated bypass more than three years ago. Oz was operating; Whitworth was acting as profusionist, the technician who keeps the patient alive while the operation is ongoing. At one point, recalls Whitworth, Oz jumped up on a standing stool, peered into the patients chest, and said, I knew we should have used subliminal tapes on this patient. Surprised by Ozs pronouncement, Whitworth felt free to talk to the surgeon about his 25 years of personal experience with mind-body healing techniques. After a few minutes, we stopped, because the O.R. was totally quiet, says Whitworth. Seven pairs of fearful eyes were staring at us. For a year, Oz, Whitworth, and a group of several other supporters met secretly once a week to discuss healing methods and ways of evaluating them that would be acceptable to their colleagues. If higher-ups had known about their meetings, Whitworth says emphatically, they would have disbanded us.
During those meetings, Oz and Whitworth planned a center to deliver mind-body medicine to medical patients and also conduct controlled clinical trials. Eventually, they gained the support of Eric Rose, chairman of the Department of Surgery, and William Speck, the hospitals chairman and COO.
Although the center could not have gone forward without Ozs already stellar reputation -- hes a four-time winner of the coveted Blakemore research prize -- his minor celebrity brought so much attention to the program that it risked backlash: In 1995, a story in The New York Times Magazine spotlighted Ozs collaboration with an energy healer who treated patients as they underwent open-heart surgery. The piece was flattering -- Oz was introduced as one of those rare beings who seem incapable of sloth -- but some colleagues, alarmed that publicity about that experimental technique might undermine the hospitals reputation, complained to top administrators, including Rose. Whitworth describes this turn of events as a low point in the centers quest for credibility at the hospital.
The administration called us and said, We have to revisit and evaluate what you are doing, recalls Whitworth. He and Oz dropped therapeutic touch -- using hands to shift the bioenergy field that presumably surrounds us -- from their practice and agreed instead to study it in clinical trials. (Therapeutic touch is the technique a 9-year-old girl recently challenged in a study published in the Journal of the American Medical Association.)
This minor retooling salvaged the center, but the pair struggled to connect with patients outside the borders of the Department of Surgery. We were merely tolerated at this institution, admits Whitworth. He says the turning point occurred last March, when -- holding an invaluable trump card -- he gave a presentation at a meeting attended by every department head and requested renewed support. Whitworths ace in the hole: Hed received a pledge from an anonymous donor of approximately $10 million over five years, but the hospital would have to match the pledge. Whitworth returned to his office uncertain of whether the deal would be accepted. An anxious hour later, he received a phone call: They would match the offer.
With that boost, the Complementary Care Center has recently transmogrified into the Department of Complementary Medicine Services, moving into a 5,500-square-foot space at the Vanderbilt Clinic on West 168th Street, replete with treatment rooms where massage, visualization, therapeutic touch, and other techniques can be administered and studied through clinical trials. When the doors open in January, the current staff of 17 is expected to swell to 55; they hope to triple the number of patients they treat each year, which stands now at 1,500.