Take Charge! Learn How to Get the Most Out of Your Health Care

M. D. Anderson Cancer Center
Community Education Event Recording
Date: September 2009
Duration: 0 / 45:30

Mary Jo Kreitzer, Ph.D., R.N.:

Well, thank you very much for that introduction. It's really a pleasure to be here. It's a pleasure because M. D. Anderson is such a world renowned cancer center and you're admired not only around the country but around the world for the phenomenal care and research that happens here. But I'm also very honored to be here on behalf of the Integrative Medicine Program. The program here I would say is one of the strongest models in the country of really doing integrative oncology and bringing together the best of conventional care with these complementary and integrative interventions.

Well, this topic tonight, taking charge of your health is a topic that I really love to talk about. It's an important topic really whether you are cancer free and whether you have never had cancer, whether you are newly diagnosed, whether you're in treatment or whether you're in survivorship, and so the post cancer treatment. What I'm gonna talk about is an openness conversation with you and I really--and I do hope at the end, and I'll be saving some time for questions that it can be a conversation. I wanna talk about taking charge of your health. What does that idea mean? What actually it doesn't mean? Why is that important? And most importantly, how do you go about doing it? In the context of doing that, I'm gonna talk a lot about accepting personal responsibility. What does it really mean to accept personal responsibility for your health, of healthcare, and wellbeing? And it's interesting, if I were talking on this topic 10 years ago or even 5 years ago, maybe even 3 years ago, there would be--a lot of people would say, "well that is just ludicrous" you know to imagine people taking more responsibility for their own health. But today, whether you look anywhere on the broad spectrum of sort of the political arena and what people are talking about about health reform, everybody agrees that personal responsibility and looking at life's--making lifestyle changes is really an important component.

So part of my message to you tonight is the importance of exploring the importance of questioning and that questioning is good. Questioning is okay, as well as taking action. I will start out by talking about developing a personal plan for health and wellbeing. And some of you may--that maybe something that you have been doing or have done for a long time, but for many of you, that actually maybe a new idea. And how interesting that is because many of us have financial plans or we have retirement plans or we have educational plans. But we've kind of let our healthcare and responsibility for our healthcare reside in somebody else's domain. So a lot of us have not really put together a personal plan for health and wellbeing where we really look at dimensions of health and really do an honest assessment of how well are we doing on the various domains, setting some goals and committing to some action steps. So, that's a big piece of what I'll talk about tonight, but I'll also talk about the importance of becoming an informed consumer so that you can better navigate the health system. And I think probably there's no one in this room that would--I would say that we have an easy to navigate healthcare system. So again, whether you are sort of diagnosed with a chronic disease or not, knowing who to call, when to call, how to call, and to sort of seamlessly coordinate your care is something that we really struggle to do right in our country. And in this conversation, I'll also be talking about how do you begin to explore options including the various integrative therapies.

So first of all, why is personal responsibility important? I think the statistic, and this really kind of complements what Dr. Cohen said is that the reality of why personal responsibility is important is that that's what works, and that's really the only thing that works. But if you look at the medical system combining drugs and hospitals and doctors, that only affects about 10 percent of the usual measures of health. It's kind of staving when you think about it. I mean you think of how much money we pour into the healthcare system and that so much of what we do in the healthcare system really can only affect about 10 percent of the usual measures of health. The remaining 90 percent of health outcomes is determined by factors of which doctors, and to some extent the rest of the healthcare system, has little or no control.

So what is it that impacts our health more than anything else? As Dr. Cohen said, this is very true for cancer prevention. It's the lifestyle choices that we make, the social conditions on which we live, and the physical environment, and so, simple public health measures. Those are the things that impact our health much more than anything else. So here is sort of the good news, bad news. Starting with the bad news, and now that it's at its estimated that 40 percent of all premature death in United States are due to unhealthy choices, whether that's tobacco use or poor diet or sedentary lifestyle or misuse of alcohol and drugs or failure to use safety equipment, whether that's seatbelts or helmets, pretty staggering. But the good news is that positive health choices, so the converse of that such as regular exercise, eating nutritious meals, managing stress, avoiding toxic substances, we know that those can have a quite dramatic effect on improving health and wellbeing. So if you really look at all of the research on, okay, this whole area of lifestyle. Where is the gold? Where--what are the kinds of things that you could be doing that would really positively affect your health outcomes? These are the interventions of health that seemed to be most important. Diet and nutrition, exercise and fitness, relationships and family, spirituality, managing stress, self care, emotions and attitudes, and the whole idea of life purpose and sort of having--and sort of be pursuing a life purpose.

So, this whole area of creating healthy lifestyle in those domains, we actually have developed a website at the University of Minnesota. That's a free website that's called Taking Charge of Your Health. So if some of what I talk about tonight peeks you and you actually wanna go in and do some of those assessments, you could just Google Taking Charge of Your Health and it's the first thing that pops up and you could actually go in and do some of those assessments. But I wanna start with the whole category of diet. And I recently read an editorial that said, "If we think that it's controversial to talk about health reform, wait till we start talking more about diet and agriculture policy." But that is actually even more controversial than health reform. In the whole area of diet nutrition, there are 3 areas that I wanna touch on tonight, what you eat, how much you eat, and why you are eating. And if you get in touch with those 3 things, you probably gonna really be able to make positive changes. Four of the top 10 causes of death today are chronic diseases that are well--that have well established links to diet. So that's true for heart disease, coronary artery disease, diabetes, stroke, and cancer.

So if you really wanna do some of the prevention things that Dr. Cohen talked about, diet is actually a really good place to start. One of my favorite books in the last couple of years is a book by Michael Pollan called "In Defense of Food". And how many of you have read that book? Okay, so there are a good handful of people that have read that, "An Eater's Manifesto". And he has 3 simple rules in that book and it's so simple, but boy, these are big. One is eat food, and you're gonna think, well, that's crazy. I'll talk about what that means. Eat real food is the point. Not too much and mostly plants. And so his whole notion of eat food is he talks about the fact that as a society, we have really gotten away from eating real food. That if you start reading labels, if you look at what you're putting into your grocery cart and if you look at what's in your pantry, an awful lot of what we eat is chemically processed foods. And there became a time, and this actually is part of that whole debate around agriculture policy when people started to actually label food differently, and there was a big lobby in terms of how food was labeled, and we started moving to instead of talking about specific nutrients, we started talking about, you know, percents that sometimes all kinds of chemicals and fatty acids that regular people knew very little about. So his point is that what we should do is avoid food that has been processed to such an extent that it's more a product of industry than of nature. So that actually really becomes difficult. If you take this seriously, you think well, even for a week I'm gonna actually eat food. You'll discover how much you have become to rely on processed foods. The other issue is quality over quantity. In many parts of the world, there are issues of under nutrition. In this country, our bigger challenge is much more over nutrition although to some extent we suffer from both, because we have human beings now that are overfed but they are undernourished.

In this whole area of eating food, another tip he has is avoid food products that contain ingredients that are unfamiliar, unpronounceable, more than 5 in number or that include high fructose corn syrups. So that's kind of, you know, if you're sort of--if you have a sort of a long string of chemicals, you know it's processed foods. Another thing he writes about is don't be purchasing things that weren't available when you're grandmother or your grandparents were shopping. And also to avoid foods that make health claims.

And this is I think just a perfect example of that. And so this is General Mills, a Minnesota company. I have to say, you know, I'm from Minnesota. I think this is atrocious. Tricks fruit flavored frost and corn pops and look at the topic, provides 25 percent of the daily nutritional needs for 7 essential vitamins and iron established by the US Government. Now if you might--you know, some people might be impressed by that. They're gonna look at that and see, US Government 20--it provides 25 percent of something. But if you actually read the label, what's the number 1 ingredient in something like that. Absolutely, sugar, yeah.

Some other tips, stay--shop the peripheries of the supermarket and stay out of the middle because it's around the periphery of the supermarket that usually the healthier choices are, and get out of the supermarket whenever you can. And I do think it's so intriguing to see what's happening now with the sustainable agriculture movement and seeing more CSAs, community gardens being formed, and more farmers markets, and a new trend, and I don't know if you started to do it here at M.D. Anderson is actually to have health centers sponsoring markets, farmers markets. A number of hospitals around the country have signed pledges for healthy food and are starting to offer locally grown organic food in the hospital. So those are all examples of strategies I think that can be very positive. So eat food.

This next one is very sobering. Don't eat too much. And what you'll see is that in 1957, if you went and ordered a burger, what you would have gotten was a 1 ounce patty and the 1 ounce patty was about 210 calories. Now, even without talking about supersizing and that whole phenomenon, many places you would go today to order hamburger, it would be 6 ounces which is 618 calories. So you can see that a whole sort of orientation of even proportion and size, you know, has really changed dramatically. Some other tips about not eating too much, and this actually comes from sort of the French cuisine. A lot of books have been written about how people eat in France and how it is that they often don't gain weight. And one of the things that there--that's sort of a cultural thing is eat until you're 80 percent full. The problem is that our stomachs and brains take a while for the message from the stomach to reach the brain. So often if we just stop eating when our brain is telling us, you know, that before we are actually overfull because we've overeaten. Do your eating at a table, and part of this is because of the importance of being mindful. When we eat when we're watching TV, when we eat when we're reading a book, when we eat when we're in front of the computer, we can often eat very mindlessly. How many of you have ever eaten a meal and don't remember tasting the food? Okay, quite a few of you raised your hand. Try not to eat alone. And that's another huge phenomenon in our country. We not only often eat fast food but we often eat alone. And then when we eat alone, it's often that we're multitasking and doing something else. So again, there is more of an inclination for over consumption.

And then finally, eating slow and eating mindfully. And then the last tip that Michael Pollan has is eat mostly plants. And there is really just very compelling evidence that there are benefits of having a plant-based diet, and that's about the only point of consensus. So then there's a lot of debate beyond that in terms of different types of diet. But people really do believe a plant based diet where you have more fiber, more antioxidants, no omega-3 fatty acids, that those are--all would lead to a healthier outcome. Thomas Jefferson in his writings used to talk about use meat as a condiment for vegetables. That's such an interesting idea. I mean, we, in this country we thought of meat as the centerpiece. So often you think about food planning and what do you start thinking of first? Well, what's gonna be the meat that we're gonna serve. You know, I saw so many of you shake your heads and then you kind of, what's around the periphery. So what this idea is to change that orientation and think of meat as the condiment which means then that you might still serve meat but a much smaller proportion or size.

And then the last piece is eating in emotions, and this is a huge piece. To get in touch with why you're eating, do you eat to relieve stress, on happiness, or other emotions? And I love this book, and this is not a new book. It's been out for a long time but the title tells it all. Life is hard and food is easy. And what Linda Spangle talks about in this book is that so much about eating is reflexive eating, that sort of mindless eating, and that we--if we develop consciousness about 2 things: to eat when we're hungry and really ask ourselves when we're about to sort of, you know, put our hand in that bag of chips or whatever. Am I eating because I'm really hungry, or am I eating because it's the social thing to do or just because the food is there? So, begin to orient your body to eating when you're hungry. And then the other is to recognize that all or none is not the answer. And so when we sort of take the point of view, well, I'm never gonna eat that lovely piece of chocolate cake or cheesecake or whatever, you know. At some point, that's not gonna work and very likely you'll then start eating it perhaps even binge instead making a very active choice but say, "you know, I am gonna eat but I'm only gonna have 2 bites or 3 bites," you know, a smaller quantity. So, a few ideas about diet and how to look at diet.

Now, then exercise and fitness is another huge category and this I think is another one that I think is very sobering in this country. We live in a very sedentary society and I would guess that many of us are guilty of this, of sending an email or picking up the phone call in an office when we literally could step up the hall and walk down a few steps. People who have done research on physical activity with boys and girls, any guesses of when the peak of physical activity is for girls growing up? Anybody, any ideas? What do you suppose the peak is when people--girls exercise the most?

Six years old? A little bit older than that, but that actually is not a bad guess. It's like middle school. It's middle school. And so that is really staggering when you sort of think about it. Boys are active a little big longer. So boy, when you think about longevity and in having good quality of life, upping our physical activity is a really important piece. And on our website, we have the sort of the health risks of inactivity and from one researcher, the top 25 reasons to exercise.

So some quick guidelines, 30 minutes of moderate exercise most if not all days of the week is a sensible recommendation. To obtain even greater benefit, engage in more vigorous physical activity for a longer duration. But the real important trick is to actually have a balance. And so what is best is to have a balance of some cardiovascular conditioning. So when you get your heart rate up, but also to do stretching, strength training, and balance. Now it's interesting when you look at this, is a lot of this you actually can do at home. You can actually do--you can do when you travel. Walking, certainly stretching, some strength training and some balance. Find something that you enjoy and are committed to doing on a regular basis. And so, making that New Year's pledge that I'm gonna, you know, work out or go to the club or sort of do whatever, you know, 4 days, 5 days a week. And if it's doing something that you don't enjoy doing, chances are that won't be something that you'll sustain for a very long time. And it's good to vary routine so that you avoid boredom. Even if that's true with doing an exercise tape, and there are some excellent walking programs and exercise tapes out there but it's really good to vary your program and what you're doing.

A couple of very easy things are the 10,000 step program, and I think many of you have probably heard about the 10,000 step program. It's wearing a pedometer, and about 2,000 steps is a mile, so 10,000 steps is about 5 miles. And there has been some really good research to show that people who walk 10,000 steps or more are healthier than people who don't. Does anybody in here wear a pedometer on a regular basis? So okay, I just see like maybe a couple of you. Even if you don't do it on a long-term basis, I really encourage you to get one and even wear it for a week to discover how much you walk, and you might be like really shocked. I mean the first time I did this and I thought, you know, I had a reasonably--I knew I had a sedentary job but I thought I'd walk, I had to walk from the ramp to my office. I discover that it was very predictable for me to have about 3,000 steps a day and to get up to 5,000, 6,000 steps I had to really work. Now I know that if I don't get under my belt 4,000 steps before I get to my office because I walk, it's unlikely I'll reach 10,000 steps. So I really encourage you to just go out, buy a pedometer and try it out.

The next category I wanna mention, the next dimension of health is a whole area of stress mastery, and this is a huge area in terms of taking charge of your health. A lot of research on acute stress as well as chronic stress, and acute stress can be a good thing, the whole fight or flight response. So when we're in an urgent situation, our body responds in a predictable way. But chronic stress is what takes its very negative toll on the body. And stress, chronic stress can really negatively impact every system of the body. And if we had time to talk in here about where you hold your stress, I'm sure we'd hear lots of different stories. For some people it's in their head, they get headaches, for others it's in their shoulders or their back, for others it's in their gut. So it's--it really varies where people feel stress. The effect between stress and the human body has been very, very well established. For decades now, there has been this field called psychoneuroimmunology. We know that our minds and our thoughts are directly connected to the nervous and the immune system. So the mind-body connection is not something that's just in your head. It's something that's very real.

So a few tips about stress mastery, one of the most important things is to begin to identify sources of stress in your life, what are the sources of stress, and become aware of where you hold stress in your body and then begin to learn ways of how to manage that stress. At the Place… of wellness, there are classes that you could take in mindfulness relaxation, and there are other ways to learn to manage your stress, whether it's tai chi or whether it's walking or play the piano or hobbies. One area that I've been very involved with is a type of stress reduction called mindfulness based stress reduction. And I'm guessing that some of you have heard about that, some of you might have even been through classes. It's a type of teaching people how to reduce their stress that began now like 25 years ago by Dr. Jon Kabat-Zinn at the University of Massachusetts, and he was working with people that had chronic pain, pain that nothing else seem to be able to effectively touch. And they began a program of meditation. That involves several forms of meditation, a walking meditation, a sitting meditation, learning how to do a body scan and some gentle hatha yoga.

And this is a very secular practice. Sometimes people, when they hear of meditation, think, well that's religious and I don't know if I wanna do something that's religious. The practice of mindfulness meditation is secular. It's a very self directed practice for relaxing the body and calming the mind. And the way it works is by focusing on present moment awareness. And I was--somebody before the session started tonight was saying to me, "You know, I just have such a hard time meditating. I know you do meditation research and I just, when I try to meditate, I just--my mind just, you know, I start thinking all kinds of things." And I was telling her about a wonderful meditation teacher we had in the couple of months ago with the Center for Spirituality and Healing, and I understand he's been here as well, Mingyur Rinpoche. And in a very large auditorium filled with people, many of whom were very anxious about the idea of meditation. He invited them to sit in their seats and he said, "No, don't meditate but just close your eyes and just relax." And he encouraged them to start focusing on their breathing. And we actually went through like 3 or 4 minutes of sort of that gentle relaxation and belly breathing. And after it was over, he said to the people, "How did that feel?" And the people gave responses. And he said, "That was meditation." And it was--it helps people so much diffuse. That was one type of meditation. It helps people diffuse so much they're sort of--sense of it something, sort of mystical or ethereal that they can't do.

In terms of my own research and Shelly asked me to mention that. I have done a number of studies with mindfulness meditation. One is a study that we just finished with people who have had transplants, heart transplants, lung transplant, liver, heart- lung transplants. And the transplanted organs function very well, we actually have, you know have miracles in this country in terms of transplants. However, a lot of people have a lot of compromised quality of life because they can't sleep, they're anxious and they're depressed. So those are the symptoms that are sometimes most impaired post-transplant. And in this--first a pilot study and then in the 5-year clinical trial, we found the symptom that was most impacted by teaching people MBSR, mindfulness-based stress reduction, was sleep. And then we actually had some people say to us, "I'm 3 years post-transplant and never could sleep. Within 2 weeks of meditating, I can't believe it, I was able to sleep." It somehow broke that cycle of anxious rumination, you know, when you start just kind of ruminating about an idea. So because we were buoyed with that success with insomnia, difficulty sleeping, and because a 5-year clinical trial can be a long time, we thought, well let's start another study and let's actually look at people that have chronic insomnia. And you know, if you're watching TV, how many ads do you see for sleep aids? I mean it's huge, it's all--it's all over there. There are lots of side effects from sleep medication. So in terms of how the pharmacy and how much money we spend in kind of, you know, morbidity associated with that, it's high. So we actually are just finishing a clinical trial now, a randomized clinical trial where we've actually put people in Lunesta, a sleep drug or mindfulness-based stress reduction. In order to find out is MBSR as good as. So stay tuned for the results, but I can tell they're actually looking quite positive.

But many other ways to manage your stress, and I don't believe one size fits all. I don't think meditation is for everybody. There are expressive arts therapies, breathing techniques, imagery, body work, walking the labyrinth, so many other ways to do it.

Few things I wanna say about emotions and attitudes, and that's a huge area. A lot of research is done, has been done looking at the effect of negative emotion and positive emotion on health outcomes. And we know that anger for example and personalities, where sort of anger is just kind of, you know, always present, as well as cynicism. Those really contribute to adverse outcomes. And there's relationship between being hopeful and health outcomes and between being hopeless and having a higher mortality. So, positive psychological states are associated with positive wellbeing. Negative attitudes, people can actually study the immune system and look at the effects of negative attitudes on the immune system. I think it's wonderful to see more and more research coming out on the whole topic of forgiveness. So when we fail to forgive somebody when we hold on, who do we hurt by doing that? Absolutely ourselves. You know sometimes I think we think naively, we're sort of hurting the other person, but lots of research that that just sort of eats us up inside, and so that's an important piece.

Relationships and family, a critical dimension of health. There are--and this has just been established and study after study, there are health risks of being alone or being isolated. And this I think is stunning. The health risks of being alone or isolated are comparable in magnitude to the risks associated with cigarette smoking, blood pressure and obesity, so it's huge. I'm sure some of you read the book "Bowling Alone" by Robert Putnam. It came out a number of years ago. He's a professor at Harvard University and he wrote about this whole phenomena of the fact as a society more and more, we are literally bowling alone. We go to movies alone, we eat alone, and what he was talking about is the importance of community and the importance of relationships and how this is something that we really need to look at in our lives. There was a very interesting and very old classic, a public health study that I love to talk about, the Roseto Study; it was a community in Pennsylvania. And this community in Pennsylvania, they had terrible health habits in terms of what they ate. They were overweight. They didn't exercise. But when people went in and they were looking at cardiovascular risk factors, they found out that even though these people were off the chart, really high risk factors, they didn't seem to have cardiac disease. And what they determined was that it was the social fabric of the community that served as a protective force and that when people left the community, their risk went up. So the risks seem depressed while they were in the community and it was because of that, that positive social factor. And when they left then, the risk would go up.

So, important questions to ask yourself about relationships and family, do you make time for the important people in your life? Do your personal relationships feel balanced in terms of giving and receiving? So if you're somebody that's always giving, giving, giving, giving, giving, do have friends where there is a balance of giving and receiving so that you're not just always putting out and never getting back. Do you listen attentively to others without judging? So in other words, are you a good friend, are you a good listener, and do you have a social support network, all important pieces.

The next dimension I wanna say a little bit about is spirituality, life purpose and service. And this is another, I think, fascinating area to look at. And the whole question of what is it that I care about, what am I committed to, what is the reason I get up in the morning, what are the hopes, gifts, intentions, do I bring to the world? We have a senior fellow at the Center for Spirituality and Healing, Richard Leider, who has published many books on purpose. And so you may have read "The Power of Purpose" and then he's written "Repacking Your Bags" and the new--one of his newer books is called "Claiming Your Place at the Fire" finding purpose in the second half of life. But he did an interesting study fairly early in his career. He interviewed people over the age of 65 and he asked them one question. He said, "If you could do your life over, what would you do differently?" And people said 3 things, they would be more reflective, they would be more courageous, and they would be clear earlier about purpose. So the interesting thing about purpose is that purpose is something that is inside each and every one of us and we often talk about purpose as being a real important dimension of spirituality. It's unique to individuals. It's not something that you can copy somebody else's purpose. And purpose is something that evolves. It's very different than a career. Sometimes people have a mistaken notion, well, I was supposed to figure that out when I was getting out of high school or getting out of college or sort of embarking on a career. But people who have studied adult cycles of development said it's very normal every 10 years to be reflecting on and rethinking your purpose. So the four questions I would encourage you to be pondering are the questions: who am I and where do I belong, what do I care about, and then ultimately that question of, what is my purpose in life. Often this becomes more than an existential crisis for people as they approach retirement. So a lot of work that we do in the center that I'm in, is that whole question of so much of my identity has been my job, what do I do after my job is over.

So summarizing that piece, what are some steps to a healthy lifestyle? There is a Mayo Clinic physician that wrote a book called "How Not to Be My Patient", Dr. Creagan. And I love this, the eight summary he has, "How Not to Be My Patient". And they parallel almost perfectly, I think mirror what I've been talking about. Form stable long-term relationships, maintain an ideal body weight, eat a plant-based diet and make sensible food choices and engage in regular physical activity. Don't smoke. Use alcohol in moderation. Foster a sense of spirituality, whether that as connectedness to nature or a higher purpose, and find purpose and meaning in life.

So as I began, I said there were 3 things I wanted to talk about and I've talked about developing a personal plan for health and wellbeing. I'm gonna talk a little bit about navigating the health system and then exploring healing choices. In terms of navigating the health system, I think one of the biggest challenges that we've had is that often I think we are afraid to ask for what we need. And it's very important to find healthcare providers who meet your needs. And I have family members and friends who have terrible relationships with their healthcare provider and yet they're afraid to change. They somehow feel well I was assigned to this person or I'll hurt their feelings or make them feel bad if I change. And my advice is that you absolutely need to find somebody who meets your needs. And sometimes I hear people say, "Well, technically they're really good. They have terrible bedside manner, but technically they're good. They are competent." And I often say, "Well, that's good but you can find somebody that's both." Learn to communicate effectively with your healthcare providers. I really encourage people to write down the questions that you have. And don't be afraid to do that. Don't be embarrassed to take out your piece of paper and go through what your questions are, and don't save the most important question to the end. That's so often what happens, is that when people are going for a health visit, health visits are shorter and shorter. And so the doctor, the nurse practitioner might give an opening question and you might use two thirds of your time or maybe seven-eighths of your time and you haven't gotten to the real reason why you came.

Find and evaluate health information on the web and elsewhere. And I think the web is wonderful, but a lot of information on the web is absolute junk and it's selling things that are crazy. And through your education center here, actually classes are taught about how to search the web and I really encourage you to check those out so that you can make informed choices regarding your healthcare. So I've been saying taking charge, take charge of your health but make informed choices. I think that's not something that you can just do blindly.

And then finally, I wanna say a little bit about exploring healing practices. And this is such an interesting area. This is one that Dr. Cohen has been in for a number of decades as well. And it used to be back in the '70s, people talked about alternative medicine. And the notion was that alternative medicine was really kind of counter culture, people on the fringe, on the edge, and the name suggested that it was an either/or mentality. So if you're a woman diagnosed with breast cancer for example, that you could either do surgery and radiation and chemotherapy, or you could pursue whacky alternatives. And that probably wasn't entirely the case ever but that was the notion people had in their mind, and that's the idea that the label alternative medicine conjures up.

In the like mid '70s, the term complementary medicine was being used more and more, and the idea between comp--of complementary medicine, not that it was free, you'll see it spelled with an E, was that it was the complement conventional care. So you have conventional care and these other kinds of therapies come in and complement. And many people say, you know, that's just not really the right term. The right idea is what you're doing here at M.D. Anderson, creating integrative care and looking at how do we draw together the best of conventional medicine with complementary. The biggest question I get to ask, and I get to ask this a lot when I do media interviews I'll say, "Evidence, is there any evidence for any of this?" And I often say, "Well, you know what, it's a young field." And yes, for some of this there is very solid evidence and you look at mind-body, you look at acupuncture, there is more evidence. But it certainly is an area that's fairly young in development. How strong is the evidence? It's early in development. There have been very few large, very large randomized controlled clinical trials. So I think it's an area that, you know, we need to continue to pursue that.

So trying to decide whether you should explore healing practices, what I often say to people is, there are considerations. You need to look at what is the risk, what is the benefit, what is the evidence, if there is evidence, what's the cost, and then ask yourself that question, is there a fit, is it right for me. So I'm gonna talk about just a few of these therapies and then we'll open it up for questions. One of the therapies--and this is one that many cancer patients use is acupuncture, and acupuncture is actually one of the most thoroughly researched and documented of the so called CAM. People talk about complementary and alternative medicine practices, so much so there had been consensus, documents done on acupuncture that many people say it doesn't even belong on the list. Well, nothing is good for everything. And so do I--would I ever say acupuncture treats everything? No. There is really good evidence that acupuncture is effective for chronic pain, for migraine headaches, for degenerative joint disease. And there have been a number of studies that have shown very effective for treating chemotherapy induced nausea. So those are the kinds of areas where acupuncture has been effective. There is such wonderful research happening at The Place… of wellness in your integrative medicine program here, and there is a study that as I'm going now looking at acupuncture for chemo induced peripheral neuropathy. So, such an important area to be looking at, you know, how can we prevent or treat that. Another study I think you're doing here is on acupuncture and pain. So that's a reasonable area to consider. And to be an acupuncturist isn't something that people do at night school. It's a 3-year course of study. There are about 7,000 TCM practitioners, Jewish and Chinese medicine in the US. And then there are some physicians who practice medical acupuncture.

Another area is the mind-body therapies, and this was a cover from a special issue of Time Magazine, how your mind can heal your body, the new science of meditation. They talked about the various types of mind-body therapies that could be pursued, and the research that's been done on those.

Another area is manipulative and body based methods, and particularly massage. So this category includes things such as massage, osteopathic medicine, cranial sacral therapy, chiropractic and body work, different kinds of like rolfing and shiatsu. But some very interesting studies of massage with cancer patients and the discovery that it can promote relaxation, it can reduce stress and anxiety, it can reduce pain, and it can improve mobility.

And so with these two examples that I've given you, well three, between acupuncture and meditation and massage, you could ask yourself the question, what's the risk? Well, the risk of this is quite low. What's the benefit? Well, it's potentially quite high. What's the evidence?

Depending on what you're talking about, it's mixed, and some of these things with acupuncture, it's actually fairly high and with some of the mind-body interventions. And so that kind of helps you then decide, you know, is that something that you wanna pursue.

A more controversial area that I wanna just say a couple of things about are biological-based therapies that include things like botanical medicine, clinical aromatherapy, essential oils and special diets. And particularly in the area of botanical medicine, that's a really mixed bag and it's a complicated area that includes not only herbs but vitamins and nutritional supplements. And in this country, it's largely an unregulated industry. So there are lots of issues with product purity and standardization. And so it is one of those issues that, you know, buyer beware. If we were to kind of open up your medicine cabinets and see what's there, it's very common that you would see things like gingko, believed to improve mental clarity, but absolutely should be stopped before you have surgery or it can prolong bleeding. Valerian, that might help with sleep. Saw palmetto, some studies have showed effective with chronic prostatitis. St. John's wort is an interesting example of one that can be dangerous. I mentioned to you I work with transplant patients. There are studies that show that people that take St. John's wort that that can interfere with their immunosuppressive drugs. So if they've had a transplanted organ, they have to be taking those immunosuppressive drugs. They're on St. John's wort, that can increase the risk of rejecting their organ. Echinacea, lots of people will swear by it, the studies haven't come through as strongly as some of the proponents would like them to. That was believed that it can decrease the duration and the frequency of the common cold. So on botanical medicine, the research evidence is mixed on studies of efficacy and I think the biggest take home message I can give you is that not everything that is natural is safe. So there are some things that are natural that can kill you.

Final few comments about this whole field of integrative oncology, Dr. Donald Abrams is an Integrative Oncologist at UCSF. And he describes integrative oncology as the evidence-based combination of complementary interventions with conventional therapy into an individualized therapeutic regimen that addresses whole person living with and beyond cancer, body, mind, and spirit. Why does integrative medicine applied to oncology so important? Because if you sort of look at surveys of everybody who uses integrative medicine approaches, the vast majority of people have chronic illness, and some studies show that as many as 90 percent of people who are diagnosed and receiving treatment for cancer are using these integrative therapies along with conventional care. So what does an integrative oncology approach look like? There are preventive things that you can do. There are things that you can do to enhance your immune system, and many things that you can do to manage your symptoms. And so manage symptoms of pain, nausea, stress, anxiety, and other symptoms resulting from illness or from the side effects of conventional treatments. So as I was talking about acupuncture and pain and massage to promote relaxation and meditation to help improve sleep, those are all examples of integrative approaches.

The Place… of wellness at M.D. Anderson, and you have materials to pick up outside, includes all of these kinds of services. It truly is a remarkable center that includes nutritional counseling, massage, acupuncture, music, mind-body therapies, spiritual counseling and support, exercise and PT. I also understand that there are some energy therapies. There is some Reiki healing touch. And the use of essential oils is very, very common. Things like lavender to improve sleep, ginger to help with--would help nausea. Integrative oncology is never advised in people to forego evidence-based treatment in favor of unproven therapy of--that's of known safety and efficacy. So I'm trusting that you're hearing that message strong tonight, that an integrative oncology approach says, "How do you explore together the risk, benefit, evidence, cost, and fit of all treatments, conventional and complementary?" So that's another notion to think about. So the same questions that you're asking about, these integrative options. You should also be asking those same questions about the conventional options.

So my final message to you about taking charge of your health is first of all, start being more intentional. Make a health plan for yourself and make that sort of, you know, part of your life planning. Be informed, it's not okay to make decisions if they're not informed decisions. And then lastly, be involved. Really become an active participant in your care. For so long, I think people had the idea that they needed to just be on the receiving end and be passive recipients of care. And there is lots of evidence that people are more successful navigating the system if they're involved. So with that, I put the website up of the center. We have a lot of consumer education information on there, and I'd be really happy to answer any questions that you might have.


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