Why Health Care Works Better Than Disease Care

By Dean Ornish, M.D.

 

This post is part of our forum on David H. Freedman's July/August story, "The Triumph of New Age Medicine." Follow  the debate here.

Many people tend to think of breakthroughs in medicine as a new drug, laser, or high-tech surgical procedure. They often have a hard time believing that the simple choices that we make in our lifestyle--what we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support--can be as powerful as drugs and surgery, but they often are. Sometimes, even better.

The effectiveness of these "alternative" approaches can be often documented in just the same way as conventional medicine. As David H. Freedman writes in his Atlantic article, "The evidence that these lifestyle and attitude changes have enormous impact on health is now overwhelming." 

Fix or Fraud?

In our research, my colleagues and I at the non-profit Preventive Medicine Research Institute used high-tech, state-of-the-art measures to prove the power of simple, low-tech, and low-cost interventions. We showed that integrative medicine approaches may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, obesity, hypercholesterolemia, and other chronic conditions. We also published the first randomized controlled trial showing that these lifestyle changes may slow, stop, or even reverse the progression of early-stage prostate cancer, which may affect breast cancer as well.

Our latest research showed that changing lifestyle changes our genes in only three months--turning on hundreds of genes that prevent disease and turning off genes and turning off oncogenes associated with breast cancer and prostate cancer as well as genes that cause heart disease, oxidative stress, and inflammation. We also found that these lifestyle changes increase telomerase, the enzyme that lengthens telomeres, the ends of our chromosomes that control how long we live. Even drugs have not been shown to do this.

As Freedman's article points out, our "health-care system" is primarily a disease-care system. Last year, $2.6 trillion were spent in this country on medical care, and 95 cents of every dollar were spent to treat disease after it had already occurred. Heart disease, diabetes, prostate/breast cancer, and obesity account for 75 percent of health care costs, and yet these are largely preventable and even reversible by an integrative medicine program of comprehensive lifestyle changes. 

The choices are especially clear in cardiology. In 2006, 1.3 million coronary angioplasty procedures were performed at an average cost of $48,399 each, more than $60 billion; and 448,000 coronary bypass operations were performed at a cost of $99,743 each, more than $44 billion--i.e., more than $100 billion for these two operations. 

Many people are surprised to learn that randomized controlled trials published in The New England Journal of Medicine and elsewhere showed that angioplasties and stents -- common surgical procedures used to treat heart disease -- do not prolong life or even prevent heart attacks in stable patients (i.e., at least 95 percent of those who receive them). And coronary bypass surgery prolongs life in less than 2 percent of patients who receive it. 

If we were truly practicing evidence-based medicine, our practice patterns would have shifted away from these expensive and relatively ineffective surgical treatments once these randomized controlled trials were published. Yet to many people, these approaches are still considered conservative or conventional medicine, while teaching people to walk, meditate, eat vegetables, and quit smoking -- which has been shown to be more effective -- is called "alternative medicine." 

Studies have shown that changing lifestyle could prevent at least 90 percent of all heart disease, and likely even more. Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle. 

Type 2 diabetes is also epidemic. If current trends go on unabated, more than half of Americans will have diabetes or be pre-diabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion, according to a report by health insurer UnitedHealth Group Inc. 

Yet studies have shown that comprehensive lifestyle changes work better than drugs, for preventing type 2 diabetes as well as for treating it. The complications of diabetes--heart disease, eye damage, nerve damage, kidney damage, impotence, gangrene--are preventable when people can control their blood sugar by making lifestyle changes without medications. 

As health care costs (what Senator Tom Harkin refers to as "sick care costs") are reaching a tipping point that is unsustainable, many Republicans are advocating dismantling Medicare whereas many Democrats are supporting raising taxes, rationing, or letting the deficit increase. There is a third and better alternative.  Integrative medicine approaches can bring together liberals and conservatives, Democrats and Republicans, because these approaches are both medically effective and cost effective.  These approaches emphasize both personal responsibility and the opportunity to make affordable, quality health care available to those who most need it--and the only side-effects are good ones. 

After 17 years of internal and external review, I am grateful that Medicare is now covering "Dr. Ornish's Program for Reversing Heart Disease," the first time that government funding has covered an integrative medicine program.

If we can address the underlying causes of chronic diseases, which are largely dependent on lifestyle changes, and provide incentives for healthy ways of living rather than reimbursing only drugs and surgery, we can create a new model of medicine that is more caring and compassionate, and that is also more cost effective and competent. The time is now. 

The debate continues here.  

This article available online at:

http://www.theatlantic.com/health/archive/2011/06/why-health-care-works-better-than-disease-care/240537/