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The most cited study around Ornish's in 1990 tested 94 patients with angiographically documented coronary heart disease, of whom 53 were prescribed yoga, group support and a vegetarian diet extremely low in fat only 10% of total daily calories (most Americans consume 35% in fat; the American Heart Association recommends 30%). Cholesterol changes among the experimental group were about the same as if they had taken cholesterol-lowering drugs. After a year in the program, patients in this group showed "significant overall regression of coronary atherosclerosis as measured by quantitative coronary arteriography." Those in the control group "showed significant overall progression of coronary atherosclerosis." The findings were well received but open to a major challenge: that the severe diet, rather than yoga, may have been the crucial factor.
In 1998 Ornish published a new study, in the American Journal of Cardiology, stating that 80% of the 194 patients in the experimental group were able to avoid bypass or angioplasty by adhering to lifestyle changes, including yoga. He also argued that lifestyle interventions would save money that the average cost per patient in the experimental group was about $18,000, whereas the cost per patient in the control group was more than $47,000. And this time, Ornish says, he is convinced that "adherence to the yoga and meditation program was as strongly correlated with the changes in the amount of blockage as was the adherence to diet."
Ornish hoped for more than the respect of his peers: he wanted action. "I used to think good science was enough to change medical practice," he says, "but I was naive. Most doctors still aren't prescribing yoga and meditation. We've shown that heart disease can be reversed. Yet doctors are still performing surgery; insurance companies are paying for medication and they're not paying for diet and lifestyle-change education." (Medicare, however, recently agreed to pay for 1,800 patients taking Ornish's program for reversing heart disease.)
Why have so few studies tested the efficacy of yoga? For lots of reasons. Those sympathetic to yoga think the benefits are proved by millenniums of empirical evidence in India; those who are suspicious think it can't be proved. (Says Coble: "There seem to be no data to substantiate the argument that yoga can heal.") Further, its effects on the body and mind are so complex and pervasive that it would be nearly impossible to certify any specific changes in the body to yoga. The double-blind test, beloved of traditional researchers, is impossible when one group in a study is practicing healthy yoga; what is the control group to practice bad yoga? Finally, the traditional funders of studies, the pharmaceutical giants, see no financial payoff in validating yoga: no patentable therapies, no pills. (Ornish's prostate-cancer study was funded by private organizations, including the Michael Milken Foundation.)
at the heart of the western medical establishment's skepticism of yoga is a profound hubris: the belief that what we have been able to prove so far is all that is true. At the beginning of the 20th century, doctors and researchers surely looked back at the beginning of the 19th and smiled at how primitive "medical science" had been. A century from now, we may look back at today's body of lore with the same condescension.
"In modern medicine, we're actually doing a lot more guesswork than we let on," says Demers. "We want to say we understand everything. We don't understand half of it. It's scary how clueless we are." Desperate patients consult half a dozen specialists and get half a dozen conflicting opinions. "Well, of course," Dr. Toby Brown, a Manassas, Va., radiologist says impatiently, "it's not as if medicine is a science." Hence the appeal of alternative medicine: aromatherapy, homeopathy, ginkgo biloba. Proponents may be crusading scientists or snake-oil salesmen, but either way, their pitch falls on eager ears: each year Americans spend some $27 billion on so-called complementary medicine. "One lesson of the alternative health-care movement," McCall warns, "is that the public is not going to wait for doctors to get it together."
Late last month the National Institutes of Health held the first major conference on mind-body research. "There is a major reason that many in biomedicine reject mind-body research: it is the pervasive sound of the popularizers," noted Dr. Robert Rose, executive director at the MacArthur Foundation's Initiative on mind, brain, body and health research. "The loudest voices, the most passionate and articulate spokespersons for the power of the mind to heal come not from the research community but from the growing number of gurus... the hawkers on TV for alternative treatments, herbs, homeopathy, handbooks." Rose distinguished the nostrum pushers from those seeking to bring yoga and science together. "Thousands of research studies have shown that in the practice of yoga a person can learn to control such physiologic parameters as blood pressure, heart rate, respiratory function, metabolic rate, skin resistance, brain waves and body temperature, among other body functions." Critics are quick to note that few of those studies were published in leading science journals.
Two oddities attend yoga's vogue. One is that America has the fittest people in the world, and the most obese. Yoga, typically, is practiced by the fit. Exercise, the care and feeding of body and possibly mind, is their second career. The folks in urgent need of yoga are the ones who are at the fast-food counter getting their fries supersize; who would rather take a pill than devote a dozen hours a week to yoga; for whom meditation is staring glassily at six hours of football each Sunday; and who might go under the surgeon's knife more readily than they would ingest anything more Indian than tandoori chicken.
Here's another peculiarity: this ritual of relaxation is cresting at a cultural moment when noise and agitation are everywhere. We work longer hours, with TVs and portable radios blaring as the sound track for frantic wage slaves. If a teen isn't trussed to his headphones or plugged into a chat room, it's because his cell phone has just beeped. America is running in place, in the spa or at work. And after Letterman and Clinton, nobody takes the world seriously; everything is up for laughs.
In this modern maelstrom, yoga's tendency to stasis and silence seems at first insane, then inspired. The notion of bodies at rest becoming souls at peace is reactionary, radical and liberating. If it cures nagging backache, swell. But isn't it bliss just to sit this one out, to freeze-frame the frenzy, to say no to all that and om to what may be beyond it, or within ourselves?
Reported by Deborah Fowler/Odessa, Lise Funderburg/Philadelphia, Marc Hequet/Minneapolis, Alice Park/New York, Anne Moffett/Washington, and Jeffrey Ressner and Stacie Stukin/Los Angeles