longevity and optimal health : working toward an integrative methodology

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LONGEVITY, REGENERATION, AND OPTIMAL HEALTH Longevity and Optimal Health Working toward an Integrative Methodology Mehmet Oz a and Jeremy Tallent b a Cardiovascular Institute, Columbia Integrative Medicine Program, Columbia University, College of Physicians and Surgeons, New York, New York, USA b Columbia Integrative Medicine Program, Columbia University, College of Physicians and Surgeons, New York, New York, USA Efforts to foster a research dialogue between traditions as seemingly divergent as West- ern biomedicine and Indo-Tibetan medical and self-regulatory practice require a care- fully conceived set of methodological guidelines. To approach a useful methodology, some specific structural differences between traditions must be negotiated, for exam- ple the Indo-Tibetan emphasis on holism in medicine and ethics, which appears to run contrary to Western trends toward specialization in both clinical and research con- texts. Certain pitfalls must be avoided as well, including the tendency to appropriate elements of either tradition in a reductionistic manner. However, research methods of- fering creative solutions to these problems are now emerging, successfully engendering quantitative insight without subsuming one tradition within the terms of the other. Only through continued, creative work exploring both the potentials and limitations of this dialogue can collaborative research insight be attained, and an appropriate and useful set of methodological principles be approached. Key words: methodology; cross-cultural; science and religion; neurophenomenology This conference achieves an important step toward the goal of mobilizing greater under- standing and ingenuity in our relationship to the aging process, through the recognition that there exists a theoretical and practical com- mon ground between Indo-Tibetan and West- ern conceptions of aging and longevity. Once this recognition has been made, however, the next step is to engage in the exploration of this common ground—to pursue newly apparent avenues of investigation through the integra- tion of theoretical and practical discourse from these two traditions. Such an effort to engen- der conversation between investigative prac- tices that have emerged from divergent cul- tural contexts—especially those that bridge the traditionally expansive gap between Eastern Address for correspondence: Jeremy Tallent, Columbia University College of Physicians and Surgeons, Integrative Medicine Program, 177 Ft. Washington Avenue MHB 7-435, New York, NY 10032. [email protected] and Western epistemologies—will necessitate a carefully conceived set of methodological guidelines. But before specific methodological conversations can occur, we must address the broader comparative framework within which a conference such as this is situated. To do so, we introduce a familiar duality— that between science and religion—which defines to many in the West the manner of dialogue encouraged by this conference. Ac- cordingly, for our purposes, the status of the Indo-Tibetan Buddhist tradition in relation to these familiar categories must be addressed. In the context of Western biomedical science, the conversation between the scientific and the religious has thus far been staged as an arm’s length meeting between largely divergent ways of knowing. Specifically, this conversation has become manifest in efforts to evaluate ab- stract elements of Western religious traditions according to standardized empirical methods of scientific inquiry. Most notable among these Longevity, Regeneration, and Optimal Health: Ann. N.Y. Acad. Sci. 1172: 338–343 (2009). doi: 10.1111/j.1749-6632.2009.04407.x C 2009 New York Academy of Sciences. 338

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Page 1: Longevity and Optimal Health : Working toward an Integrative Methodology

LONGEVITY, REGENERATION, AND OPTIMAL HEALTH

Longevity and Optimal Health

Working toward an Integrative Methodology

Mehmet Oza and Jeremy Tallentb

aCardiovascular Institute, Columbia Integrative Medicine Program, ColumbiaUniversity, College of Physicians and Surgeons, New York, New York, USA

bColumbia Integrative Medicine Program, Columbia University, College of Physiciansand Surgeons, New York, New York, USA

Efforts to foster a research dialogue between traditions as seemingly divergent as West-ern biomedicine and Indo-Tibetan medical and self-regulatory practice require a care-fully conceived set of methodological guidelines. To approach a useful methodology,some specific structural differences between traditions must be negotiated, for exam-ple the Indo-Tibetan emphasis on holism in medicine and ethics, which appears torun contrary to Western trends toward specialization in both clinical and research con-texts. Certain pitfalls must be avoided as well, including the tendency to appropriateelements of either tradition in a reductionistic manner. However, research methods of-fering creative solutions to these problems are now emerging, successfully engenderingquantitative insight without subsuming one tradition within the terms of the other. Onlythrough continued, creative work exploring both the potentials and limitations of thisdialogue can collaborative research insight be attained, and an appropriate and usefulset of methodological principles be approached.

Key words: methodology; cross-cultural; science and religion; neurophenomenology

This conference achieves an important steptoward the goal of mobilizing greater under-standing and ingenuity in our relationship tothe aging process, through the recognition thatthere exists a theoretical and practical com-mon ground between Indo-Tibetan and West-ern conceptions of aging and longevity. Oncethis recognition has been made, however, thenext step is to engage in the exploration of thiscommon ground—to pursue newly apparentavenues of investigation through the integra-tion of theoretical and practical discourse fromthese two traditions. Such an effort to engen-der conversation between investigative prac-tices that have emerged from divergent cul-tural contexts—especially those that bridge thetraditionally expansive gap between Eastern

Address for correspondence: Jeremy Tallent, Columbia UniversityCollege of Physicians and Surgeons, Integrative Medicine Program,177 Ft. Washington Avenue MHB 7-435, New York, NY [email protected]

and Western epistemologies—will necessitatea carefully conceived set of methodologicalguidelines. But before specific methodologicalconversations can occur, we must address thebroader comparative framework within whicha conference such as this is situated.

To do so, we introduce a familiar duality—that between science and religion—whichdefines to many in the West the manner ofdialogue encouraged by this conference. Ac-cordingly, for our purposes, the status of theIndo-Tibetan Buddhist tradition in relation tothese familiar categories must be addressed.In the context of Western biomedical science,the conversation between the scientific andthe religious has thus far been staged as anarm’s length meeting between largely divergentways of knowing. Specifically, this conversationhas become manifest in efforts to evaluate ab-stract elements of Western religious traditionsaccording to standardized empirical methodsof scientific inquiry. Most notable among these

Longevity, Regeneration, and Optimal Health: Ann. N.Y. Acad. Sci. 1172: 338–343 (2009).doi: 10.1111/j.1749-6632.2009.04407.x C© 2009 New York Academy of Sciences.

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is the MANTRA II trial, which sought to eval-uate the effect of blinded, remote intercessoryprayer on health outcomes after percutaneouscoronary intervention or elective catheteriza-tion.1 While this type of endeavor may defineto Western thinkers the potential conversationbetween the scientific and religious domains, itis explicitly uncharacteristic of the relationshipbetween Indo-Tibetan culture and science asunderstood in the West. Indeed, the method-ological stance exhibited by the MANTRA IItrial represents a thoroughly Western take onthe relative status of scientific and religiousmodes of inquiry. The thematic foci of West-ern religious traditions—which are, perhaps,those elements that define these traditions asuniquely “religious” expressions of culture—such as the individual relationship to the di-vine, “faith,” and “belief,” are characteristi-cally abstract and highly personal. By compar-ison, the Indo-Tibetan tradition can be said tohave a decidedly practical focus. The most ba-sic terms in which the tradition is expressed arerooted in notions of practice, and—to the West-ern mind—conspicuously devoid of referenceto faith, belief, or the status of the divine. For ex-ample, a large portion of the Buddhist traditionis framed through elucidation of the EightfoldPath—a set of practical guidelines for achievingliberation from suffering. Our intention is notto deny the place of religious symbolism, the di-vine, or issues of belief in the Indo-Tibetan Bud-dhist tradition—these symbolic, “religious” ele-ments do certainly exist, and are integrated intomany aspects of the Indo-Tibetan cultural sys-tem. But a key distinction is that dependence onthese symbolic elements is not necessarily pre-requisite for effective mobilization of the prac-tical elements discussed in this conference.

The practical orientation of Indo-TibetanBuddhism can be seen perhaps most clearlyin the emphasis placed on systematic investiga-tion of the nature of reality. In his book Buddhism

and Science, Alan Wallace states that Buddhism,like the scientific enterprise as we understand it,“[is] concerned with understanding the realmsof sensory and mental experience, and it ad-

dresses the questions of what the universe, in-cluding both objective and subjective phenom-ena, is composed of and how it works.”2 Itis exactly this investigative stance toward theexternal and internal worlds which forms thebasis of instruction in the Buddhist tradition.Practitioners are urged to undertake just thissort of examination, through deductive medi-tative practice. The tradition in its entirety isframed as the product of the Buddha’s inves-tigative journey to discern the true nature ofthe world and man’s relationship to it. In fact,the Buddha discouraged followers from simplyrelying on his word, or upon tradition or text,as “true” representations of reality. Instead, heurged individuals to “experience the truth forthemselves—for it’s the only way one can gen-uinely know anything.”

Perhaps more pertinent to our current dia-logue is a discussion of the health care implica-tions of this gap between Western conceptionsof religion and the Indo-Tibetan tradition. Ashighlighted by Richard Sloan and others,3 thepersonal, reflective character of Western reli-gious traditions largely precludes health careapplications of practices implicated therein.Even if a familiar aspect of Western religiousactivity such as prayer were empirically demon-strated to be beneficial, as the MANTRA IItrial attempted to do, most health care pro-fessionals would hesitate to recommend to pa-tients that they engage such a practice, preciselybecause of its intensely personal, conceptualcharacter. However, the idea that patients maybenefit from engaging in self-regulatory prac-tices found within the Indo-Tibetan traditionis not foreign to us, and even exists to someextent in the context of Western health carecurrently—for example in the use of biofeed-back, relaxation training, hypnosis, and othercognitive-behavioral practices. In addition, thewidespread success of Jon Kabat-Zinn’s Mind-fulness Based Stress Reduction (MBSR) pro-gram, which provides systematic training inmindfulness meditation, demonstrates a clearspace for the effective, therapeutic mobilizationof Buddhist practices in a secular fashion.

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In any cross-cultural research effort, struc-tural differences between the involved systemswill be encountered, which prevent the seam-less transfer of theoretical models or inves-tigative methods between the two. However,careful consideration and exploration of suchdifferences can help orient the cross-cultural di-alogue in a way that allows for maximal under-standing. In the context of the current conver-sation between the Indo-Tibetan and Westerntraditions, we face a disjunction in the man-ner in which specific information is relatedto a larger system of knowledge. On the onehand, we have a system with a strong tradi-tion of holism, in both theory and practice, andon the other, a system that is comparativelyconcerned with the categorical discriminationof biological systems. His Holiness the DalaiLama, speaking of the benefits of exchangeof medical knowledge between Tibetan andWestern doctors, scientists, and scholars, states:“Tibetan medicine can offer Westerners an-other approach to achieving happiness throughhealth and balance.”4 This perspective, whichweaves issues of health together with a con-cern for overall balance, in the context of thelarger goal of achieving optimal functioning—embodied as happiness—provides an exampleof the inextricable links that exist between in-dividual fields of practice and the broader ori-entations of the Indo-Tibetan tradition. How-ever, this holistic take on health and healingruns contrary to that characteristic of Westernbiomedical science, which exhibits the contin-uing tendency toward specialization and com-partmentalization in both research and prac-tice. While the rise of fields of study—suchas psychoneuroimmunology—that bridge tra-ditionally discrete areas of investigation en-courages a broader, more inclusive dialogue,a strong tradition of functional specializationpredominates in the biomedical sciences. Thistype of development is not to be criticizedper se, as it represents a deepening and focus-ing of our understanding of the physical andbiological processes underlying states of bothhealth and disease. However, the clinical effort

to comprehensively enhance health and specif-ically longevity—a dimension of health whichis relevant to all areas of medical science—demands the integration and linking of dis-tinct fields of study in a holistic fashion; theIndo-Tibetan tradition is notable for just suchan integrative perspective. In the context ofTibetan medicine, herbal treatments are ad-ministered and dosed not solely according tostrict principles of pharmacological action, butrather are given according to a holistic consid-eration of the balance of physical and mentalforces operational in patients’ health-state. Byway of additional illustration, our fellow confer-ence attendee, P. Murali Doraiswamy reportsthat nearly 35% of community-dwelling adultson cholinesterase inhibitors receive concurrentanticholinergic medications.5 While this treat-ment plan may not necessarily be clinically in-appropriate in all cases (though Doraiswamysupposes that it may be in many), it can be seento represent a tendency on the part of West-ern biomedicine to embrace certain treatmentstrategies with a less-than-complete considera-tion of overall states of physiological balance.

Yeshi Dhonden, an eminent physician inthe Tibetan medical tradition, states the differ-ence thusly: “Western scientists look througha microscope to discover the disease-causingagent; Tibetan physicians first consider the pa-tient’s disposition in terms of wind, bile, andphlegm.”4 This holistic stance is quite clearin Tibetan medicine, but is also definitive ofthe Indo-Tibetan practical tradition at large,which mutually considers behavior, cognition,and health-status in the context of an empiricalexploration of the nature of reality.

One of the greatest pitfalls we face in ourefforts to substantiate a new, integrative modelof aging and longevity is that of engaging inthe reductionistic appropriation of elements ofthe Indo-Tibetan tradition, ignorant of someother essential basis for their efficacy in prac-tice. This is the sort of investigative endeavorthat a priori dooms itself to failure. However,there exists a tension here—which we believewill become definitive of our continued efforts

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to foster cross-cultural dialogue in the context ofhealth and longevity—between a reductioniststance, which would extract particular practicalelements from the Indo-Tibetan tradition irre-spective of their cultural context, and the beliefthat the need for contextuality precludes anypossibility of effective cultural exchange. A bal-ance must be struck between these two views ofcross-cultural investigation, but it is unclear atthe outset what such a balance would look like.There have been notable recent efforts, how-ever, to substantiate research models that areboth cognizant of the need for contextuality,and eager to incorporate that cognizance intoquantitative methods familiar to Western scien-tific inquiry. The field of neurophenomenology,so-named and pioneered by the late FranciscoVarela, has incorporated an investigative ap-proach which provides an interesting foil to thepotential for reductionistic treatment of con-textualized material: to reduce individual vari-ation in neuroimaging data collected duringan experimental cognitive task, Varela et al.stratified the experimental trials according tothe self-reported strategic and attentional con-text in which the task was completed.6 Torender these first-person accounts of cognitivecontext meaningful when combined with neu-roimaging data, recurrent patterns had to bedetermined in subjects’ reports through multi-ple repetitions of the experimental situation—a3D image depth perception task. This was es-sentially a category-seeking process, in whichsubjects underwent the experimental task re-peatedly “until they found their own categoriesto describe the phenomenological context inwhich they performed it and the strategies theyused to carry it out.”6 In this way, the termsin which first-person experience of cognitivecontext became characterized are very muchowned by the subjects, as a group. It is theircontinuity in first-person description that was“lifted out” and employed as a tool of categori-cal analysis. This provides a unique opportunityin the context of neurophenomenological studyof long-term meditators from the Indo-Tibetantradition, for the various distinct and—to West-

ern thinkers—unique experiential states impli-cated in virtuosic meditative practice to gain acentral footing and avoid reductive translationinto Western experiential categories.

The collaborative engagement with thiscomparatively holistic model of health and dis-ease presents additional challenges to biomedi-cal investigation. As was mentioned above, theWestern biomedical enterprise thrives on iso-lation and categorization of discrete physio-logical and biological actions. Accordingly, wemust consider what specific practices, amongthe myriad described, we would wish to bringto patients confronting the issues of health anddisease addressed in our previous panels. Thisendeavor will pose a unique and continuingchallenge: to extract elements of a broad, inter-related tradition for study and eventual clinicalapplication without losing essential mutative el-ements located in their practical context. Toagain employ the MBSR model as an exam-ple, our inclination is to ask what specificallyis the mechanism of action responsible for theprogram’s observed success. Many distinct el-ements are surely present: Sitting Meditation,the Body Scan, Yoga practice, and a supportivegroup environment. Equally, we must considerthe therapeutic status of the program in its en-tirety, including the role of intentionality, with-out sacrificing scientific rigor. Again this tensionis revealed, between an overly reductionisticstance, and a tendency to embrace contextu-alization at the expense of investigative insight.To negotiate these pitfalls in the most creativefashion, the investigative process must be con-ducted in close collaboration with experiencedmembers of the Indo-Tibetan tradition, whoare positioned to comment on the essential re-lationships between potential interventions andthe greater health context in which they aresituated.

Perhaps the greatest certainty regarding ourefforts to move forward with this collabora-tive dialogue is that there exists no roadmapfor this type of research—no established set ofmethodological principles that will resolve at alltimes the many issues that have cumulatively

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hindered attempts at cross-cultural investiga-tion. We are truly pioneers in this sense. Evenso, given our mutual recognition that the Indo-Tibetan tradition contains practices that maybe radically effective in addressing the issuesof health and disease discussed in a previ-ous panel, it is important for us to moveforward with this effort, and begin to de-velop through experience the principles thatwill guide this type of research to fruition. Atpresent, countless questions remain: for exam-ple, Indo-Tibetan and Western traditions con-tain radically different theories of mind. Willreconciliation of these concepts become pre-requisite for collaborative investigation of ad-vanced meditative practices? As mentioned,however, to move forward with investigation,open to the instruction provided by our initialefforts, is the only way toward achieving greaterunderstanding. A Buddhist parable posits theexperience of a man who is struck by a poisonedarrow. If he were to refrain from removing thearrow until he learned the identity of the archer,whether he is tall or short, whether his complex-ion is black, brown, or golden, from which townor village the archer comes, the material fromwhich the arrow was hewn, and which crafts-man made the arrow, he would surely die beforehis knowledge was complete. Instead, he mustaddress the wound directly by removing the ar-row. In the face of a world of seemingly endlessuncertainty, the only choice is to take a path ofaction focused on effectively addressing thoseissues which face us most directly. In the contextof our work on longevity, we are directly facedwith a great opportunity, to explore the com-mon ground described during the course of thisconference, and to move forward toward a pro-gram of continued investigation, and greaterunderstanding.

The following presenters have placed them-selves at the crux of this dialogue through theircreative application of aspects of the Indo-Tibetan medical and meditative traditions tothe solution of questions unresolved by West-ern methods of inquiry. It is within the course ofsuch work that the specific terms of the relation-

ship between Western and Indo-Tibetan sci-ences will be negotiated—appropriate report-ing techniques, outcome measures, etc. As such,theirs are the sort of efforts that will define theongoing conversation between these two ap-proaches to health and healing.

First, Dr. Theise will take a critical look at oneof the most basic assumptions of the Westernscientific endeavor—that the organism mustbe understood primarily in terms of the orga-nized interaction of relatively discrete actors—individual cells; in so doing, he will help us un-derstand how this particular heuristic principlemay preclude validation of explanatory mod-els for a variety of “alternative” phenomena,such as acupuncture and bioelectromagnetism.Through Dr. Theise’s deconstruction of the ob-servational stance of Western biomedicine, wewill be provided with a conceptual foundationupon which we can reconstruct a multidimen-sional model of the body capable of integratingIndo-Tibetan and Western perspectives. Thiswill prove to be the basis for the studied under-standing of phenomena which seem inaccessi-ble within certain representations of the humanorganism.

Our subsequent panelists build upon this ex-panded potential with discussions of researchwork incorporating Indo-Tibetan conceptionsof physical and mental phenomena; they willprovide us with powerful examples of the in-tegrative perspective in action, as it happenson the ground and in the laboratory. Drs.Cynthia Husted and Lobsang Dhondup willshare their strategy of using analytic categoriesfrom the Tibetan medical tradition to inter-pret pathophysiological changes implicated inthe onset of multiple sclerosis. As they accu-mulate data to refine their Tibetan medical in-terpretation of multiple sclerosis, Drs. Hustedand Dhondup illustrate the functional corre-lates of Western and Tibetan understandingsof the body, through the use of Western obser-vational methods; in so doing, they are estab-lishing a framework for the application of Ti-betan medical principles within other areas ofstudy.

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Finally, in his discussion of the use of mind-fulness meditation for treatment of generalizedanxiety disorder, Dr. Lobsang Rapgay will of-fer commentary on the product of a previ-ous effort to integrate Indo-Tibetan medita-tive practice and Western biomedicine—JonKabat Zinn’s Mindfulness Based Stress Reduc-tion (MBSR). The integration of mindfulnesspractice into a Western context, as in the caseof MBSR, is essentially a translational effort—to make specific cognitive principles, strategies,and appraisals from one cultural context un-derstandable to an audience unfamiliar withtheir use or utility. Dr. Rapgay demonstratesthe importance in such a translational processof attending closely to traditional understand-ings of both the mechanism of action, and thepresence of any foundational principles thatmust be incorporated into a successful instruc-tive schema. What is revealed is the necessityof careful contextualization as we move for-ward in the development of a true cross-culturalmethodology.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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2. Wallace, B.A. Ed. 2003. Buddhism and Science: Breaking

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spirituality, and medicine. Lancet 353: 664–667.4. Avedon, J.F. 1998. The Buddha’s Art of Healing: Tibetan

Paintings Rediscovered. Rizzoli, New York.5. Doraiswamy, P.M. & M.M. Husain. 2006. Anticholin-

ergic drugs and elderly people: a no brainer? Lancet 5:379–380.

6. Lutz, A., J.P. Lachaux, J. Martinerie & F.J. Varela.2002. Guiding the study of brain dynamics by usingfirst-person data: synchrony patterns correlate withongoing conscious states during a simple visual task.Proc. Natl. Acad. Sci. USA 99: 1586–1591. Epub 2002Jan 22.