Best-selling author Deepak Chopra, MD, is a pioneer in integrative medicine and a prolific writer. He is the founder of The Chopra Foundation, a non-profit entity for research on well-being and humanitarianism, and Chopra Global, a health company at the intersection of science and spirituality. He is Professor of Internal Medicine at the University of Central Florida, Clinical Professor of Family Medicine and Public Health at the University of California, San Diego, and serves as a senior scientist with Gallup Organization. In addition, he is an Adjunct Professor of Urology at the Icahn School of Medicine at Mount Sinai.
Over the years, he has discussed areas of collaboration with the Department, notably a mutual interest in the study of the mind-body connection, such as examining whether meditation and other forms of alternative medicine can be used in conjunction with traditional treatments to improve overall physiological and psychological health and well-being. For example, the Department has explored a study in a clinical setting of whether mind-body intervention through meditation and other practices such as yoga reduces inflammation and thus prostate cancer progression.
In this wide-ranging conversation, Dr. Chopra and Ash Tewari, MBBS, MCh, FRCS (Hon.), Professor and System Chair, Milton and Carroll Petrie Department of Urology, discuss wellness and well-being—what it means for patients, such as how a better understanding can help in treating inflammation and cancer, and how this can help all members of the Department strike a better balance between their responsibilities at work and at home.
Dr. Tewari: I want to thank you for being a part of our Department.
Deepak Chopra: Thank you very much. It's a great privilege to be counted as one of your colleagues at the Department of Urology. I'm very privileged to have you as a friend and a colleague and be part of this conversation.
Dr. Tewari: If you think about it, you have devoted your entire life to wellness, and this is the buzzword now that people are thinking about—how to integrate wellness into their life both in our work and showing patients and the family how they can learn and benefit from what you have to offer. So my first question is: How do you define wellness?
Deepak Chopra: Right now, wellness has become a cultural meme. Everybody's talking about it. And as I understand it, when I look at the physician population talking about it, or even health care providers, non-physicians, nurses, and other people in a hospital setting, wellness is being defined as essentially biological. So is your blood pressure and cholesterol normal? How about your inflammatory markers? A good physical exam by a physician defines wellness as we understand it today. So wellness is a medical term, meaning that your anatomical, biological, biochemical, physiological markers are within a certain range, which suggests homeostasis or absence of disease. However, there's a new term that's being introduced, which is called well-being. Well-being is a different thing altogether.
Dr. Tewari: So how do you think about well-being?
Deepak Chopra: It's a state of awareness, and how you define it in many buckets. We have created certain criteria for well-being. So I'll start with a very simple question. You ask somebody how's life, how are you feeling? On a scale of one to 10, if they say eight, nine, or 10, they are thriving. If they say seven or six, they're struggling in some area of life. It could be sleep, it could be a relationship, or marital problem, or financial situation. Or a little bit of chronic anxiety, depression. We are finding this is a pretty reliable approach.
Now we can take this one simple question and apply it to every aspect of our existence. So for physical well-being, there's one simple question: On a scale of one to 10, how much energy do you have to do everything you want to do? A person who says eight, nine, or 10 is thriving. If they say six, seven, they're struggling. And if they say less than that, they're suffering. They probably have a chronic illness already.
Now we can apply that to other aspects. How happy are you at your job? About your finances? About your family and friends? When you total all that up, you can actually say whether this person is thriving, that the future is good, or if this person is struggling, usually in one area like sleep or stress management or exercise or the wrong kind of inflammatory food or disruption of their circadian rhythms, or some emotional distress or just basically feeling a little bit of existential anxiety.
Dr. Tewari: Why is this important?
Deepak Chopra: We've been doing some meta-analysis during COVID-19, and it was very interesting. We look at the data from everywhere. What we found was all the people who are getting sick, if they were older they already had some chronic disease, such as diabetes or metabolic syndrome. If they are younger, they were having inflammatory storms. So the underlying factor in all these cases was sympathetic overdrive, and sympathetic overdrive creates anxiety, depression, and inflammation. As you know, inflammation markers are measurable. So this is a very good indicator that anxiety, depression, stress, inflammation actually precede both chronic and acute illness, sometimes by several months, sometimes by decades. Only five percent of disease-related gene mutations are fully penetrant, and that includes all types of cancers. Somebody has the BRCA gene, you know they're going to get breast cancer. Same thing for prostate cancer. But only a few gene mutations are fully penetrant. The rest are dependent on stress.
Helping Health Care Providers During the Pandemic
Dr. Tewari: I’d like to turn the focus to our team here at Mount Sinai. Our department is pretty big, and our institution is pretty big. In the last few years, we have gone above and beyond what a medical professional goes through. That means wearing an N95 mask for hours and hours; caring for patients who sometimes need help and sometimes don't do as well as we would like; dealing with our own fears and dealing with our own family at the same time. I am so proud of what my team of more than 200 people has done. But I think they all can benefit from some ray of hope, some real happiness, and some guidance on what they can do practically, small things that can bring this work, life, health, mental balance together. You are a role model for how you have balanced high achievement, a lot of hard work, and yet being happy.
Deepak Chopra: When we look at this kind of team, especially in the health care industry, it is most at risk. First of all, almost everyone is a front-line worker. Even in the absence of a pandemic, doctors and health care workers are at a high risk of burnout, which means they don't have the capacity or the energy to fulfill all the demands on them. Only recently has this become a big issue, because when we were trained, it was fine. You worked 48 hours, and then you went moonlighting in the emergency room.
Dr. Tewari: What suggestions can you make?
Deepak Chopra: For everyone on the team, there are certain things that are absolutely essential: Eat well. Eat a diet that is good for your microbiome. Give your bacteria a diet that includes the maximum diversity of plant-based foods, which will actually change the gene population of your gut and will also enhance the quality of expression of the human genes. You can change the entire software of the body, your genetic information, just through a good diet. Not everybody is ready to be vegetarian. If you are eating meat or fish, make sure it doesn't have lots of antibiotics, lots of inflammatory products, or steroids. You're putting poison in your body if you're using factory meat. Avoid alcohol as much as you can; if you're going to drink alcohol, maybe one glass or two of wine. Make sure you're hydrated. Take short breaks to breathe properly, and manage your emotions and sleep.
Dr. Tewari: What else can we do to help each other?
Deepak Chopra: Pay attention to each other, which means deep listening, caring for each other. We notice that a good team requires, like a sports team, everybody complementing each other's strengths and acceptance. We must accept each other as we are right now. It's hard enough for us to change ourselves; when we try to change other people, that doesn't work.
Dr. Tewari: For health care workers, when a phone call rings in our offices, it's not just a phone call. It's someone with cancer, someone has a problem. Or family members reaching out to our office because someone is in pain. We can help. That is a satisfying feeling; we say working in health care is a privilege. People trust us with their lives. Health care workers have that purpose. But when they are working long hours, have a long commute, sleepless nights, sometimes this purpose disappears, goes into hiding. Our role is to bring that out and remind them what they do, that we are so proud of them.
Dr. Tewari: What do you advise a patient with cancer? What can they do to minimize cancer recurrence, minimize cancer growth? What lifestyle changes can they make?
Deepak Chopra: The very word, cancer, becomes a nocebo, the opposite of placebo. When you tell a patient they have cancer and have six months to live, that's almost like a death sentence. If the patient believes the doctor, they fulfill that. But statistics do not necessarily apply to the individual. We know there are advances in cancer therapy. Most cancers these days are being looked upon as a chronic illness. Many people don't die of prostate cancer, they die of something else. Of course there are very aggressive types of cancer, and you have to pay attention to those. But for the vast majority of people who get cancer, it's not a death sentence anymore. It's a chronic illness.
Dr. Tewari: What does that mean?
Deepak Chopra: We should think of it like type two diabetes or heart disease, and we should be managing it like a chronic illness. We should give patients the reassurance that they have hope. A lot of people get scared emotionally. So we can provide emotional support and especially support in things like anxiety, depression, and fear of death. This is something that we are not doing a good job at as cancer specialists or other people involved in the treatment of cancer, simply because of the way reimbursement is and also the way doctors are rushed. But the time has come for every cancer patient to have team support. In hospitals, we have something called a tumor board. But right now tumor boards don't include dieticians. They don't include sleep therapists. They don't include hypnotherapists.
Dr. Tewari: What new things are you looking at in this area?
Deepak Chopra: I'm looking into this whole thing, and maybe we can collaborate on this. We recently created an emotional chatbot for treatment of depression and suicide prevention. I think you and I should work on an emotional chatbot for cancer patients, particularly prostate cancer patients.
Dr. Tewari: How would that work?
Deepak Chopra: We can use artificial intelligence. We found that if you have AI chatbots people are very comfortable. They don't feel judged; there's some degree of anonymity, and if the situation gets really serious they know that there's somebody at the back. So that's how we're doing it. Right now for diabetes management and cancer treatments, particularly side effects, there's a big role for AI. If you want more I will come by someday and show you a demonstration of this—the future of AI as it pertains specifically to treatment of cancer patients. There will be cancer counselors for patients, but AI could save a lot of time and also be more precise in identifying what is concerning the patient.
Dr. Tewari: I am a big believer in AI. About 20 years ago, I was writing articles on neural networks and artificial intelligence in prostate cancer. Technology was not ready then. But now it is, and with your guidance and your collaboration, I think we can really make some progress. Thanks again for your time, your wisdom, and your friendship. And for being part of our Department.
Deepak Chopra: I am very privileged to work with you and look forward to collaborating even more. Thank you.
Ash Tewari, MBBS, MCh, FRCS (Hon.)
Chair of Urology of the Mount Sinai Health System and Surgeon-in-Chief of the Tisch Cancer Hospital