Transforming Lives and Healthcare | Dean Ornish | Talks at Google

[MUSIC PLAYING] JACK: Very, very special guest today with us here on Main Campus in building 43 at Google This individual who’s going to speak with us today is somebody who has revolutionized medicine and health care, both here in the US and abroad, with a 35-year career And we’ll hear very soon about the early part of his career, where he really started on a very different track– a track that took him to a lot of new ideas that have brought us to a lot of revolutions across cardiac care, diabetes, and now Alzheimer’s and other diseases as well Our guest today has six books, all best sellers on “The New York Times” Best Sellers list Our guest today graduated from the Baylor College of Medicine and then did his fellowship at Harvard and Mass General Please help me welcome Dr. Dean Ornish [APPLAUSE] DEAN ORNISH: Thank you JACK: Dean, it really is a pleasure to have you here today Here at Google, we’re very, very concerned about looking at health care from many different points of view You actually chaired– you were one of the former chairs– of the Google Health Initiative back in 2007 to 2009, so you’ve had– DEAN ORNISH: With Adam Bosworth and Marissa Mayer JACK: Yeah, so you’ve had a lot of good involvement with Google over the years Let’s actually start at the beginning You’re in medical school You’re in the first, second year of medical school, and right off the bat, something is strange about you What is strange about you, and what realization did you have, and what study did you conduct– even just as a medical student, right then and there– that led you down this new pathway? DEAN ORNISH: I have to say, no one’s ever asked me a question about how strange I was early on [LAUGHTER] I guess that would make me Dr. Strange JACK: Yes, exactly DEAN ORNISH: The beginning, actually, was even before that It was when I was in college at Rice University in Houston, and I became suicidally depressed And it’s a long story, but I met a swami named Swami Satchidananda who, when I was really ready to do myself in– because first I felt like I was an imposter, like I was stupid and then somehow managed to fool people into thinking otherwise And now that I was with a bunch of really smart people– kind of like maybe some people feel when they come to Google, I felt like it was just a matter of time before they figured out that they had made a big mistake in letting me in But I also had a spiritual vision that was really more than I could handle at the time, which was that nothing can bring lasting happiness Nothing external can bring lasting happiness And so the combination of feeling like I was never going to amount to anything, but even if I did, it wouldn’t matter, was like, well, why don’t I just kill myself? Because people who are dead look like they’re happy and peaceful And I was all set to do that, but I got so sick– I’d run myself down so much with infectious mononucleosis– that my parents realized I was a mess I went home to Dallas And as crazy as this sounds, as strange as this sounds, I wanted to get well enough and strong enough to kill myself But in the meantime, my older sister, who had been a child of the ’60s and who had studied with this ecumenical swami had really helped her And so my parents decided to have a cocktail party for the swami Now, in Dallas in 1972, this was pretty strange, as you would say And he started off by saying a little lecture in our living room Nothing can bring you lasting happiness– which I’d already figured out, except I was ready to do myself in, and he was glowing I was like, what am I missing here? And he went on to say what probably sounds like a new-age cliche, but it turned my life around, which is that nothing can bring you lasting peace and happiness and health, but it’s our nature to be happy and peaceful And our whole culture teaches us that if we just get more stuff– more money, more power, more beauty, more accomplishment– then we’ll be happy And he would say, once you set up that dynamic– that view of the world– however it turns out, you’re generally going to be miserable, because until you get it you feel bad If someone else gets it and you don’t, then you feel really bad And it confirms that we have this very hostile, zero-sum game, dog-eat-dog view of the world But even if you get it, it’s great for the moment It’s very seductive I got it I’m happy But invariably, it’s soon followed by– well, now what? It’s never enough Or so what? Big deal It doesn’t really provide that lasting sense of meaning So then we say, well, this didn’t, but maybe that will And one patient years ago told me– he said, the letdown that comes from getting something that I thought would make me happy was so great, I always make sure I’ve got a dozen projects going at the same time so I can immediately shift my attention So– JACK: So you had this epiphany moment just in the college years– DEAN ORNISH: Yes JACK: What led you to decide, then, to go to medical school? DEAN ORNISH: Well, I always wanted to go to medical school Actually, I was going to be a photographer, and there was a photographer named Philippe Halsman who did over 100 “LIFE” magazine covers in the heyday of life And I said, I want to be a photographer like you He said, oh, no, don’t be a photographer It’s a terrible life Be a doctor So then you can take all the pictures you want and you don’t have to worry about pleasing an editor and so on But I actually always wanted to be a doctor, too And so I went from not being able to read the headline on a newspaper when I was in college and tell you five minutes later what it said to doing really well and graduating first in my class and giving the baccalaureate and all of that And I say that just to say how powerful these beliefs are for better and for worse and affecting our lives

So when I went to medical school, I was learning how to do bypass surgery with Michael DeBakey the heart surgeon, who was one of the inventors of bypass surgery And we cut people open We bypass their clogged arteries You tell them they were cured And more often than not, they would go home and do all the things that had caused the problem in the first place– eat junk food, smoke cigarettes, not manage stress, not exercise And their new bypasses would clog up, and we’d cut them open again, sometimes multiple times So that, for me, became the metaphor– the paradigm, or the guiding principle that all of my work for the next 40 years, which is that– instead of literally or figuratively bypassing the problem, let’s treat the cause Sometimes when I lecture, I’ll show a cartoon of doctors mopping up the floor around a sink that’s overflowing, and no one’s turning off the faucet And the idea is that what we’re finding is the more diseases we study, the more underlying biological mechanisms we do research on, the more reasons we have to explain why these simple changes are so powerful and how quickly people can get better to the degree they make them at any age It’s an incredibly powerful and motivating and empowering message So we were able to show for the first time that heart disease was reversible, that diabetes and high blood pressure and high cholesterol People get put on these drugs and they say, doctor, how long do I have to take these? What does the doctor usually say? Forever, right? How long do I have to mop up the floor? Well, why don’t we turn off the faucet? So we can routinely reduce or get people off of these medications We can reverse heart disease, diabetes It turns out, now, that getting your blood sugar down– half the population today is diabetic or pre-diabetic Getting your blood sugar down with drugs doesn’t really prevent all the horrible complications– blindness and amputations and heart attacks and impotence and so on Getting it down with lifestyle, you can prevent virtually all of them And the same is true for prostate cancer JACK: But back then, in the ’70s, when you first had some of these realizations, it was really almost heresy to say that you could stop, let alone reverse, heart disease DEAN ORNISH: Oh, yeah JACK: I mean, in a sense, would you say it was a naivete of somebody just fresh in medical school who maybe didn’t know better that gave you that impetus to say, hey, I’m going to try this and see if it works? DEAN ORNISH: Yes, that was definitely a big part of it And the other part was– having decided not to kill myself, I figured, OK, if I’m going to choose to live, I’m going to lead a really messy life I need to know what’s real and what’s not I need to find out for myself, because I didn’t really trust anyone at that point And that means I was going to make a lot of mistakes And I said, I can live with making mistakes In fact, later when I became a doctor, most people on their deathbeds don’t regret what they did They generally regret what they didn’t do Because if you do something and it fails, then you learn something really powerful And there’s a lot of wisdom that comes from making mistakes– as you know– and learning from them But if you don’t try, then you just don’t know So I figure, what’s the worst that could happen? So I took a year off between my second and third years of medical school, much to my parents’ dismay, and began this study And fools rush in I didn’t know what I didn’t know And so I said, let’s try it, and whatever it turns out, we’ll learn something JACK: But one of your professors was supportive of it, right? DEAN ORNISH: Oh, yeah They were very supportive And that was the nice things about going to medical school in Texas, where they have this pioneering ethos It’s a crazy idea It’s going to fail, but you’ll learn something Go for it We’ll support it When I went to Harvard, it’s so hierarchical there You have to wait till you’re 40 and work in someone else’s lab for 10 years before you even get a chance to do anything like that And I remember, by the way– I mean, things have changed so much since then The idea, even, that the mind affected the body was a crazy idea then JACK: So take us through the four pillars– let’s start with the heart program And it’s very similar for the other programs, but let’s just start with the four pillars that you have now shown And I want to talk about the data in a minute, because here at Google, obviously, we’re very data-focused And what’s, I think, very interesting about your program is it’s not just, oh, people are feeling better Clinically, as you measure their blood, as you measure their biomarkers, through a course of a 12-week program doing these four pillars, you’re actually seeing the biomarker data change over time So take us through the four different parts of how someone can go from having heart disease, worsening heart disease, and now stop it and then begin to reverse that clinically DEAN ORNISH: Yeah, they not only feel better, they are better in every way we can measure And we’re using these very high-tech, expensive, state-of-the-art scientific measures to prove the power of these very simple and low-tech and low-cost and often ancient interventions So we started with heart disease And we found that in just a month, the blood flow to the heart improves– using specthalium scans There was a 91% reduction of the frequency of angina, or chest pain Most people who couldn’t walk across the street without getting pain or make love with their spouse or play with their kids or go back to work, within a week, are pain-free And it wasn’t just a placebo response, because the heart was actually getting more blood in ways we can measure We then did a randomized trial, and we found after just 3 and 1/2 weeks, the ability of the heart to pump blood improved– using a test called radionuclide ventriculography After my medical training, we did the most definitive study using cardiac Positron Emission Tomography, or PET, to measure blood flow to the heart And we found a 400% improvement in blood flow compared to the randomized control group And quantitative arteriography to measure the blockages in the arteries, and we found that they actually got less clogged after one year, and even more improvement after five years– JACK: And again, Dean, this is all without pharmaceutical or surgical intervention? DEAN ORNISH: That’s right The program is– JACK: So give us the four pillars of this program DEAN ORNISH: And it’s been the same in all of these programs, which I’ll talk about in a moment

It’s basically a whole foods, plant-based diet that’s naturally low in fat and refined carbs or sugar It’s not low fat versus low sugar It’s really both And also– JACK: Would you say it’s– on the diet side, would you say it’s close to the Mediterranean-oriented diet, or how should people think about the diet? DEAN ORNISH: It’s fruits, vegetables, whole grains, legumes, soy products in their natural, unrefined forms So that’s the diet The exercise is walking a half an hour a day or an hour three times a week Various meditation and yoga techniques, which has been great at Google [INTERPOSING VOICES] JACK: The third is meditation [INTERPOSING VOICES] DEAN ORNISH: That’s right JACK: You’ll be happy to know we have meditation rooms in almost every building, so, yeah DEAN ORNISH: I know, and I love that And that was one of the things we did back in the day when we were running Google Health– that and trying to make healthier food here, which was fun And the fourth is what we call psychosocial support, which is really love and intimacy Or if you reduce it down even further, it’s eat well, move more, stress less, love more That’s it, boom And the more diseases we study and the more mechanisms we look out, the more we find that these same lifestyle changes have impacts– to the degree people make them We’ve found it to reverse heart disease, diabetes, prostate cancer, change your gene expression, lengthen your telomeres JACK: Now, I want to get to genes in a second But first, I want to drill in– I think all of us would really understand that changing your diet, moving more– yeah, definitely would have an impact on the physiological self But let’s drill into the second two Let’s talk more about how meditation, these mindfulness exercises, really affect the physiological And talk to us– I think there was a Canadian study called InterHealth There’s other studies that you’ve cited and been part of and leading over the years showing the physiological impact of something like meditation Let’s talk about meditation first, then let’s move to the social impact of friend circles and things like that DEAN ORNISH: Yeah, well, meditation is a powerful way of bringing your mind to one focus And when that happens, your fuse gets longer, for lack of a better way to put it Some people say things like, I’ve got a short fuse and I explode easily Well, your fuse gets longer Things don’t bother you as much And when you’re under stress, your body goes through the fight or flight response So all of your arteries constrict Your blood pressure goes up Your eyes dilate These are things that are designed to help you If a mythical saber tooth tiger jumps out in front of you, you want your arteries to constrict and your blood to clot faster, for example, because if you get bitten, you don’t bleed as quickly But we’ve evolved to deal with these intermittent stresses So you’re walking in the jungle The tiger jumps out Either you run away from the tiger, you kill the tiger, it eats you But one way or the other, it’s over JACK: But it’s done It’s not a continual– yeah DEAN ORNISH: Today, it’s just chronic and relentless throughout the day And so these same mechanisms that have evolved to protect us can harm us, or even kill us, because it’s not just the arteries in your arms and legs that can go into spasm or blood clots that can form there It can form in your heart and cause a heart attack, or in your brain and cause a stroke So anything that can manage stress better– virtually every illness has been found to– you’re more likely to have it if you’re under chronic stress And the other side of that is the social factors One of the real radical shifts in our culture in the last 50 years has been the breakdown of the social networks that used to give people a sense of connection and community 50 years ago, most people had an extended family they saw regularly They had a neighborhood with two or three generations of people that grew up together They had a job that felt secure they’d been at for 10 years or more They had a church or synagogue they went to And today, most people don’t have any of those– maybe one And we know that those things affect the quality of our lives, but they actually affect our survival And to a much larger degree– one of the books I wrote was called “Love and Survival,” back in 1998 And it reviewed what were then hundreds– and now literally thousands– of studies showing that people who are lonely and depressed and isolated are three to 10 times more likely to get sick and die prematurely from pretty much everything than those who have a sense of love and connection to community So I think– JACK: And one of the studies, also, that you cite looks at predictors based in high school and college years of prediction of health over this 40-year period And it was the social bonds, actually, that were very much determining a lot of that health over many years DEAN ORNISH: That’s right They also did a study at Harvard Medical School where they gave one questionnaire to a group of Harvard students and said to rate how close they were with their parents 30 years later, only 15% of the people that were close with their parents had chronic diseases in midlife, and yet the majority of those who weren’t did Now, you might say, well, how could one questionnaire do that? Well, how you– JACK: So note to the audience– everyone should call their parents after this OK DEAN ORNISH: So intimacy is healing Anything that brings us together is healing Even the word healing comes from the root to make whole Yoga is from the Sanskrit to yoke, to unite, to bring together, union These are really, again, old ideas And so when we have that sense of love and connection and community, it not only improves the quality of our lives, it improves our survival More than any other factor– more than smoking, more than anything And it also interacts with those People are more likely to abuse them– we tend to say– at Google, there’s this– we are drowning in information, which is awesome I just love, because I can just pick out anything anytime I need it in Google But information is not enough for most people to change their behavior I mean, if it were, nobody would smoke

It’s not like you go, hey, Jack, I want you to quit smoking It’s really bad for you JACK: Right, the rational argument itself does not seem to be sufficient DEAN ORNISH: Yeah If I say, Jack, I want you to quit smoking It’s bad for you I didn’t know I’ll quit today Everybody knows it’s bad for you It’s on every pack of cigarettes But so then I ask, why do you smoke? Why do you overeat? Why do you drink too much? Why do you abuse yourself? And I used to ask patients in our studies, because we got to know each other I’d say, teach me something Why do you do these things? They seem so maladaptive And they say, you don’t get it They’re not maladaptive They’re very adaptive, because they help us deal with our loneliness, our depression They say things like, I’ve got 20 friends in this pack of cigarettes, and they’re always there for me, and nobody else is You’re going to take away my 20 friends? What are you going to give me? Or food fills that void, or alcohol or opioids numb the pain, or working all the time is a more socially acceptable way of numbing the pain, or video games or whatever So we’ve learned that it’s not enough to give information It’s not enough to focus on the behavior We need to deal with the deeper issue– the loneliness, the depression, the pain And so we create support groups that are not really designed to help people stay on the diet They’re designed to create a safe environment to recreate what people had 50 years ago– a safe environment I mean, right now– social networking was supposed to really bring us all together Facebook has, what, 1.6 billion people? But it actually has, often, a way of making you feel more lonely and more isolated, because most people don’t– if you grow up in a family with two or three generations, they know where you messed up And you know that they know, and they know you know that they know, and they’re still there for you And there’s something really primal about that JACK: There was an analysis called “Bowling Alone”– [INTERPOSING VOICES] JACK: –which is all about how– ’50s and ’60s, there were these bowling leagues, and people had their shirts and they had their bowling ball They had the initials My dad has a bowling ball still with his initials on it, and he had a bowling league growing up DEAN ORNISH: So that’s why JACK: But now we’re, quote, “bowling alone,” because we don’t have those types of– [INTERPOSING VOICES] DEAN ORNISH: Yeah, or you look at someone’s Facebook profile or their Facebook feed, and it looks like they have the perfect life And it’s like, why don’t I? Or their bio sketch, they look great They don’t talk about all the things they’ve messed up And so in our support groups, we just create an environment and say, look, let down your emotional defenses Just talk openly and authentically about what’s really going on in your life without fear that someone’s going to judge you or criticize you or give you glib advice So somebody might say, I may look like the perfect dad, but my kid’s on whatever– some drug And instead of someone else saying, oh, well, why don’t you send them to a drug rehab program– like they hadn’t thought of that– it’s like, what feeling does that evoke in you? And share it as a feeling Oh, I’m really sad to hear that Or gosh, my kids have other problems, or I used to have a drug problem, whatever Suddenly, it doesn’t fix the problem, but it fixes the loneliness and the shame and the isolation It’s the part of my program that most people have the most apprehension about Most people think it’s all diet, and it’s not But also, it’s the part that’s invariably the most meaningful And we have people that were in our study 30 years ago– they’re still meeting And they didn’t like each other when they first got together They just happened to be going to the cath lab at the same time Because that need for connection and community is a primal, fundamental human need And even if you’ve just scratched the surface of that, you can create a Facebook or a multibillion-dollar company So whatever people out here are doing in the world, to the degree that you can create real, authentic connections between people, it’s going to be that much more successful, and ultimately that much more healing JACK: So Dean, let’s talk about genetics now What’s interesting is, again, people often think of genetics as something hereditary I have what my parents gave me, and that’s what I’m stuck with But what you’ve shown is that these kinds of lifestyle changes– not only, again, the diet and the exercise, but the stress reduction with meditation, the bonds– are actually changing the expression of the genes And so across 500 genes, both in terms of up-regulating good ones and down-regulating bad ones– we’ll get to telomeres in a second, but let’s just talk about those kind of studies that you’ve been involved with where you’ve shown– again, with actual sequencing– to show that the genetic expression has changed with these kinds of changes DEAN ORNISH: Well, just that I mean, so often, people say to me, oh, I’ve got bad genes What can I do? In fact, Bill Clinton is a good example When his bypasses clogged up, one of his doctors had a press conference He said, oh, it’s all in his genes His lifestyle had nothing to do with it So I sent him a note, and I said, actually, it has everything to do with it– not to blame, but to empower Because if it’s all in your genes, you’re a victim What can you do? I said, you’re not a victim You’re one of the most powerful guys in the world And so he began making these changes, and he’s still doing it now, nine years later, which I think sets a great example, whatever your politics, when a former president who was known for not eating particularly healthily does that But we found that, again, it’s another example of how dynamic these mechanisms are In just three months, we found over 500 genes were changed As you say, up-regulating the healing genes and down-regulating the– JACK: So three months of change in lifestyle? DEAN ORNISH: 501 genes JACK: 500 genes DEAN ORNISH: And we published this with Craig Venter in the “Proceedings of the National Academy of Sciences,” and we particularly down-regulated chronic inflammation– genes that cause chronic inflammation– oxidative stress, and what are called the RAS oncogenes that promote prostate, breast, and colon cancer– just like that Again, it’s amazing how dynamic people can get better or worse when they make these lifestyle changes JACK: Let’s talk about telomeres now Talk to us– you’ve been interacting with one of the founders of the whole telomeric medicine– DEAN ORNISH: Liz Blackburn JACK: –science Liz Blackburn– won the Nobel Prize Talk to us about what are telomeres, first of all, for those in the YouTube land who may not know yet? And what findings did you show in terms

of the impact of these kind of changes on telomeres themselves? DEAN ORNISH: Well, telomeres are– the analogy that Liz Blackburn often gives is they’re like plastic tips on the ends of your shoelace to keep your shoelace from unraveling They keep your DNA from unraveling And as we get older, our telomeres tend to get shorter And as our telomeres get shorter, our lives get shorter, and the risk of premature death from heart disease, diabetes, most forms of cancer, Alzheimer’s, goes up proportionate to that Now, she had done an amazing study with Elissa Epel where they found that women who are under chronic emotional stress because they were caregivers of either parents with Alzheimer’s or kids with autism– the more stress they felt and the longer they felt that way, the shorter their telomeres were And they calculated that the difference between the high and low-stress women was nine years in terms of– excuse me, 17 years in terms of longevity But what was even more interesting to me is that it wasn’t an external cause It was how the women were reacting to it that determined its effect on their telomeres In other words, even if you’re in a bad situation, you can mitigate and modulate that by doing the kinds of things we’re talking– by meditating, by eating healthily, by exercising, by having social support And so I thought, well, OK, if bad things make your genes shorter– I mean, your telomeres shorter– maybe good things make them longer So we did a study together, and we found that after just three months, the telomerase– which we published in “The Lancet Oncology”– increased by 30% And after five years, the telomeres got 10% longer, whereas they got shorter in the control group It’s still the only control study showing that any intervention can actually make your telomeres longer And when “The Lancet” sent out a press release, they called it “Reversing Aging at a Cellular Level,” which I think is true And so many of these things that we think are in our genes, we really have a lot more control over Again, not to blame, but to empower JACK: So let’s talk about the medical establishment itself You’ve had a deep engagement there What’s great is that you went through med school You went to Harvard for fellowship, Mass General And so you’re deeply familiar with the core establishment And in fact, you’ve been invited, now– over the past number of years, particularly– to some of the key establishments to give rounds, to actually describe your science So no longer is it something like, what is Dean doing over there? You’re now inside the Cleveland Clinic You’re inside Mass General You’re inside these areas Yet, if you look at the curriculum of med school, if you ask most doctors till today how they were trained and how they’re being trained, we don’t see enough of the kind of science that you’re talking about Again, not just feel-good stuff, but core science and impact What will it take, or what do you recommend as a prescription, as it were, to the med schools– as you talk to deans of med schools around the country– what do we need to do? DEAN ORNISH: Well, it’s a really good question I used to think if we just had good science that would change medical practice and education And to some degree it did, but not nearly as much as I thought What I finally learned– and I learned this the hard way when– I started a nonprofit institute called The Preventive Medicine Research Institute, and we’ve been training hospitals and clinics and physician groups around the country and doing research and so on And so through that, in the early ’90s, we trained 53 hospitals around the country We got bigger changes in lifestyle, better clinical outcomes, bigger cost savings, and better adherence than anyone’s ever shown, and a number of them closed down because we didn’t have the reimbursement So the painful lesson is– if it’s not reimbursable, it’s not sustainable JACK: So you went on a quest– an odyssey DEAN ORNISH: So I went on a quest JACK: And it took you what, just a few months? Joke DEAN ORNISH: Yeah, right It took 16 years, actually Because I’d been working with the Clintons since ’93, and when he was president, I also was working with Newt Gingrich’s daughter, who had had some health issues And so we had the President of the United States, the Speaker of the House, 20 members of the Senate, 30 members of the House– they all said, this is a great idea And they still took 16 years to get Medicare to cover it But they did, and I’m really grateful that they finally did JACK: Just to clarify that– so when people now want to do these lifestyle changes of the diet, the exercise, the stress reduction, and the bonding– that program, now, is now covered? Even though– again, highly unusual situation, because typically, most insurance companies want to cover a pharmaceutical intervention, a drug, a surgical intervention– DEAN ORNISH: Or a device JACK: –but now they’re going to cover– they’re covering something, now, that is not that? DEAN ORNISH: That’s what took 16 years And they’re covering it as a Dr. Dean Ornish program, which is great So we partnered with a company called Sharecare which is– excuse me– Jeff Arnold, who started WebMD, and Mehmet Oz– Dr. Oz– and Don Whaley and others, and we’re training hospitals, physician groups, health systems, and clinics around the country And again, we’re getting the same thing– bigger changes in lifestyle, better clinical outcomes, bigger cost savings, better [INAUDIBLE] We’re also doing these 12-day retreats where people can come from anywhere And Medicare is paying for it, and most insurance companies are paying for it, too And so what I’m learning is that when you change reimbursement, you change medical practice, and even medical education And it is changing It’s slower than I would like It’s been 40 years I’ve been doing this work The president of the American College of Cardiology, last year– Dr. Kim Williams– found that his own LDL cholesterol was really high

Didn’t want to go on statins the rest of his life Did a literature review Came across my work Went on my program His LDL came down 50% Wrote about it in all the medical literature And at the American College of– JACK: This is the head of the American College of Cardiology himself– DEAN ORNISH: That’s right JACK: OK DEAN ORNISH: And he headed a six-hour seminar on lifestyle medicine And lifestyle medicine is using lifestyle to reverse disease and to treat it, not just to prevent it, which I think is the most exciting trend in medicine today And we did a seminar on lifestyle medicine, and over 1,000 cardiologists came That wouldn’t have happened five or 10 years ago So things are changing, and it makes me really happy to see them JACK: So we talked about cardiology We talked about diabetes Let’s talk about cancer You’ve now shown– you did a series of studies on prostate cancer to begin with, and now, I believe, maybe on some other cancers– showing that, again, these kinds of non-pharmaceutical interventions did have a powerful effect, for example, in prostate Talk about that study DEAN ORNISH: Well, prostate cancer is the number one cancer in men other than skin cancer And there was a major study that came out a year ago that looked at a 10-year study of randomized trial– in “The New England Journal of Medicine.” And what they found is that men who had the conventional treatments– which were surgery or radiation– didn’t live any longer than men who did nothing who had biopsy-proven early-stage prostate cancer And yet, the complications of the treatments tend to maim guys in the most horrible and personal ways You’re wearing diapers because you’re incontinent, and you can’t have sex because you’re impotent, in many cases, for no benefit at huge economic cost So I did a collaborative study with Dr. Peter Carroll, who’s the Chair of Urology at UCSF, and the late Dr. Peter Carroll– excuse me, Bill Fair– who, at the time, was the Chair of Urology at Memorial Sloan Kettering Cancer Center When you’re doing something disruptive, it’s good to work with the most respected people, because it’s easier to get things published People believe it And we did a randomized trial, and we found that these same lifestyle changes could slow, stop, or reverse the progression of men who have early-stage prostate cancer– just the lifestyle changes alone So if a guy has a biopsy– their PSA goes up, gets a biopsy The doctor will invariably say, you’ve got prostate cancer– if they have it– and you need to have it taken out, or you need to have radiation But most guys don’t want to do that, but they don’t want to, quote, “do nothing.” This idea of watchful waiting– waiting for something bad to happen– is like sitting under a sort of Damocles, waiting for the other shoe to drop People don’t want to do that They say, I’ve got this cancer growing I’ve got to do something about it So we give people a third alternative An aggressive– if you want to put it in more macho terms– nonsurgical, non-pharmacologic intervention And then Dr. Carroll has developed these algorithms where they can monitor people very carefully and find out, who is that 1 out of 50 people who really would benefit from surgery or radiation? And the others can do this And unlike most things, the only side effects are good ones JACK: That’s great So what is next? You’ve done, now, cardiac, diabetes, cancer Now you’re thinking about Alzheimer’s as well DEAN ORNISH: And by the way, before I forget, if it’s true for prostate cancer, it’d almost certainly be true for breast cancer And Dr. Laura Esserman, who runs the Buck Breast Cancer Center at UCSF, and I have been talking about doing a study for a long time to show that And I’m quite sure that’ll be the case as well JACK: For breast cancer as well? DEAN ORNISH: For breast cancer as well JACK: Great DEAN ORNISH: So what we did– we just began the first randomized trial to see if we can reverse Alzheimer’s disease People are more afraid of Alzheimer’s than anything In fact, James Watson– you know, Watson and Crick– when he had his genome first sequenced, he said, I want to know about everything except the APOE4 gene, which is the one that increases your risk of Alzheimer’s Because why would I want to know if I can’t do anything about it? So we think you actually can do something about it I think we’re at a place with respect to Alzheimer’s very much like we were 40 years ago when I first started doing research on heart disease There’s every reason to think it’ll work There are animal studies, epidemiological studies, anecdotal case reports, randomized trials where they use less intensive lifestyle interventions that could slow or stop the progression I think a more intensive lifestyle intervention can actually reverse it So we’re doing a collaboration with Dr. Bruce Miller and Joel Kaplan at the Memory and Aging Center at UCSF, who run that And we’re going to take 100 men and women who have early-to-moderate Alzheimer’s, randomize them into two groups, put half on the program and not the other, and compare them using PET to look at amyloid and MRI to look at hippocampal volume and looking at cognitive function testing and biomarkers and so on And we’ve raised most of the money that we need to do this, so we’ve already started it We just got our IRB approval last week, and we’re ready to begin And I’m cautiously optimistic You never know, but I’m pretty sure this is going to work And it runs in my family, too, so I have a personal interest in this And if we could show that we can reverse the progression of early-to-moderate Alzheimer’s by changing lifestyle, that would really give millions of people new hope and new choices Because when you lose your memories, you lose everything JACK: Particularly as– in society, our demographic’s getting older [INTERPOSING VOICES] JACK: People age– DEAN ORNISH: Exactly JACK: –and live longer, this is going to be more prevalent So before we turn to audience questions, let me just ask a very practical question for folks here, and also watching on YouTube In terms of the kinds of things that people should do, in addition to the diet, the lifestyle, meditation, stress reduction, and the social bonding, are there certain– in terms of the diet that we get– the nutrition we get, I want to use– the word nutrition may be even better than diet People sometimes confuse diet for a diet–

some kind of– DEAN ORNISH: A way of eating JACK: –bizarre regimen But the kind of supplements that people should think about using or not thinking about using– fish oil supplements, good or bad? Mushrooms? I don’t mean shrooms I mean mushrooms [LAUGHTER] JACK: What are the kinds of things– DEAN ORNISH: Actually, there’s some good studies on shrooms, as well JACK: What are the kinds of things that people should or should not consider? DEAN ORNISH: Before I answer that, let me say one thing that I forgot to mention, which is that with all this interest in personalized medicine, it’s the same lifestyle program that we found could do all of these things It can down-regulate all these mechanisms that could reverse all these different conditions And I think it’s because they share certain common underlying biological pathways, although we tend to silo them as being different diseases, they really may be more different manifestations of the same kind of underlying processes Now, if you’re trying to do a targeted immunotherapy for melanoma– like you so brilliantly– I mean, I don’t know if you know Jack’s dad– is it OK to talk about your dad? JACK: Sure DEAN ORNISH: Jack’s dad developed melanoma Now, most people, when their dad develops melanoma, they go, oh, that’s so bad I’m so scared Jack, who’s not an oncologist, decided he would learn everything he could about melanoma, developed a treatment– an immunotherapy– and his dad is cured So that’s Jack JACK: I didn’t develop it myself We supported other people’s work DEAN ORNISH: Yeah, but you were the one who actually directed that It wasn’t just giving them money It was actually saying, let’s study this Let’s see what happens It was really your work that they put into practice So if you’re doing something like that, I think a targeted immunotherapy or whatever is brilliant But for the vast majority of chronic diseases, it’s these same lifestyle changes that can prevent and reverse them And it’s not all or nothing I wrote a book called “The Spectrum,” which was based on the finding that in all of our studies, the more you change, the more you improve in every way we can measure So if you have a life-threatening illness, that’s more of the pound of cure You really do have to make big changes That’s why we were the first to proe that, because most people didn’t go far enough But if you’re otherwise healthy, if you indulge yourself one day, eat healthier the next If you don’t have time to exercise one day, do a little more the next You get the idea In terms of supplements, the ones that I take– I take fish oil every day I think in general, it’s better to get your nutrients from food, but I think Omega-3s may be an exception to that if you’re going to eat fish, because– JACK: I guess that’s my question In other words, it’s obviously better to get it from food, but what is available to us in the average– even organic– grocery, what do you feel is missing from that general availability that we may want to think about [INAUDIBLE]?? DEAN ORNISH: I think the Omega-3s and fish oil are really worth doing, because there are no clean fish All fish are contaminated with either mercury, dioxin, PCBs– bad stuff in varying degrees But when you take the fish oil, if you take certain brands, they remove all the bad stuff so you just have the pure [INAUDIBLE] Or you can take the plankton-based Omega-3s, which are vegan, which is really where the fish get it from anyway–from eating the plankton And then you don’t get the bad stuff, either So I think three grams of fish oil or flaxseed oil or a plankton-based Omega-3s a day are a really good idea I think that depending on– I think the probiotics, actually– there’s a lot of– we’re actually also doing some studies on the microbiome JACK: The microbiome Let’s talk about the microbiome a second Just describe that DEAN ORNISH: Well, you know, there are trillions of cells in our body that we exist in a homeostasis with, and we’re just realizing how powerful those are– and again, how dynamic you can change your microbiome We did a pilot study We found in just three days, we could show significant changes in the microbiome in healing directions So I think for most people, if you’re not eating a particularly healthy diet, taking one of the microbiome supplements can be a good thing The Omega-3s we’ve talked about I think most people don’t get enough vitamin C in their diets, so taking 500 or 1,000 milligrams of that is a good idea The turmeric– I know you like to drink turmeric tea, which we share– [INTERPOSING VOICES] JACK: Right here Here it is DEAN ORNISH: Turmeric is a very powerful anti-inflammatory This is one of the reasons why it’s been linked with reducing Alzheimer’s, but also other conditions Most people aren’t going to drink enough turmeric tea or eat it in their diet– or curcumin– so I take a supplement It doesn’t make you smell like curry, and those were good So those are the things that I think most people can benefit from JACK: Cool Let’s turn to the audience Is there questions from the audience? Why don’t we start? You have a question? Yeah, let’s use the microphone Make sure the microphone’s on so our YouTube audience can hear AUDIENCE: I guess it’s on JACK: Yes Tell us your name and what your question is Let’s keep your questions short, because we want to get a lot of questions in Go ahead AUDIENCE: My name is [INAUDIBLE] Thanks for coming and giving us this excellent talk DEAN ORNISH: Thank you AUDIENCE: My question is about– so my dad– so I’m an Indian, and my dad lives in India and he’s having heart disease So my question is, how are your diets mapping to Indian food? Because food, as you said, is a major part of the plan But if the food is– so Indian food is typically pretty [INAUDIBLE] But if we move into a different kind of diet, then he will not like it and he’ll probably reject it So how is that going? DEAN ORNISH: There are a couple of doctors in India that are offering my program there And it’s working really well They have thousands and thousands of people who have gone through But you’re right, the traditional Indian diet, even if it’s vegetarian, is generally high in fat with all the oils and so on, and also

generally high in ghee and butter and things like that, and saturated fat and so on So there’s a lot of room for improvement And for whatever reason, people of Indian descent are usually more predisposed particularly to type II diabetes, and often to heart disease So these lifestyle changes are even more important And unfortunately, what’s happening in India is happening in China, is happening in most of the developing world– is that they’re starting to eat like us and live like us, and all too often die like us And 50 or 60 years ago, heart disease and diabetes were really pretty rare in India and in China And now they’re by far the number one causes of death And it’s diverting a lot of precious resources from things that really do require drugs, like AIDS, TB, and malaria– the things that can be largely prevented, or even reversed, by changing lifestyle So copy our successes, but not our mistakes JACK: Thank you Other questions, please AUDIENCE: So I have two questions JACK: Your name and then question, please AUDIENCE: My name is [INAUDIBLE] Two questions So is there some effort to develop the recipe books for, let’s say, different parts of the world? So I suppose you’ll need like 20 different recipe books for different parts of India DEAN ORNISH: Can you say it just a little slower? AUDIENCE: Sure [CHUCKLES] So are there some efforts to develop recipe books for the different parts of the world? JACK: Recipe books? AUDIENCE: Yeah JACK: Yeah AUDIENCE: Customized to the spices and ingredients found in different parts of India, for example? The second question is, do you have books or something for teenage kids? So what are we doing about teenage kids in USA? JACK: Teenage kids, yeah DEAN ORNISH: Yeah, yeah, well, we don’t have anything that’s specific to India for spices But I’d love it if you or someone like that could– JACK: We have some recipe books But I don’t think– DEAN ORNISH: Oh, we have [INAUDIBLE] Yeah, there are hundreds of recipes in all of my books but nothing specific to Indian food JACK: So maybe a new collaboration, I think DEAN ORNISH: Yeah, maybe so That would be great if you could do that JACK: How about teenage– DEAN ORNISH: I’ve got a 17-year-old son and he was vegetarian until he hit about 14 or 15 And he said, look, Dad, it’s either meat or heroin What do you think? So I said, meat, good choice [CHUCKLES] He had to rebel in some way But when he was younger, I learned that even more than being healthy, whether you’re six or 60, people want to feel free and in control And he’s a pretty strong-willed kid And Jack has been mentoring him, which we’re very grateful for And I knew that if I told him he couldn’t have certain foods, he’d want them And he’d probably develop an eating disorder So I said, look, the rule in our family is nobody can tell you what to eat, not even me, and I’m your dad, and I know more about food than a lot of people, because it’s your body You control it This is why we eat what we eat But you decide what you want to have And so we taught him how to read labels So he’d go into a store and say, oh, that has too much of this Or I don’t think I should have that Now that all shifted when he went through puberty But I think that the idea of empowering your kids and teaching them and if you can help them grow food and actually see where it comes from or visit a farm if you don’t want to do it yourself, it’s magic to them And they get their taste when they’re younger, their taste preferences, which are really malleable So if you tend to feed them healthy food from the beginning, they begin to actually prefer those kinds of foods So I haven’t read a book yet like that, but I’d like to But Bill Sears has written some good books about that JACK: Bill Sears? DEAN ORNISH: Yeah JACK: Yeah I think it’s so challenging, because particularly here in the US, there’s so much packaged food and even, quote, “healthy” packaged food It does make it easier for a very busy parent You’re a busy parent You have lots of kids You’re feeding things like that, and you just get a lot of packaged food But it is disconnecting us from the source of the food and where things are from DEAN ORNISH: It’s true JACK: It’s something that unfortunately is a major challenge that– DEAN ORNISH: Well, to the extent at least the meal kits or whatever can be used to– the meal kits are different than the frozen foods, and so on, because you’re actually making dinner But they just have done the hard part So it makes it easier And there are studies that show that just when the family sits down together to have a meal together, just the sitting down together, there’s better academic performance, lower truancy, lower illness, all the kind of things that you want Again, it goes back to the social factors and the power of community and family JACK: Great Other questions, please Your name? AUDIENCE: Hi, my name is [INAUDIBLE] My question is about what are the things we can adopt and encourage that can help build a stronger immunity against diseases JACK: Stronger immunity, yeah DEAN ORNISH: Well, one of the most powerful things you can do is to actually have more love in your life, believe it or not There was a study that was done by Sheldon Cohen that was in the “Journal of the American Medical Association.” And I don’t know how he got this through the Institutional Review Board, but he got volunteers And he dripped rhinovirus that causes colds in their noses 100% of them got infected But not everybody that got infected actually got sick And they found that the more social contacts they had– the more friends visiting them, the more phone calls, the more love that they had– they had four times fewer signs and symptoms of a cold, even though they were all infected So [INAUDIBLE] is we have this idea that the bacteria or the germ causes the disease But it’s a necessary but not always sufficient factor, even with people who are– Margaret Chesney did a study at UCSF where she found that men and women who were HIV-positive who were lonely and depressed were more than twice as likely to develop AIDS and die from it than those who weren’t So diet is important Exercise is important These all affect our immunity, but probably more than anything, these social factors

And we tend to think that the time we spend with our friends and family is a luxury that we do after we’ve done the important stuff And to me, the value of the science is that it increases awareness So we understand just how powerful those things are, and that the time that we spend with our friends and family is not the stuff we do after we’ve done the important stuff, that it is the important stuff JACK: And that’s also a message for employers I mean, obviously, here we put a lot of emphasis on that People are encouraged to take their vacations, go home, be with their families, things like that So it’s a real message around if you want your employees to be healthy, that it’s just not a nice-to-have, it’s a must-have DEAN ORNISH: And it’s unfortunate that the startup tech world is often the mythical let’s stay up all night and eat pizzas and really run ourselves into the ground And yet, you can do that for a short time But if you really want to keep your creativity at its maximum, as you know, taking care of yourself makes you smarter and makes you work more effectively JACK: Great Other questions Please, right here in the front, and then– oh, good, good There, and then the front We have two mics? OK There– yeah AUDIENCE: So my name is [INAUDIBLE],, and my question is regarding caffeine There’s a lot of confusion regarding whether it’s good or, if so, how much I would love to hear your thoughts DEAN ORNISH: Why do you want to know? [LAUGHTER] That’s what I’m like when I have too much caffeine I’m very caffeine-sensitive If I even have decaf, it’s like, hurry up! Can’t you go any faster? [CHUCKLES] It’s really– it makes me very aggressive And I’ve learned to avoid caffeine in all of its forms But my wife can drink three cups of coffee and go to bed So there is a lot of individual variation around that The problem with caffeine is that for some people like me, it makes your fuse shorter It can potentially add stress It makes you more likely to be stressed out For other people, it doesn’t do that And there are other things that are in coffee besides caffeine– the polyphenols, and so on– that actually may be protective against some of the more common chronic diseases So you decide If you find that you don’t have those negative side effects from doing caffeine, then that is probably good for you, up to a point JACK: This one right in front here, and then we’ll go to the back DEAN ORNISH: I’m like Robin Williams on speed if I have caffeine [LAUGHTER] AUDIENCE: So thanks for the really interesting talk I’m [INAUDIBLE] JACK: Sorry, is the mic on? Just make sure it’s on AUDIENCE: Oh, sorry JACK: Good AUDIENCE: I’m [INAUDIBLE] And so my question is on– so a lot of the improvements you describe, they’re these very human lifestyle improvements So I was curious about whether there’s any sort of technology that’s emerging that you’re excited about that might also effect these improvements in people’s lives DEAN ORNISH: Yes, technology is a powerful force I don’t have to say that here at Google But it can be used to bring us closer together It can isolate us more, as we talked about earlier If you look at other people’s Facebook profile, it makes you separate But on the other hand, we found that support groups are so powerful And after they finished their Medicare– and most insurance companies are paying for 72 hours of the people meet twice a week for 9 weeks, or a 12-day immersion retreat– and afterwards, we found that because they’ve developed a sense of trust already– and trust is really everything, because you can only be intimate to the degree you can open your heart and be vulnerable And you can only do that to the degree you feel trusting And so that’s why trust is really fundamental to healing And so once you develop that sense of trust with a group of people, we then meet– instead of having them come in a central place which we found was hard, and particularly if they came for a tour or retreat from different parts of the country, they can all use– we use Zoom as a technology But we could use Google or anything to say, OK, between– they pick a day, like Thursdays, from 5:00 to 6:00, we’re going to have our support group It’s 15 people And they all chime in I like Zoom, because whoever is talking immediately fills the screen Except for people who are not very tech-savvy, it’s an easy way to do that And so that’s just one example of how technology can really be healing in a powerful way AUDIENCE: One really quick follow-up question, what about machine learning? So this is something I work on, so I was just curious as to– JACK: Artificial intelligence, machine learning DEAN ORNISH: Yeah, well, you’re talking to the man here He’s having a conference here for the next three days on that What particular aspect of that are you asking about? AUDIENCE: So one thing people are excited about in machine learning at least, in health applications, is trying to take image data and try and spot sort of the progression of diseases, for example So– yeah DEAN ORNISH: Well, certainly, we’re already seeing things in pathology that artificial intelligence can actually diagnose cancers more accurately and sooner than even the most experienced radiologists But I defer that question to you, Jack JACK: Sure Yeah, I would say, it’s a very exciting field I think we’re just at the beginning If you look at medical imaging as an example, and there are several projects across this campus and other startups and lots of people beginning down this road, the good news is I started my career in medical imaging at NIH And it’s one of the fields that has been most digitized So the good news is, coming out of most major scanners– Phillips, GE, so on and so forth, Siemens– you get a digital file Unfortunately, most of those files

get stored away in some data center And no one ever looks at them again We’re beginning now as a technology community to begin to tap into that and then hook that up with the electronic medical records, which again can be our ground truth as to what did, in fact, happen to this person? What were they diagnosed as based on the medical imaging? And then what was the ground truth over the next five, six years of what actually developed? And that becomes a rich source of supervised learning possibility for neural networks or other models that we can use So I do expect this kind of technology to really enhance the role, say, for example, of the radiologists, where the radiologist now is not just popping something up on a screen I literally still visit hospitals today where people are printing out films And so it’s still happening today, where rather than looking at it in a high-resolution monitor, they’re still printing out film So that is changing There are other parts– there are still a lot of records that are not electronic yet There is a lot of movement to make that happen And even when they are electronic, we have to be very, very careful It’s clear now that we have to be– as we’re ingesting this data for the role of supervised learning, there’s often errors in terms of the labeling And we have to be careful about what we’re training, what we’re not training We also to make sure that we have a diversity in terms of the demographics that we’re ingesting into these AIs And so if we’re going to do this, we want to make sure that we have population pools that are drawn from a wide gamut of society so that we haven’t inadvertently trained the AI to do a great job on this part of the demographic when their medical image is taken in, but not that part of the demographic And I also think it’s important to do this on a global scale There are some initiatives in other countries to begin to add to this database But it’s really just beginning So my biggest concern right now is about diversity, is about making sure that as we’re going through this, we have a real wide diversity of patients that are coming into this thing But yeah, go ahead DEAN ORNISH: Let me say one more thing There’s a company called Lark that Julia Hu organized with a group of MIT people that actually does AI text-based messaging So it feels like there’s a health coach on the other end, but there’s not And actually, you can scale that for virtually nothing, because you don’t have to have a coach on the other end And so it’s actually getting increasingly effective at motivating people to make behavioral changes that can be scaled at virtually no cost JACK: Yeah The one real-world example I would also point people to in the UK is something called Babylon Health People in the audience and viewing this can check out that company That company has not just created a fun app which you can use to engage on your health issues and also triage– the National Health Service of England, of the UK, uses it to actually officially triage 1.5 million citizens in the UK And so it’s actually an official part DEAN ORNISH: Yeah, it’s beautiful JACK: It’s one of the first examples that I’ve seen of a health service incorporating this technology in an official capacity DEAN ORNISH: And by the way, TRICARE is using the AI in their app as well So I think we’re seeing this more and more And I think it’s really the wave of the future JACK: Yeah I think we had a question back here Yeah, please, your name and– go ahead AUDIENCE: Hi My name is [INAUDIBLE] I’m interested to know that most people coming from India suffer from vitamin D deficiency And so we’ve been prescribed by the doctors to take it as a supplement What are the precautions actually needed to mix it [INAUDIBLE]? And there are some articles that I read online that you shouldn’t take it with this supplement You shouldn’t take calcium supplements along with iron There are so many confusing things about taking supplements Can you clarify it? DEAN ORNISH: Well, it’s not just people from India Most people in this country are vitamin D3 deficient And so I think that I would add that to my list of supplements for most people is take 1,000 units of vitamin D every day And I wouldn’t worry so much Vitamin D is a pretty innocuous thing about combining that with other supplements I’m not aware that that’s really going to create any major problems for most people JACK: Cool Question here in the front, we have a– great AUDIENCE: Hi, this is Alexis [INAUDIBLE] Thank you so much, Dean I have a question around sleep We haven’t touched on that And I think all of us would agree that it’s increasingly important And it’s, in fact, one of the most important So what are your thoughts? DEAN ORNISH: Well, sleep is one of the ways that your brain detoxifies itself And so there are a lot of people who think, I don’t need much sleep, and so on But Bill Clinton famously said that the worst decisions he ever made were when he was sleep-deprived And I think Arianna Huffington has done a of work in raising the awareness about the importance of that So I think if you want to really be creative and innovative, as opposed to imitative, try to get more sleep It can really make a big difference JACK: Yeah, I think what’s interesting about sleep also is that we don’t fully know the science yet of how sleep is helping us And so I think a lot of times, we’re willing to cut corners on sleep, because we don’t have that immediate knowledge about what is actually happening in the brain during the sleep But obviously, it’s now come out

And it’s very clear from many studies DEAN ORNISH: Well, I think, even from an evolutionary standpoint, why would we evolve to do something that’s going to make us use up so much of our life, make us completely vulnerable to predators while we’re sleeping, unless it was really important And I think that’s part of why when I’m in the middle of the night and wanting to get up and do work, I have to remind myself of these things [CHUCKLES] JACK: Exactly, great We have one more question back here AUDIENCE: Hi, my name is [INAUDIBLE] My question is about the prescription, the four pillars which you mentioned Does that change based on the ethnicity or the underlying problem which a person is trying to treat, like obesity or heart disease or cancer or those things? Or is it all [INAUDIBLE]? DEAN ORNISH: Not really so much I mean, we fine-tune a little bit Some people can metabolize refined carbohydrates or gluten or things like that better than others But for the vast majority of it, it’s really the same And when I started doing this work, I predicted– incorrectly, as it turns out– that the younger people who had less severe disease would do better And what we found, it wasn’t a function of age or disease severity It was simply a function of the more you change your diet and lifestyle in these areas, the more you improve in every metric we looked at and every disease we studied Now, there may be ways of fine-tuning this as we learn more But what I’m still so struck by is that these same lifestyle changes, the more diseases we study and the more biological mechanisms we research, the more reasons we have to explain why they are so powerful And it’s so hard for a lot of people to believe, like, you mean talking about my feelings is going to help me live longer? Are you kidding me? [CHUCKLES] Is that the best you can do? It’s like, yeah, as a matter of fact, it is I mean, David Spiegel did a landmark study at Stanford years ago, where he took women with metastatic breast cancer, randomized them into two groups Both groups were getting the same chemo and radiation and surgery But one group had a support group once a week for an hour and a half for a year, in the same way as we were talking about And then they stopped Five years later, he told me he almost fell off his chair when he looked at the data Those women lived twice as long So these simple things can really make a powerful difference JACK: Great With that, thank you very much for coming Thank you to our YouTube audience Thank you, Dean Ornish DEAN ORNISH: Thank you [APPLAUSE] JACK: Let me just mention that if folks want more information, I believe your website is ornish.com? DEAN ORNISH: Yep JACK: Your nonprofit is PMRI.org DEAN ORNISH: Yep JACK: And the general website is ornish.com for people to get more info DEAN ORNISH: That’s it Thank you JACK: Thank you, Dean DEAN ORNISH: Thank you, Jack JACK: Thank you [APPLAUSE]