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 Center’s 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; he’ll 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 Holiness’s 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 city’s 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-Presbyterian’s 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 Center’s 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 you’re going to feel wonderful and when you wake up, you’re 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 didn’t work,” she continues matter-of-factly. “It’s not going to kill me if they use the tapes; it’s not like it’s 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 it’s 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 don’t 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 School’s 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 it’s 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.”
Spiegel’s study on breast cancer also has its detractors. “It’s 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. “I’m not saying these guys are crooks,” he concedes. “I’m just saying they are delusional.” The self-styled G. Gordon Liddy of medical quack-busting, he’s so sure about the fallacy of mind-body science that he doesn’t even need to see the numbers.
There is a third camp that falls between Herbert’s vehement dismissal and Merrell’s firm commitment. Some doctors still think the science isn’t strong enough or needs to be replicated but take a pro-mind-body-medicine stance, if only because it’s popular with patients. Craig Smith, chief of the cardiothoracic-surgery division at Columbia-Presbyterian, whose own division provided critical early funding for the hospital’s Complementary Care Center, falls neatly into that category. “I don’t buy into the effectiveness of all these techniques, and I don’t 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 York’s 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 School’s Dr. Herbert Benson, a leader in mind-body medicine, shortly after completing her degree. When patients join a mind-body program at Benson’s 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 Boston’s 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 patient’s chest, and said, ‘I knew we should have used subliminal tapes on this patient.’ “ Surprised by Oz’s 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 hospital’s chairman and COO.
Although the center could not have gone forward without Oz’s already stellar reputation – he’s 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 Oz’s 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 hospital’s reputation, complained to top administrators, including Rose. Whitworth describes this turn of events as a low point in the center’s 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. Whitworth’s ace in the hole: He’d 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.
All of the big six teaching hospitals have respected social-work and “liaison psychiatry” departments that offer support groups and counseling to patients. But beyond those services, mind-body medicine has been available only via what Steve Horowitz, chief of Beth Israel’s cardiology division, and a longtime proponent of mind-body medicine, calls the tchotchke principle. “Leaders of the hospitals don’t buy into complementary medicine. Then they suddenly look around at other people doing it and think, We should have something like this,” says Horowitz. “So they store one on a shelf like a tchotchke – it’s not incorporated into the mainstream design of the house, but it’s there when someone asks if you have it.” At New York Hospital- Cornell Medical Center, for example, only one clinician, Dr. Robert Allan, primarily treats the emotional fallout from heart disease with relaxation training and cognitive therapy. At Mt. Sinai, the Behavioral Medicine Program is geared to patients with psychiatric disturbances, not people experiencing the normal distress associated with a serious medical diagnosis. Richard Grossman, a Beth Israel- affiliated physician, thinks of these programs, which he wholly supports, as “strange little dents in the body troglodyte.”
At his stress-disorder clinic, NYU’s Moskowitz uses emotion-focused psychotherapy to treat patients with stress-related conditions and works with one biofeedback trainer. Moskowitz credits NYU for its decade-long support of his program, but his work seems strangely disconnected from the life of the institution. He sees patients in his small, private office 60 blocks north of NYU Medical Center, and though he gets referrals from NYU doctors, many stressed-out medical patients will never hear about his service. “Even within NYU, many respected physicians don’t know about this program,” says Moskowitz.
The medical world’s reluctance to endorse these alternatives baffles some scientists. “It’s considered radical to send someone to a modified Dean Ornish cardiac program,” marvels Stephen Josephson, an assistant professor of psychology at Cornell Medical College. “But to crack their chest open to do a bypass, that’s considered conservative.”
Barron Lerner, a physician and historian at Columbia University’s Center for the Study of Society and Medicine, believes that several cultural factors have produced New York medicine’s embrace of the one-cause, one-cure philosophy that disregards the role of the mind in health and healing. To start, the city has a singular conglomeration of major academic institutions – there’s so much competition that no one can risk the one potentially false move. Lerner cites the contrasting example of Case Western Reserve in Cleveland, noted for its progressive medical education: “If you’re the only game in town, you are going to be more comfortable experimenting.”
But why would the city more closely identified with psychiatry and psychoanalysis than any other, save Vienna, be resistant to principles of mind-body interaction? Lerner explains that the antipathy between medicine and psychiatry, between psychiatry and psychoanalysis, and, in particular, between medicine and psychoanalysis has prevented the cross-disciplinary communication needed to develop integrated mind-body programs. He adds yet another wrinkle: The psychiatrists and analysts who might otherwise champion mind-body medicine may actually see it as a competitive threat. Finally, theorizes Steve Horowitz, New Yorkers “who feel they have to be productive every moment” may not provide the ideal market for, say, meditation.
Sloan-Kettering is one hospital that has long had a tradition of encouraging group or individual therapy for cancer patients. Jimmie Holland, the formidable chairman of the Department of Psychiatry and Behavior Sciences, is considered, in fact, a founder of the field of psycho-oncology. But the hospital’s mind-body offerings are spotty: Its Evelyn Lauder Breast Center has solid support services and one psychotherapy group that offers relaxation techniques and cognitive therapy, but there are few support groups for patients suffering from other, rarer kinds of cancer. And the more prevalent counseling programs are targeted to patients experiencing severe psychological difficulty; the cancer patient who is merely terrified but not clinically depressed may not always be alerted to resources. Holland has been criticized by therapists in the mind-body community for being too wary of judgments by peers at her hospital who view meditation or hypnosis as borderline quackery. But Holland – who stresses that she’s involved in psychological counseling, not “mind-body” medicine – says she simply feels that her role is to focus on quality of life rather than to push healing techniques that haven’t been clinically proven. “Group psychotherapy is certainly going to make you feel better, but we still don’t know whether it extends life,” says Holland, who points out that some key encouraging studies have yet to be replicated. “And I’m concerned about patients who feel, ‘I didn’t get to the group, so I’m going to do myself in.’ “
Still, Sloan-Kettering, the city’s standard-bearer of conventional biomedicine for cancer, plans to open the Program for Integrative Oncology early next year. Housed in a ne bvnm,cw facility on East 53rd Street, it will offer relaxation techniques, stress management, group therapy, art therapy, and pastoral counseling as well as nutrition and physical therapy. Dr. Sidney Winawer, the hospital’s soft-spoken gastroenterology chief, has been named the program’s director, while Jimmie Holland will provide the psychosocial components. Winawer acknowledges that with the consolidation of mind-body medicine at Memorial will come “resistance on the part of the physicians,” but, he says, “it’s normal for physicians to be skeptical.” Helping to overcome that resistance is the full-throttle support of philanthropist and holistic-medicine advocate Laurance Rockefeller, who has committed between $5 million and $10 million to the project, sources close to the hospital say. But development has been slowed by institutional caution. Says Abby Bloch, coordinator of clinical research for Sloan-Kettering’s Gastrointestinal and Nutritional Service and one of the program planners: “We need to satisfy the concerns of people in the center who want to be certain we can support what we are doing with evidence and scientific rationale.”
If Sloan-Kettering’s major mind-body effort has been launched largely with the gift of a single outside donor, and Columbia-Presbyterian’s has been willed into existence by a team of two, Beth Israel Medical Center has come to its latest initiative more organically, through widespread support from administration, doctors, its CEO, and its unusually open-minded 65-member board of trustees. Already in place at Beth Israel is a project directed by Steve Horowitz, the Samuels Planetree Model Hospital Unit. On this spalike hospital floor, the patients, mostly there for cardiac care, are offered access to their medical charts, meditation sessions, massage, and musical concerts. And through Beth Israel’s Program for Humanistic Health Care, a five-year-old effort to educate the center’s health-care providers about complementary care, the hospital now hosts workshops, training programs, and weekend retreats that stimulate the staff’s interest in alternative therapies.
The board of trustees generously subsidized the Humanistic Health Care program, which also relies on foundation grants. Now about ten select members of that board are personally bankrolling Beth Israel’s Center for Integrative Healthcare, a freestanding facility scheduled to open this fall. The center, says CEO Matt Fink, will include not only internal medicine, OB/GYN, and pediatrics but also acupuncture, hypnosis, meditation, imagery, and psychological support. The supportive trustees are providing most of the program’s $2 million annual budget for its first two years of operation. Among those trustees most devoted to the project are William Sarnoff, former chairman of Warner Publishing, and Beatrice Renfield, the Broadway producer behind the original productions of Carousel and Brigadoon.
And it was a board member whose connections brought the Dalai Lama to Beth Israel this week. Attorney Alan Abramson, who lost a son to brain cancer seventeen years ago, now serves as the board liaison to INN. Through a friend who knows Columbia University’s chair of Indo-Tibetan studies, Robert Thurman – the academic who gets equal billing for being Uma’s father and the Dalai Lama’s friend – Abramson extended an invitation to the Dalai Lama to attend the conference, which quickly became the hot ticket for neuroscientists nationwide.
“I don’t want everyone to just have a meeting where we walk away saying, ‘What a wonderful experience,’ and everyone forgets it. I want to come out with a plan to implement a number of concepts of the Tibetans in our environment,” says Fred Epstein, director of INN and the country’s leading pediatric neurosurgeon. “I have a wonderful teenage patient who is terminally ill. He has a brain tumor, but he has all his cognitive function. Is there something in the techniques of the Buddhist tradition that will help him die peacefully?” The doctors are also hoping to get the Dalai Lama’s blessing, so to speak, for a number of studies of Tibetan meditation techniques.
Carole Carlson, 57, was diagnosed with advanced ovarian cancer almost two years ago, and she is still fighting for an elusive “complete remission.” Carlson, a patient at NYU, likes her doctors but says, “I never got any support at the medical center.” Although NYU has support groups run by social workers, no one told her about them. There is no program of stress management or meditation specifically for people with cancer. Instead, she finds those services at Gilda’s Club, a downtown mecca named for the late comedian Gilda Radner that offers meditation, yoga, and group support to people with cancer. “That place has brought me back to life,” she says. The best thing she can say about NYU’s psychological services: “I found the brochure for Gilda’s in the oncology waiting room.”
Carlson says that in an ideal world, most hospitals would offer the services that Gilda’s does. (Even Columbia has yet to establish in-house support groups for cancer patients.)
“The important thing here for all hospitals – and I think Beth Israel has realized it earlier and in a more aggressive way – is that these services are going to be driven by the consumer, the patient,” asserts Beth Israel trustee Sarnoff. “They’re going to demand it as time goes by because it does work.”
Sarnoff, no stranger to market forces, may be right. “I said to my oncologist, ‘Shouldn’t I be in a support group or something?’ “ recalls one 25-year-old patient at Mt. Sinai who has battled Hodgkin’s disease since she was 14. Her doctor’s response: “Why? You’re not an addict.” She says that after attending Mt. Sinai on and off for the past eleven years, she’s now considering seeking care somewhere with better support services. (Mt. Sinai does have a well-respected hypnosis program for pediatric patients.) “I have no confidence that I’ll beat this thing if it’s treated strictly as a biological condition. And the worst part about hospitals is when doctors don’t treat you like a person,” she says. “Why wouldn’t I go somewhere that’s willing to treat me not just as a patient with platelet counts but as a person?