April 12, 2000
		Medicare to Try Dr. Ornish's Plan for Critically Ill Senior Citizens In the April 11 edition of the New YorkTimes, journalist Barbara Whitaker wrote about Medicare's first-ever experiment with a lifestyle-modification program, specifically Dr. Dean Ornish's program. Medicare has set out to learn if the plan would work on a large scale and bring down medical costs spent on caring for critically ill elderly people. According to the Institute of Medicine, 86 percent of the estimated 34 million Americans over age 65 have at least one chronic condition like high blood pressure or diabetes that might be helped by nutritional education. Dr. Ornish's program combines a low-fat, vegetarian diet with exercise and meditation. Fat is limited to no more than 10 percent daily, and smoking is not allowed on the program. Werner Hebenstreit, an 85-year-old who had suffered two heart attacks before beginning Ornish's program 14 years ago, takes no heart medication, is robustly energetic, and believes that Ornish's recommendations have saved his life. "At 71, I was convinced I would die very soon. I feel healthier now than when I was 40 years younger." The Medicare experiment with Dr. Ornish's plan is designed to determine whether dramatic changes in lifestyle and eating habits can prevent the need for angioplasty and heart bypass surgery. This interest in Dr. Ornish's plan represents a desire to shift from disease treatment to disease prevention. Over the next three years, about 1,800 elderly heart patients will volunteer to follow the program for one year, run out of at least 15 centers whose staffs are trained by Dr. Ornish. It will cost $7,200 for each patient, which will be paid for by Medicare.This is not a clinical trial; they are interested in seeing whether people who stick with the program cost Medicare less. "The challenge for us is how to modernize Medicare from a medical, acute care model to a comprehensive, health care model emphasizing successful and healthy aging through health promotion and risk factor reduction," said Jeffrey Kang, chief clinical officer with the Health Care Financing Administration, which oversees Medicare. Still, this interest in Dr. Ornish's program has not been without controversy. Officials from the American Heart Association have said that the diet is too restrictive for the average heart patient, and that more information was needed on which parts of the program had the most effect. Dr. Michael Hash, deputy officer of the Health Care Financing Administration, disagrees. "We wouldn't be proceeding to demonstrate this with the Medicare population if we didn't have confidence that it had produced evidence of effectiveness in reducing heart disease. We have determined that it is promising as a possible alternative to bypass surgery." Dr. Ornish began developing his plan, which emphasizes consuming a large variety of whole grains, vegetables, fruits and legumes, as a medical student 23 years ago. He noticed that patients would be admitted for heart surgery, continue the same lifestyle once they went home, and have to be readmitted for another surgery. "For me that became a metaphor," Dr. Ornish said. "Like mopping up the floor without turning off the faucet." ©1998-2000 Vegan Street