Chapter 16:  The Future of Integrative Medicine

Title

Chapter 16: The Future of Integrative Medicine

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Dr. Cohen shares observations about where he is in his career and the support that MD Anderson is currently providing to Integrative Medicine now that John Mendelsohn is no longer president. He also observes that the timing might be right for a change, as growing evidence about the value of IM approaches may support insurance reimbursement. He talks about the health trends in China and India, both of which are now in the "Reagan Era Good Life" period, with threats to quality of life and health. He expresses his hope that colleagues at Fudan University will become involved in quality of life studies.

Identifier

CohenL_03_20160824_C16

Publication Date

7-24-2016

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Personal Background; The Researcher; Healing, Hope, and the Promise of Research; Building/Transforming the Institution

Transcript

Lorenzo Cohen, PhD:

I don't know. I don't know. I mean, I can picture a lot of different things, some of which don't include me being here, or some of which would include me being here if this institution is willing to embrace it. Frankly, at the moment, they're not. They are permissive. They are weakly supportive. And compared to many other places we are phenomenally large and successful, but, you know, you know MD Anderson, and you see what we're investing in the Moon Shots and, you know, all these other programs, and we're a drop in the bucket, you know. Does that mean I want, you know, the institution to support with millions and millions? No, but we have one dietician, one psychologist, one exercise coach, and two doctors, and now I'm going to have to go and fight for a third doctor when we're in the non-economic crisis.

T. A. Rosolowski, PhD:

Right. What's -- how does MD Anderson in integrative medicine compare with other institutions?

Lorenzo Cohen, PhD:

Oh, it's much larger. It's much larger.

T. A. Rosolowski, PhD:

Really?

Lorenzo Cohen, PhD:

Yeah, other institutions have to rely on philanthropy. They have to rely on patient revenue. And we rely a bit on philanthropy and patient revenue, but, you know, at the support of now Patrick Hwu, the division head, and Buchholz, physician in chief, we're a pretty significant loss leader.

T. A. Rosolowski, PhD:

Could you imagine, or is there a chance that if your book is very successful, if the study does, indeed, show an impact on disease outcomes, or reduction in disease, would it turn around the institution's attitude?

Lorenzo Cohen, PhD:

Well, my hope, it's -- goes beyond the institution, right? I mean, independent of the book, it's all about the study. I think if the study's successful, and we can show that we can do it here, in person, intensive, and the next, what we're calling Comp Life 2.0 in more virtual -- because the criticism is going to be, well, that's so intensive and it's so expensive. Well, as we talk about in the article that hopefully will get published, it's 72 hours of counseling. Some may say that's a lot. I would argue that's not a lot if we can decrease recurrence of disease. If that study's successful, and the book will be a vehicle, of course, of communication, we'd have to obviously publish a second edition pretty quickly after the study comes out, and the timing's probably going to be right, because this book, if we're anywhere near on schedule, will come out sometime in 2017, and this study will probably get published in '19, or even '20, so that, you know, would be a good follow-up. Is that -- you know, as John said to me, Mendelsohn, years ago, "Can we get reimbursed for dietary counseling, exercise counseling, and behavioral counseling? Sort of like the three-legged stool of creating this change. And I said no. And then he said, "Well, what -- how am I going to pay for this? Because our hospital makes money primarily based on insurance, and insurance isn't willing to pay for it. If there's a clinical trial published from MD Anderson, that's not going to be the only reason insurance is going to step in, but the time is right. This study, if positive, is going to come out at a time where the evidence from the epidemiological side is just overwhelming, and then we'll have a clinical trial from the number one cancer center in the country saying, and if you modify the risk factors, as Hortobagyi described it, we can modify the outcome. And then that could be a tipping point. Probably overly optimistic, because, again, we're -- it's not a fancy drug. It's not a gene manipulation, although the genes will probably change when we're measuring all that stuff. But until it's reimbursed, until it's paid for, we're not going to do it. You know, we'll do what we're paid to do. So, I'm hopeful, but I'm also realistic that that may not happen. [] On the side, if MD Anderson's not excited about it, and insurance isn't going to pay for it, I still think it needs to be done, and so there may be a spinoff company that exists to train people in this area. There's lots of lifestyle coaching going on now, but I think they're kind of missing that -- the critical element of social support, which is necessary to be successful and to have long-term engagement in lifestyle change. Almost everyone in this country has gone on a diet, and almost everyone in this country has gone off a diet. And what allows people to sustain, I think, is kind of the missing ingredient. And, you know, I'm no different -- you know, there's a lot of people in this domain -- this is going to become a really crowded and popular domain in the years to come, and that's great, you know, both private and public. I know when the Obamas leave the White House, I would be shocked if Michelle Obama didn't start a foundation that focused specifically in this area of health and wellness and trying to create true transformation, which I think she'll be more successful at doing outside the White House than she was as a marginalized First Lady, because our country can't deal with women leaders, as we're seeing (laughter) in the current situation.

T. A. Rosolowski, PhD:

Let's hope they prefer them to the alternative. (laughter)

Lorenzo Cohen, PhD:

Yeah, who knows? So I don't know where it'll go. I don't know where it'll go. But I kind of have a feeling that things will change if this book is very successful.

T. A. Rosolowski, PhD:

Yeah, yeah. Well, it's a --

Lorenzo Cohen, PhD:

Looking forward to it, if...

T. A. Rosolowski, PhD:

Oh. Absolutely, yeah. And a great -- I mean, I thought it was interesting -- you know, you had the turning point of Fudan when you, you know, needed that in your career, and now you've got this, so this -- these phases in your career, which are all good turnarounds.

Lorenzo Cohen, PhD:

And I try to, you know, in -- so the thing with Fudan -- what's interesting that's going on in Shanghai is, you know, they -- China and India are now becoming the -- not becoming -- China and India are the diabetes capital of the world, and they are leading the Western lifestyle. They're leading, you know, the Reagan-era good life, in particular in China with this burgeoning middle class. I was just speaking with Peiying, who I was describing briefly, who is doing the research in sugar and doing a lot more research pre-clinically in animals, and we were talking about rice, and she's shown that white rice flour in her animal models is as bad as sugar. And I said, "But what about, you know, the Chinese? You know, the Chinese have been eating rice, white rice in particular, for millennia, and they, until recently, had the lowest breast cancer, the lowest prostate cancer. And she said, "Well, for most of the time actually they never had enough food, so they were on calorie restriction. Now the Chinese are eating fast food, eating tremendous amounts of food, and breast cancer's the number one cancer in China, in the urban areas. And so when I was at Fudan and meeting with the president of the hospital -- this was back in 2002, 2003, and we're going through the different cancers that we could study, because it's unique -- they have different cancers. They have more liver cancer. They have more nasopharyngeal cancer, due to EBV, and here it's our -- that cancer's due to HPV. And I said, "Well, we probably aren't going to do much research with breast cancer. And he goes, "No, no, no, breast cancer is the number one cancer in women in Shanghai. And I said, "What? I thought it... You know, I read the China study, and it's the lowest. And he said, "Western lifestyle. The diet, the lack of exercise, the chronic stress, women joining the workforce. It's probably the pollution, but it's hard to sort of put your finger on pollution. So I've tried to interest my colleagues at Fudan in comprehensive lifestyle change. What better...? And Taiwan and China have bought our book, so perhaps that would be the vehicle, if the book is popular in China, to then start some research with Chinese breast cancer patients, which is a growing epidemic in the country. So I hope to actually get back engaged, either in China or in India, because I grew up in Italy, and my wife grew up in England, and being trapped in Houston is not something certainly we want to do after Chiara graduates, which is in six years. It's not very long. (laughter)

T. A. Rosolowski, PhD:

And her name again is...?

Lorenzo Cohen, PhD:

Chiara, C-H-I-A-R-A, and that's our last of three.

T. A. Rosolowski, PhD:

So there's Chiara, there's...

Lorenzo Cohen, PhD:

Chiara, Luca, and Alessandro.

T. A. Rosolowski, PhD:

Well, I know --

Lorenzo Cohen, PhD:

So, yeah, who knows what the future has in store.

T. A. Rosolowski, PhD:

Yeah, but all exciting stuff, which is cool.

Lorenzo Cohen, PhD:

Yeah. Yeah. Got to get the book written first.

T. A. Rosolowski, PhD:

Well, I want to thank you for --

Lorenzo Cohen, PhD:

Looming over us.

T. A. Rosolowski, PhD:

I want to thank you for your time, and, you know, is there anything else you'd like to add?

Lorenzo Cohen, PhD:

I don't think so. (laughter)

T. A. Rosolowski, PhD:

OK. (laughter) It was a really interesting conversation. I thank you for spending the time.

Lorenzo Cohen, PhD:

Yeah, again, could do a whole one on China. And I needed to write a paper on this China experience but never wrote... You know, I've only written the scientific papers, not the -- you know, the kind of how do you start a center, and the cultural side, and...

T. A. Rosolowski, PhD:

Is that something you want to cover? Do you want to schedule a time to do that? I mean, it's an interesting institution-building topic.

Lorenzo Cohen, PhD:

Yeah, I don't know. I mean, if you -- have you done an interview with [Oliver] Bogler [oral history interview] yet?

T. A. Rosolowski, PhD:

I have, but he hasn't -- he didn't talk in detail, really, about that from an onsite --

Lorenzo Cohen, PhD:

He didn't talk about the sister institutions?

T. A. Rosolowski, PhD:

He did talk about them, but not from an onsite perspective. If you'd like to do that, I'm more than willing. It'd be a very interesting perspective.

Lorenzo Cohen, PhD:

Well, let's hold for now, but --

T. A. Rosolowski, PhD:

But let's... OK. We can chat about it, keep it on deck.

Lorenzo Cohen, PhD:

Yeah, when we get the book done.

T. A. Rosolowski, PhD:

Yeah, sounds good. (laughter) All right, well, for the record, thank you again, and I am turning off the recorder at ten after 11:00.

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Chapter 16:  The Future of Integrative Medicine

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