Saturday, November 29, 2014

Ornish and the American Working Class: Reflections on Heart Disease

A week of mild chest pain sent me to the bookstore to look up Dean Ornish MD.

When a patient broke my ribs and damaged my lung and back a couple years ago, a CT of the affected area revealed that I have moderate to severe Coronary Artery Disease (CAD). The test revealed calcification of those ever important arteries that keeps the heart alive. After getting the diagnosis, I did all the things you are supposed to do: I got a stress test. I had already gotten my cholesterol under control and have had dramatic improvement in those important numbers. I take a statin. I take Niacin and Fish Oil, Cinnamon, Vitamin D, Calcium, Magnesium. These items have brought my cholesterol down and my HDL/LDL ratio to dramatically improve. The numbers say I am at a low risk; I know better than that.

For those who don't know, Dr. Dean Ornish is the guru of diet, exercise and stress reduction to treat heart disease. His program is revolutionary in that he actually proved that CAD can be reversed. In his latest book, Spectrum, he tries to change his image from the No Fat Ascetic that he used to be, to a more reasonable, "everything in moderation" sort of guy. His whole approach now is to lean to the Spectrum of good health behaviors and diet, according to the desired result of the patient. The sicker you are, the more to the good side you should spend most of your time. It is a Spectrum.

When Ornish originally introduced his program, it was very effective. The problem was that the lifestyle changes required were not sustainable for most people. It was too severe.

What Ornish and his colleagues have also discovered is that you can treat Prostate Cancer with the same approach and have documented evidence of slowing and stopping the progression of Prostate Cancer by using his techniques.

Well, I have both conditions. Coronary Artery Disease and an elevated PSA that resulted in a negative biopsy last Spring. I will never, ever have another biopsy, no matter what my PSA numbers elevate to, because the one I did have got infected and I felt extremely ill for almost two months after it. The procedure is painful and often leads to infection. I'll take my chances on cancer.

So how's the chest pain? I started back on a blood pressure medication that I had run out of  and that seems to have taken care of it. But with CAD, you know it is there, lurking like a shark, waiting to attack.

I have a very sedentary new lifestyle. I love this new job, but driving from 7 am to 7 pm takes a toll. I drive to drop Kylie off in the morning, then drive to an appointment and then sit and talk; drive to the next one and sit and talk; drive to the next one and sit and talk. It is not unusual for me to drive over 200 miles a day. My territory is huge from Oroville to Corning; Los Molinas to Willows; Orland and Chico to Magalia. My territory is as large as some New England States. That's a lot of sitting.

I joined a gym but have been increasingly fatigued while trying to muster the energy to run on the treadmill. I walk now--when I can fit a visit in. My new life of getting up so damned early, not getting enough sleep, 16 hour days, a job that requires lots of home time charting, and endless travel have taken a toll.

Since nothing can really change in my life (I need this job to survive with all the travel, long hours and sedentariness)---the only thing that can really change (and needs to change) is the way I eat. Ornish is right about this.

But there is something that just makes me feel very unsettled about these health Gurus like Ornish and Andy Weil. What I find so unsettling about both of them is the way they advocate a certain amount of personal piety but do not ever examine the larger picture that creates the need for the personal piety.

Ornish acknowledges his friends in the back of the book: it reads like a Whose
Who from Bono to Bill Clinton. Tony Robbins is even in there---and if there was ever a Guru of personal self indulgence with no hint of social responsibility it would be Tony Robbins. The impression is that this lifestyle is for the elite; and in fact, it is mostly the middle to upper classes who have the economic privilege to be able to spend the time and energy it takes to become healthy. You don't see many low wage workers from McDonald's entering Ornish's program at the Cleveland Clinic. Alternative heart disease treatment is for the well educated monied class. The rest of us take a pill and go back to work with the endless hours, low pay and fast food drive-thrus.

It is too easy to sit back and blame the lazy American for being fat and not caring about his/her health. Screw that: the American Working Class are working too hard to provide for their families to pay attention to taking care of themselves. And the choices offered are easy, unhealthy but time saving. And time is the one thing the American Working Class does not have.

And so that leads me to this question: What is more important for the health of a population: an Active Government that is interested in the health of its citizens (think Norway or Cuba) or the Personal Piety of the democratic masses (think Ornish and Weil)? I would argue that the Government is more important.

Something to think about. In the meantime, time to start eating oatmeal and broccoli.

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