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Lions Roar : January 2011
SHAMBHALA SUN JANUARY 2011 88 skeptics, ornish argues that compliance rates for drugs like lipitor are actually abysmally low. “People don’t want to take a pill to prevent something so horrible they don’t want think about it,” he told me. “but our data shows that most people are able to make and maintain these life- style changes because they feel so much better so quickly. feeling better is sustain- able. Joy of living is a much better motiva- tor than fear of dying.” folloW the (insurance) Money ornish believes that one of the most critical aspects of health care reform is the reim- bursement of integrative medicine practices that have been demonstrated to be safe and effective. Insurers are currently much more likely to reimburse costly surgical procedures and medications—the american Heart association puts the price of coronary by- pass surgery at $99,743—than inexpensive lifestyle changes that could, according to ornish, prevent ninety percent of cardiovas- cular disease. at places like Duke Integrative Medicine, the vast majority of patients pay out-of-pocket for services. brantley com- pares the cost of a health immersion or an- nual membership ($2,995) to a vacation—a reasonable expense for many but an unaf- fordable luxury to others. Having to pay out of pocket will keep many people from invest- ing in their health, leading to higher personal and societal costs in the long run. reimbursement also drives physicians’ medical decisions, ornish says, even more than evidence. “We could do a thousand studies, but until something is reimbursed, the practice of medicine won’t change.” He points to a large study published in 2007 in The New England Journal of Medicine which found that the most common sur- gical procedures for heart disease—angio- plasties, stents, and coronary bypasses—do not prolong life or prevent future heart at- tacks for 95 percent of patients who receive them. “you’d expect that once that study came out, the number of angioplasties and stents would go down. Instead, it’s increased—because it’s paid for.” ornish has spent sixteen years working to get his lifestyle intervention for cardio- vascular disease reimbursed by Medicare. at absenteeism, employee retention, pro- ductivity, and performance. sixty-three studies addressed financial outcomes, and all but one reported positive cost- effectiveness, cost-benefit ratio, or re- turn on investment. Pelletier estimates that the typical return on investment is actually between 3.5 and 4.9, but that it takes about three years to fully real- ize the financial payoff. at a minimum, integrative medicine programs break even, despite the upfront costs, but convincing employers and insurers to adopt such programs will require both vision on the part of those footing the bill, and more hard data confirming the long-term economic rewards. the PoWer of lifestyle on february 26, 2009, Dean ornish, MD, went to Washington to testify before the senate committee on Health, edu- cation, labor, and Pensions, chaired by the late senator edward M. kennedy. ornish is the founder and president of the non-profit Preventive Medi- cine research Institute in sausalito, california, and the bestselling author of books such as Dr. Dean Ornish’s Program for Reversing Heart Disease. He made ten key recommendations to the committee for health care re- form, including funding more scien- tific studies in integrative medicine, changing farm subsidies, incentivizing food companies to make and market healthier foods, putting mandatory physical education back in schools, and incentivizing a focus on wellness rather than illness in health plans and at corporate worksites. ornish’s own studies over the last thirty years have shown that when people make major lifestyle changes, ex- traordinary benefits are possible, includ- ing reversing or slowing the progression of cardiovascular disease and cancer. His program, laid out in bestsellers like The Spectrum, includes a wide range of health-supporting behaviors, such as moderate exercise and a low-fat, plant- Healing the Whole Person continued from page 61 based diet. It also emphasizes stress reduc- tion, through yoga and meditation, and social support. “Part of what I’ve learned is the need for connection,” ornish says. “It’s a primal human need. People who are lonely and depressed die sooner. this is the real ep- idemic, the breakdown of social networks. We create environments that feel safe for people to talk about what’s going on in their lives. When you can meet an unmet need, this is very powerful. Intimacy is healing.” Many studies have demonstrated both the clinical success and cost savings of ornish’s program. for example, a trial using patients at eight hospitals found that almost 80 percent of individuals with cardiovas- cular disease who were eligible for bypass surgery or angioplasty could avoid these surgeries through lifestyle changes. the esti- mated savings per patient was $30,000. the most recent studies of ornish’s pro- gram have used some high-tech, cutting- edge measures to demonstrate the power of these low-tech, common-sense lifestyle changes. a 2008 paper in the Proceedings of the National Academy of Sciences analyzed the expression of over 500 genes in the prostate cells of men with prostate cancer. after patients followed ornish’s program for three months, many genes that pro- mote cancer, heart disease, and inflam- mation were downregulated, while many health-promoting genes were upregu- lated. this suggests that lifestyle changes, social support, and stress reduction have a measurable impact on something as con- crete as our genes. a 2008 study published in The Lancet Oncology reported that the same participants showed an increase in telomerase, an enzyme that helps preserve telomeres, the bits of Dna at the end of chromosomes. Previous research has shown that shortened telomeres is a sig- nificant predictor of disease and mortali- ty. the ornish study is the first to demon- strate that any intervention has a positive effect on telomerase, and, by extension, may increase lifespan. Many in the medical profession applaud ornish’s findings but question whether pa- tients will really make these kinds of com- prehensive changes. after all, it’s easier to take a pill than change your diet and make time for exercise and meditation. to these