Chapter 14: A New Holistic Focus on Quality of Life and Transformation
In this chapter, Dr. Cohen talks about his shift in focus away from "reductionist research" to a whole-life view of health and transformation. He explains that perspective goes back to experiences he had as a child and young adult in Italy, when he learned the benefits of being mindful about everything in his life. Next he tells the story of a turning point in 2009, when John Mendelsohn was interested in bringing author David Servan-Schreiber to MD Anderson to talk about his book, Anti-Cancer Way of Life. [NOTE: health info discussed, but Servan Schrieber is on record about it.] He tells the story of how Dr. Servan-Schrieber was able to inspire philanthropists to contribute several millions for a pilot Comprehensive Life Study in Stage 2 and 3 breast cancer patients. Dr. Cohen talks about how the design of the study and its transformational effect on patients.
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
The Interview Subject's Story - The Researcher; The Researcher; Personal Background; MD Anderson Culture; Professional Path; Multi-disciplinary Approaches; Discovery and Success; Healing, Hope, and the Promise of Research; Human Stories; Offering Care, Compassion, Help; Patients; Patients, Treatment, Survivors; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Professional Practice; The Professional at Work; Collaborations; Controversies
Tacey A. Rosolowski, PhD:
So what's the relationship with Fudan now? I mean, are you -- or what do you expect in the future?
Lorenzo Cohen, PhD:
I don't know. I mean, so I'm, I'm kind of a mixed... The area that I've really gotten interested in, that we can start to shift to and give you the story, is looking at comprehensive lifestyle change. So all this research that I've described to you so far is what we could call reductionistic research: yoga for breast cancer patients during radiation to improve sleep or quality of life; acupuncture to treat xerostomia; huachansu as a single product to treat cancer patients, drug development, that kind of stuff; research that Peiying's doing, ongoing, super exciting, looking at the harms of sugar in animal models, just this one constituent. I have colleagues in behavioral science doing exercise research, and trying to get people to lose weight. And in our clinic, in the Integrated Medicine Center, when patients come in they meet with an integrative oncologist, or integrative medicine physician, and we review everything that's going on in their life. You know, how are they sleeping? What is going on with their mood? How are their symptoms? How many fruits do you eat on a regular basis? Are you exercising? What's your stress like? Do you meditate? And we prescribe a prescription for them that targets the areas of social -- of physical, mind, spirit, and social wellbeing. And we weren't doing any research in that area, and we weren't testing anything in that area. And, you know, I've started to get more and more interested in that, from my conceptualization -- and this actually happened when I was living with my grandmother in Italy, back in nineteen eighty... Oh, when was I there? Eighty-seven, '88, after I graduated from college, and became pure vegetarian, and was doing yoga every day with her, that, you know, not only was my body changing physically, but I became much more sensitive to the foods that I was eating. I was becoming -- colloquially, overused term -- more mindful, you know, mindful about everything in my life, and realized that it people engaged in Yoga, with a capital Y, that that would happen. So when I started the research with VYASA in particular, because they come from this -- and I didn't describe sort of their history: Vivekananda was the first individual back I think it was in 1895, 1890-something. We can actually look it up, because he came and he gave a talk at the Convention of Religion, or there's some international convention of religion, and he talked about yoga. Again, this was back in the late 1800s. This is, you know, pre-Beatles, pre-Maharishi Yogi and all that stuff.
Tacey A. Rosolowski, PhD:
What would you do without Google?
Lorenzo Cohen, PhD:
Yeah. Parliament of the World's Religions, 1893, is when he gave that lecture. And, you know, he sort of, you know, brought to the West these Eastern concepts of yoga. Anyway, why that... Why that segue is because my colleagues, the Vivekananda group, base their yoga on the ancient texts, and really going back to traditional yoga, not yoga as it's been conceived of in the West. And that really resonated with me because, you know, I wanted to go beyond just the physical, which has been the main focus of the West. You go to the YMCA, there's not a lot of meditation. There's not a lot of yogic philosophy. And, you know, so they talk about diet, they talk about, you know, the body as this temple that you need to, you know, treat appropriately, and interaction with others, and, again, yogic philosophy. So I kind of knew in living with my grandmother that if you're to engage in Yoga with a capital Y, then everything in your life would sort of change, and yoga was kind of a gateway to get you to become that better person. And so that's why working with the Vivekananda group was very appealing. You know, they -- you know, it's -- you know, at the end of their talks that they would give, they would have, you know, these grandiose statements, like, "Well, if everyone in the world was just doing yoga, then that would bring peace to our world. And, you know, at the time I was, you know, sort of rolling my eyes -- whatever, we need to do a clinical trial and get the grants submitted. But, of course, they're absolutely right, and that's kind of this crazy mission that they're on. They've now been deemed a degree-granting university. They have been for a number of decades now, where they give PhD in Yogic Sciences, and people have -- they have to do research in yoga. They have to learn yogic philosophy. They read the texts, and they have -- typically are doing some type of clinical trial, whether it's in pediatric populations or schoolchildren or Alzheimer's or diabetes or obesity, etc. They're graduating hundreds and hundreds of students every year from this university to try and get everyone in the world to be doing yoga, to bring peace to the world. I mean, so it's like, you know, kind of incredible.  So what was clear to me in our yoga research that continues today is people aren't doing yoga as a capital Y. Now, some of the women became really engaged with yoga, and it did transform their lives, and there's many examples. This one woman, you know, loved it so much she hired our yoga therapist part-time to come to her work every week to teach her and her whole staff, and she had a small company of forty-something people. And I believe many of these people did have their lives transformed by yoga, but it was really the minority. And, you know, when a friend of mine is diagnosed with cancer, if somebody walks into the Integrative Medicine Center, or a friend of a friend, and you get these emails all the time, I don't say, "Well, you know, why don't you just do yoga during radiation? Everything will be fine. I talk about their sleep. We talk about their diet. We talk about exercise. We talk about stress, and, you know, mind/body, and engaging this, and so what one would call a more comprehensive approach. So in 2009, I believe it was February -- and this is in my book, and we'll get to that -- in February of 2009, John Mendelsohn sends me an email and says, "I've just come back from Davos, Switzerland, where I was a speaker at the World Economic Summit, and I was on a panel discussing, of course, health, with this psychiatrist from Pittsburgh named David Servan-Schreiber. Have you ever heard of him? And I was like, "No, I've never heard of David Servan-Schreiber. And I looked him up, and he's a psychiatrist and, you know, did research in, I think, schizophrenia and some other psychiatric disorders, MD/PhD neuroscientist. And John said, "Well, you know, I encourage you to read his book, Anticancer: A New Way of Life, and if you're interested, I'll support inviting him to give a talk, because I think he's, you know, right on target. So, you know, John Mendelsohn. We're talking about the president of MD Anderson, right, (laughter) who, of course, you know, is the reason why we founded and had a super successful integrative medicine program.  So I read David's book and was just blown away, not only his personal story that he was diagnosed with a brain tumor, living in Pittsburgh, peak of his career, publishing in top journals, ego, you know, bigger than, you know, you could fit in a room, and was diagnosed with this brain tumor, and said, "Eh, OK, cut it out, and do what you've got to do, and I've got to get back to work. And he has this picture of himself, you know, I think it was, like, after the treatment, and sitting at a table, and he's got Coke cans, and he's on his laptop, and he's like, "You know, whatever, I gotta get back to work. And then he had a recurrence shortly thereafter, and he essentially said, "I'm not gonna survive this if something doesn't change. And when he went to the doctors and he said, you know, "What should I do now? You know, and then he underwent chemo and more surgery -- and, you know, it was much harder recovering the second time -- essentially the doctors said nothing, just like we do here, and, you know, all around the world. And he's like, "That doesn't make sense. I'm going to go and look in the literature. He knew nothing about cancer because he was a psychiatrist. And he uncovered all the literature that exists supporting why integrative oncology exists in the first place. So back in 2003, we formed the Society for Integrative Oncology: myself; Dr. Barrie Cassileth, who is the head of Integrative Medicine at Memorial Sloan Kettering, our collaborator, nemesis, competitor in New York City; and Dr. David Rosenthal, who was oncologist and then the head of Integrative Medicine at Dana-Farber Cancer Center in Boston. He was the former head of -- president of the American Cancer Society. So the three of us partnered together, and we founded the organization called Society for Integrative Oncology, based on, you know, everything that was going on in the field of integrative medicine at the time.  There's -- the -- what David did so successfully in his book that was first written in French and then translated and published by a British publisher in English before it came to the United States -- and the first English translation, I believe, was in 2007, and then it was re-- second edition rereleased in 2009 -- is he brought together all the literature in the area of diet, exercise, mind/body stress, and the environment in one area, and it is very powerful and compelling when you see it all in one place at one time. So I was familiar with in particular those three areas of research, of diet, exercise, and mind/body, not as much in the area of diet, because I hadn't gotten as engaged in the area of diet up until that point. But actually, that previous summer had read a number of lay books in this area of diet, stuff like Michael Pollan's Omnivore's Dilemma, and this book about the food industry, David Keller's book, The...
Tacey A. Rosolowski, PhD:
The End of Dieting?
Lorenzo Cohen, PhD:
The End of Overeating, America's obsession with food, and some of those books. And so kind of, you know, was building my evidence base, so to speak, in this area. And so when -- you know, so I read David's book and was like, "Wow, this guy's fabulous. Yes, John, let's invite him. So John, you know, invites him, and CC's me, and we started this email communication back in actually early -- still early 2009. It all happened very quickly. Then David came in July of 2009 and gave grand rounds, integrative medicine grand rounds, as well as doing an evening lecture. At the evening lecture it was, you know, standing room only. It was like he was a rock star. Everyone knew about this book. There was over 400 people in the auditorium. John introduced him. We had a number of our philanthropic friends who came that evening. We had Jen Duncan, who's Dan Duncan's wife. Dan Duncan subsequently died. They gave us $50 million for the Duncan Prevention Center. Mary Lester was another very important person who was there that evening, whose deceased husband is the -- was the founder and owner of William Sonoma. And so actually I didn't go out to dinner with them -- and maybe it's better that I didn't, but anyway, you know, that's hindsight. I had something else I had to do. I was with David the night before. So David went out to dinner with a bunch of these philanthropists who, you know, were enamored with David's message, and probably enamored with David, because he's super charismatic and good looking and has a French accent and blue eyes, and... And so at dinner, David's -- the message is essentially all this data is, in some sense, from a lawyerly term, circumstantial evidence. There are correlative studies, and association is not causation, so just because women who eat more fruits and vegetables live longer after diagnosis of breast cancer doesn't mean that if you do a clinical trial that's what you're going to find. So it's -- it wasn't -- these -- most of the data didn't come from experiments. And actually, the experiments that had manipulated, like fruit and vegetables, or the horrible road we went down of ill-defined fat, failed, or were really mediocre. And it wasn't until -- and David mentions some of these studies in his book, when in, like, the study that increased fruit and vegetable consumption in breast cancer survivors in a clinical trial, that you also looked at whether they increased their exercise habits. Then you started to see survival differences. But nobody had really done that kind of research. So the philanthropist said to David, "Well, what would it cost to do that kind of a study? And he threw out this ridiculously low number of a million dollars, and they're like, "Well, that's easy, we just get, you know, ten of our friends, we all give $100,000, and... You know, and to these women, that was like really peanuts.  So David contacts me the next day, or shortly thereafter, and he says, "I gotta tell you about the conversation that we had, and these women are hot to trot. Let's -- are you interested, you know, to design a study? And let's do it at MD Anderson. And that's kind of what, you know, we needed to kind of get this question that had been sort of lingering in my head -- Yoga with a capital Y, you could call it -- this comprehensive lifestyle change. So in the next two years, with David's super hard work, as well as John Mendelsohn going with me one time to New York to do a fundraiser specifically for the comprehensive lifestyle study -- so that, again -- I mean, John is just, like, such a fabulous guy to do that kind of thing. And it's because he believed in it, and he believed in David, the message, and at the end of the day it's not belief. He's a scientist; he believed in the science, right? Because he could read the articles and see with his own two eyes that this stuff really mattered, the area of lifestyle. So we were able to raise $5 million to do this study, primarily through philanthropy, as well as some -- one foundation that helped to support this. Lots of family foundations, but... So... And literally from all over the world. So David, on his book, was extremely successful. Needless to say, he sold over $1.8 million. Anticancer still remains the number one lay cancer book in the world, and it was last published in 2009, and it's still in hardcover.
Tacey A. Rosolowski, PhD:
Lorenzo Cohen, PhD:
Never went to softback in the US. And David died in 2011, and it still remains the number one selling cancer book. So David went around, you know, the US, and, you know, gave lots of talks, met lots of people, and through his website, as well as connections, we received I think it was close to 300 donations from, like, 48 different states, and 10 different countries, to do this clinical trial. And the clinical trial is ongoing. We call it the Comp Life Study, Comprehensive Lifestyle Change, specifically in stage two and three breast cancer patients as they're entering their radiation treatment, and, you know, this teachable moment, building on the yoga research that we did and are continuing to do. But they get intensive counseling in the area of diet, exercise, stress management, learning some yoga techniques and meditation, and behavioral counseling. So they have seven hours of one-on-one training with four therapists per week for six weeks, and then when they're done with their radiation they go home and they continue weekly contact with the behavioral counselor for six months, and then it's monthly for the subsequent six months. So really, a total intervention time of a year and six weeks. They're kind of boot camp. The study is transformational. The stories we're hearing from these women are just -- you know, they bring tears to my eyes every time we meet and review the patients on a weekly basis and hear from each of the therapists, you know, what's going on with the patients.
Cohen, Lorenzo PhD and Rosolowski, Tacey A. PhD, "Chapter 14: A New Holistic Focus on Quality of Life and Transformation" (2016). Interview Chapters. 633.
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