1. Weill Cornell Center for Integrative Medicine What we know u People are living longer and want to assume greater responsibility for their own health and well-being u Explosion in the numbers of people using mind-body approaches and natural products u Critical and growing need for assessment of efficacy and for quality control over products, programs and practitioners

2. Who advises patients? u Americans see physicians for only 10-20% of illness episodes. u Social network and family advice u More people see CAM practitioners than primary care physicians.

3. Why do patients seek CAM? u Beliefs about etiology, susceptibility and controllability as well as risks and benefits of therapies are deeply rooted at the cultural level. u Patient–doctor interactions are transactions between explanatory models that often involve major discrepancies in understanding, expectations and goals.

4. How about you? Have you tried: u Acupuncture u Massage u Guided Meditation & Mindfulness u Tai Chi u Yoga

5. Would you recommend: u Acupuncture u Massage u Guided Meditation & Mindfulness u Tai Chi u Yoga

6. Weill Cornell Center for Integrative Medicine Center’s scientific focus Develop knowledge required to evaluate the health effects of interventions involving: u Natural products u Mind-body interventions

7. Weill Cornell Center for Complementary and Integrative Medicine Natural products DSHEA strictly limits FDA authority over herbals, botanicals and supplements. The FDA: u cannot require evidence of either safety or efficacy u may only prohibit sale of supplements proven unsafe

8. Weill Cornell Center for Integrative Medicine Natural products - What is in the bottle? u What methods are currently used for identification of herbals and botanicals? u Are any biological contaminants present? u Why are such approaches so limited?

9. Weill Cornell Center for Integrative Medicine Natural products - How are they standardized? u Pharmaceuticals: single active ingredient u Herbals: marker compound or putative active principal u Yet, Hundreds of compounds, many may be active Active compounds may not be known Standardization on compounds not responsible for biological effect lead to spurious results

10. Weill Cornell Center for Integrative Medicine Mind body interventions How many people here have experienced stress?

11. Weill Cornell Center for Integrative Medicine Stress

12. Weill Cornell Center for Integrative Medicine Have you experienced stress? Was the stress related to: u work u school u competing demands u caregiving u life events u illness

13. Weill Cornell Center for Integrative Medicine I was NOT stressed out!!

14. Weill Cornell Center for Integrative Medicine What does stress do? Repeated exposure to stress disrupts basic biological processes central to homeostasis Allostatic load: Cumulative physiological toll of stress A few facts: u Higher allostatic load, greater all cause mortality u Higher perceived stress, shortened telomeres in caregivers u Emotional isolation predicts death after MI

15. Weill Cornell Center for Integrative Medicine What is the impact of stress? Hormonal: Sympathetic, cortisol, immune, inflammatory Neural: Remodelling, reduced processing in pre- frontal cortex, impaired attention Symptoms: Sleep, memory difficulties, impaired concentration, rumination, decreased creativity, increased negative emotions, vigilance. Behavioral: Eating, reduced exercise, smoking, drinking

16. Weill Cornell Center for Integrative Medicine What could ameliorate the impact of stress? Mind-body interventions

17. Weill Cornell Center for Integrative Medicine Why has medicine been slow to adopt mind body interventions?