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Three sessions: 4 May 2016, 6 July 2016, 24 August 2016
Total approximate duration: 5 hrs 25 minutes
Interviewer: Tacey A. Rosolowski, Ph.D.
To supporting materials, please contact:
Javier Garza, MSIS, firstname.lastname@example.org
About the Interview Subject:
Lorenzo Cohen (b. November 14, 1964, Rome, Italy) came to MD Anderson in 1997 as an assistant professor in the Department of Behavioral Science in the Division of Cancer Prevention and Population Sciences. Since 2002 he has served as director of the Integrative Medicine Program. He has primary appointment as Professor in the Department of General Oncology and the Department of Palliative, Rehabilitation, and Integrative Medicine, both in the Division of Cancer Medicine. Dr. Cohen has been responsible for developing the largest and best-funded integrative medicine program in the nation, with the widest research to build the evidence-base for the value of integrative approaches.
Major Topics Covered:
Personal and educational background; early experiences with nutrition, yoga, eastern practices, alternative healing
Clinical psychology research; stress, impact of stress on cancer patients
History of integrative medicine as a field
History of integrative medicine at MD Anderson; the Place of Wellness; Integrative Medicine Program; acceptance by MD Anderson clinical faculty
Innovative research: yoga, stress management, meditation, hypnosis, alternative medicines
Partnerships with other institutions and programs
Comprehensive quality of life study
New book on quality of life practices
Regarding the Transcript and Audio Files
In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 4 May 2016
A Family Experience Rich in Influences
Chapter 01 / Personal Background
A Path to the Emerging Field of Health Psychology
Chapter 02 / Educational Path
Professional Goals Coalesce During a Post-Graduation Gap
Chapter 03 / Personal Background
Identifying a Purpose
Chapter 04 / Professional Path
A Graduate Focus in Health Psychology
Chapter 05 / Professional Path
Interview Session Two: 6 July 2015
Early Research and the Art of Grantsmanship
Chapter 06 / The Researcher
Building Psycho-Oncology at MD Anderson; Setting Up Research
Chapter 07 / Building the Institution
Opening the Place of Wellness [The Evolution of Integrative Medicine, Part 1]
Chapter 08 / Building the Institution
A Vision for the Integrative Medicine Center; Building Support among Faculty [The Evolution of Integrative Medicine, Part 2]
Chapter 09 / Building the Institution
Integrative Medicine at MD Anderson: Challenges and the Future
Chapter 10 / Building the Institution
Interview Session Three: 24 August 2016
Research Projects at MD Anderson, the First Focus on Integrative Methods
Chapter 11 / The Researcher
Consolidating the Focus on Mind/Body Research
Chapter 12 / The Researcher
Research with Chinese Partners at Fudan University Shanghai Cancer Center
Chapter 13 / The Researcher;
A New Holistic Focus on Quality of Life and Transformation
Chapter 14 / The Researcher
A New Book on the How-To of Quality of Life
Chapter 15 / The Researcher
The Future of Integrative Medicine
Chapter 16 / Overview
Interview Session One: 4 May 2016 (Listen/Read)
Interview Identifier (Listen/Read)
Chapter 01 (Personal Background)
A Family Experience Rich in Influences (Listen/Read)
In this chapter, Dr. Cohen talks about the rich array of influences his family life offered. He talks about his multicultural upbringing by an American father and Florentine mother. He recalls his summers spent in Italy, notes that he speaks fluent Italian, and observes that Italy feels like home to him. He begins to talk about the maternal line of his family and particularly his grandmother, Vanda Scaravelli, whom the family would visit each summer and who became one of his most important mentors.
He recalls early influences that raised his awareness of the pleasures and health benefits of foo in the early 1980s, his parents did research for their first cookbook (he was their “number one taster”) and that his uncle, Alberto, was a vegetarian and macrobiotic gardener. He recalls their garden in Italy and the “gourmet vegetarian” foods that would be prepared.
Chapter 02 (Educational Path)
A Path to the Emerging Field of Health Psychology (Listen/Read)
In this chapter, Dr. Cohen talks about his educational path and the evolution of his interests. Because of his interest in marine biology, he attended Reed College (Portland, Oregon, BA conferred, 1987), but was uncomfortable with the institution’s policy about early specialization. He explains how he gravitated toward courses in psychology, pharmacology, and physiology, eventually becoming a psychology major. He talks about the professors he worked with and animal experiments he helped conduct on drugs and behavior. He notes that his thesis on the role of alcohol in disrupting complex behavior was published in APA.
Chapter 03 (Personal Background)
Professional Goals Coalesce During a Post-Graduation Gap (Listen/Read)
In this chapter, Dr. Cohen tells the story of his experiences during a two-year gap period after his graduation from Reed College. He begins with the influence of mentor, Arthur Patton, whom he had met at the age of fifteen and who encouraged him to take time off after graduation to spend time with his grandmother, Vanda Scaravelli, and take music and yoga lessons from her. Dr. Cohen describes the impact of this time, particularly on his sense of discipline, noting that his grandmother was his “main mentor.”
Dr. Cohen then talks about his uncle Alberto, who had a dream of going to India and inspired him to go to India for three months.
Chapter 04 (Professional Path)
Identifying a Purpose and a Graduate Focus in Health Psychology (Listen/Read)
Dr. Cohen begins this chapter with an anecdote about an experience he had while traveling in India that convinced him he needed to find a purpose. This motivated him to think about graduate study, and he again gravitated toward the field of health psychology, selecting a program in Medical Psychology at the Uniformed Services University of the Health Sciences, Bethesda, Maryland (MS conferred, 1993; PHD, 1994). Dr. Cohen stresses that his aim was to go into research. He describes research he conducted during his fellowship years [1/1994-11/1995 National Cancer Institute of Canada and The Toronto Hospital, Toronto, Canada, Paul Ritvo; 1/1995-12/1997 Postdoctoral Research Fellowship, National Cancer Institute of Canada, Division of Behavioral Medicine and Oncology, University of Pittsburgh, Pittsburgh, PA, Andrew Baum]. He goes into detail about his work with mentor, Andrew Baum and the value of medical school courses he took in Bethesda.
He then narrates how he came to focus his research on cancer. He observes that the field of health psychology was just forming and framing research questions to explore how psychological processes have an impact on health. He recalls his excitement when reading an influential study published in 1990 that showed that HIV patients who took part in stress management had improved immune markers. He was also influenced by John Kabat-Zinn’s work applying eastern based philosophy to medical problems. He talks briefly about his dissertation research on the effects of surgical stress on the immune system. He recalls that the research pathways available when he left graduate school were “HIV or cancer.” He discusses why cancer was a good choice for him.
He mentions meeting his wife, Alison Jeffries, in graduate school. He explains how he ended up working with Andrew Baum at the University of Pittsburgh, noting that he learned to collaborate with a surgeon and run a small clinical trial.
Interview Identifier (Listen/Read)
Chapter 06 (The Researcher)
Early Research and the Art of Grantsmanship (Listen/Read)
Dr. Cohen begins this chapter by explaining that he transferred his fellowship work to the University of Pittsburgh because he was unable to do the research he wanted at Toronto Hospital: he was approved to transfer his grant money from NCI Canada to do this work.
Dr. Cohen explains that his study originally focused on how group support post-surgery influenced outcomes for men with prostate cancer. This next turned into a study of pre-surgical stress management.
He then talks about the art of writing grants to “market” research to a “reluctant buyer.” He talks about how he adjusted to the medical center environment at the University of Pittsburg and discusses the importance of the support of surgeons for his work.
Chapter 07 (Building the Institution)
Building Psycho-Oncology at MD Anderson; Setting Up Research (Listen/Read)
Story Topics Covered
Dr. Cohen first tells the story of applying for a position at MD Anderson, noting that he wanted to leave the University of Pittsburg in order to become more of a leader in his field. He notes that no one was focusing on psycho-oncology at MD Anderson when he came in 1997; he explains why he was hired, noting that it was rare for a new faculty member to “walk in with an RO1.”
He then talks about the first studies he set up in collaboration with other faculty members. He also talks about learning to work with temperamental researchers and explains that the environment at MD Anderson was very drug focused with little focus on patient experience.
Chapter 08 (Building the Institution)
Opening the Place of Wellness [The Evolution of Integrative Medicine, Part 1] (Listen/Read)
In this chapter, Dr. Cohen talks about how the development of integrative medicine services at MD Anderson began with a survivorship conference in 1997, where patients became enthusiastic about yoga, massage and other complementary offerings and asked, Why don’t we have this at MD Anderson?
Dr. Cohen then describes how the Place of Wellness began as a very small, very patient-driven initiative with very little budget, but nonetheless the first integrative medicine center in a free standing cancer hospital. He notes studies indicating that the majority of cancer patients favored using complementary medicine to supplement standard of care treatments.
Then around 2000, Dr. Cohen explains, the Physician in Chief and John Mendelsohn directed more support to formalize Integrative Medicine as an initiative to improve patient quality of life and conduct research. Dr. Cohen was approached to design the program and sketch a 5-year budget for a center and a department. The program was approved, and the Place of Wellness became a center incorporative research.
Chapter 09 (Building the Institution)
A Vision for the Integrative Medicine Center; Building Support among Faculty [The Evolution of Integrative Medicine, Part 2] (Listen/Read)
Dr. Cohen begins by explaining that he had the vision of turning the Integrative Medicine Center into a Department, but this would take time. He talks about the administrative homes the IMC had over time.
Next he talks about the process of promoting the new array of treatments and services and building support for prescribing these treatments in the medical consultation process. He notes that the Center originally offered more than 200 programs but eventually streamlined in order to offer what could impact cancer outcomes based on evidence.
Dr. Cohen talks about the aggressive promotions he and others did to build awareness of the Center’s offerings and tells several anecdotes to illustrate the process, including how physicians often need to directly experience benefits of complementary techniques in order to support them.
Chapter 10 (Building the Institution)
Integrative Medicine at MD Anderson: Challenges and the Future (Listen/Read)
Dr. Cohen talks about the impact that executive leadership had on Integrative Medicine at the institution by insisting that the program “start small,” but nonetheless has supported recruitments.
Dr. Cohen talks about how John Mendelsohn has served as a mentor for him. He also talks about his shift in perspective, accepting that serving patients is more of a goal for him than transforming the Center into a department. He offers observations about the hierarchical organization at MD Anderson and how this influences getting things done.
Next he talks about obstacles to building integrative medicine into the standard of care.
Interview Identifier (Listen/Read)
Chapter 11 (The Researcher)
Research Projects at MD Anderson, the First Focus on Integrative Methods (Listen/Read)
Dr. Cohen notes that the first phase of his research conducted when he arrived at MD Anderson in 1997, focused on “conventional psychodynamic studies” such as his study of management of presurgical stress in breast and prostate cancer patients.
He notes that a turning point came when he met Alejandro Chaoul, a graduate student at Rice University who was volunteering at MD Anderson, and initiated a study of the effects of yoga on post-surgical lymphoma patients (published in Cancer). He explains the focus of the study, the results, and how it evolved.
Next, Dr. Cohen talks about the life quality issues of primary concern to cancer patients, including fatigue, pain, peripheral neuropathy, and sleep disturbances.
Chapter 12 (The Researcher)
Consolidating the Focus on Mind/Body Research (Listen/Read)
Dr. Cohen explains how his focus on mind/body research intensified once he met Dr. Raghuram Nagaranthna from the VYASSA Institute. He talks about the mission of the institute and explains the organization of the pilot study they ran studying the impact of yoga on the quality of life of breast cancer patients undergoing radiation therapy. He talks about the publicity that this study attracted then tells an anecdote to illustrate how a radiologist became convinced of the value of yoga and became a supporter of the study.
Next he talks about a study of the treatment of “chemo-brain” with Tibetan sound meditation. He then describes new work on the use of hypnosis in combination with local (as opposed to general) anesthesia for breast cancer procedures. He explains the risks of general anaesthesia.
Chapter 13 (The Researcher)
Research with Chinese Partners at Fudan University Shanghai Cancer Center (Listen/Read)
In this chapter, Dr. Cohen talks about the turn his research took when he began to build a research partnership with Fudan University Shanghai Cancer Center [now a Global Academic Partners sister institution]. He first explains that he was interested in partnering with institutions that offered a combination of western and traditional treatments and details why Fudan was a good choice.
Next, Dr. Cohen talks about three clinical trials set up at Fudan, looking at natural products, acupuncture and chi quong. He talks about the results of the studies and the impact on Fudan University.
Chapter 14 (The Researcher)
A New Holistic Focus on Quality of Life and Transformation (Listen/Read)
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.
Chapter 15 (The Researcher)
A New Book on the How-To of Quality of Life (Listen/Read)
In this chapter, Dr. Cohen explains his approach to a new book that is intended to be a practical follow up to Dr. Servan-Schrieber’s more theoretical, Anti-Cancer Living, with Dr. Cohen’s wife, Alison Jeffries serving as the “how to” voice.
He explains the approach taken in the book and how he and Ms. Jeffries approached Penguin/Random House to secure a contract. He also talks about working with agent Doug Abrams.
Dr. Cohen also explains the complexities of basing the book on the in-progess comprehensive life study at MD Anderson. He talks about anticipated criticisms from colleagues.
Chapter 16 (Overview)
The Future of Integrative Medicine (Listen/Read)
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.