Excerpt: Dean Ornish's 'The Spectrum'

You may be surprised to learn that angioplasty does not reduce the risk of a heart attack and does not prolong life in patients with stable coronary heart disease. This was the remarkable conclusion of a study published in June 2005 in Circulation, the American Heart Association's lead scientific journal, in which researchers reviewed all eleven randomized controlled trials of angioplasty. The same conclusion was found in a recent large-scale randomized controlled trial published in The New England Journal of Medicine.

It's hard for many people to believe that comprehensive lifestyle changes work even better than drugs and surgery in treating heart disease, but they often do. For example, a major study, also published in Circulation, found that regular physical exercise worked even better than angioplasty for preventing heart attacks, strokes, and premature deaths. Another study, published in The New England Journal of Medicine, found that those taking the cholesterol-lowering statin Lipitor had 36 percent fewer cardiac events after eighteen months than those undergoing angioplasty.

Several randomized controlled trials have shown that coronary bypass surgery prolongs life only in those with the most severe disease, which is only a small percentage of those who receive it. Angioplasty and bypass surgery may reduce the frequency of angina (chest pain), but most people can reduce angina at least as much in only a few weeks just by changing their diet and lifestyle, if these changes go far enough in the healthy direction on the Spectrum.

In short, most insurance companies have been paying billions of dollars for surgical procedures that are invasive, dangerous, expensive, and largely ineffective, whereas they pay little or nothing for the diet and lifestyle interventions described in this book, which are noninvasive, safe, inexpensive, and powerfully effective in treating coronary heart disease as well as many other chronic diseases. And the only side effects are good ones.

The managed care approach of shortening hospital stays, limiting reimbursement, capitation, and forcing doctors to see more patients in less time leaves everyone frustrated and unhappy because this approach does not address the more fundamental causes of why people get sick. It's a different type of bypass.

Last year, more than one million coronary angioplasties and more than 400,000 coronary bypass operations were performed in the United States at a cost of more than $100 billion. Among Medicare beneficiaries, the number of these operations increased 543 percent between 1984 and 1996 despite the absence of clear outcome benefits. This challenges the sustainability of Medicare.

These health care costs (as mentioned earlier, these are really disease care costs) are also challenging the viability of many businesses and corporations. General Motors spends more on medical care for its employees than it does to buy steel. Howard Schultz, the founder and chairman of Starbucks, said that he spends more on health care for his employees than for coffee beans. As the population ages and health care costs continue to outpace inflation, many corporations project that they will reach a tipping point in only a few years in which health care costs exceed their entire profits. Clearly, this is not sustainable.

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