ized medicine and person-centered care. However, as several panelists pointed out, “we are more than our genes,” and it is the epigenetic influences—the interactions of genes with other factors—that shape health and illness. Dr. Mitchell Gaynor reported on numerous studies indicating the influence of diet and other environmental factors on the expression of genes and, consequently, their effects on health.

Psychosocial factors including stress, loneliness, and depression, all mediated by the brain, were described by McEwen and Dr. Esther Sternberg as strong contributors to health and disease. As the brain responds to stress, hormones are released that can, for example, interfere with the immune response and metabolic processes and damage the cardiovascular system. Something as simple as having a support group, a wide social network, or a nurturing belief system helps people manage stress and recover from illness, Ornish and Sternberg said. People with high levels of stress can be found throughout society. Dr. Nancy Adler noted that people in lower socioeconomic strata are particularly vulnerable to the effects of stress, which is reflected in their lower health status and premature aging at the cellular level.

Panelists said that lifestyle choices are important not only because unhealthy choices contribute to many of the leading causes of mortality, but also because healthy choices hold the potential to outperform commonly prescribed drugs, increase brain function, and affect the expression of genes. As individuals around the world begin to adopt an “American” lifestyle, especially our diet, the challenges of preventive medicine are becoming global, Ornish said.


Dean Ornish, Preventive Medicine Research Institute and University of California, San Francisco

The good physician treats the disease;

the great physician treats the patient who has the disease.

—Sir William Osler

Ornish is a scientist and clinician who has spent much of the last three decades conducting clinical studies in what is now called integrative medicine. He described integrative medicine, or “prospective medi-

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