"The Myth of Lifestyle Choices" — Introduction to The Epi Edit

Hello, and welcome. I'm Dr. Randi Paynter, and if you are returning to Changed By Cancer, thank you for coming back. And if you are brand new to this channel, I am so glad you found us.

We’re doing something a little bit different today. If you look at your feed, you’ll see we’ve dropped two episodes under a new title: The Epi Edit. Moving forward, alongside our deep, narrative interviews with survivors, caregivers, and providers, I’m going to be stepping behind the mic for some solo sessions.

I want to take this first episode to explain exactly what The Epi Edit is, and why this channel exists, and the specific perspective I am bringing to these conversations. Because when we talk about cancer, we often talk about it in isolation—as a private medical crisis. But cancer doesn't happen in a vacuum. It happens to people who live in specific communities, navigate specific systems, and face distinct structural realities.

Let’s start with the name. "Epi" is shorthand for epidemiology, which is my field of study. I am a cancer epidemiologist. To people outside of public health, that title can sound a bit academic or clinical, so let's strip away the jargon.

In clinical care, an oncologist interfaces directly with the patient; they diagnose the disease and manage their immediate treatment. A pathologist looks through the microscope at the individual cells to determine exactly what kind of cancer it is. But as an epidemiologist, I look at the bigger picture. I track patterns through data from entire populations—and those data are grounded firmly in real people, real families, and real-life outcomes across communities. We look at the "who, where, and why" of health and disease across studies and populations. And these can include hundreds, or thousands, or even millions, of lives.

But "epi" is also a Greek prefix. It means "over," "on top of," or "upon." You hear it in words like epidermis—the outer layer of the skin over your body. Or epicenter—the point on the earth's surface directly above an earthquake. Or an epilogue—the final section that stands over the rest of a story.

So, The Epi Edit is two things at once. It’s an epidemiologist's edit of the complex healthcare landscapes we talk about on this channel. But it is also an overall edit—an editorial, a high-level view on a specific theme, system, or logistical barrier that affects the cancer community. It’s an invitation to step back from the microscope for a moment and look at the systemic forces shaping our health.

People often ask me how I ended up in this field. The truth is, I’ve been interested in and deeply concerned about cancer since I was a child. And it wasn’t because it ran in my family at the time—it didn’t. To a kid looking at the world, cancer just seemed like this massive, devastating problem, and I knew I wanted to help solve it.

As I grew older and pursued my education, I began to study public health, and I learned about health disparities. But I want to be entirely transparent with you about my own journey: at first, I believed a lot of what standard public health frameworks taught, especially back then. And a lot of that traditional teaching, frankly, leaned toward blaming the patient. It focused heavily on patient-specific risk factors that are labeled “risky behaviors"—like what people eat, how much they exercise, or whether they smoke.

The underlying message in that older framework was simple: If you just modify your behavior, you can prevent this.

But the more I learned, and the more research I conducted, and the more I looked at the actual data, the more I realized how fundamentally flawed and deeply unfair that framework is. People do not make choices in a vacuum.

Let’s look at what we call "choices" through a realistic lens.

Take diet, for example. Everyone knows that it’s important to eat fruits, vegetables, and a balanced diet. We are bombarded with that messaging constantly, and have been for our entire lives. But actually doing that is nearly impossible for people who live in food deserts—neighborhoods without a single grocery store selling fresh, affordable produce. If you depend on SNAP benefits, your options are tightly constrained by what *budget* allows, and what local *corner stores* actually stock. Choosing an organic salad isn't a matter of willpower if your reality only offers processed, shelf-stable goods.

The same goes for exercise. We are told to get our movement in, to go for walks, to join a gym. But there are many folks who live in neighborhoods that don't have safe outdoor spaces, sidewalks, or parks. And they might not have reliable transportation to get to those spaces, let alone the extra money in the budget for gym memberships.

If you look at rural communities, the challenges change but remain just as restrictive. Many rural folks don't have access to gyms or fitness centers at all, and depending on where they live, weather and seasonal limitations dictate how much they can safely be outside for a large portion of the year.

Even when we look at the big risk factors like smoking or air quality—it is rarely a simple "choice." Second-hand smoke in a household or a workplace isn't a personal preference. Living in an area with environmental bad air, near highways, or downwind from industrial plants is an exposure that people are born into or trapped in by economic reality. It is an involuntary exposure, not a lifestyle choice.

When you look at the data, you see clearly that why people eat the things they do, why they have the sleep patterns they do, or why they move their bodies or don't, has everything to do with systems, environments, and structural barriers that cross generations.

When I realized that my own family and my own health have been impacted by these very same systems, it was a profound turning point for me. We can absorb these challenges in isolation, feeling the weight of them individually, or we can use our collective experiences to drive real change. I chose to do something. And that is exactly what gave rise to Changed By Cancer.

This podcast is designed to be a model of how that change can happen, and I fundamentally believe that we can make a measurable difference by working through four core pillars together:

• Learning: Together, we will actively learn by listening to each other's lived experiences, analyzing population data, and uncovering how different communities across the country actually navigate care.

• Communicating: We will work as a community to discover and model better, clearer approaches to communication between healthcare providers, patients, and the families who support them.

• Empathy: We are going to engage with each other deeply to foster true empathy, consciously dismantling the judgment and patient-blaming that so often surrounds complex diseases.

• Policy: Ultimately, we will put our heads together to discuss systemic barriers and advocate for the structural policy changes that support all, focusing on those who need it most.

To get there, I will continue focusing on lived experiences. We will hear from people who have had cancer, parents of children who have faced it, family members who have actively supported loved ones, and the dedicated healthcare providers who care for them.

If you are listening to this and you have a story to tell, I need to hear from you. You can reach out to me directly by messaging the Changed By Cancer Facebook page, or by using the contact form on the website.

As we move forward, there are two quick guardrails I want to mention. First, on this channel, we will be focusing primarily on patients who’ve sought out their health care through the traditional Western US medical healthcare system. This isn't a knock against any other approaches to healing. It’s simply the system I know best, and crucially, it is the system where I can find and evaluate peer-reviewed research. There are plenty of wonderful channels covering other modalities, so I will leave those spaces to them.

Second, I believe we build true value when we interact with one another—but to do that, people need to feel entirely safe. I’ve looked for ways to do this that would be easy to use across age groups and across any tech divide, and would be accessible to all adults. Because I want us to be able to talk openly without being dependent on Facebook's noise, clutter, and algorithms, I’ve set up a brand-new, dedicated community space on Patreon. It’s completely free to join.

Think of it as a quiet, safe digital living room where we can digest these episodes together, share resources, and talk about the structural fixes we need.

You can find the link in the show notes right below.

Thank you for being here, thank you for listening, and I’ll catch you on the next episode.