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Mindful : April 2018
eginning in 1979, when Jon Kabat-Zinn went into the base- ment of the University of Massa- chusetts medical school and led a small number of patients through a program he dubbed Mindful- ness-Based Stress Reduction (MBSR)—combin- ing meditation with simple yoga movements— mindfulness was not a word you heard much. There were no studies of the effectiveness of mindfulness practices published in scientific journals, and your doctor was not likely to have heard of it, much less prescribe it. some relief from suffering, breathless overpro- motion inevitably ensues. In fact, a recent paper by a group of 15 researchers called for a halt to extravagant claims surrounding mindfulness, citing a need for more careful definitions of exactly what mindfulness is when it is studied, more rigorous clinical studies, and a check on media reports and advertising of mindfulness as a virtual cure-all. In their recent book on the science of mind- fulness, Altered Traits, Richard Davidson and Daniel Goleman emphasized that the mind- fulness meditation practices generally under study were not “originally designed to treat illness” and that after decades of study there is “little we can say with certainty, given the great excitement (and okay, hype) about meditation as a way to boost health.” They speculated that mindfulness interventions for health care may not be worth the effort and perhaps focus should instead be aimed at generalized well-being. When I asked Brewer whether these sober- ing assessments of the state of mindfulness research, particularly in the area of health care, were discouraging to him, he said, “I am enthu- siastic about mindfulness having a place within health care, but I am also very realistic about how much hard work that is going to take.” He echoed what Jon Kabat-Zinn, Amishi Jha, and many other prominent mindfulness proponents have said: The research into mindfulness is in its infancy. But he was also very firm on why mindfulness has a place in medical institutions: “Few places are as dedicated to increasing well-being as hospitals. Health-care institutions are excellent places to do responsible testing of methods of self-care.” The key to wider acceptance in the mainstream medical world is evidence that the methods work, but the nature of that evidence is critical. You can’t just put 25 people in a room once a week for eight weeks, teach them to meditate, and simply ask them how they feel at the end. “The gold standard in medical research,” Brewer says, “is to identify a mechanism, a pathway, that is leading to the condition you are trying to cure or alter, and then to present evi- dence that you can interrupt that pathway, you can mess with that mechanism, in a way that changes the outcome.” Brewer cites the example of clinicians developing pharmaceutical treat- ments for a particular cancer. They look at a mechanism that prior research has identified—a protein pathway that has mutated—and they see if the drug they’re developing successfully attacks that pathway, resulting in the cancer B Now, almost 40 years on, there are racks and racks of popular books on the subject and special publications galore in supermarket and bookstore aisles. Over 650 studies of the effects of mindfulness were published in 2016, which is more than double the number in 2013. Aetna, one of the world’s largest health insurers, now has a chief mindfulness officer; mindfulness is taught in grade schools, high schools, and colleges; and UMass has now become the first university whose medical school contains a Division of Mindfulness (see page 59). Judson Brewer—who is the acting director of the newly created Division of Mindfulness and has been the director of research at the Cen- ter for Mindfulness for several years—is both a medical doctor and a PhD. And he embraces mindfulness with the same inspiration that launched MBSR: Mindfulness practice is a methodology that has a place not just in monas- teries and retreat centers but in doctor’s offices and hospitals. Brewer is proud to stand on the shoulders of pioneers like Jon Kabat-Zinn and Saki Santorelli, who ran the Center for several decades before his recent retirement. Brewer also knows that while mindfulness has grown in popularity and acceptability, a mixed blessing lurks there. When something takes on the aura of a fad, in the way of Pet Rocks or Fidget Spinners, the very fact of popu- larity has a notorious way of trivializing some- thing and reducing its credibility within estab- lished institutions. And in the rush to respond to the demand for something that promises BY BARRY BOYCE, EDITOR-IN -CHIEF 50 mindful April 2018 health care