A Heart Surgeon Finds Many Ways to Care for His Patients

Show: FRESH AIR
Date: OCTOBER 20, 1998
Time: 12:00
Tran: 102001np.217
Type: FEATURE
Head: Healing from the Heart
Sect: Medical
Time: 12:06

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross.

A typical complaint about surgeons is that they cut you open, do the job, close you up, and never deal with you as a full person -- a full person with a lot of pain and anxiety. My guest, Doctor Mehmet Oz, is a heart surgeon who performs bypasses and transplants. But he is incorporating alternative therapies for use before and after surgery: alternatives such as hypnosis, yoga, massage, acupuncture and music.

To do this work and to investigate its effectiveness, he founded the Complementary Care Center at Columbia Presbyterian Medical Center where he also directs the heart-assist device program.

Dr. Oz has a new book about his work called "Healing from the Heart." I asked him first to describe a heart transplant from his point of view as a surgeon.

DOCTOR MEHMET OZ, CARDIOVASCULAR SURGEON; AUTHOR: We get the phone call, usually, traditionally around midnight. And that's because it usually takes that long for the donor family to come to grips with the realization that they have lost a loved one.

It's only healthy hearts that we desire, so almost invariably it's a sudden death that has led to the availability of the heart. Once the family has agreed, we get a phone call from a donor coordinator; never from a donor family itself.

So, we carefully and meticulously choreograph the departure of the harvest team, the surgeons who go and get the heart for me with the team --the home team, that will put the patient to sleep and begin the process of removing the patient's heart. Beyond -- with phone contact continually as they fly to the destination where the donor is.

GROSS: Tell me about the process a little bit, about how you open up the body to transplant heart.

OZ: We use a blade which is quite large because it gets it down to the bone quickly. And one of the benefits of doing these a lot is you get quick at getting the heart out. There's a saw that we use, it looks just like a band saw, that we use to split open the bone. Once through that structure, the protective structure - called the sternum, we then enter the pericardial cavity, which is where the heart is hidden.

And the jewel of the heart is connected to the body in four major areas. We actually put tubes into the major tubes that you naturally have in your body, you know, to suck the blood out of you and put back into you. As those plastic tubes do their job of recirculating the blood, we cut out your heart. Once that is done, I wait. I wait for the donor heart to come back.

GROSS: And then?

OZ: Once you get the donor heart, for me, one of the miracles of medicine begins. With suture material that looks much like fishing line, it's made of polypropylene, we sew in, one by one, all those connections. At the end of that process, we are never really sure if the heart is going to survive. And, therefore, if the patient will survive.

So, we restore the blood supply to the heart and we wait. Sometimes pray and sometimes to other voodoo tricks, but try to get the heart to beat again. And usually, much as a fish lying in a bucket of water, the heart will, all of a sudden, out of nowhere, will go "flip-flop," "flip-flop."

And then after a few seconds of pause will begin that rhythm, that life rhythm that it has had throughout its existence with a constant cadence of "flip-flop," "flip-flop," "flip-flop." And we know the heart is OK.

GROSS: What's the most iffy period? For the patient who has had the surgery?

OZ: The most iffy period, really, is that period of expectation and anticipation. Once we restore blood supply to the heart because -- if there's been a problem, either because the donor of the heart was sick, or because there was difficulty with the taking of the heart, then the heart will never beat again.

It will indeed be dead. It's actually called a "stone heart" when that happens. But if that's the case, the heart will harden as you watch it and it will not beat, and those are the cases that we fear the most.

GROSS: Are you amazed at the body's ability to recover from heart surgery? Considering you've cut the person open, you've sawed through their bone, you've disconnected their heart?

OZ: It is absolutely stunning. Even at this stage of my career, you do things to the human body you could never envisioned doing when you're growing up. And yet, at the end of this there's some basic principles that you keep in mind, and usually it turns out remarkably well.

Indeed, one of the major changes that has occurred over the past few years of heart surgery is that it has moved away from being a life and death endeavor, which it still is, by the way.

But now, instead of being a 10 or 20 percent chance of not making it through the surgery, it's only a two or three percent chance. And with that improvement in the amount of people surviving, we now deal with the quality of life more of the people who are surviving.

GROSS: Have you found that a lot of people who survive either bypass or heart transplant surgery have the equivalent of a near death experience during the operation?

OZ: I wouldn't say the majority do, but it is one of the more common operations to take some awareness back home with you from it. And there are a couple of reasons for that, Terry.

One of them is that we use a type of anesthetic which tends not to be as deep. The reason for that is because all anesthetics affect the heart, and the less we impair the ability of the heart function after surgery, the better off everyone will be.

So, patients often will have some recall. Generally speaking, it is a very vague sense of what is going on. But I have had patients awaken from surgery and recount to me that I used a tool (unintelligible) back handed suture to repair a hole in their aorta. And it's highly unlikely that they would have imagined that. And indeed, that is the case when that happens. So, it's not rare.

But there also some patients, and I have had a few, as have most surgeons, who really have felt as though they were leaving this world. That they were traveling into lights, and it was a blissful experience. One in which they were really doubtful that they wanted to return to this world for. And those patients, are actually for me, many times the most interesting to carry on a conversation with.

GROSS: Why?

OZ: They have often had major insights into their own raison d'etre. They bring to the table and understanding of what they went through, which is a bit more profound than most patients, and oftentimes more than the physicians who are responsible for their care.

GROSS: How often do you find people change their habits after surgery? Not just because of the fright that the surgery -- the health problems caused them, but because of the experience of having survived it and any kind of transformation that that has brought on?

OZ: I think for two reasons patients don't usually change their life after surgery. The first is, if they're going to change it they usually start changing it before they have surgery, and that's actually one of my most successful tacks, I think, is that, if I want to ask somebody to stop smoking, I make them do it before I operate. I don't beg them to do it afterwards when I have a little less control over the situation.

GROSS: How to make them do it?

OZ: I actually do not operate on patients who smoke. And I tell them that. Unless they are actually in the process of dying, and it would be wrong for me to not give them a chance to quit in the future, which is uncommon, I will insist that they stop smoking.

I tell them, after all, that I'm busy, they're busy, we have many things to do in our lives. And if they're not going to work together with the health-care team to recover themselves, i.e., stopping smoking and some other abuses they may be involved in, then I don't think we should embark.

Now, it is actually true that is better to stop smoking before you have surgery, but more importantly it's the major time that I have control over them. My biggest opportunity to impact upon them is before I operate, not after they've gotten through the process and think that they're free to do what they wish.

The second reason, Terry, if I could add.

GROSS: Yeah.

OZ: Is because I don't think we as physicians play as active a role as we should, to get our patients to make the changes that are so important. It takes a lot longer to explain the patient why it's so important that they adjust their diet, stop smoking, reduce stress, etcetera, than to just go through the brief outline of what the operation itself entails.

Often times we draw this imaginary line around our responsibility and just encompass the actual factual material that needs to be conveyed, leaving for others the responsibility of impacting on the lifestyle, for example. But for many patients the major guide is going to be their physician's advice. And so, it is partly my responsibility, I think, one that I advocate, if I don't address.

GROSS: If you're just joining us, my guest is Doctor Mehmet Oz, and he is the co-founder of the Columbia Presbyterian Complementary Care Center. He also directs the cardiac-assist device program there, and he's a surgeon, and he is professor at Columbia University. His new book is called, "Healing from the Heart."

You co-founded Columbia Presbyterian's Complementary Care Center, which is the alternative therapies that you use in conjunction with the surgery that you perform. What was your introduction to complementary care, and to believing that there really should be a role for it to play in your work?

OZ: Terry, as we go through medical school we are taught a wide array of hard science reasons for why the body works. And I am proud of that heritage that I bring to medicine. And yet, as you actually practice the field of medicine, you realize that many times patients have not read the same books you have.

And you begin to realize that you're actually taught a model of how the body works. It's not really how the body works in totality. Indeed, this whole concept of cartusian dualism, this separation of mind and body, we have, I think, taken one step too far in modern medicine, in that we purposely ignore the role of the mind in the body. Not out of some evil desire, but because it's easier to teach people how the body works in the absence of the effects of the mind.

And so, we go through our careers and we learn this body of knowledge and we carry through. And so, I started doing my mechanical heart surgery, and I was very happy with the results. And I was patting myself on the back at what a great job I had done saving somebody, and I'd realize, the patient really wasn't happy. And this wasn't just one or two times, this was actually a fairly frequent occurrence.

Now, whether they were unhappy and that's what caused their problems to begin with, or they were unhappy because they didn't sense that they had to return to full health, I don't know, it varied. But nevertheless, I was left with an empty feeling that I hadn't really done all I could to heal. Because my job really wasn't to put a new pump into their heart, that was part of a job. The purpose of doing that task was to restore them to health.

I remember one individual particularly, a very spiritual man who, in his religion, believed he was better off in a new world -- their spiritual world, than having this pump in him; and he actually was suicidal.

So, I got around that problem in him, in particular, by getting his clergy involved in this process, and you bring an evangelical process to him so he could do it. This, for me, was an example of the role that I needed to start to play, and complementary medicine arose from that.

GROSS: It's interesting that you should be saying that, you know, because a lot of people just list depression as one of the common side effects on heart surgery. And so, you know, once it's an official side effect, then your doctor or surgeon might say, just give it time and you'll get over it, and kind of that's that, it's a side effect really for a while then it's over.

OZ: Well, depression does occur in one in three heart surgical patients, but what most people don't recognize is that the second-most important predictor of death after a heart attack is depression. So, it's not just a minor inconvenience this you're depressed. For the families, it's actually the single most important morbid factor, a factor that reduces their happiness after surgery, but indeed, it's correlated with death after heart attacks.

So, it has, I think, been raised to a new level of awareness appropriately in the medical profession. We need to start dealing with depression because it's a marker of many other problems that the patients are experiencing.

So frequently, Terry, patients retire and then have their heart attack. Or they are divorced and then they had their heart attack. Or they get sued and then they have their heart attack. Or their spouse dies and then they have their heart attack. Much more than you would think could be explained by pure coincidence.

Indeed, if you look at when people have their heart attacks, the most common time that you have a heart attack is Monday morning. And the second most common time, by the way, is Saturday morning. Why? Because Saturday is calm, and everyone else is having a good time and has great plans for the weekend, and you don't. That's very depressing.

GROSS: Why do you think depression is such a common after effect of heart surgery?

OZ: I think depression is important as a complication of heart surgery because it's a result of patients' recognition that they are not immortal. They've got to come to grips with the fact, that at some point in your life, you're not going to be here anymore.

But it also forces patients, especially younger patients, to deal and reconcile with the problem that it's not going to be business as usual when they're done this. You don't just have heart surgery and go back to work without any changes in your life. You now have got to take a whole new approach, and that can be intimidating.

GROSS: So, when you have these realizations that your patients were kind of suffering emotionally and spiritually often after the surgery, where did that lead you?

OZ: Well, I began to realize that I needed to help them. And yet, I didn't have those tools at my fingertips. That's not what I was good at. I'm really good at figuring out why the complex physiology of why the heart pump hasn't worked.

I spent most of my waking hours thinking about that problem, but if I need to get to somebody; into their psyche, into their family relationships, indeed convince them that they need to take a new paradigm of understanding to how their health functions, then I may not be the best person.

Maybe I can be the cheerleader to get them interested in that, but I needed to bring in professionals. And the problem in complementary medicine is, where to find professionals? So, the creation of the center, for me anyway, was an experience that was really circling around how do you standardize complementary medicine? How do you make it palatable to the average American and for the average physician? That was the challenge I had in front of me.

GROSS: My guest is heart surgeon Dr. Mehmet Oz, director of Columbia Presbyterian Medical Center's Complementary Care Center. His new book is called, "Healing from the Heart." We'll talk more after our break.

This is FRESH AIR.

BREAK

GROSS: If you're just joining us, my guest is Doctor Mehmet Oz, and he co-founded Colombia Presbyterian's complementary care center. He is a cardiac surgeon, and the Complementary Care Center brings in alternative therapies like yoga, and massage, and relaxation techniques to work in conjunction with whatever heart procedures are being done. He also has a new book called, "Healing from the Heart."

Now, one of the ways that you've used these complementary techniques as a surgeon is that you -- first of all, you like to tell patients that they shouldn't see the surgery as just this passive thing where they come in and you operate them. That you want them to be kind of involved in the process of healing and everything. And one of the things you do is suggest relaxation techniques that they could use before, during, and after surgery. Tell us how that works.

OZ: Well, one of my most important tasks when I meet a new patient is to convince them that they really need to be empowered in the process. Just to use a sports analogy, they are not the ball, they're a player on this team. And that's important that they understand because if not, they won't take charge of their own care. They'll walk into my office, see my white jacket, be petrified no matter how successful they are in their walk of life. And not take charge.

And once I've gotten across to them how important it is that they play some role in this, their next question usually is, well, how? Well, audio tapes end up being a good example of the role the patients could play. Now, as a scientist, if I'm asked the question, do audiotape work in the operating room? That's an unanswerable question. I need to break that down into answerable sub-segments, and this is a perfect example of how you do research in this area.

So the first question is: do you have any awareness when you're under general anesthesia? Well, the way to do that is to place brainwave leads on your head and look at your brain waves during surgery. And we do this to 35 patients who are having their heart stopped for heart surgery. And you know what we found? Every single one of those patients had intact brainwaves.

In step two of the process, now that I know that there is some awareness, some alertness still existing during surgery -- given heart surgery was to figure out if I could condition that awareness. So, if I asked the audience, what word jumps into your mind if I say the word "black?" The average American -- 70 percent will say "white."

Now, what if I put you to sleep and in your tapes I start playing "black, brown", "black, brown" and then I awakened you. Seventy percent of people now answer with "brown" when prompted with that same word, black. So, I can actually condition you to respond differently to these words. That's step two.

And step three, the ultimate study, is to prove that, indeed, I can condition you to behave in a better fashion, post-surgery. For example, have less depression, have less anxiety, have less pain. And that's what we're doing right now.

But these studies, as you can tell, take a long time to accomplish. And by the way, because they were meticulously done, they were accepted at our major heart meeting and published in a major heart journal. So you can publish it in standard period journals, but it's tremendously labor-intensive.

GROSS: So, what kind of tapes you have patients listen to during surgery, and what are you hoping it accomplishes?

OZ: Well, if they're willing to enter into the study, then I use a tape which has a soft, sort of New Age music tone. But the subtext, the words underneath that music, are convincing them that they actually are going to do well during surgery. Reassure them that their surgeon is competent, which I hope is the case, and convince them that they're going to get better quickly.

GROSS: Did you have your publicist write that?

OZ: That's right. Paid our bills.

LAUGHTER

OZ: The tapes should give them confidence that they have some ability to impact in their care, and if they stay calm and collected, and enter into that zone, that calm period, in their existence, they can get through the process.

GROSS: There's a problem someone like me has with this. I like the idea of relaxation, and Lord knows, I can use some more of that. But, you know, once New Age music starts entering into it there's a lot of music that comes under that official category of relaxation music that drives me insane because to me, it sounds just very insipid. I think even if I were lying there unconscious I still wouldn't like this music.

OZ: Well, one of the things we found is that a lot of patients don't like that music. Indeed, especially older patients feel it sounds like the music you play in a morgue.

LAUGHTER

And so, they are petrified by that, and that's one of the biggest problems with doing this research because, if I happen to like music -- for example, I like Sufi music, you know, the sort of five-tonal musics to come out of Central Asia, to me it's very soothing.

If I use that music for the average American undergoing heart surgery, they're not going to like that at all. So, it's one of our biggest challenges, and indeed, I believe when we start to do this on a broad scale, as opposed to doing it only for study, then patients should be offered a variety of tapes for them to choose.

But that complicates the matter of fair amount. How do you standardize that? What if you picked the wrong tape for yourself? What if you picked Led Zeppelin, and we know Led Zeppelin is not for you.

LAUGHTER

And you'd be better off with Beethoven or Mozart. So, it raises to -- the most obvious level, the paradoxes of using complementary medicine.

One of the problems that I see what the whole field of complementary medicine is that we're looking for quick solutions. We look for that shortcut which cures all brain cancer. It's highly unlikely that's true. It is possible, perhaps, that some types of short cartilage cure some types of brain cancer in some types of patients. But if we don't explain that and get those subtleties ironed out, then the whole field risks being written off as being hocum.

GROSS: Doctor Mehmet Oz is a heart surgeon, who directs the complementary care center at Columbia Presbyterian Medical Center in New York. He'll be back in the second half of the show.

I'm Terry Gross, and this is FRESH AIR.

BREAK

GROSS: This is FRESH AIR. I'm Terry Gross.

Back with Doctor Mehmet Oz. He is a heart surgeon who performs bypasses and transplants. But he's found that his patients often need more than surgery to recover their health and their enthusiasm for living. So he recommends the use of alternative therapies before and after surgery, such as yoga, hypnosis, massages, and acupuncture.

To research the effectiveness of these therapies, he founded the Complementary Care Center at Columbia Presbyterian Medical Center. He's written a new book called, "Healing from the Heart."

You did a heart transplant for the blues guitarist and singer Johnny Copeland, the late Johnny Copeland, though he lived for awhile after the transplant. At what point were you brought in?

OZ: I was actually at a meeting in Chicago and was called by my colleagues back at Columbia, that a black male was dying of heart failure. I had no idea that it was Johnny Copeland, and I got on a plane, got back as soon as I could and I met the patient in the operating room. It was around 11 o'clock that evening.

I spoke to his wife very briefly, and without knowing the patient or the family, which is not a rare event in this business, was forced to do an emergency operation. We operated until dawn, and it went reasonably well, but he was so sick that I was having a lot of trouble with this heart.

And we took him to the recovery room, and about an hour and a half later I was called from my office where I had gone to sleep until the morning and was told that he had died. I ran quickly downstairs and started doing chest compressions on him, and managed to get back enough of a rhythm to his heart that I thought we could go back to the operating room.

What we got him back there I realized that he was in bad shape, and I needed to put in an extra one of these piggyback hearts. Which I did, and took him back to the ICU. And I was forced to have a very frank discussion with...

GROSS: The piggyback heart is a mechanical valve, the mechanical pump.

OZ: Exactly. They are mechanical pumps. I use the word piggyback heart because it explains, I think, better, the function of these hearts in that it sucks blood out of your natural heart, which is not working, and pumps it to the rest of your body.

I had a frank discussion with Sandra Copeland that I was unsure if her husband was going to survive. He had enough time without a blood pressure that there was a pretty reasonable chance that he would be brain dead. And we waited there. We waited, they prayed. I said my own versions of those prayers in medicalese, and did all the things we could do just to get him to wake up, and we really couldn't.

And during this process she said, Johnny really likes his music, for him it was his language. Can I put his tapes on his ears? And I saw no problem with that, and certainly I would've welcomed any possible intervention that might help him. And so she put the tapes on his ears, and we were standing outside talking about 15 minutes later, and Sandra noticed that he was crying. And we walked over there and he was beginning to wake up.

Whether the audio tapes had anything to do with his deciding to wake up at that moment or whether he was going to wake up on his own, we don't know. It's one of the classic problems in complementary medicine. There's too many things happening at once to tell what's responsible. But certainly, for him, that was a catalyst to decide to wake up at that moment. That was an event that his wife and I had remembered, but Johnny never remembered.

GROSS: Wow. He never remembered hearing it while he was in the coma?

OZ: No. He remembered after waking up listening to the tapes, but he didn't recall why he woke up.

GROSS: Now, he used this mechanical pump for awhile, and you wondered how this was going effect his music. What did he tell you?

OZ: Johnny went on to make some record breaking records with his device. But he complained to me, interestingly, that the cadence of the device was interrupting his own rhythm, because it was such an important part of his day-to-day life that after a while, it is internal, that music. Not just the pump but the sound that it makes. The "boomp, boomp, boomp, boomp" sound was always around.

And so, late at night, when he would do most of his best composing, it would intermittently interrupt him. But I had the pleasure of seeing Johnny play many times after that day. And for me, it was truly a catharsis because in the medical profession, we spend our entire days, and lives, taking care of individuals, trying to get them out of the hospital. But once we achieve that healing process, we often don't see them again.

I remember going to see Johnny play at a blues club in New York, and watching the members of my team that had come along with me to watch him and watching them get stronger, heal, so to speak; fueled by that rejuvenation of having been part of his recovery process, as they listened to him create music. It was a remarkable even, one that I am confident that every member of the team will save in a special part of their heart.

GROSS: Did you give him a new heart after he used the artificial pump?

OZ: Johnny was on the heart pump for almost two years. He was one of the longest survivors of that pump ever. And finally -- I had promised his wife that I would transplant him before the New Year, and as luck would have it, New Year's Eve she came to me and she said, you know, Doctor Oz, you promised me you'd get him a heart before the New Year. And I realized that I wasn't going to be able to make it, but I told her that the year wasn't up yet.

And about two hours later, at eight o' clock that evening, I got a call about a heart for him. And we did indeed transplant him that night at midnight. And missing New Year's Eve parties that had been planned all over the place. And he survived that and did well for about seven or eight months, and then developed a very rare type of fungal infection which sometimes happens to transplant patients, and suddenly died, which was very disheartening to all of us.

Indeed, one of the biggest problems in medicine is that we each, from ourselves, as healers sometimes, instead of rejuvenating ourselves with our successes, we cut out a little bit of ourselves and leave it with all the patients that we don't save. And that's a very detrimental process because we then lose our ability to serve as healers for society.

GROSS: Do you think of heart transplants as still being very experimental techniques, or do you think of them as being closer to mainstream medicine now?

OZ: I think the actual heart transplantation is mainstream. But development of an approach to getting these patients to return to a full existence is still experimental. So we can get patients to recover physiologically. Their hearts beat, their kidneys work, they're not short of breath, nor having chest pain. But usually, they still have difficulty returning to a full existence. That's our biggest barrier in heart surgery today.

GROSS: And you attribute that to?

OZ: Many times patients that come into heart transplantation have had life-changing events that would normally have impacted on their ability to live their usual normal life. A good example is because they were sick for so many years they haven't been able to maintain gainful employment. Or they have lost many of their loved ones, either because they couldn't maintain a marriage or they don't have the same social connections that healthy patients would have.

So, when you fix their heart, if you haven't restructured to social restraints on them, the limitations that they sense returning to a full existence, they can impact on their ability to return to a normal life. Much as a person who is blind their entire life who is suddenly given eyesight might have difficulty coping with that.

GROSS: My guest is heart surgeon Doctor Mehmet Oz, the director of Columbia Presbyterian Medical Center's Complementary Care Center. His new book is called, " Healing from the Heart." We'll talk more after our break.

This is FRESH AIR.

BREAK

GROSS: If you're just joining us, my guest is Doctor Mehmet Oz. He is a cardiac surgeon at Columbia Presbyterian in New York, a professor at Columbia University, and he directs the cardiac-assist device program and the complementary medicine programs. His new book is called "Healing from the Heart."

You have made some very convincing cases for using complementary care with coronary surgery, relaxation techniques of various sorts, I'm sure diet would be included in that as well. Are the HMOs convinced of the necessity of this?

OZ: I have been disappointed by the role that managed care, health maintenance organizations in particular, have played in complementary medicine. This really does afford a organization interested in preventive medicine a unique opportunity to really achieve that goal.

You really can change the number of patients who were going to have heart problems, and I think, a lot of other medical problems. You can really impact on their abuses, their vices, including among that, by the way, dietary indiscretions.

But that really hasn't been the focus of managed care. I think -- to me, that is an indication that the major goal of managed care is just to find a way of managing the delivery of organized health care, but not really dealing with the health of the public in general.

And from a societal point of view, that's really where the emphasis should be. If I'm not mistaken, a lot of the impetus for the early subsidy -- subsidies that were given to managed-care organizations were given because it was believed that they would providing more global approach to health to the American public.

We are continually hearing about problems with the health-care budget, and the difficulty of reconciling progressively improving medical care, like mechanical heart pumps, with the tremendous expense that they incur. I can spend a couple hundred thousand dollars to save someone's life. But is that the right thing to do?

It would be smarter for us to take a more aggressive look into complementary modalities if only because it might impact on our ability to provide some of this preventive care. But I think conventional medicine itself needs to move in that direction, and the physicians wish to do it, but we don't have that unified voice in order to accomplish that goal.

GROSS: What obstacles, if any, do you have in getting the complementary care program established at Columbia Presbyterian, where you work?

OZ: Major obstacle at Columbia Presbyterian was that the recognition by some very well-wishing, and bright individuals, that complementary medicine may not work. That really, the majority of the interventions that would provide the patients, based on heart science, will provide the vast majority of the benefits to those patients as well.

And that patients could be deluded into thinking that instead of getting appropriate chemotherapy or surgery for a problem, they should go off on some tangent which was dictated more by complementary alternative approaches.

And that's a real fear, and I don't blame them for having that healthy skepticism. The argument we made back was that if our task really is to examine everything that might heal a patient then we should take charge in investigating these new modalities. To give a solid example, if I hear about the Rocky Mountain Institute of Alternative Medicine developing some cure for AIDS, it's highly unlikely we're going to believe that at first glance, but that similar publication comes out of Columbia University, people take notice.

And so we have been given, by society, the right to be aggressive in examining health. We should take advantage of that by really doing a good job of figuring out what works and what doesn't work. Our job is not to advocate for complementary medicine or really for any medicine. It's to evaluate, and if it works, we should use it.

GROSS: Is there anything that you were just kind of naturally skeptical of that you just decided to keep an open mind to anyway?

OZ: For me, personally, a good example was energy medicine. It doesn't fit into how I believe the body works.

GROSS: Can you describe what it is?

OZ: Energy medicine is a whole series of beliefs, and include things like acupuncture, but in this country usually manifests themselves by therapy, touch, or Ricci (ph) therapy. These are treatments in which practitioners believe that by waving their hands over patients, they can actually change the energy fields that these patients give off in one of a variety of means, and in that way affect disease processes.

So, for example, if my third chakra is out of whack, then I can impact on that by doing Ricci therapy, and thus, restore you to an energetic balance. So these energy treatments are given by practitioners all over the country, and there are actually practice a lot by the nurses in the hospital under the name of therapeutic touch.

And I, as a physician -- the overwhelming majority of physicians are very skeptical of these. On the other hand, if he takes a very skeptical patients and you expose them to energy therapies like the ones I've mentioned, they will sometimes, not always, but sometimes come back to you and say, you know, I know this shouldn't have happened, but I felt these strange colors around me or these strange sensations of heat and cold.

And as a clinician, it's my responsibility to learn that. And to realize that for some people there seems to be some impact. Now, whether it's purely in their minds or really there is something going on, that's part of my job as a scientist to figure out. But if I don't help in that process, with all the education that I've been blessed to get, learning about outcomes, analysis and the statistics of doing these studies, and the access to funds to do these studies - then they'll never get done.

GROSS: What's ahead, do you think, in terms of cardiac surgery? Do you think there's incredible breakthroughs on the horizon?

OZ: The biggest breakthroughs for us are going to be the management of heart failure. We have, in this country, between 40,000 and 60,000 dying of heart failure. We don't really have the ability to deal the overwhelming majority of these patients.

Heart surgery has evolved now away from the simple plumbing that many would say (unintelligible) repairs and coronary bypass surgery entail to really much more of a molecular-level investigation of why the heart fails. So, not the vessels themselves that supply blood to the heart, but why the muscle itself fails.

So, one of the things that mechanical heart surgery allows us to do is to keep people alive so we can get their hearts to repair. Now, how do you do that? It turns out that just by resting the heart itself, putting these mechanical pumps in, you can get some of these hearts to recover. It's not a high percentage, but it's high enough that we do this in an organized fashion.

Second major breakthrough is going to be figuring out, at a metabolic level, why the heart works. So that as they rest their hearts we can actually impact on them. For example, but there is a vitamin or enzyme deficiency, or difficulty metabolizing certain nutrients that causes hearts to fail on their own. Then we should deal to learn what that cause is and treat it, and we're making major headway in that.

And the third major tier (ph) is actually providing to the heart to support that it may need to recover. And this includes transplanting new muscle cells into the heart or these growth factors that can enhance blood supply to the heart. So this is what heart surgery has done, it has moved away from the more large-scale, gross repairs of the heart to a more microscopic, molecular-level approach to dealing with our biggest killer -- of heart failure.

GROSS: Now, you have a reputation, I understand, for being incredibly energetic, and for you know, doing several operations a day and then giving a lecture later in the afternoon. What do you do as a relaxation technique, or if anything, do you feel you need it?

OZ: Everybody needs relaxation. There a couple of tricks that I have, and one of the reasons that I got interested in providing some of these techniques for my patients is because I looked at my own life and saw that part the reason I felt I was successful was because I used some therapies, for example yoga. And I should pass that along to my patients.

So when I am tired, and it's 3:30 in the morning, and I just finished a couple bypass operations and heart transplant, and I know that I've got a full schedule the next morning at six, I don't have much time. And for me that time is better spent doing yoga and lying down 15 minutes. And that's one of the tricks I use. Yoga, especially the deep breathing that it focuses me on -- it highlights, by the way, a problem that many of us have: I'm a terrible meditator.

I try to meditate, my mind wanders, I get mad myself, which is the wrong thing to do, and off I go on some cascade of self-deprivation. In reality, what I should do, and which I do do is to take yoga, for example, which focuses me on my body, and makes me concentrate on just one or two things, and I take good, deep breaths. And that usually put me over the top, allows me to relax and reach that second state.

Not all Americans are going to respond in the same way to all these therapies. I would be much better off with some of the therapies if I were having open heart surgery, including yoga and audio tapes and others. Including, for example, some of the energy therapies. That's what I believe in my mind would be best for me.

One of my pleas to my patients, indeed to those listening to the program, is you really should be the world expert on your body. The word doctor means teacher. We should be teaching you to be your best friend, your best expert. And when we're not doing that, we really are abdicating our responsibilities.

GROSS: You say that deep-breathing is very effective for you. I know a lot of people claim that to be true. Physiologically, why is deep breathing relaxing for the body? Why does that slow the body down? What impact does it have?

OZ: Well, this is a great question because it really gets to the crux of the issue. We don't really know one hundred percent, why deep breathing helps you so much. It seems to work for a lot of us, we advocate it, but why it works is debated. And I can prove that by one simple fact. There are so many hypotheses for it. You've got one really good answer that's usually the only answer.

But I will list a couple to you: for one, when you take a good deep breath, you open up all the small air sacs in the lungs. That tends to be good for couple of reasons. One, you don't let bacteria grow in those sacs, which is important after open-heart surgery. But in addition, you stimulate the lung to clear out any toxins that may be within the lung sacs.

Number two, when you take good, deep breaths, you make sure that the blood that you have in your body has as much oxygen as it can. So there is very little inefficiency with the delivery of oxygen to the body.

And I think the third reason, and perhaps even the most important reason, is that it forces you to focus on something that you're doing. And by focusing on that you allow your mind to center itself and accomplish the task at hand. Even to this day, if I have a very difficult suture to place on a beating heart, I will take a deep good breath and then go back to the task because it centers me.

GROSS: Well, Doctor Mehmet Oz, I want to thank you very much for talking with us.

OZ: Thank you, Terry.

GROSS: Doctor Mehmet Oz is the author of "Healing from the Heart." He's a heart surgeon and directs Complementary Care Center at Columbia Presbyterian Medical Center in New York.

This is FRESH AIR.

This is a rush transcript. This copy may not
be in its final form and may be updated.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Terry Gross, Philadelphia
Guest: Mehmet Oz
High: Dr. Mehmet Oz is the author of "Healing from the Heart: A Leading Heart Surgeon Explores the Power of Complementary Medicine." He is a cardiovascular surgeon at New York's Columbia Presbyterian Medical Center. He combines leading western medicine with ancient methods of self healing. The result is faster recovery for patients. He believes our physical health is linked to our spirituality, psychological make-up and emotional well being.
Spec: Health and Medicine; Science; Lifestyle; Mehmet Oz

Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Healing from the Heart

Show: FRESH AIR
Date: OCTOBER 20, 1998
Time: 12:00
Tran: 102002NP.217
Type: FEATURE
Head: "Belle in Sebastian"
Sect: Entertainment
Time: 12:50

TERRY GROSS, HOST: Belle in Sebastian isn't a duo, it's an eight person band from Scotland led by singer-songwriter, guitarist and keyboardist Stuart Murdoch (ph). They released their first album as part of a Glasgow University course in the music business.

Self-made and distributed, it's now a rare collector's item. The groups new CD, "The Boy with the Arab Strap," on Matador Records is easier to find, and rock critic Ken Tucker finds its to charms irresistible.

(BEGIN AUDIO CLIP OF MUSIC -- "BELLE IN SEBASTIAN")

He had a stroke at the age of 24 It could've been a brilliant career
Leading fights in a school
I was too well known
Leading fights with a friend who had gone before
She challenged everyone to a fight
But the people all backed down
I realized I had it tough (unintelligible)
She drank and swore and smoked
And at times she was a bitter joke

KEN TUCKER, ROCK CRITIC: There aren't many bands who begin a song with the line "he had a stroke at the age of 24, it could've been a brilliant career." But Belle in Sebastian are not your usual downer group from the other side of the pond. The band may specialize in whispered confidences and small anecdotes intended to illustrate dismal romantic moments, but it has little use for cheap despair or flourid melodrama.

(BEGIN AUDIO CLIP OF MUSIC -- "BELLE IN SEBASTIAN")

I spend a summer wasting
The time was passed so pleasantly
Save material goods now
The only things we need are basic
I spent a summer wasting under a canopy of heaven.

Seven weeks of gravel walkways
Seven weeks of reading papers
Seven weeks of feeling guilty
Seven weeks of staying apart

TUCKER: The band takes its name from a short story Stuart Murdoch wrote about two musicians, and a number of his songs operate as short stories as well. Take one called "Seymour Stein" (ph), for example. It seems, at least, to be about being invited out to dinner by the man of the title, a real-life record executive, Seymour Stein, who headed up Sire Records, home of bands like the Ramones.

Belle in Sebastian's Seymour Stein, however, becomes a figure of mysterious elusiveness, a symbol of power, and of power to be denied.

(BEGIN AUDIO CLIP OF MUSIC -- BELLE IN SEBASTIAN, "SEYMOUR STEIN")

Seymour Stein, I feel lonely
Got a glimpse of some woman's face
It reminded me I've been crying
How can all the rain take care of all the pain

Record company man
I won't be coming to dinner
My heart's so far away
I'm working on my (unintelligible)
Our country girl, I think she's going to stay

Promises of pain
Promises of poetry
L.A. to New York,
San Francisco, back to Boston...

TUCKER: Belle in Sebastian's music is frequently compared to that of fragile flowers like Nick Drake, the Smith's Morrissey, or hardier breeds like the Velvet Underground or Jonathan Richman. It's true that Murdoch pitches his voice low and confiding. Tamping down emotions with flat line readings. But there's an energy to their lilting melodies, and often a spiky sense of humor, as on this song, "Sleep the Clock Around," on which cellist Isabel Campbell shares the vocals.

(BEGIN AUDIO CLIP OF MUSIC -- BELLE IN SEBASTIAN, "SLEEP THE CLOCK AROUND")

(UNINTELLIGIBLE LYRICS)

Belle in Sebastian prides itself on its wallflower obscurity. They turn down most interview requests, and have been content to release a few hard to find eps of material; or offer their Internet fans free tunes to download from their Web site. They like to keep their pop stardom small time, in keeping with the small, precise songs they compose.

For once, such self-affacement doesn't seem coy or calculated. It seems perfectly in keeping with the simple charms of these quietly hard-working musicians.

GROSS: Ken Tucker is critic at large for "Entertainment Weekly." He reviewed "The Boy with the Arab Strap" by the group Belle in Sebastian.

I'm Terry Gross.

This is a rush transcript. This copy may not
be in its final form and may be updated.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Terry Gross, Philadelphia
Guest: Ken Hunter
High: Critic Ken Hunter reviews Belle in Sebastian's new album.
Spec: Entertainment; Belle in Sebastian; Music Industry
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: "Belle in Sebastian"
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.