After we and others proved that the progression of coronary heart disease and other chronic diseases could often be reversed by making comprehensive lifestyle changes, these misconceptions slowly began to change. Now most doctors believe that heart disease is reversible.
Then the skepticism shifted. Although most physicians believe that the diet and lifestyle program I recommend works, they often think that the majority of people can't follow it because it's too strict, too hard, and too boring. So why bother? "Okay, your patients changed, but you live in California. It's an altered state. They'll do anything there. And you're some kind of guru; you can somehow brainwash people to change."
All About the Benjamins
When we published our research findings, I thought these would significantly change medical practice, but I was a little naive. With all the talk about evidence-based medicine, we really live in an era of what I call "reimbursement-based medicine."
I realized that it wasn't enough to have good science; we also needed to change reimbursement. We doctors do what we are paid to do, and we are trained to do what we are paid to do. Therefore, if we could change reimbursement, then we would improve both medical practice and medical education. As Sean Combs sings, "It's all about the Benjamins" (Benjamin Franklin on hundred-dollar bills).
Beginning in 1993, my colleagues and I began training personnel in more than fifty hospitals and clinics around the country in our diet and lifestyle program via our nonprofit research institute. We conducted three demonstration projects--one with Mutual of Omaha, a second with Highmark Blue Cross Blue Shield, and most recently with Medicare.
We began in 1993 with a demonstration project sponsored by Mutual of Omaha. The questions we wanted to answer were: (a) Could people in Omaha, Des Moines, and South Carolina (where they told me "gravy is a beverage") follow this program as well as those in San Francisco, Boston, or New York? (b) Could we train other health professionals to intervene with their patients as effectively as we could? (c) Was this medically effective as well as cost-effective?
In this first demonstration project, we trained personnel in eight hospitals: Beth Israel Medical Center in New York; Beth Israel Medical Center at Harvard Medical School in Boston; the University of California, San Francisco; Scripps Institute in La Jolla; Alegent Medical Center in Omaha; Richland Memorial Hospital in Columbia, South Carolina; Broward General Hospital in Fort Lauderdale, Florida; and Mercy Hospital in Des Moines, Iowa. Our data-coordinating center was at Harvard Medical School, directed by Alexander Leaf, M.D., who was chair of the Department of Medicine at Harvard Medical School.
Reimbursing comprehensive lifestyle changes is not only medically effective, it's also cost-effective.
In brief, we found that almost 80 percent of patients who were eligible for bypass surgery or angioplasty were able to safely avoid it for at least three years. Mutual of Omaha found that it saved almost $30,000 per patient in the first year! We published these findings in the peer-reviewed The American Journal of Cardiology.