 The title of my talk today is called Change is a Float. And that was really a deliberate hopeful talk about how the current regulatory and scientific environment in this country have come together to a point where not only are people more interested in taking care of their own health. But really for the first time, insurance companies are incentivized to have people do real prevention instead of to keep sending people for procedures, which is the way that they used to get paid. So I think all paths to health care reform follow the money. And I'm going to talk to you today about something that you may not realize about the Affordable Care Act and that I think we have an incredible opportunity in our country for improving the health of the population and utilizing some of what used to be alternative care, which I think is going to get relabeled to preventative and complementary care. So that's what I hope that I can do with you today. And that's why I called my presentation Change is a Float, because I think that within the next two or three years we're going to see some actual real practical changes that you can appreciate. So I'm going to talk to you today about my journey and how come I get to talk to you and what I hope that I can leave you with, because it's not about me, it's about you, and what I hope that I can give to you that will be incredibly useful to you that you may not know about are some of the regulatory changes that are happening in the health care industry. I'd like to give you just a tiny little brief primer about practical brain neuroanatomy and biology and why that really matters to you who like to float or who are encouraging people to float. And then I'd like to talk to you about a concept called the healthy mind platter, because the more that you can use the language of the predominant cultural health care system and translate some of that brain science to speak to insurance executives who don't want to do anything too weird and woo-woo, I think the more successful will all be, the more that we have a shared language to talk about. So I want to just describe to you just briefly how come I do get to talk to you today besides the fact that I love the two owners of Float On, and it's kind of odd that a physician would actually get to know the owners of a float tank company so well. So I want to tell you about my own journey to becoming more open-minded, which may be of some value to you when you encounter other physicians who haven't quite gotten there yet. I went to Oregon State University to be a translator in the Foreign Service. I wanted to translate documents and help people understand each other. So that was originally what I thought my career path and my passion was. And at Oregon State University, I discovered I really, really liked science. And I really liked science well enough that eventually I just decided to go into pre-medicine, which was really about that thoughtful, and got into medical school, went through medical school and discovered that it's mostly a trade school for drugs and surgeries, if you didn't know that, right? It has really little to do with health. It has to do with curing diseases. And I don't want to diss doctors because I wouldn't be here without my cesarean section. I would have died in labor with my kids. You know, having my cataract out is miraculous. I can see. The blind can see. So I don't want to diss medicines and surgery. But I also discovered, which you probably already know, is that there's very little about health in traditional health care. It's mostly about curing disease. And the absence of disease isn't flourishing. And here I am speaking to the choir, like I just discovered this. You all know this. But physicians don't know this, and nurses don't know this, and health insurance companies are starting to know this. So I went to medical school and was totally, absolutely bored with the algorithms about, you know, look in the kid's ear and it looks bad and you try this antibiotic. And I thought, well, that's kind of dull. You know, why did I do all this science for that? So I picked the one thing that was more creative, which was psychiatry, where people's stories and people and the relationship and people's own body wisdom still mattered some. So I became a psychiatrist, went off to practice here in town at Kaiser Permanente, was a clinician. I loved hearing people's stories, treated them. I saved a lot of them from medications and sent them off to meditate and to exercise and that kind of thing. And I really enjoyed it. And when I could retire, I did and went off to get another certification in integrative medicine, which really looks at prevention. So why am I telling you all this? It's because in the last about 30 years integrative medicine has gained a lot of traction at medical schools. We're now starting to teach medical students about health. And at Oregon Health Science University, we're trying to teach them about healthy habits. And I am the director of medical student education there. And we use the concept that I'm going to show you so that you can speak the same language that the medical students are starting to speak. So you're actually the ones that are going to teach us about what it means to thrive and to flourish. We are behind all of you and we're trying to catch up. So I met the owners of Floodon at Portland State actually. They're very good at marketing, as you might have noticed. And they just called me up and said, oh, we'd love to come to your stress management class. And I thought, at that point in time, I thought, oh, sure. I'm going to talk to these people about cortisol and about tumor necrosis factor and all this stuff. So one day I had to go off to a conference. They didn't have anybody to cover me. So I called them up and said, would you come and cover me? So they came over and did the lecture. And when I got back, the students said, that was the coolest lecture we've ever had. So the next term, I invited them when I could listen and it really was the coolest lecture. So since then, I've started to send medical students down to Floodon to learn how to relax because medical students are literally drinking out of a fire hose, so much information. And a lot of medical students use alcohol and drugs to relax. And so what we are trying to do is teach medical students how to take care of themselves better so that they can talk to their patients about taking care of themselves better. So my most recent job, I did not go back into traditional health care but I was kind of discouraged about the lack of interest in alternative kinds of care. And health care is a three-legged stool, medicine, surgery, and self-care. You take away any one of those three legs and it's a very unstable stool. So when a job came open as a chief medical officer at Health Republic Insurance, this insurance company is in fact different. For one thing, it's a co-op and members are on the board of directors and they do not pay people outrageous sums of money and pretend they're nonprofits so that they can put their names on athletic facilities. So for those of you who are in Portland, that's a little jab at Moda and Providence Park because honestly, watching other people run around while you're eating hot dogs and drinking beers is not anybody's idea of health. It's okay every once in a while but it's not a community health benefit. So Health Republic Insurance is different. They offer alternative care to members and I brought with me or she came by herself, my quality nurse colleague and I'm going to, when the lights come back on, you can stand up and you can go talk to her. We're trying to develop some programs particularly for obesity where we have a multifactorial approach to weight gain including offering people float tanks paid for by their insurance company. Floating, not float tanks. Floating in someone else's float tanks. So let me share with you just my three ambitious goals for you and some of you already know this but I think it's a hopeful kind of message. So this particular slide and many of you know this, if you've watched Escape Fire for example, many of you watched that documentary Escape Fire. It's readily available. It talks about the problems in U.S. healthcare. The United States surprisingly is not the healthiest country in the world. We don't live the longest. Our babies don't thrive very well. We have a lot of very chronic diseases but we sure have a lot of MRI machines if you look up there. So that's the point of this slide is that healthcare in our country is run by the funding mechanism and the funding mechanism is that the more procedures you do as a doctor or a hospital or insurance company, the more profitable you are. You make zero dollars talking to somebody about reducing their stress but if you're a clinician and you order an MRI, you're going to make a lot of money. So this is a problem right here. This is a huge problem. Then if you go to the next slide, which is how much this costs us and eats up of our gross national product, we cannot sustain this trend. We can't keep having people who are diabetic who need dialysis machines. In about 10 years we won't even have enough dialysis machines to take care of all the people. We have to do something that improves the health of the population and reduces this cost. So I just want you to look at the upward trend and how unsustainable that is. So I just want to show you this one other slide which is about, again, how many MRI machines per 1 million residents we have. I was shocked some... Oh, I was in Homer and they were bragging to me about their hospital about how they had an MRI machine, how this was so wonderful and I thought, oh, no, it's not so wonderful. It's really not because, of course, how are you going to pay for that? You're going to send a lot of people there who don't need it, which is the point, is that the technology drives a lot of unnecessary care. And the Institute for Healthcare Improvement talks about how approximately 25% of the care delivered in this country is unnecessary and actually harms people. So we, as a group of citizens, needs to be informed and we as a group of alternative healthcare clinicians and me as the chief medical officer in MARTA as the quality nurse needs to offer people some real maps for how you can, in fact, improve your own healthcare. So I want to talk to you about the brain for just a minute and you can take a whole year's worth of neuroanatomy at Portland State and drive yourself absolutely insane, summarizing all the myelinated pathways. But you already have the brain in your hand and you already have it. So if you go like this, you will notice that this is the brain stem. The brain stem is the involuntary part of your brain that controls a lot of stuff like your heart rate and sends out signals for sleep. This part is the emotional part. It's called the middle part of your brain. And then the part over the top is the cortex and it's the part that makes us kind of uniquely human. It's the part that's relatively late evolutionarily and it's the part that allows us to understand things, decide things, recall things, memorize things and inhibit. And inhibition is actually the biggest and hardest thing that this part of the brain does. So it inhibits you from running out when you're bored to douth with the speaker. It inhibits you from attacking the person next to you because you find them very sexually attractive. It inhibits all kinds of things. So this is a good thing that we have this part of our brain because you look at animals. I mean, you look at my cat, Mr. Butch, who lives outdoors. If he sees a bird he likes, he'll just get off of my lap and go pursue the bird. He doesn't have any inhibition like, oh, this is the person that feeds me. I should stay on her lap, you know. He doesn't have that. So we like our prefrontal cortex. So the deal about our brains, that's really a practical thing that relates to float tanks, is that this cortex part of your brain that actually does the thinking is the very tiny part of your brain called the prefrontal cortex. So if the rest of your brain was like the gross national product of the United States, the prefrontal cortex is the few pennies in your pocket. It's a very tiny little part of your brain. And we don't take care of it very well. We abuse it like crazy. Nobody taught you in health class how to take care of your brain. So the healthy mind platter that I'm going to talk to you about next is really the owner's manual for the brain, because most of us, well, maybe not you, but the people that I hang out with, they think, oh, you know, they can think all day long without feeding themselves, without going to the bathroom, without doing any healthy exercise, without taking a break. And so what we really know from science and, of course, what you really know if you pay attention to your own self is that that's not really how your brain works. So the healthy mind platter is wonderful for those people who really have to have everything proven by science that you really can't use your brain all day and have it be effective. You know this. After you've been really nice to customers all day long and you've inhibited your nasty thoughts that come out of your brain, you go home and that whole thing of haggendoss is just calling to you in the freezer. Maybe that doesn't happen to you, does it? No. Or, you know, you just can't inhibit it anymore. So I'm going to talk to you about the healthy mind platter. But think about the brain in your hand. It's a really good thing. And this thumb part is the amygdala. And we all know about the amygdala. Amygdala is the part that skips for danger and gets turned on by all kinds of stuff. Noise, pollution, worries about the future in the past. And so this amygdala can really do what's called hijack, the cortex. And so that's where you come in. Floating and some other activities can really calm the amygdala and allow your cortex to function better. The other point about the brain in the hand is that this little tiny part then would be the prefrontal cortex. And there's some other parts of the cortex. So if you can quit thinking, thinking is one way that we use our brains. The second mode that's different than thinking, that you can discern on an EEG or an MRI or a PET scan, is the so-called direct experience network. In other words, when you quit using just this little teeny part of your brain and you use the rest of your cortex and you activate all of your senses, you can give this little teeny part a break. So what we tell the medical students is taking a break from thinking is really good for you. And part of the way you do that is that you engage the rest of your brain, you engage the direct experience network. So in other words, you start thinking about your breathing. You start thinking about, what am I smelling? You start listening more. So you become more mindful. Mindfulness is activating your direct experience network and it gives this thinking part a break, which we really need. So there's a lot of ways to be mindful, but I'm going to tell you the story of what our chief operating officer, who I finally convinced after, I don't know, eight weeks to go floating, she said, I got in the tank and I just felt my body. I haven't felt my body for such a long time. I quit thinking. I could feel myself breathe. I could hear my heartbeat. It was the most relaxing thing. So it feels relaxing, but it's a different way of being, and it gives this part of your brain a break. So let's go to the Healthy Mind Platter, which is a set. I didn't make this up. I wish I did. I have a Nobel Prize now. The Healthy Mind Platter was made up by a group of researchers called neurobiologists, neuroanatomists, and it is a summary of a set of activities that optimize flourishing, thriving, resiliency, whichever word you'd like to use. So this is a picture of it, and there are handouts out on the table for you to take with this. If you can possibly see the tiniest little bit at the bottom, it says Modified by Loretta Young and Nikki Stuckler. Because if you looked online at the Healthy Mind Platter, I would see this with the exception of we added healthy food and meaning and purpose for our medical students. So we just published a book on teaching medical students how to thrive and flourish, and this is our version. So I didn't come up with the rest of it. So I'm just going to zip through this because you can look it up. I wanted to introduce the concept to you, but these are the kinds of things that we need to be healthy, and it's a way that you can look at your own life and go, am I getting enough sleep? Am I getting some downtime? And what I'd like to tell you about is that float tanks fit into downtime and time in, which is the hardest thing for the American public to get. We don't have very good words in our culture for downtime. We call it lazing around, goofing off. Downtime is not hobbies, like quilting or shopping on the internet. Downtime is when you're totally non-focused without any specific goal and you let your mind relax. The data about downtime is that if you have this at some point for your brain, you will solve your problems more easily. You will sleep better and you will be happier. So downtime is a really important thing and it's hard for a lot of people in this country to get because they think downtime is shopping on the internet or watching TV, and that's not it. Time in is also something that the float tanks give us. Time in is another word for the relaxation response. It's not relaxing, but it's a certain kind of brain state where you have alpha and gamma waves and you are focusing on your direct experience network. In other words, you're focusing on your breathing, you're focusing on how your arms feel. It's a specific kind of activity that you can get in float tanks. You can also get it by mindful walking, mindful eating, various meditation practices. So that's the idea about the healthy mind platter. So let's now talk just in the last five minutes that I've got about how come right now we have an unparalleled opportunity in the regulatory environment for encouraging people to do self-care. And that's because the Affordable Care Act, which some people call Obamacare, I'm not going to call it that, the Affordable Care Act has some provisions in it for insurance companies to do prevention activities. And the idea is that if we don't start doing prevention activities, we're all going to go broke, including these insurance companies. So there are some funding mechanisms for the health insurance companies to stay in business for the next three years that I'm not going to bore you with, but Marta and I are deep into the thousands of pages of the stuff. But it allows us to get some money to do some projects. So what does that mean for you? So for you, if you are looking to expand your business and to bring the benefits of floating in terms of time in and downtime to more people, I think you can really effectively approach two particular entities. One is the Veterans Administration Hospital, who has a huge grant to do alternative care for all veterans, particularly for issues that they don't treat very well, like post-traumatic stress disorder, insomnia, depression, and arthritis. Those would be perfect things that you could partner with the VA to get some of those funds about. Huge amounts of money. There's a woman named Tracy Godet, G-A-U-D-E-T. If you want to Google her, you can watch her YouTube speaking about the innovations at different VAs. She's the head of this alternative care focus. I think you might also approach new innovative insurance companies in your area. There are co-ops. I think in 23 states, there's certainly co-op here in Portland, and Health Republic is going to be talking to Graham and Ashkan about an obesity project with floating, but I think that you can go approach them about pilot projects to bend the cost curve. Because again, there's funding for this now funded through the Affordable Care Act. So I'd like to end with hoping that I met my goals for you today, that you learned some words to use, that you got educated a little bit in the science and that maybe we can all speak a similar language. And I would like to end with... I ended up being a translator after all. Thank you.