Advisor Spotlight: Dean Ornish, MD
Note: The use of the term "Integrative Medicine" here means evidence-based.
On February 2, 2009 Dr. Ornish testified before the Senate Health Reform Committee, therefore we began our interview talking about his view regarding lifestyle medicine and healthcare in America. "I am encouraged that something may happen; the world is catching up," he responded. "I am cautiously optimistic that reimbursing physicians and other health professionals to teach people how to make intensive lifestyle changes will be covered under the new administration's health plan."
For more than thirty years, Dr. Ornish has been at the forefront of doing evidence-based research as a catalyst for health; the health of individuals as well as the health of the educational, medical, insurance institutions that exist for teaching and providing effective health care. Dr. Ornish's testimony in support of lifestyle medicine was essential for the Senate to hear and for the unfolding healthcare debate in this country to heed. With healthcare reform potentially imminent and the voice of lifestyle medicine so important, several highlights of Dr. Ornish's testimony are noted here:
He opened his remarks saying, "The theme of my presentation is this: if we want to make affordable health care available to the 47 million Americans who do not have health insurance, then we need to address the fundamental causes of health and illness, and provide incentives for healthy ways of living rather than reimbursing only drugs and surgery."
After painting a clear picture of the research and benefits of lifestyle medicine, Dr. Ornish proposed ten recommendations to the Senate Committee. The first four are:
- Change the reimbursement system for doctors and other health professionals to pay for integrative medicine practices that have been proven to be safe and effective. Reimburse these at the same level as surgical procedures. Good science is important but not sufficient. In an era of what I call "reimbursement-based medicine," if we change reimbursement, we change not only medical practice but also medical education.
- Fund more scientific studies in integrative medicine.
- Incentivize wellness rather than illness in health plans and at corporate worksites.
- Require physicians to share evidence on the efficacy and side-effects of surgical procedures before using them, as Jan Wennberg and others have done.
..."In summary, integrative medicine approaches bring together liberals and conservatives, Democrats and Republicans, because they are both medically effective and, important in our current economic climate, cost effective. These approaches emphasize both personal responsibility and the opportunity to make affordable, quality health care available to those who most need it. They can be an important part of health reform. As Senator Harkin said in our recent Newsweek interview, 'To date, prevention and public health have been the missing pieces in the national conversation about healthcare reform. It's time to make them the centerpiece of that conversation. Not an asterisk. Not a footnote. But the centerpiece of health care reform.' "
Dr. Ornish's "cautious optimism" will be validated the more that lifestyle medicine practitioners, and beneficiaries thereof, speak up. To read the full transcript of Dr. Ornish's Senate testimony, please go to: http://www.pmri.org/press.html
The interview continued:
"Here's some very good news: in August, Senator Ron Wyden (D,Ore) introduced new legislation, the "Take Back Your Health Act" (S. 1640) that will pay for intensive lifestyle changes as treatments, not just prevention, for these conditions as a complement to regular medical care. This legislation was co-sponsored by Senator John Cornyn (R,Tex) and Senator Tom Harkin (D,Iowa). Dr. Ornish, along with Dr. Mark Hyman and Dr. Mike Roizen, intensively consulted on this legislative language."
"'This is a groundbreaking bill, based on the proven idea that lifestyle changes can improve the health of those with chronic disease if people stick with a program that has that goal in mind,'" said Senator Wyden. The "Take Back Your Health Act" gets doctors and patients invested in the success of treatment, since doctors won't be paid unless their patients actually get better.'"
"'This legislation will provide seniors who have chronic diseases with the care coordination, training, and support necessary to make and sustain intensive lifestyle changes that have been clinically proven to beneficially affect or even reverse the progression of many chronic diseases," said Senator Cornyn. "I'm pleased to join with my colleagues in a bipartisan fashion and will continue pushing for common-sense solutions to our health care system.'"
"'The health reform debate is not about continuing the status quo, but about changing our health care system and the medicine we do," Senator Harkin said. "This legislation will change the medicine Medicare does by reimbursing health care professionals for proven programs to address disease, including coronary heart disease, diabetes, and some forms of cancer, through intensive lifestyle change. Health reform is about giving individuals more choices and individuals should be given the option to engage in a lifestyle treatment program instead of surgery and pills.'"
Background
Dr. Ornish is founder and president of the non-profit Preventive Medicine Research Institute (PMRI) in Sausalito, California which he founded in 1984. He is also Clinical Professor of Medicine at the University of California, San Francisco and the author of six best-selling books, including New York Times' bestsellers Dr. Dean Ornish's Program for Reversing Heart Disease; Eat More, Weigh Less; Love & Survival; and his most recent book, The Spectrum. He is also Medical Editor of The Huffington Post.
Dr. Ornish's extensive clinical research has demonstrated, for the first time, that changes in diet and lifestyle can reverse the progression of coronary heart disease and prostate cancer, make a powerful difference in our health and well-being, how quickly these changes may occur, and how dynamic these mechanisms can be. Randomized controlled trials and demonstration projects showed that these comprehensive changes in diet and lifestyle are both medically effective and cost effective. "In our studies, we used the latest in high-tech, expensive, state-of-the-art measures to prove how robust these very simple, low-tech, and low-cost interventions can be," explains Dr. Ornish. "They show that your body often has a remarkable capacity to begin healing itself, and much more quickly than had once been thought."
Re-defining What is Possible for Health and Healing
Dr. Ornish began conducting research in 1977, when he was a second-year medical student at the Baylor College of Medicine in Houston. While studying bypass surgery with Dr. Michael DeBakey, he wondered what might happen if people addressed the underlying lifestyle factors that often cause coronary heart disease rather than just literally or figuratively bypassing the problem with surgery or a lifetime of medications. That one curious thought has led to a lifetime of profound, far-reaching work, re-defining what is possible for health and healing.
He decided to take a year off from medical school to conduct a pilot study of 10 patients with severe heart disease. After only one month, he found that blood flow to the heart improved and the frequency of angina (chest pain) diminished by over 90%. This study was published in the journal Clinical Research. He returned to medical school and received his M.D. in 1980. After finishing his internship and residency in internal medicine at the Massachusetts General Hospital and Harvard Medical School in June 1984, Dr. Ornish moved to San Francisco. He and his colleagues began conducting the Lifestyle Heart Trial, a randomized controlled trial designed to study the effects of these comprehensive lifestyle changes using two state-of-the-art measures: quantitative coronary arteriography to measure coronary artery blockages, and cardiac PET scans to measure blood flow to the heart. This was the beginning of PMRI.
After one year, the amount of coronary artery blockages (atherosclerosis) showed significant reversal. In contrast, the amount of coronary atherosclerosis increased significantly in the comparison group of patients who were not making these changes in diet and lifestyle. This study was published in The Lancet in 1990 and was the subject of an award-winning one-hour documentary on NOVA, the PBS science series. Based on these findings, the National Heart, Lung, and Blood Institute of the National Institutes of Health provided funding to extend the Lifestyle Heart Trial for four more years. They found even more reversal of coronary atherosclerosis after five years in the group of patients who made comprehensive lifestyle changes, and found 2.5 times fewer cardiac events such as heart attacks, bypass surgery, or angioplasty in these patients when compared to the control group.
Patient Compliance, i.e. Sustainability
Again from Dr. Ornish's Senate Testimony: "What is sustainable is pleasure, joy and freedom, not deprivation and austerity. 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...not just to live longer, but also to live better." "...Making comprehensive lifestyle changes significantly improves the quality of life very quickly, which is what makes these changes sustainable and meaningful. Finally, it's worth pointing out that what's good for your personal health is good for the planet's health; what's personally sustainable is globally sustainable. For example, eating a diet high in red meat increases the risk of heart disease and many forms of cancer. It also increases global warming: livestock cause more global warming than all forms of transportation combined."
Simply put, "not fear of dying, but joy of living," is the sustaining benefit that Dr. Ornish and his colleagues have witnessed worldwide since doing this work. "What's sustainable is joy, freedom, and pleasure," he said. "In all of our studies, we found that the more people changed, the better they became. My new book, The Spectrum, shows people how to personalize a way of eating just right for them, based on their own needs, genes, and preferences."
Health Insurance Companies Respond
In 1993, PMRI began a series of demonstration projects to determine if diverse populations throughout the U.S. would be able to make and maintain these comprehensive lifestyle changes. Mutual of Omaha became the first major insurance company to cover Dr. Ornish's lifestyle program and the first insurer to cover any type of integrative medicine program. With this landmark Multicenter Lifestyle Demonstration Project, they found that almost 80% of people who were eligible for bypass surgery or angioplasty were able to safely avoid it by following Dr. Ornish's guidelines. Mutual of Omaha calculated saving almost $30,000/patient in the first year.
In a second demonstration project, Highmark Blue Cross Blue Shield compared patients who went through Dr. Ornish's program for reversing heart disease to a similar group of patients who did not. They found that overall health care costs declined by 50% after only one year and by an additional 20-30% when compared to a matched control group.
Based on these findings, the Centers for Medicare and Medicaid Services began a demonstration project to determine the effects of these comprehensive lifestyle changes in Medicare beneficiaries with coronary heart disease. These findings in over 2,000 patients were reviewed in a formal Medicare Coverage Advisory Commission hearing on January 25, 2005. Based on these outcomes, Medicare agreed to cover Dr. Ornish's program for reversing heart disease, the first time that Medicare has covered an integrative medicine program. This makes the program more available in a sustainable way to those who most need it.
Dr. Ornish notes, "I used to think that good science was sufficient to make lifestyle programs widely available, but reimbursement is equally important. It took fourteen years of research, demonstration projects, and bipartisan political support to get Medicare coverage for patients to receive intensive lifestyle change programs for reversing heart disease. My relentless persistence is one of my best and worst personal qualities. Medicare is covering intensive lifestyle programs by expanding the cardiac rehabilitation benefit to include stress management techniques, support groups, and nutrition counseling as well as exercise. We are currently working with them with the goal of increasing the amount of reimbursement and to expand coverage beyond coronary heart disease to also include type 2 diabetes, metabolic syndrome, prostate cancer, and breast cancer."
In clarifying financial and insurance benefits to the Senate Committee, Dr. Ornish referenced that "A RAND study projected nearly 81 billion in annual national health expenditure savings due to prevention and disease management programs."
Prostate Cancer and Lifestyle Changes
In 2005 Dr. Ornish and his colleagues at PMRI published the first randomized controlled trial showing that the progression of early-stage prostate cancer may be stopped or even reversed by making these comprehensive lifestyle changes. This was the first randomized controlled trial showing that the progression of any type of cancer may be stopped or reversed by making lifestyle changes. What is true for prostate cancer is likely to be true for breast cancer as well.
In 2008, PMRI and UCSF published the first study showing that these comprehensive lifestyle changes may beneficially affect gene expression in men with early prostate cancer: "turning on" or up-regulating disease-preventing genes, and "turning off" or down-regulating genes that promote breast cancer, heart disease, and chronic inflammation. This study was published in the Proceedings of the National Academy of Sciences. In only three months, over 500 genes were beneficially affected, up-regulating ("turning on") genes that prevent disease and down-regulating ("turning off") oncogenes that promote breast cancer, prostate cancer, and colon cancer as well as genes that cause chronic inflammation and oxidative stress.
They also showed that this program may significantly increase telomerase, and thus telomere length, by almost 30% in only three months. Telomeres are the ends of our chromosomes that control aging; longer telomeres = longer life. This is the first study showing that any intervention may increase telomerase. This study was published in The Lancet Oncology and was conducted in collaboration with Dr. Elizabeth Blackburn, who recently received the Nobel Prize in Medicine for discovering telomerase.
PMRI continues to conduct leading-edge scientific research and to form strategic alliances to make this work available worldwide. For more information: www.pmri.org
ACLM Disclaimer: Our Practice Spotlights are intended to provide examples of Lifestyle Medicine in practice. We recognize that Lifestyle Medicine practices vary widely, and inclusion in Practice Spotlight is not intended to imply official endorsement of individuals or practices.
