Dr. Dean Ornish’s new article at Huffington Post offers a clear-minded explanation of why lifestyle-based prevention is the key to making our health care system work. Absent that, what we have is little more than a disease management system. And the world’s most expensive one, at that.
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. Often, even better.
These choices are especially clear in cardiology as an example of this larger issue. Large-scale studies have shown that changing lifestyle could prevent at least 90-95% of all heart disease. 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.
In contrast, many people are surprised to learn that bypass surgery and angioplasty don’t work very well. In 2006, for example, according to the American Heart Association, 1.3 million angioplasties and stents were performed at an average cost of $48,399 each, or more than $60 billion. In addition, 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion — i.e., more than $100 billion for these two operations.
Despite these costs, a major randomized controlled trial found that angioplasties and stents do not significantly prolong life or even prevent heart attacks in stable patients (i.e., in most patients who receive them). Earlier randomized controlled trials of coronary bypass surgery found that this procedure prolongs life in only a small fraction of patients–those with left main coronary artery disease or equivalent and left ventricular dysfunction (ejection fraction less than 30%). A recent randomized controlled trial in diabetics found that neither bypass surgery nor angioplasty prolonged life or prevented heart attacks.
