Asking the right questions about health care
August 18th, 2011
07:29 AM ET

Asking the right questions about health care

Thomas Pynchon once said: “If they can get you to ask the wrong questions, then they don't have to worry about the answers.”

Here’s the wrong question: Should we cut back on or even dismantle Medicare, or should we just keep raising taxes and let the deficit continue to increase unabated? Since neither choice is optimal, the debate - some say debacle - in Washington these past few weeks about how to deal with our rising deficit, much of which is due to rising health care costs, has polarized and paralyzed our country.

There is a third alternative: When we address the underlying causes of most chronic diseases - our lifestyle choices - our bodies have a remarkable capacity to begin healing, and much faster than was once realized. When we address these lifestyle causes, then we can make better care available at lower cost to more people. And the only side effects are good ones.

When I lecture, I often begin by showing a slide of doctors busily mopping up the floor around an overflowing sink, but no one is turning off the faucet.

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 loving relationships and social support - can be as powerful as drugs and surgery, but they are. Often, even better.

Although cardiovascular diseases kill more people worldwide prematurely than just about all other causes of death combined, heart disease is almost completely preventable and even reversible today if we simply put into practice what we already know.

The same lifestyle changes that can prevent or even reverse heart disease also help prevent or reverse many other chronic diseases as well. For example, in the EPIC study, patients who never smoked, were not overweight, had at least 30 minutes/day of physical activity, and adhered to healthy dietary principles (high intake of fruits, vegetables, and whole-grain bread and low meat consumption) had a 78% lower overall risk of developing a chronic disease. These included a 93% reduced risk of diabetes, an 81% lower risk of a heart attack, a 50% reduction in risk of stroke, and a 36% overall reduction in risk of cancer than participants without these healthy factors.

What causes a heart attack?

For the past 35 years, my colleagues and I have conducted a series of randomized controlled trials showing, for the first time, that heart disease is reversible simply by changing diet and lifestyle. Because of this, we appreciate that Medicare is now covering “Dr. Ornish’s Program for Reversing Heart Disease,” the first time that Medicare has covered an integrative medicine program. Since reimbursement is a primary determinant of both medical practice and medical education, this is a game-changer.

Our research also showed, for the first time, that these same lifestyle changes can slow, stop, or even reverse the progression of early-stage prostate cancer. We also found that these lifestyle changes beneficially altered the expression of over 500 genes in only three months, “turning on” protective genes that prevent disease and “turning off” oncogenes associated with breast cancer and prostate cancer as well as genes that cause heart disease, oxidative stress, and inflammation.

Learn more from the American Heart Association

In collaboration with Dr. Elizabeth Blackburn, who received the Nobel Prize in Medicine two years ago, we published the first study showing that these lifestyle changes increased telomerase, the enzyme that lengthens telomeres, which are the ends of our chromosomes that control how long we live. Even drugs have not been shown to do this. As your telomeres get longer, your life gets longer.

These findings are capturing the imaginations of many people. Many people believe, “Oh, it’s all in my genes, there’s not much I can do,” what I call “genetic nihilism.” Now, we understand how dynamic these mechanisms are, even on a genetic level, which are giving many people new hope and new choices.

Also, type 2 diabetes, high blood pressure, and elevated cholesterol levels may be reversed by making these same lifestyle changes. More than half of Americans will have diabetes or be prediabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion if current trends go on unabated, according to health insurer UnitedHealth Group Inc. The ravages of diabetes - heart disease, blindness, amputations, impotence, kidney damage - are completely preventable for most people by changing diet and lifestyle.

In 2006, according to the American Heart Association, 1.3 million coronary angioplasty procedures were performed at an average cost of $48,399 each, or more than $60 billion; and 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion.

Despite these costs, many people are surprised to learn that randomized controlled trials found that angioplasties and stents do not prolong life or even prevent heart attacks in stable patients (i.e., the vast majority of those who receive them). Coronary bypass surgery also does not prolong life.

In other words, Americans spent more than $100 billion in 2006 for these two procedures that are dangerous, invasive, expensive and largely ineffective, most of which could be avoided by making comprehensive lifestyle changes instead. The major benefit of angioplasty and bypass surgery is to reduce angina (chest pain), but similar or greater reductions in angina occur in only a few weeks by making comprehensive lifestyle changes.

From omnivore to vegan: The dietary education of Bill Clinton

My colleagues and I conducted demonstration projects at hospitals throughout the country to determine if comprehensive lifestyle changes could be a safe and effective alternative to bypass surgery or angioplasty in those who were eligible to receive it.

After one year, almost 80% of people were able to safely avoid heart surgery or angioplasty, and Mutual of Omaha calculated saving almost $30,000 per patient in the first year. In a second demonstration project with Highmark Blue Cross Blue Shield, these comprehensive lifestyle changes reduced total health care costs by 50% after only one year and by an additional 20-30% in year two and year three when compared to a matched control group.

The idea that changing lifestyle is difficult if not impossible, but taking a pill is easy, is not what the data show. Two-thirds of people prescribed cholesterol-lowering drugs are not taking them just a year later, whereas adherence to lifestyle changes was 85-90% after one year.

Why? Because cholesterol-lowering drugs don’t make you feel better, but lifestyle changes do. What is sustainable are joy, pleasure, and freedom, not risk factor reduction. Most people who have heart disease become free of chest pain after just a few weeks when they make comprehensive lifestyle changes.

When you eat a healthier diet, quit smoking, exercise, meditate, and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. The latest studies have shown that your brain may grow so many new neurons that it may get measurably bigger in only a few months - this was thought to be impossible only a few years ago. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent - the same way that drugs like Viagra work.

For many people, these are choices worth making - not just to live longer, but also to live better.

soundoff (55 Responses)
  1. bonitasayers

    I learnt from "Penny Health" that Instead, try saying, "There's medically necessary treatment that I'm seeking." Remember, words have power and insurers are all about finding limitations and exclusions if you say the wrong thing.

    August 18, 2011 at 08:27 | Report abuse | Reply
  2. Leo

    Good points, all of them. And it's true – our country would save billions of dollars if people would put down the cheeseburger, step away from the doughnut, and get some exercise. Rates of all sorts of disease would plummet if people just took care of themselves. Quality of life would certainly improve.

    But... riddle me this: will good diet and exercise cure RA and lupus? News flash - no, they don't.

    August 18, 2011 at 08:27 | Report abuse | Reply
    • Valentijn

      And then there's the question that doesn't get asked in these articles: are these people healthier because of they behave, or do they behave differently because they're healthier? I literally can't exercise due to a medical condition with an unknown cause, and losing weight requires me to eat far less than 1200 calories per day. Most fat people I know aren't lazy people that like getting fat ... they struggle against it, but nothing seems to work. How many of them have underlying problems resulting from environmental toxins and such?

      August 18, 2011 at 12:35 | Report abuse |
    • Tom

      Actually RA symptoms can be greatly reduced or eliminated by removing all grains (including corn) and sugar from the diet. See marksdailyapple.com for a lifestyle that literally changes lives for the better. Low carb diet high in healthy fats and protein is the way to go.

      August 18, 2011 at 22:05 | Report abuse |
    • Pam

      While they may not cure RA or Lupus (although generally being fitter and healthier will ease some symptoms), most people will never develop RA or Lupus – unlike the vast numbers that develop heart disease, diabetes, and other chronic metabolic disorders. Watch your diet, exercise and feel better. That's the point.

      August 21, 2011 at 20:38 | Report abuse |
    • Pacific Bariatric

      I completely agree with your comment. Change your life for the better. Change your life for good. No one has to tell you about the downside of morbid obesity. If you're at least 100 pounds over your ideal body weight, you already know about the severe health risks. Not to mention the feelings of frustration, depression, and hopelessness that can be absolutely overwhelming. But, there is an answer. At Pacific Bariatric you can change your life and your health. Visit us here to find out more.

      February 1, 2012 at 11:24 | Report abuse |
    • Pacific Bariatric


      February 1, 2012 at 11:25 | Report abuse |
  3. Conrad Shull

    Fine words, but the greater part of medical (hence Medicare) expenditures are expensive high-cost near end-of-life procedures which happen at 68 as well as 88.

    August 18, 2011 at 09:04 | Report abuse | Reply
    • Dawn

      people don't want to die we were all suppose to die around 45 to 50 now with better healthcare we live to 70 and its still not enough for some

      August 18, 2011 at 11:39 | Report abuse |
  4. charls

    The time to make these changes is at the beginning of life. Teaching our children proper nutrition and good health habits should be started at birth and continue in kindergarten. Waiting until the first sign of heart disease is about 40 or 50 years too late. The US does not have a medical system; our current medical practice is just a huge ER for all of the diseases that afflict humans. The US has probably the best ER care in the world but unfortunately almost all of our medical care is just an extension of ER care. Until proper nutrition education is embedded into our society, our medical cost will continue to skyrocket at an unsustainable rate.

    Americans suffer from malnutrition at epic rate. For most people, it is almost impossible to get enough of the necessary vitamins and minerals from food. It is imperative that people take a vitamin/mineral supplement every day. This one action would have tremendous long term affect upon the health of everyone. Women; especially women of child bearing age must take a vitamin/mineral supplement prior to pregnancy in order to prevent the disease spina bifida. By taking adequate amounts of folic acid before pregnancy, this terrible disease can be greatly reduced. The only way to insure that an adequate amount of folic acid is being consumed is by taking a vitamin supplement every day. Do a google search of "spina bifida folic acid" to learn more. less

    August 18, 2011 at 09:42 | Report abuse | Reply
  5. Carlos Monteiro

    I would beg to differ about what really causes a heart attack. There is the myogenic theory of myocardial infarction developed in 1972 by Prof. Dr. Mesquita, with the prevention and treatment of acute coronary syndromes with cardiac glycosides (Digitalis, strophanthin, etc) that demonstrated in thousands of patients his efficacy. This theory was unfortunatelly suppressed by the medical mainstream turning to be a taboo in medicine. You can enlight yourselves about the Myogenic Theory at http://www.infarctcombat.org/MyogenicTheory.html. Please see part of the history about the Myogenic Theory written by the courageous Dr. Thomas Cowan at http://www.westonaprice.org/cardiovascular-disease/what-causes-heart-attacks.
    Alternatively, there is The Acidity Theory of Atherosclerosis that was developed by us in 2006. It complements the Myogenic Theory in the coronary side. It is discussed in our blog aciditytheory.blogspot.com.

    August 18, 2011 at 11:22 | Report abuse | Reply
    • Bill

      It doesn't mater if you believe that heart attacks are caused by cholesterol build up or the myogenic theory (arteries deprived of oxygen and nutrients), the treatment is the same – a healthy diet, exercise, no smoking etc etc etc.

      August 30, 2011 at 20:31 | Report abuse |
  6. Good Days

    Lifestyle choices are definitely important when it comes to chronic disease. Our organization, Good Days from Chronic Disease Fund, is dedicated to helping chronic disease sufferers with their medical care. Please help these sufferers too, and support our organization! http://www.gooddaysfromcdf.org/

    August 18, 2011 at 12:57 | Report abuse | Reply
  7. TFGMD

    the problem with too many patients is that they don't want to change their behavior or lifestyle and they rely on docs and hospitals to solve their problems. these healthcare articles and blogs IMO represent "preaching to the choir" as those on the lower half of the intelligence curve are just not informed. it's those people who are the problem with healthcare in America. there is no accountability and expectations are totally out of touch with reality.healthcare providers are scared of these obese, ignorant, lazy, self abusive patients and therefore they get everything they want and just keep coming back for more

    August 18, 2011 at 14:03 | Report abuse | Reply
  8. numbnut

    A good book to read is Dr. Joel Fuhrman's, "Eat to Live".

    August 18, 2011 at 14:11 | Report abuse | Reply
  9. Phyllis Robb

    I agree that better health choices would help. However, the figures over the long pull speak for themselves. A little easy research shows that in 1955 the average cost per family for healthcare was $240, and the average family income was $4,400 – about 5 1/2% spent on health care. In 2006 the average cost per family for health care was $15,000, and the average family income about $50,000 plus a little, or close to 30%. As a pecentage of US GDP in 1960, health care was 5.2%, in 2007, 16%. Analysts seem to think about 1/2 of the increase is due to advances in medicine, a bargain given increased life span over that time. Still, there is a lot of fat out there. We pay much more per person than in any other developed country, with poorer results.

    August 18, 2011 at 14:24 | Report abuse | Reply
  10. snorincats

    You're all wrong. What will decrease the cost of healthcare is regulations with real teeth that will curb the heinous profits adn CEO bonus payouts-paid for by the suffering of the rest of us-that the health insurance companies net every year. They make billions in profits and pay out millions to high executives-and STILL raise our rates and lower the quality of the care we receive. Then there's the article that recently came out that said sticking to the recommended Food Pyramid was too expensive for most Americans. The solution put forward? NOT curb the gouging of the public by food distributors. No, the solution was to lower the standards of the Pyramid itself! Shameful. We need to stop being sheep and stop putting up with the beatings we're constantly getting.

    August 18, 2011 at 16:34 | Report abuse | Reply
  11. GaryG

    We need to mstop subsidizing foods that are fed to animals that people eat and subsidize foods that nourish us humans. Better for us, better for the environment. Plant-strong.

    August 18, 2011 at 21:44 | Report abuse | Reply
    • Pam

      It probably wouldn't hurt a bit to stop subsidizing altogether. And we need far more regulation of the meat industry. Factory farms and inhumane ways of keeping animals is deplorable. Beyond that, Americans eat way too much meat. We seriously need to cut back!

      August 21, 2011 at 20:44 | Report abuse |
    • Pam

      We need to stop farming subsidies altogether
      . And we need far more regulation of the meat industry. Factory farms and inhumane ways of keeping animals is deplorable. Beyond that, Americans eat way too much meat. We seriously need to cut back!

      August 21, 2011 at 20:45 | Report abuse |
  12. Brett Robert

    This article contains a flat out lie. From the article: "Coronary bypass surgery also does not prolong life."

    From the linked research paper: "Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. "

    This is clearly a deliberate misrepresentation.

    August 18, 2011 at 22:59 | Report abuse | Reply
    • Marcelo

      He is referring to patients who have stable angina with normal myocardial function. Bypass surgeries have been shown to prolong life in patients with multivessel disease and decreased left ventricular ejection fraction and in patients who have severe left main coronary artery.
      The problem is that in the USA, with a profit-driven health care system, many heart surgeries are performed in situations where they have been shown only to control symptoms, not to prolong life. In this aspect Dr Ornish is right. The only problem of his approach is that it is difficult to convince people to change their lifestyle radically. Most patients are very impressed with the high-tech gadgets and surgeries that we use, but don't realize that most of these have little impact on the general health of the population, whereas preventative measures are low-tech and less impressive, but make a much bigger impact. The US has some of the worst population health indicators (child mortality, life-expectancy, maternal mortality, etc) of the developed world and even falls behind poorer countries despite their super high tech approach.

      August 19, 2011 at 15:53 | Report abuse |
  13. Ana

    A few months ago my husband had a close family member who died suddenly and quite young from a heart attack. It turns out heart disease is rampant in his family...I had previously read one of Dr. Ornish's books a few years and thought it sounded too austere...but I picked one up again this Spring and decided to put our whole family on it. I don't have my hubby's family history, but I thought it wouldn't hurt me and the support would help him. And you know what? I feel a whole lot better physically and in many other aspects of my life. People are always asking us how long we are going to stay on this diet. I think in a way that could be one of the problems our society has. We think healthful lifestyle changes are temporary and that we can then go back to eating whatever crud we want when we've lost the weight. Getting healthy, losing weight, etc. all require permanent lifestyle changes. I can honestly say I'm not suffering on this diet, and I really thought I would be at first but I feel so much better I don't even miss the junk.

    August 19, 2011 at 11:26 | Report abuse | Reply
  14. KBB

    It is interesting how the same data can be interpreted in opposite ways. Scientists have been trying to understand how to suppress telomerase, because cancer cells rely on this enzyme to maintain the telomeres of the faster dividing cancer cells. In the study mentioned by Ornish they showed that telomerase is increased by about 20% (in blood cells). If I was a doctor, I would say drop the diet and the lifestyle changes, since they are making your cancer worst. Many studies show that the higher the telomease the worst the cancer. Recent study also show that high carb diet actually promotes cancer growth and low carb (the diet was also low in fat) diet slowed it. Perhaps prevention of cancer and heart disease require to some degree different lifestyles?

    August 21, 2011 at 11:52 | Report abuse | Reply
  15. Maule5662h

    Dr. Gupta and Dr. Oz, our best media doctors, are doing excellent educational presentations on the great health benefits of going to the evidence-based / science-based / experience-based healthy lifestyle. The experts that they learn from are Dr. Esselstyn, Dr. Campbell, Dr. Ornish, Dr. McDougall, Dr. Barnard, Dr. Fuhrman, Dr. Popper, Dr. Diehl, RD Novick, and many others. These experts agree that the optimal nutrition for us herbivore-designed (plant eaters) humans is a plant-based, whole-foods diet focused on complex carbohydrates, green and yellow vegetables, and some fruits. Minimize/eliminate processed oils. Go to their websites to get their guidance! Dr. McDougall's is probably the best one to learn from and you can get his free monthly email newsletter. My family of four participated in his ten-day "Total Health Solution" clinic ~nine years ago and we have been healthfully on his plant-strong nutrition program since then. I am 75+ and take no medications, not even statins, aspirin, vitamins and minerals. Get these nutrients from plants and the sun. 80% of better health comes from food, 20% from exercise - so focus on healthy foods since we do have to eat! Goggle "maule5662h" and see more of my guidance materials!

    August 28, 2011 at 03:26 | Report abuse | Reply
  16. Bobby Fernandez

    I greatly respect and admire Dr. Ornish for his advocacy of Ayurvedic medicine and lifestyle modification. Bringing lifestyle medicine to the fore-front (turning off the faucet before grabbing a mop) is my mission in life. I do however disagree that there can be a single set of dietary guidelines that should be advocated as "optimal" for all. At the heart of Ayurveda and holistic medicine is that each person is their own microcosm of the macrocosm around them; that is to say we are all infinately unique. There are standard practices and procedures to cure an illneess but the practice of building wellness can never be standardized. Nutrition is at the foundation of building wellness and must be addressed with each patient individually.

    August 30, 2011 at 14:40 | Report abuse | Reply
  17. health coach

    Really good points here!!taking care of our individual health is always and should always be our concern..living in a healthy life is so much happier than suffering in illness.In my view as a health coach,as early as now we should practice healthy living and teach our children on how to be healthy by providing them the right food.For more health tips feel free to visit this site http://authentichealthcoaching.podomatic.com/

    September 1, 2011 at 00:21 | Report abuse | Reply
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    Why do drug costs vary depending on what state you live in? Why is the state involved in setting health care costs?

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