Change Your Habits, Change Your Health

Cover-#70Walter Alexander Interviews Dean Ornish, MD

A medical doctor's story of personal awakening, perseverance, and how his research-based work is bringing about a new standard of care in heart medicine and more

Dean Ornish, MD, is president and founder of the nonprofit Preventive Medicine Research Institute in Sausalito, California, as well as Clinical Professor of Medicine at the University of California, San Francisco. He is best known as the physician who proved that the narrowing of arteries in the heart caused by atherosclerosis can be reversed without drugs through diet, exercise, meditation, and psychosocial support. His subsequent research has shown, as well, that comprehensive lifestyle changes may slow, stop, or even reverse progression of early-stage prostate cancer, while switching off cancer promoting genes and switching on disease-preventing ones.

The list of his awards and honors fills pages. LIFE magazine listed him as “one of the fifty most influential members of his generation.” The documentary film Escape Fire: The Fight to Rescue American Healthcare, which prominently features Dr. Ornish and his work, opened in October 2012 to laudatory reviews and comparisons to Al Gore’s global warming film An Inconvenient Truth.

I interviewed Dr. Ornish in Chicago at the 2012 American College of Cardiology Annual Meeting after he presented a talk, “Intensive Lifestyle Changes for the Treatment of Coronary Artery Disease.”

Walter Alexander: How did you become interested in reversing already established heart disease through meditation and diet and social support?

Dr. Ornish: When I was a freshman at Rice University in Texas, where I grew up, I was overcome with the feeling that I was stupid and an impostor, and became a bit obsessed by a vision that nothing could bring lasting happiness.

I became so depressed that I actually planned to get drunk and run my car into a bridge abutment—but I had gotten sick with mononucleosis—after being up for a week straight as a result of the severe agitated depression I was experiencing—and was too weak even to do that. My parents visited me at school, took one look and whisked me back home to recover. My plan was to get well enough to kill myself.

My older sister, who had been sort of a “child of the sixties” (this was in 1972), had studied with the renowned ecumenical yoga teacher, Swami Satchidananda—and my parents saw that it had really helped her in her own personal life. So my parents, when they heard that he was in Dallas, threw a cocktail party for him (which was unusual for Dallas, especially back then).

He gave a lecture in our living room saying, “Nothing can bring you lasting happiness” —which I had already figured out—except that he was radiant, and I was miserable! He went on to say something that turned my life around. It sounds like a New Age cliché, but at the time, it really made a profound difference in my life. He said you already have lasting happiness —but not being mindful of that, you end up running after all these things that you think are going to bring it to you, and in the process, you disturb what you could have already, if you’d just stop running. He said that the goal of all spiritual practices is not that they bring you happiness, but that they help us to slow down our minds and bodies enough to experience an inner sense of peace that‘s actually always there.

WA: So, you took up the practices that he recommended?

DO: So, I said, let’s try it, and I gave up my Texas diet of eating meat five times a day and chiles and cheeseburgers and chalupas, and began eating a plant-based diet, doing some yoga when I could sit still long enough to do it, walking more—and I began to get little glimpses of what that meant. And it was enough to really turn my life around.

WA: Can you give us a glimpse of one of those glimpses?

DO: There was one very empowering realization—that people have power over you only if you think they have something that you need—so when I thought I had to get into medical school to become a doctor in order to be lovable, I was so agitated that I couldn’t even read a headline in a newspaper. But when I became, to myself, more inwardly defined—I was able to go back to school and did extremely well. I graduated first in my class. I went literally from one end of the spectrum to the other.

And then later, when I was in medical school, when I was doing work-ups of patients and spent time with them, I realized that more often than not they were dealing with the same issues of being depressed that I had been.

WA: Where were you then?

DO: I was on Michael DeBakey’s surgical service at Baylor College of Medicine in Houston. DeBakey was a pioneer of open heart surgery, bypass graft surgery, and the artificial heart. I was learning how to do bypass surgery. We cut people open and bypassed their sick arteries—and they went home and often continued to do all the things that caused the problems in the first place (smoking, eating junk food, and being sedentary). More often than not, their bypasses would clog up, and we would cut them open again.

I thought, “There’s got to be a better way.” I began to read voraciously and saw that you could cause animals to have heart disease if you put them on an unhealthy diet, made them smoke, and put them under psycho-social stress, or put them in isolation. But, you could reverse it if you changed those conditions.

WA: And when you wanted to try it with people then, who listened to you?

DO: Everybody thought it was a crazy idea. So, I decided to take a year off between my second and third years of medical school. The nice thing about Baylor is that it is not as hierarchical as the Harvard system. I got to do things at Baylor as a med student that I couldn’t do as a senior resident in the Harvard system. They went along with my idea. I put 10 men and women in a hotel for a month under closely controlled conditions, and we found that the blood flow to their heart improved after just a month.

WA: One month! I hadn’t realized the study period was so short.

DO: It changed my view of the body. The idea of heart disease back in 1977 was that it was like rust in a pipe. It took decades to build up, and if you could change your habits, it would take decades for the benefit to show up. We now know that the vasculature is so much more dynamic than that. It’s not like lead pipes. The arteries are joined with smooth muscle that can constrict or dilate. So with that rapid improvement, I’ve become increasingly respectful and impressed by how quickly our bodies can often begin to heal if you simply stop doing what caused the harm in the first place.

WA: So, you went back to complete your training then?

DO: I went back and finished my MD and then ran a second randomized trial which replicated the first study. That was published in JAMA (The Journal of the American Medical Association). After that, I went to Boston and Massachusetts General Hospital and Harvard for my residency and fellowship in internal medicine.

WA: You had found your task already as a medical student. How would you define it?

DO: I want to help create a new paradigm of medicine that is both more caring and compassionate, as well as more cost-effective and competent.

I thought, once we published all these studies and show that diet and exercise, and social support and meditation work so well—enough to reverse the development of lesions already established in coronary arteries—I thought, “That will change medical practice.”

WA: That’s the great myth, isn’t it? Scientists say, “Show me the data, and I’ll change my mind.” But if you show them data, and the findings run against the grain of their current understanding, you might as well shout into a stiff gale at the ocean.

OR: That’s the story of my life! Yes, you get a lot of talk about evidence-based medicine. Look at the lack of evidence that angioplasty and stents prolong life or prevent heart attacks! But they’re putting them in more than ever, because they are reimbursed. It’s human nature—but it’s not science.

So the real message was that the most powerful driver of medical practice is not only science, but also reimbursement. If it’s not reimbursable, it’s not sustainable.

WA: So you gathered your forces…

DO: …and we began going to insurance company after insurance company. Mutual of Omaha was the first to say “yes,” and cover our program. Then, over time, 40 companies began covering our program, including Highmark Blue Cross Blue Shield. It was a very tough row to hoe because most people don’t go into insurance administration because they’re entrepreneurial—you know, it’s insurance. So despite all this effort, the number of people able to get reimbursement for our program was still relatively small.

I realized in 1994 that we needed to get Medicare to pay for this. If Medicare paid, then most everybody else would. That would change medical practice, and even medical education.

WA: Before we go into what that journey entailed, could you say a bit about other key insights that shaped your work?

DO: Yes. One of the most powerful was that it is not enough to give people information—that doesn’t touch the social isolation, the loneliness, and the depression. For that, you need to work at a deeper level. Telling somebody who’s lonely and depressed that they are going to live long if they just take Lipitor or change their diet is not that motivating. If you had told me that when I was 19, I would have said, “You don‘t understand. I don’t want to live.”

The need for love and connection and community is a fundamental human need that is as powerful as the need for food, water, and air. And, so often it goes unfulfilled in our culture because of the breakdown of the social networks that used to give that to people. Many people do not have a nuclear family, or an extended family, or a job that feels secure. They don’t have a neighborhood with two or three generations of people they grew up with. They don’t have a church or synagogue they go to regularly. And those things affect our health and survival, not just our quality of life.

WA: You saw the necessity—if you really want to be a healer—to cross the invisible line between physical and psychological health.

DO: I’m always looking for ways that we can use the experience of suffering as a doorway or a catalyst for transforming people’s lives. Change is hard, but if they’re hurting enough they may say, “Wow, maybe I’ll try this weird stuff.” And when they try it, and they feel so much better so quickly, that’s when they may say that perhaps it was a blessing in disguise that they were diagnosed with something.

WA: Is biographical work part of the program?

DO: In the support groups, people speak authentically about their lives and their problems. It doesn’t solve them, but it does solve the problem of feeling isolated and powerless. The participants experience intimacy, and develop incredibly deep bonds. That’s the secret sauce. It’s very meaningful for them, and that’s why they continue to meet for years.

WA: Does formally recognizing this interface between information science—the science that does meta-analyses of clinical trials and so forth—and spirituality represent a true breakthrough?

DO: I think it does. Spirituality implies that, while at one level we are separate from one another, there is something spiritual that connects us all. Even to give it a name limits what is essentially an ineffable experience. Altruism and forgiveness and compassion and so on are part of all spiritual traditions because they are what free us from our suffering. They enable us to let go of the things that isolate us. There’s a horizontal intimacy between people or between animals, and there’s a vertical intimacy that connects us to that which connects all of us.

WA: Have you worked hard to find ways to say this without any denominational flavor?

DO: Yes, but we don’t just present our methods as stress management techniques, either. You know the ancient swamis, rabbis, priests, nuns, and monks didn’t develop these things to unclog your arteries or lower your blood pressure. Their intent was to give you the direct experience of interconnectedness. So what we try to teach people is to be able to maintain that double vision. That it’s not this or that—it’s both. You can’t really be in the world in a healthy, effective, fun way unless you see on another level that we are all interconnected. Compassion naturally flows from that.

WA: Have you reached some kind of accommodation between conventional medicine and the stringent lifestyle changes you first recommended?

DO: Yes. We’ve found that a synergy between lifestyle changes and drugs is optimal for many patients. For example, their adherence to statin drugs is much higher if they change their lifestyle. And the drugs work better with those changes.

WA: Non-adherence to medications is a huge problem for medical practice, in general.

DO: In our program we are getting 85-90 percent adherence to a program of intensive lifestyle changes after one year, not the 30-40 percent adherence to statins and other medications after only three months that is typical.

WA: What accounts for that?

DO: They aren’t passive. When they are actively participating in their healthcare, they feel better and more empowered. For high blood pressure, for obesity, for most chronic conditions—we have found that lifestyle changes are synergistic with medication.

WA: Let’s go back to the 16-year odyssey—from the realization about Medicare reimbursement to the day you actually achieved it.

DO: I knew that if I went to Medicare and said I want to teach people how to quiet down their minds and bodies and open their hearts and rediscover inner sources of peace, joy and well-being, they’d say, “You’re out of here, buddy.” So, I spent 35 years doing randomized controlled trials with quantitative arteriograms, cardiac PET scans, radionuclide ventriculograms, and SPECT thallium scans, and showed the gene expression changes, and demonstrated the money they would save, and all these things. And, it took a demonstration project, a Medicare Coverage Advisory Commission hearing, two National Coverage Determinations, and an Act of Congress for the authorization to create a new benefit category called Intensive Cardiac Rehabilitation. And finally, we got it after 16 years—for which I remain deeply grateful. But, we end up with the possibility of being able to create a system that makes these kinds of changes sustainable. Better healthcare for more people at lower cost—and the only side-effects are good ones.

WA: You are determined. Did you always have that quality?

DO: This is my life’s work, and I love doing it. There were times when my patience was really tried—but my persistence is probably my best and my worst quality. It can drive people crazy at times. I just realized that it was not going to happen otherwise. Our work was just going to be a footnote and remain on the fringes of history, regardless of the three decades of research, unless we could change reimbursement. Then medical education and medical practice would follow. Now we can create systems and sanctuaries that enable people to use the experience of suffering to transform their lives for the better.

WA: You’ve mentioned the opportunities created by suffering a few times…

DO: When people come to a physician with a serious physical ailment, when they are hurting, there’s a receptivity they don’t have at other times in their lives. That’s sacred. We’re all human, we’re all suffering in some way. If we can connect with one another and be compassionate, if I learn how to use that pain as a doorway and a catalyst for transforming my life and the lives of my patients, it brings meaning to them and to me.

WA: Can you say what the meaning is for you?

DO: Since I didn’t kill myself years back, I have felt in many ways like I’m on borrowed time. It’s my way of giving back.

WA: But not every doctor can or wants to wade into those depths.

DO: They often have the same struggles, though. Maybe especially in academic medicine.

WA: Why so?

DO: There’s an old saying: Things get so vicious in academic medicine because the stakes are so low. There’s so little money in it that power, turf, and prestige get overblown. And so—there’s a lot of pain there, and a lot of frustration. Also, for all doctors, managed care is making it hard to practice the kind of medicine that people want to practice. You know, most physicians wouldn’t recommend medicine as a profession for their sons and daughters because there is so much pain and suffering in the profession. These messages often resonate with their souls, as well. My unique role is to be able to bridge that gap in many ways. The science is only one part of it.

WA: Yes, but the fact that you’ve done the science gives you credibility.

DO: Yes. Thirty-five years of research gives me credibility, and permission to talk about other things.

WA: Now that your program is approved, what next?

DO: We’ve trained people at 51 hospitals and clinics. But we want to scale it up and make it a new paradigm of care, a standard of care. We’re looking for a partner to help with that.

WA: To sum up, it seems that what you’re saying about medicine is that it needs to go deeper. And you want that message to go out more widely.

DO: You could say that.

WA: Would you say that your approach professionally carries over to your personal life?

DO: It is my main focus. Trying to go deeper with my family and my friends. With my wife and our glorious relationship. We were best friends for 15 years, and have been married for eight, with two children. The Indian sage Ramakrishna, more than a hundred years ago, said that rather than digging a lot of shallow wells and never reaching water, it’s better to dig one deep well and reach the wellspring.

WA: Do you still have a private practice?

DO: No, I see only friends and family, and I continue to conduct research and develop our programs.

WA: We wish you the best. Thank you!

DO: Thank you.