[Senate Hearing 111-526]
[From the U.S. Government Publishing Office]
S. Hrg. 111-526
INTEGRATIVE CARE: A PATHWAY TO
A HEALTHIER NATION
=======================================================================
HEARING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
ON
EXAMINING INTEGRATIVE CARE, FOCUSING ON A PATHWAY
TO A HEALTHIER NATION
__________
FEBRUARY 26, 2009
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
senate
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
EDWARD M. KENNEDY, Massachusetts, Chairman
CHRISTOPHER J. DODD, Connecticut MICHAEL B. ENZI, Wyoming
TOM HARKIN, Iowa JUDD GREGG, New Hampshire
BARBARA A. MIKULSKI, Maryland LAMAR ALEXANDER, Tennessee
JEFF BINGAMAN, New Mexico RICHARD BURR, North Carolina
PATTY MURRAY, Washington JOHNNY ISAKSON, Georgia
JACK REED, Rhode Island JOHN McCAIN, Arizona
BERNARD SANDERS (I), Vermont ORRIN G. HATCH, Utah
SHERROD BROWN, Ohio LISA MURKOWSKI, Alaska
ROBERT P. CASEY, JR., Pennsylvania TOM COBURN, M.D., Oklahoma
KAY R. HAGAN, North Carolina PAT ROBERTS, Kansas
JEFF MERKLEY, Oregon
J. Michael Myers, Staff Director and Chief Counsel
Frank Macchiarola, Republican Staff Director and Chief Counsel
(ii)
C O N T E N T S
__________
STATEMENTS
THURSDAY, FEBRUARY 26, 2009
Page
Harkin, Hon. Tom, a U.S. Senator from the State of Iowa, opening
statement...................................................... 1
Mikulski, Hon. Barbara A., a U.S. Senator from the State of
Maryland....................................................... 3
Enzi, Hon. Michael B., a U.S. Senator from the State of Wyoming.. 4
Prepared statement........................................... 5
Oz, Mehmet C., M.D., Director, Cardiovascular Institute and
Complementary Medicine Program, New York-Presbyterian Hospital,
New York, NY................................................... 6
Prepared statement........................................... 9
Hyman, Mark, M.D., Founder and Medical Director, The
UltraWellness Center, Lenox, MA................................ 26
Prepared statement........................................... 28
Ornish, Dean, M.D., Founder and President, Preventive Medicine
Research Institute, Sausalito, CA.............................. 37
Prepared statement........................................... 39
Weil, Andy, M.D., Director, Arizona Center for Integrative
Medicine, University of Arizona, Vail, AZ...................... 44
Prepared statement........................................... 48
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Senator Kennedy.............................................. 76
(iii)
INTEGRATIVE CARE: A PATHWAY TO
A HEALTHIER NATION
----------
THURSDAY, FEBRUARY 26, 2009
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The committee met, pursuant to notice, at 10:01 a.m. in
Room SD-430, Dirksen Senate Office Building, Hon. Tom Harkin
presiding.
Present: Senators Harkin, Mikulski, and Enzi.
Opening Statement of Senator Harkin
Senator Harkin. The Senate Committee on Health, Education,
Labor, and Pensions will come to order.
Good morning, everyone. This is the latest in an ongoing
series of hearings that will guide us as we craft comprehensive
healthcare reform legislation in the months ahead.
In his speech to Congress Tuesday evening, President Obama
made clear that he expects Congress to pass a bill this year,
and we fully intend to take him up on that challenge. I might
also point out that President Obama, in his speech the other
evening, clearly mentioned prevention and said that prevention
must be a central part of it, and it was only through
prevention that we could keep people healthy and reduce costs.
That was a welcoming comment by the President.
I want to thank our committee Chair, Senator Kennedy, for
giving the go-ahead for this hearing. Of course, we look
forward to his speedy return to this committee.
I am pleased to co-chair this morning's hearing with
Senator Mikulski. Senator Mikulski and I have worked for a long
time on what might be called integrative health, alternative
health practices. We have worked and our staffs have worked
together on this for many, many, many years.
I am eager to continue to work with Senator Mikulski, as we
have said before, to make sure that alternative, complementary,
or integrative medicine is a key part of our healthcare reform.
I am eager to hear our distinguished witnesses' ideas on
using integrative care to keep people healthy, improve
healthcare outcomes, and reduce our costs. It is fashionable
these days to quote Abraham Lincoln. So, I guess I will.
[Laughter.]
In his 1862 address to Congress, Lincoln said,
``The dogmas of the quiet past are inadequate to the
stormy present. The occasion is piled high with
difficulty. As our case is new, so we must think anew
and act anew. We must disenthrall ourselves, and then
we shall save our country.''
Well, clearly, the time has come to ``think anew'' and to
``disenthrall ourselves'' from the dogmas and biases that have
made our current healthcare system--based overwhelmingly on
conventional allopathic medicine--in so many ways wasteful and
dysfunctional. It is time to end the discrimination against
alternative healthcare practices.
It is time for America's healthcare system to emphasize
coordination, continuity of care, patient-centeredness, and
prevention. It is time to adopt an integrative approach that
takes advantage of the very best scientifically based medicines
and therapies, whether conventional or alternative.
This is about giving people the pragmatic alternatives they
want, while ending discrimination against practitioners of
alternative healthcare. It is about improving healthcare
outcomes. It is, yes, about reducing healthcare costs.
Generally speaking, alternative therapies are less expensive
and less intrusive, and we need to take advantage of that.
We need to place much greater emphasis on preventing
disease and keeping people healthy rather than merely treating
people once they become sick, and integrative care can help us
achieve that goal. This has been a priority of mine going back
many years.
In 1992, I authored legislation creating the Office of
Alternative Medicine at the National Institutes of Health. I
might just say that this wasn't something I just woke up one
morning and decided to do. It was because of a friend of mine
that I had known for many years and served in the House with,
who had left the House of Representatives because of an
illness, who sought out alternative care and became well.
That was Congressman Berkley Bedell, who is with us today.
Former Congressman Bedell, who led the charge and got me
thinking about it. I hope Berkley doesn't mind me telling this
little personal story. I saw Berkley--this was around 1988. He
had left the House. He was very ill. I had seen him once, and I
went home and told my wife, Ruth, I said, ``You know, I think I
have seen Berkley for the last time.''
That was 1988. Look at him now.
[Laughter.]
He used alternative therapies, and that got me thinking
about it. What are we missing? So, because of that and talking
with Berkley, I set up this Office of Alternative Medicine
through the Appropriations Committee.
In 1998, working with then-Senator Frist, we sponsored
legislation to elevate the office to what is today the National
Center for Complementary and Alternative Medicine.
Now, again, I must say that one of the purposes--when we
drafted that legislation back in 1992 and continuing in 1998--
of this center was to investigate and validate alternative
approaches. Quite frankly, I must say publicly it has fallen
short. The focus--I think, quite frankly, in this center and
previously the office before it--most of its focus has been on
disproving things rather than seeking out and approving things.
Since 1992, the field has evolved and matured. Today, we
are not just talking about alternative practices but about the
integration between conventional and alternative therapies in
order to achieve truly integrative health. We need to have
practitioners talking with each other, collaborating to treat
the whole person. This is the model we intend to build into our
healthcare reform bill.
On several occasions, I have laid down a public marker,
saying that if we pass a bill that greatly extends health
insurance coverage but does nothing to create a dramatically
stronger prevention and public health infrastructure and
agenda, then we will have failed the American people.
This morning, I want to lay down a second marker. If we
fail to seize this unique opportunity to adopt a pragmatic,
integrative approach to healthcare, that, too, would constitute
a serious failure. I know both Senator Mikulski and I do not
intend to fail in that effort.
We welcome our witnesses. We look forward to hearing their
best ideas, and I will recognize Senator Mikulski and then
Senator Enzi.
Statement of Senator Mikulski
Senator Mikulski. First of all, we want to welcome both Dr.
Oz and our other distinguished panel that will come. I am going
to be brief in my remarks because there will be a vote at 10:30
a.m. We want to hear from Dr. Oz and then be able to move very
quickly to our second panel.
Senator Harkin and I each chair a working group in terms of
the healthcare debate. Senator Harkin chairs the one on
prevention. I chair the one on quality. We both feel that that
is almost an artificial barrier on many of the topics because
not only should medicine and healthcare be complementary, but
we need to begin to change the paradigm and have a continuum of
healthcare.
This is why we are doing a joint hearing this morning
because we are talking about prevention, and we are talking
about quality, and we are talking about improving the health
outcomes of the American people.
This is the second set of hearings in what is really a
week-long discussion in Washington on the concept of
integrative medicine or integrative healthcare, which is to be
patient-centered, focused on health outcomes, and how do we
offer to marshal the resources of what our current system has
to offer to think differently and also to empower the American
people to also take better charge of their own healthcare? This
is what the dialogue this week is all about.
What is the sound science involved? How can we better
identify the elements that are involved in prevention of
disease, but also not only the prevention of disease, but the
promotion of healthcare? If we promote healthcare, whether it
is fresh fruits and vegetables in our schools, all the way
through a variety of other things, we will be actually
promoting healthcare.
We have a lot to do in this committee, and we don't want to
just focus on the status quo or the stagnant quo. I want to
compliment my colleague from Iowa because he has been bold and
innovative and has already changed the paradigm over his work.
We also joined together to include women in the protocols
at NIH and then also helped change the protocols there, using
the best of Western medicine. Now, we want to use the best of
healthcare thinkers to know that when we do our reform that we
are doing not only insurance reform, but we are doing
healthcare reform and actually healthcare transformation.
I look forward to hearing the witnesses. They have already
made a major contribution. I will be able to say something
complimentary about each one.
But, Dr. Oz, you are already the surgeon general of the
airwaves. You have done more to promote healthcare and sound
living, and also we want to hear so much more about your
HealthCorps, which is these wonderful, talented young people
helping us achieve these healthy, what is it, healthy habitats
and healthy people.
Senator Harkin. Thank you, Senator Mikulski.
Senator Enzi.
Statement of Senator Enzi
Senator Enzi. I want to thank the co-chairs for holding
this hearing and for their tremendous effort and work in
healthcare and all of the other areas that this committee does.
I think this committee has one of the biggest jurisdictions on
the Hill, and we have been very productive at getting through
those.
I look forward to the testimony of today's hearing, and I
want to also welcome Dr. Oz. I first met you in New York City
at the time your first book came out and have been following
those books and television and some other things. I am still a
little surprised that people have you come into their home and
clean out their refrigerator for them.
[Laughter.]
I can see where the advantage would be on that.
I do have a full statement to submit for the record, but I
primarily wanted to comment today that yesterday the President
made a statement that he was going to have a $634 billion
reserve for healthcare. I am on the Budget Committee. So, I
know how the reserves go, and I know that isn't real money. It
gives us some room to play with.
I am a little disappointed that the figure was so precise
without showing us exactly--it makes it sound like there is an
exact plan out there. Of course, he promised us that he would
let us work through a process, and that is what makes it
bipartisan, when we can work together at the beginning. A
number of us have been doing that in a number of different
ways.
I think that Senator Baucus kind of put out a white paper
earlier that a lot of people have been working off of. Senator
Wyden has had a plan. Everybody has had a plan. I have been
busy collecting all of those plans so that we could put
everything on the table and arrive at something that will take
care of every American if we can get all of it done.
I noticed that we do things comprehensively around here,
and it gets weighted down by the parts that people don't like.
I hope that we can put together pieces--large pieces--but
pieces that will make it through the process and get things
solved for people.
I also, every time I come here, will be encouraging us to
do roundtables. We really ought to have a roundtable on the
Massachusetts plan and have a bunch of people in, that have
been involved in that, that can tell us where it went right and
where it went wrong. Because I can see that we are going to be
fashioning things after a lot of those things.
The reason I mention a roundtable, is when we do a hearing,
one side gets to pick all the witnesses but one, and the other
side picks the one. Both sides come to pick on each other.
I prefer the roundtables where we invite in people that
have actually done things in the field, and quite often, we
have that. It is a joint invitation and with just a few
questions that can kind of bring out what they have done, and
then they discuss how their idea would work with someone else's
idea. I think that really helps to expand our capability to
make the right kind of decisions when the time comes instead of
concentrating on clever questions.
I thank you for doing this hearing and the other hearings
that we have been doing this year. They are extremely helpful.
[The prepared statement of Senator Enzi follows:]
Prepared Statement of Senator Enzi
Good morning and thank you for joining us today. The HELP
Committee has spent ample time conducting hearings to gather
information about our healthcare system to answer questions
about the best way to move forward on health care reform.
Today we will learn about alternative ideas for keeping
people healthy. Dr. Oz will discuss a holistic approach to our
health and provide suggestions on how to engage more people in
their own health care decisions.
Before we begin I would like to comment on the process in
which Congress will move forward on healthcare reform. I was
told by Senator Tom Daschle in his confirmation hearing that
healthcare reform would be a bipartisan effort. I have also
heard from Senator Baucus on the Senate Finance Committee that
he would like 80 votes for a healthcare reform package. I hope
that other members of Congress will begin to echo their
colleague's commitment to a bipartisan process for health care
reform.
Unfortunately, the HELP Committee has not been conducting
bipartisan hearings, and as a result there has been less
participation. Members of the committee need to come up with
the hearing topics on health care reform together, and not
conduct hearings that only interest a few.
I also want to note my concerns about the President's
budget blueprint, which came out today. $634 billion is a lot
of money and a very precise number. The message the President
has sent is concerning. His budget blueprint does not send a
bipartisan message. A health care reform proposal pushed by the
White House will undercut the will of Congress and I strongly
encourage him to allow Congress to act first. I am not
encouraged by the President's blueprint and hope he will echo
his colleagues support for a bipartisan health care reform
package in the future.
Working together on a plan means agreeing where we want to
go, and then being willing to take different paths to get
there. Paving a highway and then dragging people down it is not
bipartisanship. The bipartisan road is built together and it's
built with action more than words.
Today we will hear from individuals about ways in which we
can improve the health of our Nation through ideas that require
individuals to take personal responsibility for their actions
and inactions. I look forward to hearing the testimonies and
want to thank the witnesses for their time and dedication to
improving the lives of others.
Senator Harkin. Thank you very much, Senator Enzi.
I see this hearing as sort of the beginning of a process,
and I take your advice to heart that perhaps the second round
ought to be some kind of roundtable discussions where we bring
in more integrative practitioners.
I can assure you, I know each one of these individuals who
are here today, and they are all practitioners. These aren't
people who are just sitting behind ivory towers some place.
Every one of them are active practitioners.
Senator Enzi. I wasn't referring specifically to this
hearing.
Senator Harkin. Oh, OK.
Senator Enzi. Some of the others have been a little bit
more focused on a particular direction that somebody wants to
go, and we need to be examining a lot of different directions.
Senator Mikulski. Colleagues, we vote at 10:30.
Senator Harkin. Well, this is it. This is it.
Dr. Oz, welcome. We have a vote at 10:30, so we will
probably break and then come back right after that vote.
STATEMENT OF MEHMET C. OZ, M.D., DIRECTOR, CARDIOVASCULAR
INSTITUTE AND COMPLEMENTARY MEDICINE PROGRAM, NEW YORK-
PRESBYTERIAN HOSPITAL, NEW YORK, NY
Dr. Oz. Well, I want to thank the Senators very much for
allowing some of us to offer some insights on how to get more
value for the money that we are already spending in healthcare.
I am not going to talk about insurance. I am going to talk
about the broader philosophy of the personal responsibility we
each have. Tip O'Neill often quipped that all politics was
local. I think all healthcare is personal. I am going to speak
a bit about the smart patient movement and what we should be
empowering Americans to be able to do.
I was sent last fall by The Oprah Winfrey Show to look at
places around the world where people live the longest and live
the best. These are places like Sardinia and Costa Rica, Loma
Linda in this country as well. What we learned in these
countries where people have a four times greater chance of
living to age 100 than they do in this country--think about
that. Four times more chance of getting to age 100 in Costa
Rica or Okinawa than in this Nation.
We learned that the reason they are able to do it is
because it is easy to do the right thing. It is easy to make
the right decision.
I did a show recently with Ms. Winfrey, where we
recommended that folks eat 100 percent whole grains. One of the
most common comments we got on the show was, ``We can't find
100 percent whole grains where we live.'' I went out and
started looking, and in many parts of this country, that is the
case.
How do you make it easier for folks to make those
decisions? I think the complementary and alternative medicine
movement has, in part, been about that--empowering people to
take charge of their own health, and because they are doing
that, they begin to play a more active role and they find
paths, sometimes serpentine paths to health that they wouldn't
have normally expected to run into.
I started in this field not because I was interested in
massage therapy, but because I was putting in these kinds of
little heart pumps. This is a device that we use to support the
heart of a person who is dying from heart failure. These people
were just barely gripping the oppressiveness of life, about to
fall into the chasm of death.
I began to realize that they wanted more than just a pump
that kept the blood moving forward. They wanted vitality. They
wanted that more holistic approach. They began calling in their
massage therapists, and they want to have aromatherapy around.
Pretty soon, I was calling the social workers to see if we
could have Reiki masters in the operating room.
As the story sort of progressed, we created a complementary
and alternative medicine program that was not designed to
advocate for these therapies. It was designed to evaluate them.
As we began to create that and I traveled around the world,
I finally recognized what many of my colleagues were already
talking about is the globalization of medicine. Taking
therapies that have worked in other parts of the world and
offering them as a possible solution to Americans who suffer
similar ailments.
We have global finance. We all know that from the current
environment. We have global media. The books that we write, the
Oprah show, they are in many different countries. We don't have
global medicine. Medicine has remained remarkably provincial in
many ways.
With this in mind, I wanted to push us to think about what
the smart patient movement is all about. We actually worked
with the Joint Commission, which is the Nation's health/safety
watchdog organization, to write books on this topic. This is
one of them.
These texts, that are given out at hospitals, are designed
primarily to help people to understand what responsibility they
have. Now the first question people ask, and this is true of
complementary medicine, whether you are going to take bypass
surgery or medical therapy for heart disease, it is all about
being an insightful and inquisitive member of the healthcare
team.
The first question people ask is, ``My goodness, aren't I
going to get shot if I put my hand up and ask about this
alternative approach?'' You know what Senators, if you are the
only one who puts your hand up, you might get labeled as the
troublesome patient in room 21. But, if we create a movement
and make it easy for people to access some of these therapies,
it becomes the norm.
I believe that if we can get about 10 percent of the
population to shift the mindset, their responsibility that they
perceive in this healthcare system, we can drive quality.
Because if you are going to put an extra quarter in to go first
class as a practitioner by bringing in an acupuncturist to your
practice or understanding nutrition in a bit more sophisticated
way and building a team to do that, you ought to get people to
come to you because they value quality.
We need to create a market mechanism, and I have a couple
of suggestions of how we can do that. First, I think it is
important that we allow people access to better information
about what the healing options available to them are. The major
problem we have in academic medicine right now is we are asking
the wrong questions. Because the questions being asked in
trials are generally funded by endeavors that can profit from
the answer.
So we ask you, is this a better tool, or is this a better
tool? What we really want to ask you is, is this a better tool,
or is nothing really needed for you to get better and allow the
body to heal itself?
Second, I think we need to have the information systems
that will also help the healers, people like me. The
information systems that we talk about don't just benefit the
patients, they benefit the people who are using information to
judge whether or not you can get better from one therapy or
another, and they ought to incorporate many of these
complementary and alternative medicine therapies.
Third, we need a culture of wellness. By that, I mean, very
specifically, we should not be tasking physicians necessarily
with some of the chronic care issues that plague our Nation. I
mean, we spend twice as much per capita on healthcare in this
country than most European countries, in part, because we are
almost twice as sick.
We should have health extenders play an active role in this
and the health coach movement that would allow people who have
that care-giving personality, maybe they are social workers or
they are physical therapists or, actually, they could come from
the army of alternative medicine practitioners that are already
out there.
Let us create mechanisms to let this health coach movement
prosper, move forth, and provide them as sources to patients.
All of a sudden, these people become their health advocates,
their health advisors to try to control the system.
And fourth, and my final recommendation, is that we think
about this ServiceNation movement that you are already
debating. Why ServiceNation? Because when we make it the norm
for an 18-year-old leaving high school to serve his country, he
or she doesn't have to do it just through the military, they
can serve by becoming members of organizations that actually
serve the Nation by teaching, among other things, health.
We have created a program called HealthCorps, which has
spread quite quickly around the country. We are in seven
different States. We touch about 15,000 different lives. The
basic principle is this.
Think of the Peace Corps, right? The Peace Corps, we took
energetic, passionate kids who were just graduating from
college, and we sent them all over the world as foreign policy
advisors pretty much for this Nation because we learned a lot
about those countries, but we put our best foot forward.
Take those same energetic kids, harvest that American
talent, and put them in schools around the Nation. It is
inexpensive. It is scalable. We estimate that the cost is about
$1 per year of life lived per child. What is really cool about
it is we have young people advising young people. It is pure
mentoring.
Then what happens? You have got activists being created.
You have got high school students who now think, my goodness,
they taught me about how to eat, and they are giving me advice
about physical activity. Now I am not getting fat anymore. It
helps with the obesity epidemic.
More importantly, you have taught me mental resilience. You
have taught me how I can be in charge of my own body because if
I can't be in charge of my own body, I can't change the world
out there either.
These kids become activists. They fight for changes in
their communities. They will go to a local bodega and say,
``You know what, we need to have 100 percent whole grains in
our communities. If we don't have them, then people can't eat
right. Let us make that change happen.''
These are the kinds of changes that I think HealthCorps can
afford, as we have done randomized trials to show efficacy. I
am very passionate about it, as you can probably tell. I think
it is a great way to build another generation of people who are
savvy about health to do service learning and teach this Nation
about health.
By doing that, we create this complementary approach to
holistic wellness that we have seen looking around the world
that I started my conversation with in countries that really
have great value for the healthcare they are offered.
[The prepared statement of Dr. Oz follows:]
Prepared Statement of Mehmet Oz, M.D.
Executive Summary
America must find new ways of addressing the poor health record and
staggering health care expenditures gripping our country, especially in
light of the growing ranks of uninsured people. We spend roughly twice
as much per capita on healthcare than our counterparts in Europe, but
do not appear to derive value for this investment. Part of the reason
is that Americans are twice as sick as Europeans as a people because of
our chronic disease burden. Since lifestyle choices drive 70 percent of
the aging process, we should focus on what we put in our mouths (food
and addictions), how we tune our engines (exercise and sleep) and how
we cope with stress (community and psychological growth). A key
solution is support for a Smart Patient movement that integrates
complementary and alternative medical (CAM) approaches to conventional
medical treatment. We can combine the best of modern American medical
practices with alternative approaches to wellness and harvest the
natural healing powers of our bodies.
As Vice-Chair and Professor of Surgery at Columbia University and
Director of the Heart Institute at New York Presbyterian, I'm in the
operating room every week and have performed thousands of heart
operations utilizing the most state-of-the-art equipment and innovative
approaches of science to save lives. My specialty was mechanical heart
pumps and transplantation and my patients were barely gripping the
ledge of life. To survive, they needed a pump to replace their failing
organ, but also wanted to return to a fulfilling life, so they
introduced me to their ``other'' healers-hypnotherapists, massage
therapists, spiritual healers, and energy experts like Reiki masters.
I soon realized that CAM is really the globalization of medicine, a
field which has remained remarkably provincial. The globalization of
medicine mandates that we incorporate Eastern approaches like
traditional Chinese and Ayurvedic healing practices into Western
medicine.
A major driver of chronic disease in this country is obesity and
the increase in childhood obesity rates is twice as fast for adults. No
single remedy will make America well. Instead, public/private
partnerships will produce the most successful vehicles for educating
and empowering children and families to make healthful decisions and
value their bodies. With this in mind, 5 years ago, I founded
HealthCorps www.healthcorps.org, an in-school peer mentoring program
for teens that focuses on nutrition, fitness and mental resilience. It
reflects the message of the ServiceNation initiative to make
volunteerism part of mainstream American life and we hope to bring it
to all 50 States by 2012. We've even proven benefits of the program in
randomized trials.
The HealthCorps model is fashioned after the Peace Corps and can be
duplicated in other areas like broadening the reach to seniors of CAM
and physical fitness approaches that are proven to reduce the burden of
dementia and improve function. HealthCorps Coordinators, who are the
heart of the program, are typically recent college graduates who defer
graduate studies to participate in public service by leading fun daily
seminars on practical life skills associated with integrative health.
The mechanism whereby we can institutionalize the concept of
``HealthCorps'' and take it quickly to all 50 States already exists at
the Federal level--AmeriCorps. An AmeriCorps/HealthCorps partnership
also represents investment in a broad nationwide movement. HealthCorps
is strategically partnered with leading like-minded private and public
initiatives such as The Tiger Woods Foundation, ServiceNation, the
Center for Disease Control, and the David Lynch Foundation, among
others.
We need to support systems that empower our citizens to get
personally involved in improving the health of our Nation. There is no
free lunch in health; instead you need to act for yourself to gain the
vitality you desire. Our leaders need to deliver this honest message
which is why I support the WIN proposal outlined by Dr. Jonas that
would create a White House office focused on lifestyle-based chronic
disease prevention. And please remember that we cannot have a wealthy
nation if we are not a healthy nation.
______
I commend the committee for reaching out to find new ways of
addressing the poor health record and staggering health care
expenditures gripping our country, especially in light of the growing
ranks of uninsured people caused by the economic turndown.
We spend roughly twice as much per capita on healthcare than our
counterparts in Europe, but do not appear to derive value for this
investment. Part of the reason is that Americans are twice as sick as
Europeans as a people because of our chronic disease burden.\1\ Since
lifestyle choices drive 70 percent of the aging process, most experts
agree that we should focus on what we put in our mouths (food and
addictions), how we tune our engines (exercise and sleep) and how we
cope with stress (community and psychological growth). A key solution
is support for a Smart Patient movement that integrates complementary
and alternative medical (CAM) approaches to conventional medical
treatment. We can combine the best of modern American medical practices
with alternative approaches to wellness and harvest the natural healing
powers of our bodies. CAM is not just about extreme treatments for
advanced disease when no other solutions are available. It is about
taking a population that has gotten comfortable living with half of the
energy and sense of physical well-being that they should have at their
age and moving them up the spectrum to live at full vitality.
---------------------------------------------------------------------------
\1\ Kenneth E. Thorpe, David H. Howard, Katya Galacionova,
Differences in Disease Prevalence as a Source of the U.S.-European
Health Care Spending Gap (Data Watch, October 2, 2007) 678-686.
---------------------------------------------------------------------------
I saw this first hand when we traveled to the oldest populations on
our planet for the Oprah Winfrey Show. Dan Beuttner helped us
understand why the odds of living to age 100 with the vitality we
desire was four times higher than the United States in places without
advanced health care technology like Okinawa, Costa Rica, and Sardinia.
These people live with simple habits like daily arduous physical
activity, eating whole foods, and relying on local healing practices
that are minimalistic yet effective. We also found a similar cluster of
centenarians in our own country, Loma Linda, CA.
complementary and alternative medical practices
We can combine the best of modern American medical practices with
alternative approaches to wellness and harvest the natural healing
powers of our bodies. If successful, we can provide our population with
the vitality that we crave. Please let me explain this vision by
explaining how I got involved in the movement.
As Vice-Chair and Professor of Surgery at Columbia University and
Director of the Heart Institute at New York Presbyterian, I'm in the
operating room every week and have performed thousands of heart
operations utilizing the most state-of-the-art equipment and innovative
approaches of science in order to save lives. I spent much of my life
past the cutting edge as I operated on the bleeding edge of medicine.
My specialty was mechanical heart pumps (See Appendix A--Visual of
Mechanical Heart Pump) and transplantation and my patients were barely
gripping the ledge of life as they pulled themselves up from the
crevice of death. To survive, they needed a pump to replace their
failing organ, but this was not enough. They also wanted to return to a
fulfilling life, so they introduced me to their ``other'' healers-
hypnotherapists, massage therapists, spiritual healers, and even energy
medicine experts like Reiki masters. Clearly these patients had not
read the same books that I got in medical school.
We began offering massage and meditation, and even audiotapes in
the operating room with some internal resistance, but general support
from a medical community that recognized that conventional medicine
alone could not offer the robust, holistic approach that our patients
deserved. We started a center where we paid salaries of complementary
and alternative medical (CAM) practitioners to offer free services to
all of our heart surgery patients. We had two goals. First, introduce
patients to new powerful lifestyle approaches that they could do on
their own after discharge. Second, evaluate rather than just advocate
these unconventional approaches to see what works and spread the word
by publishing in mainstream journals. We researched if we could reduce
pain medications with hypnosis, if we could improve survival after
heart procedures with prayer, and if we could alter memory with what
patients hear during their operations. As we merged high-tech to low-
tech approaches, folks around the hospital started to notice, and so
did the media as evidenced by this early piece in the New York Times
Magazine.\2\
---------------------------------------------------------------------------
\2\ Chip Brown, The Experiments of Dr. Oz (The New York Times
Magazine) 21-23.
---------------------------------------------------------------------------
My interest in incorporating these CAM techniques began to spread
as I followed the literature and traveled overseas to perform heart
surgery in China, visit medical facilities in Turkey and train in
France. Foreign patients and practitioners had different expectations
from their health care systems than Americans. In fact, I realized that
CAM is really the globalization of medicine. My testimony today will be
quickly available all over the world with other news from today.
Financial services are clearly global, which is part of today's
economic turmoil story. Medicine has remained remarkably provincial.
The globalization of medicine mandates that we incorporate foreign
approaches like traditional Chinese and Ayurvedic healing practices
into Western medicine.
globalization of integrative health treatments
In fact, people are crying out for the opportunity to play a
greater role in their own well-being. We need to take the experience of
a few and make it the norm for all. What we are really speaking about
is morphing the current sophisticated health care system into one that
is continually audited and improved by Smart Patients. What we have
built are remarkable highways that carry people towards health. But to
create a superhighway that is safe, we need better driver's education.
And we need Smart Patients to spread this approach throughout the
system. We even wrote a YOU book with the Joint Commission, our
Nation's health safety advocate, to serve as a metaphorical driver's
education pamphlet. (See Appendix B for reference to You:The Smart
Patient.) The book hit the New York Times best-seller list,
demonstrating the voracious appetite that our population has for
information if presented in an accessible fashion.
So how do we provide a booster rocket for improving our
population's awareness of complementary and alternative medical (CAM)
and lifestyle solutions? First, we need to incorporate CAM into the
conventional health care economy, including insurance company
reimbursement when appropriate. This means we need simple means for
credentialing all these practitioners and easier access to research
money for unconventional therapies. CAM treatments often cannot afford
major investments into proving their efficacy because the potential
profits are limited. Ironically, the most cost-effective therapies are
the most difficult to research for the very reason that our government
and other payers desire them.
healthcorps--a peer mentoring model for a healthier america
Second, let's support the ServiceNation initiative that seeks to
make volunteerism part of mainstream American life. Many of these
volunteers could help spread health lifestyle information throughout
our Nation, as we have proven through the HealthCorps
www.healthcorps.org peer mentoring initiative in our Nation's high
schools. I founded HealthCorps in 2003. (See Appendix C-HealthCorps
Summary)
Here was our rationale. The major driver of chronic disease in this
country is obesity and the increase in childhood obesity rates is twice
as fast as the adult rate. I am seeing this first hand as we have
started operating on obese 25-year-olds with artery blockages. I have
been invited to Department of Health and Human Services panels to
brainstorm solutions and contend that no single remedy will make
America well. Instead, public/private partnerships will produce the
most successful vehicles for educating and empowering children and
families to make healthful decisions and assume responsibility for the
most valuable asset they'll ever inherit--their bodies.
The HealthCorps model is fashioned after the Peace Corps and can be
duplicated in other areas like broadening the reach to our seniors of
CAM and physical fitness approaches that are proven to reduce the
burden of dementia, as well as offer improved function.
As you most likely know, children and teens like to make their own
decisions and often reject the advice of parents and elders.
HealthCorps Coordinators, who are the heart of the program, are
typically recent college graduates who defer graduate studies to
participate in public service. Our Coordinators represent a cross
section of demographics, talent and achievement. Coordinators are
assigned one school where they serve as a positive role model leading
fun daily seminars on practical life skills associated with integrative
health. They teach kids about nutrition and exercise and the tremendous
power of positive thinking.
The mental resilience portion of the curriculum is arguably the
most important--especially in light of the disturbing rise in teenage
suicide in this country. The ten-fold increase in depression that we
have seen in young people since the 1950's is not a result of genes. It
is most likely attributable to significant societal changes such as
lessened sense of community, a lessened sense of social purpose greater
than oneself, as well as a shrinking familial base of support. By
empowering kids to take charge of their own bodies as well as effect
change in their communities, we believe we can contribute to their
sense of purpose, community and confidence.
Our Coordinators serve as a nexus for school-wide and community
health events and activities, such as helping to script local health
policy and working with other wellness non-profits to execute large-
scale community health fairs. And the wonderful thing about service
programs is that they not only influence those served, they influence
the people serving, a new generation of doctors, health practitioners
and future policymakers who disseminate a philosophy of integration.
private/public partnerships
Instead of the expensive tests, procedures, medications and
interventions that we now use to try to cure our Nation, the methods
HealthCorps proposes are attainable, affordable and sustainable with a
long-term substantial return on investment. The mechanism whereby we
can institutionalize the concept of ``HealthCorps'' and take it quickly
to all 50 States already exists at the Federal level--AmeriCorps.
At a time when the job market is shrinking, young Americans have
fewer choices after college. As an AmeriCorps program, HealthCorps
could harness the power of thousands of amazing young people across the
country to spread the message of integrative wellness and at the same
time offer them a worthwhile job opportunity. HealthCorps can also
partner with great Federal programs such as the National Association of
Community Health Centers (``NACHC'') to prospect for high school
graduates interested in health careers who might devote a couple of
years to service prior to considering college.
An AmeriCorps/HealthCorps partnership also represents investment in
a broad nationwide movement. HealthCorps is strategically partnered
with leading like-minded private and public initiatives such as The
Tiger Woods Foundation, ServiceNation, the Center for Disease Control,
the David Lynch Foundation, the International Health, Racquet and
Sportsclub Association, Cleveland Clinic Initiatives, the Smart Choices
Coalition, the Corporation for Public Broadcasting, the Human
Neuroimaging Lab at Baylor College of Medicine, and the United
Federation of Teachers (``UFT''), among others. HealthCorps also
mobilizes a 20-member Advisory Board (which includes experts in CAM,
conventional medicine, business and non-profits) to participate in
programming and community outreach.
I know that our public/private partnership is a good investment
because science is substantiating our gains. In June, I will present
the results of an independently conducted 2-year efficacy study funded
by Affinity Health Plan. Results of the study showed significant
benefits of HealthCorps on decisions made by students.
conclusion
We need to create systems that empower our citizens to get
personally involved in improving the health of our Nation. In fact, the
most important contribution of CAM therapies is that frequently no one
is giving you a pill or procedure or quick fix answer. There is no free
lunch in health; instead you need to act for yourself to gain the
vitality you desire. Our leaders need to deliver this honest message
which is why I support the WIN proposal outlined by Dr. Jonas that
would create a White House office focused on lifestyle-based chronic
disease prevention. And please remember that we cannot have a wealthy
nation if we are not a healthy nation. Thank you for your valuable
time, Mr. Chairman and committee members.
Appendix C: Healthcorps Summary.--Program Summary
healthcorps responds to the need
HealthCorps' is a proactive health movement that responds to the
obesity crisis through school-based health education and peer
mentoring, in addition to community outreach to underserved
populations--mostly Hispanic and African-American as well as groups
with lower than average educational levels. HealthCorps
(www.healthcorps.org) was founded in 2003 by cardiac surgeon, Dr.
Mehmet Oz.
Along with educating students in healthy lifestyle principles, we
extend our mission to their families and communities. Unlike the
expensive tests, procedures, medications and interventions that we now
use to cure our Nation, the methods we propose are attainable and much
more affordable. Our goal is to shift the paradigm towards health and
wellness now and for the future of our children.
problem statement
Obesity in the United States has reached epidemic proportions, with
more than 35 percent of Americans classified as obese and an additional
30 percent as overweight. Obesity has been a steadily rising trend
since the late 1970s. Experts now predict that, without an
intervention, the majority of the country will be obese by 2012.
Alarmingly, the steepest increase is in children and adolescents.
Obesity is directly linked to high blood pressure, type 2 diabetes and
atherosclerosis. In turn, these unhealthy conditions are the major
cause of heart attacks, strokes and heart failure. We are now seeing
cardiovascular disease in teenagers and the average age of first heart
attacks has dropped by over 10 years in the overweight patient. Other
morbid conditions linked to obesity are certain cancers and arthritis.
There are many regional, ethnic, and economic divergences across
the population of obese and overweight people in the United States.
Hispanics are the most overweight, although obesity is the highest
among African-Americans.
The American healthcare system is in crisis; unless we reverse the
obesity epidemic, it threatens to exhaust the system's manpower and
economic resources in caring for those suffering from diseases
associated with obesity. To avoid these mostly preventable diseases,
our Nation's medical emphasis must shift from illness to wellness.
Healthcorps is a catalyst for that change.
the healthcorps program
HealthCorps is a national service program with tax-exempt status
under Section 501(c)(3) of the Internal Revenue Code. The
groundbreaking educational program currently runs in 44 high schools in
seven States (CA, FL, NJ, NY, OH, PA, TX). HealthCorps' strategic plan
calls for implementation in 1,000 high schools in all 50 States by
2012. The program impacts approximately 500 high school students per
school per year.
The HealthCorps in-school program shows teens practical life skills
through fun, interactive seminars focused on the value and power of
students' bodies and minds. Teens become educated consumers and health
activists and are encouraged to develop positive behavioral shifts that
enhance self-esteem.&
HealthCorps is based on a peer-mentor model, which has been shown
to improve in a range of areas the outcomes of littles, including their
academic performance, attitudes, and behaviors. HealthCorps
Coordinators are typically recent college graduates who defer medical
school or graduate health program studies to participate in public
service.
Each Coordinator is assigned one school in which he or she lead
seminars 5 days a week on fitness, nutrition and mental resilience. The
seminars are taught through health or other academic classes or through
after school clubs, as designated by the school principal. Seminar
content is included in a 250-page curriculum and program guide
developed by the HealthCorps Advisory Board.
In addition, we plan to introduce initiatives--through associations
with the Tiger Woods Foundation and the David Lynch Foundation--to
enhance the mental resilience portion of the curriculum in each
HealthCorps high school.
HealthCorps' delivers its in-class curriculum to approximately 500
students annually in each school. The students share some of the
messaging with their friends and parents--thus increasing the reach to
1,500 people per school. In 2009, we hope to launch an online distance
learning program, which will most likely increase reach to an
additional 1,000 people per school annually.
HealthCorps extends its message beyond the four walls of the
classroom in unique and far-reaching ways. First, each semester, the
Coordinators host a community health fair--with typically about 2,000-
3,000 attendees. Second, through a program with Sirius XM Radio,
HealthCorps Board Chairman, Dr. Mehmet Oz, periodically features
lessons from the HealthCorps curriculum with his radio audience. In the
coming year, Dr. Oz will continue to promote the HealthCorps curriculum
to parents of students via the daily syndicated Dr. Oz Show, which
launches in September 2009. These radio and television broadcasts will
reach millions of American homes.
In addition to driving HealthCorps student and community outreach,
HealthCorps sponsorship represents an investment in a broad nationwide
movement. HealthCorps is strategically partnered with leading private
and public initiatives such as The Tiger Woods Foundation,
ServiceNation, the Center for Disease Control's Alliance to make U.S.
the Healthiest Nation, the David Lynch Foundation, the International
Health, Racquet and Sportsclub Association, Cleveland Clinic
Initiatives, the food industry's Smart Choices Coalition, National
Association of Community Health Centers, Channel 13 and the United
Federation of Teachers (UFT), among others.
organizational capacity
The heart of HealthCorps is the Coordinator. As noted above,
Coordinators are recent college graduates who have deferred medical
school or graduate programs in health. At their assigned high school,
they are full-time, salaried advocates for healthy lifestyles.
Coordinators work with teachers before, during and after school to lead
interactive workshops based on the HealthCorps curriculum. In addition,
they serve as positive role models--mentors who help students form
healthy attitudes, lifestyles and action plans.
HealthCorps Coordinators, graduates of some of the most respected
universities in the United States, represent a diverse cross section of
talent and achievement. HealthCorps follows strict hiring guidelines
for Coordinators and requires that all Coordinators undergo requisite
school system background and fingerprinting checks prior to assignment.
Many Coordinators will emerge as future leaders in medicine and public
health policy.
For the 44 available Coordinator positions this year, HealthCorps
received over 300 applications. We believe that we will have no
difficulty recruiting and selecting Coordinators to facilitate our
expansion.
The executive staff of HealthCorps consists of 10 full-time
salaried employees based in New York City. The home office is
responsible for the ongoing enhancement and evolution of the
HealthCorps curriculum, Coordinator recruitment, relationships with and
outreach to schools, community events and finance, marketing, and
fundraising. The HealthCorps executive staff brings a wealth of public/
private partnership, managerial, financial as well as educational
experience to the organization. As we grow, we anticipate adding a few
positions--primarily in finance, Coordinator recruitment and training.
A seven-member Board of Directors governs the organization. Members
of the Board have expertise in finance, medicine, law, and
entertainment.
A twenty-member Advisory Board, which includes experts in health,
medicine, business and non-profits, participates in the ongoing
enrichment of the programming and community outreach. We recruit these
dedicated professionals from the entertainment, marketing, consumer
products, human resources, finance and education communities. A list of
board members is available at http://www.health
corps.net/boardofdirectors.jsp.
HealthCorps' founder and Chairman, Dr. Mehmet Oz, is one of the
world's leading cardiac surgeons as well as a best-selling author, and
Health Expert on The Oprah Winfrey Show http://www.healthcorps.net/
droz.jsp. He presides over the Board of Directors and guides the
organization and its program.
At least 40 Celebrity Ambassadors--actors, musicians, athletes,
authors--also volunteer their time to raise funds, generate media
attention and build awareness for HealthCorps at community and
fundraising events.
efficacy
In June, Dr. Oz will present the results of an independently
conducted 2-year efficacy study overseen by a methodologist from
Cornell University and funded by Affinity Health Plan. The focus of the
study was to quantify the impact of the HealthCorps program on a
predominately Hispanic New York City intervention group. Results of the
study found significant benefits of HealthCorps on three dimensions:
(1) soda pop consumption decreases by 0.61 times per week; (2)
participants are 36 percent more likely to report that they are more
physically active; (3) participants score 10.7 percent higher on the
test of health knowledge. (These estimates assume zero benefit for
dropouts; excluding dropouts results in larger effect sizes.) The Palm
Healthcare Foundation, the leading healthcare foundation in Palm Beach
County, FL, is currently conducting an efficacy study in five Florida
intervention schools. Results from this study are expected in 2010.
The Baylor School of Medicine, Human Neuroimaging Lab is funding
and launching a 6-month groundbreaking brain imaging efficacy study of
the HealthCorps program in January 2009. Results from this study will
be available by July 2009. HealthCorps will be seeking $1,500,000 in
funding for the continuation of this study (to be overseen by Baylor
through MRI lab strategic partners) over the course of the next 4 years
in all HealthCorps States.
budget
HealthCorps' total operating budget for fiscal year 2009 is $4.5
million. The New York City Council, through the Department of Health
and Mental Hygiene, is funding $1,500,000 of HealthCorps programming in
the current fiscal year (July 1 through June 30). In fiscal year 2009,
The New Jersey Department of Health and Mental Hygiene is funding
$225,000 of HealthCorps programming and New York State will be
contributing $25,000. HealthCorps currently receives no Federal
funding. Total funding is garnered through a combination of State,
city, private foundations, corporate and individual contributions.
Each HealthCorps school program costs approximately $75,000.
HealthCorps projects it will be in 65 high schools in 12 States,
including the District of Columbia (AZ, CA, DC, FL, GA, MS, NJ, NY, OH,
PA, TN, TX) by fall 2009 (our fiscal year 2010).
Senator Harkin. Whew. Oh, wow.
[Laughter.]
Dr. Oz. I had 5 minutes to deliver 4 years of work.
Senator Harkin. Since it was Senator Mikulski who insisted
that you be here and invited you, I want to turn to Senator
Mikulski for questions first. Wow.
Senator Mikulski. Well, Dr. Oz, thank you very much for
that very powerful presentation, and we know we will hear from
others who are well known to us in their work or well known.
First of all, I am a social worker. I love to give case
examples. I am going to give you a case example I think all too
familiar with you and see how in your smart patient movement it
would be different, and you could do that.
Let us take someone who is admitted to a well-known, well-
established, well-respected hospital for heart disease. It
could be for undiagnosed heart arrhythmia, or it could be for
bypass. The medical intervention is brilliant--the appropriate
diagnosis, the appropriate surgery.
Then they are ready for discharge. They are given a bag of
drugs, and it is usually in a bag. Told to take them, and it
could be everything from the blood thinner to the beta blocker
to all the things that they have to take and a little side
thing for acid reflux and so on. They are told to come back,
and then they are also told that no matter what you do, because
it is heart disease, it is diet and exercise.
They bring up somebody from the kitchen who gives you one
sheet that says kind of fruits and kind of vegetables, scrub
them well because you don't know what is on them. By the way,
start an exercise program, even though you have been diagnosed
with heart disease, and you are afraid to exercise. You are
afraid to have sex. You are just afraid. You are afraid of the
beginning of a very chronic and debilitating situation.
They have had smart care, but when they leave, they are
usually depressed as they walk out the door about what lies
ahead. Or saddened by what they have and often gripped by fear.
What would be different in your frame of reference that we
should be pursuing?
By the way, everything that I said is incentivized by the
way we pay for it. We will pay for the drugs. We certainly pay
for the care. Yet we have two goals. One for chronic illness
not to see it progress, and also if you have had a significant
acute care hospitalization, you want to prevent recidivism and
coming back for either that or the consequences of something
you have had.
Dr. Oz. Senator Mikulski, as you know, we have lots of data
to show that in exactly those situations, providing a broader
holistic approach to the discharge process reduces re-
admissions and increases the long-term value of what they have
received.
We have a balkanized system. We all acknowledge that. With
this balkanization, you also have reduction of trust in the
system. When that happens, then you end up suffering because
suffering is not just about pain. Suffering is lack of control
over your destiny.
The best solution for someone like this who is going home,
I think, is found through some of the things that we are
actively investigating. One are programs that allow people to
take their health records with them. HealthVault has one that
we are spearheading later this month at New York-Presbyterian
Hospital, where I practice.
That is built by Microsoft. Google is doing sort of the
same thing. These programs are sort of like PayPal. You know,
you are not giving them your medical record because you don't
give PayPal--they are not buying the product for you. You just
trust them to store the stuff so you can buy something on
Amazon or eBay.
These HealthVault programs will give you your medical
records, because we will give them to your personal Web site to
own, and when you go home and it is confusing about what
medications you are supposed to be on, you will have this site
that your pharmacist will use to give you the right
medications. You will have them to show your loved ones who
have to help you back to full recovery.
You could use them to show to a massage therapist, for
example, or physical therapist who is working with you, who is
trying to make you better again, to achieve that health that
you lost when you were admitted to the hospital with your
cardiac ailment. That kind of a more robust approach that
allows you to own the record and you to control where it goes
also would allow you, if the reimbursement systems are
effective, to be able to drive health through the system.
Also this is the kind of place where HealthCorps plays a
role because now if you have got a group of people in the
community making it easier to do the right thing--I am going to
come back to that. If there is no sidewalk in your
neighborhood, you are not going to go walking outside. If you
can't find leafy green vegetables and cruciferous vegetables
that we know are important for the liver to detoxify things
like medications, you are not going to buy them.
We want these programs out there so we make it easy for you
to make the right decision. That is partly the reason, by the
way, that we have had such an earnest uptake by partners. The
CDC is working with us on these issues, the National
Association of Community Health Centers, the Tiger Woods
Foundation, David Lynch Foundation. I mean, large endeavors
that are parallel to us see this unifying approach to taking a
generation that is normally not involved in this process and
making them part of that foundation.
I started off by paraphrasing Tip O'Neill. I don't think we
can do this if we don't empower people to do these things in
their homes because, ultimately, that is where the real
decisions are made. When I tell you something on the Oprah
show, don't eat junk food, that doesn't work unless you take
that information when you hear it and tell others. That is
where real communication happens in our society.
Senator Mikulski. Well, I know my time is up, but if the
Chairman would permit to just summarize. Under the scenario
that I said, there would be the hospital admission. As one gets
ready--and there would be a health record established.
Technology will be our tool and our friend and help provide for
the case management and the case follow-through.
Then, as you are ready to be discharged, hopefully, with
somebody who you love and cares about you, you will, first of
all, learn about your prescriptions. That is an important part
of staying well. You do need that medication to help you. You
would not only learn what you are going to take, but even the
sequence for taking it.
I mean, I have heard stories where men--gals take it maybe
one at a time. Guys might take all 15 pills at the same time,
get the darned thing over with. You would learn what to take,
the order, the sequencing.
Then, as you leave, you might even have technology to
monitor your heart to see what you can do for those first 2
weeks home. You lowered the fear for activities of daily living
and starting an exercise program.
Then, as you hook up with your cardiologist and your
primary care doc, you would be hooking up with other people in
the community for additional nutritional help, for real
exercise stuff, and so on. That would be the continuum. Am I
correct in that?
Dr. Oz. A hundred percent correct.
Senator Mikulski. That is where the health coach comes in.
Not somebody with a baseball cap going, ``Hoo-ha, hoo-ha.''
[Laughter.]
Someone who is actually saying this is what we need to help
you comply with your regime, but these are the things that will
make the difference that you can be in charge of. What you
physically do, what you eat, how you take your medicine--you
are the one in charge working with this great health team.
It is not only a medical team, but it is a health team.
Dr. Oz. It is the exact vision. I think what we need to
push for most is that people on the front line who are living
this, making this decision every day, appreciate that is a
possibility and then demand it.
We have to delight our customers in medicine. We have
historically not treated our patients like customers. There is
a special covenant that we have with our patients. You give us
rights as doctors to do things that other people in society get
arrested for, like opening your chest.
That stated, I think we have the opportunity, if we make it
the norm, that people will say, ``You know what, I know they do
that down the street. How come you don't do that?'' That is
what would drive the competitive forces of healthcare to
creating better value in the system for each of us. It is not
going to just be because we pay for things differently.
Senator Mikulski. OK. I will come back, if we have time for
a second round, on the HealthCorps.
Thank you, Mr. Chairman.
Senator Harkin. Senator Enzi.
Senator Enzi. Thank you for all of your words of wisdom and
the way that you are changing our culture from ``sick care'' to
truly healthcare. I appreciate your comments about health
records, and you have expanded them. We passed that out of this
committee twice. We haven't been able to get the whole thing
done yet. There is part of it in the stimulus package.
You expand on that to the person--and we have talked about
this, but we haven't included it, having the person have access
to it themselves. That would make a tremendous difference in
what Senator Mikulski was talking about, about people being
able to actually read the sequence they are supposed to take
things.
You started out by saying there were three points, I think,
and you gave us the first one, which was the health IT. I want
to go back to the HealthCorps thing that you mentioned. I think
you said you have that in seven States.
How do you fund that, and how do you train them?
Dr. Oz. HealthCorps volunteers, who we select from a large
group of people who apply over the Web for the positions, are
college graduates. We bring them to New York City, where the
training center is. We put them up in dorms for 2 months. Just
like the Peace Corps trains its volunteers, we give these kids
education not just in health, but in how to teach.
We have a several hundred-page syllabus of lesson plans. It
is well vetted by folks who are professional educators, and
they help these young, enthusiastic, passionate folks--as they
go back into their schools--understand how to pass along this
key information.
Once the kids go back to their schools, and they are in New
York and Pennsylvania and New Jersey and Florida and Texas and
California. I mean, they are spread all over the country, Ohio.
Once they go back to their home States and enter into the
schools, we work with principals to figure out how we can best
help the school.
For example, in some schools, we will just teach the health
class. We will take 1 day and go through the whole program, and
we will teach. We will bring organs to the school from a local
hospital and show kids what really happens inside your body
when certain things happen. We will explain it in a hip and a
little bit of an edgy way, with a little attitude, some of the
things you can do, if you are a 15-year-old, to be healthier.
Because if we just lecture you, if I gave the lecture with
my calcified neuronal processes, kids won't want to hear that.
I have tried that already. I failed with my own four kids. I
think if we go in there with energetic kids who are 4 years
older than the person they are talking to, it is a very
different dialogue.
We set the agenda of what is talked about, but in fairness,
a lot of it is how you deliver the message. By doing it at
lunchtime and after-school programs or together with teachers
within the day, we have had huge and very successful uptake.
In fact, the teachers unions are often very supportive of
our endeavor because we supplement what they are doing. We
don't move in there and try to take away positions or tasks
that are currently being fulfilled by the members of their
groups.
Senator Enzi. I think I am going to switch directions
completely here because one of the things that comes up at town
meetings a lot is somebody that has had several operations, and
they have several different specialists that are out there.
Unless there is somebody from their family that is kind of
coordinating that, things can go awry, and nobody has any
responsibility for it.
We place a lot of emphasis through incentives to having
specialists rather than primary care and, as you are
mentioning, kind of a primary care coordinator who wouldn't
necessarily have to be the doctor, although we would probably
get in a lot of trouble if we start talking about any other
field.
Are you running into that same thing, and is there a way
that we can involve more of these people in doing this kind of
coordination for people?
Dr. Oz. It is probably the most straightforward way to
improve the healthcare system is to build a culture of health
advocates. Call them health coaches for now. I think frequently
they probably should not be M.D.s. Not because doctors can't do
it, but it is probably not what doctors are passionate about
doing usually.
I went to medical school because I was curious about the
physiology of the heart. I liked the tension, the exhilaration
of being in an operating room. If you put me in charge of
managing hypertension in the chronic ailment, I probably
wouldn't do it as well.
Studies done on this topic have demonstrated that nurse
practitioners will often manage chronic illnesses more
effectively for that reason. They love doing it. That is what
they get up in the morning thinking about.
I think my brethren within medicine don't see that as a
threat. It is a physician extender. You are helping me. I
think, within the hospital care system, we are now beginning to
use these models.
In my hospital, New York-Presbyterian, my physician's
assistant is the healthcare coordinator, not me. Because at 2
p.m., when they have a problem with a test that hasn't been
done on time or they don't quite know what the neurologist is
going to say, I am in the operating room. So they can't get to
me. It doesn't work for me to have that power base. I would
rather delegate it to someone who I trust, train them to do it,
and let them do a better job than I would do.
I think the value of health coaches across the platform is
that it is less difficult for people to train to be health
coaches. People are passionate about doing that level of help
can do it, and it takes advantage of a resource we have for the
American public and a need that we have, this coordination of
the healthcare system.
Senator Enzi. My time just expired. I wish there was a lot
more time because this is just such a tremendous resource.
Senator Mikulski. We will be able to pick it up in the
second panel, and if Dr. Oz has time to stay. As we said, there
is an Institute of Medicine summit going on right this very
minute to talk about this concept of integrative health, which
was the hearing we kicked off on Monday, and the summit is
going on.
It is really a week-long conversation, and we will be
getting the report of the summit so that we can talk about
this.
Dr. Oz, I want to come back to the conversation on
HealthCorps, which we will draw the distinction to a health
coach. To me, the health coach is someone where we will have an
established body of knowledge and even a certain level of
credentialing so we don't have quacks out there saying, ``I am
your health coach,'' and all they want to do is push bottles of
something.
But the HealthCorps, we are going to be working on national
service legislation. To me, the HealthCorps is really a very
dynamic idea. Do you see the HealthCorps--you have established
it. You, through a foundation, I believe. Is that correct?
Dr. Oz. That is correct.
Senator Mikulski. My question would be, would you see that
as also part of national service, or should we do it the way,
if I could use Teach America and AmeriCorps? Teach America, as
you know, is such an outstanding organization, and now for its
20-plus years of operation has really changed public education.
Changed the lives of children in the classroom and have gone on
to be reformers themselves.
Then we have AmeriCorps that goes into classrooms, does
tutoring and so on, but they are different than Teach America.
Would you encourage us, as we do national service, to have some
type of grassroots HealthCorps component to it? But you,
meaning HealthCorps, as you have established it, keep on going
the way Teach America has kept on going?
We are trying to look at some of the public policy. Senator
Enzi, you know it is something to really be thinking about in
national service from everything from even how we use
agricultural agents differently. You know we have in the
Department of Agriculture, which Senator Harkin has guru
status, we use agricultural agents to go out to talk to farmers
about growing it.
Maybe we need food extension agents to come into our
communities to talk about food, and maybe we need a department
of food?
Dr. Oz. You want a hybrid approach. You want to have
HealthCorps--by the way, HealthCorps is funded by public and
private funds. It is a 501(c)(3). We collect money from folks
who want to give back to the system voluntarily, but we also
have support from the city of New York. We have support from
other Government agencies and local States. I think that
HealthCorps ideally would fit into AmeriCorps.
The reason HealthCorps works is because it is a service-
learning model. By that I mean if we had the educators within
AmeriCorps--so they are funded, they know that they have a
long-term strategy and a tasking of what to do--and then the
people they bring to do a lot of the change in communities are
volunteers, it takes time and money to train volunteers to give
their time back.
I think that we can combine the two of them together, we
have the perfect model. We are already working with
ServiceNation. I feel very strongly about the things they are
doing that are so valuable for this Nation.
Let us make it easy for folks who want to give back by
making the country healthier to do that, but to build an
infrastructure within AmeriCorps or Teach for America, one of
these programs that already has so much experience, that is
already within the Federal jurisdiction.
Senator Mikulski. Well, thank you, Doctor.
We are going to temporarily recess because there is a vote
going on. Senator Harkin will return to pick up the hearing.
Don't go anywhere.
He has already voted and on his way back. Could you,
though, introduce your HealthCorps director?
Dr. Oz. Sure. The whole HealthCorps team is here. We have
got them lined up. Michelle Bouchard to my right.
Senator Mikulski. OK. And Michelle--we will introduce
others. When we have our national service hearing, we are going
to ask Michelle to participate and really devote part of our
national service hearing--because we are going to have public
hearings, Senator Enzi, as you have so rightfully encouraged--
and we would like to hear your experience in a more in-depth
way than we can go into today.
The committee stands in temporary recess until Senator
Harkin returns.
Dr. Oz. Thank you.
[Recessed.]
Senator Harkin. Well, such is life around here with votes
and all that kind of stuff. The committee will resume its
sitting.
I am going to use this break period to ask the other people
to join us. It was just kind of an interesting arrangement. We
have such learned and distinguished practitioners, as I
mentioned to Senator Enzi, of alternative medicine, integrative
medicine. I am going to ask them all to come up at this time.
Dr. Mark Hyman, I just saw Dr. Hyman earlier. Dr. Andrew
Weil, Andy and Dean Ornish. Dean, if you could join us? If all
of you could come up. Good.
I welcome you all here. I will wait until my colleagues get
back for a more formal introduction. I thought I just might use
this point just to finish or to ask a couple of questions of
Dr. Oz before they come back.
I guess some of this was covered a little bit while I was
gone. I need to know more about this ServiceNation, about the
HealthCorps model. You started this. There are already some
integrated with AmeriCorps now?
Dr. Oz. Well, we have spoken with AmeriCorps.
We have spoken with Federal organizations. We work more
with city programs, but we are working with a couple of
elements of the Federal Government. The CDC has asked us to
partner on some endeavors because childhood obesity is causing
chronic disease. They have gotten involved in these endeavors.
The National Association of Community Health Centers, also
a group that is charged with, to a certain extent, bringing
health into communities, has recognized HealthCorps as a
potential ally. We have spoken with AmeriCorps because I think
it is a logical place for the program to live.
Right now, it is funded in part by private philanthropy, in
part from city and State organizations that give us grants. We
have some money coming through States from the Federal
Government to support the program. It would make sense to take
this model, as it grows, and we purposely, by the way, started
and grew this outside the Government because we were advised to
do that by people inside the Government.
They said go out and do it, show that it works, get some
data for us so we understand its efficacy and its costs. Then,
when it makes sense, bring it back. Then if it is the right
thing for the American people, we will adopt it.
I think one of the beautiful things about this whole
HealthCorps model is that it allows us to bring service into
the equation. It allows us to help people who want to give back
to our country to play that role. Whether it is getting
involved and bringing farmer's markets into communities or
playing an active role getting kids in the school to have
physical fitness as part of what they think is part of their
life.
Senator Harkin. I guess that is what I was wondering about,
training. I mean, what kind of training would they have to
undergo before they could become a part of this HealthCorps?
Dr. Oz. The training process is the exact same one that
they use for the Peace Corps. We take these college graduates
after they finish school, and we put them in a 2-month
intensive program where we teach them not only about health,
but also how to teach.
After this 2-month period, they are put into schools, which
we have already selected for them, where they have partners
with local teachers and principals and understand the culture
of the school. Then because they are embedded in there, like a
mentor, they play an educational role that is very different
from that of the teachers, and they will mold to whatever is
needed by the school.
The key for us is not just to let it end there. It is to
teach high school kids so then they can go and teach middle
school kids, or go home and audit their refrigerator, or get
involved in opening the gym on the weekend so the kids can play
sports.
They can make a difference because they become activists.
They want to be part of change, and we are teaching them how to
do that.
Senator Harkin. Well, I love the concept. I don't know, I
need to know more about how we might expand on that in the
future.
One other thing, in your testimony, you support the WIN
proposal outlined by Dr. Jonas that would create a White House
office focused on lifestyle-based chronic disease prevention.
Last year, along with several cosponsors, I introduced
legislation to create a high-level task force on prevention and
public health that would coordinate efforts among Federal
departments.
Now you mentioned earlier about if you don't have
sidewalks, people don't walk. I tried in the last
authorization, reauthorization of the highway bill to put a
simple amendment in, Doctor. All it said was that if you
receive Federal moneys for highways and streets and stuff like
that, you had to incorporate in your planning--you just had to
incorporate. I didn't say you had to do it.
You just had to incorporate it in your planning, bike paths
and walking paths. I lost that amendment. I am not going to
lose it next time. We have got another reauthorization.
But the idea being in the Department of Agriculture, this
year we have the reauthorization of the child nutrition bill.
We have got to do something about getting better food for our
kids in school.
This is a theme I want to be coming back to with you, Andy
and Dean and Dr. Hyman. We have got to start thinking about our
kids and in schools and what they are eating and the junk food
and the vending machines and how you change that. And get whole
grains and the other things in our schools.
It is transportation, it is education in schools, it is
Department of Agriculture. All of these things need to be
coordinated. Again, I ask if you could expand on the role that
you envision this office having, this office of lifestyle-based
chronic disease prevention?
Dr. Oz. Well, one of the reasons I am supportive of this
initiative to put someone in charge of integrating these
different health-touching divisions and departments that are
currently in a silo mentality, often ignoring the health costs
of their decisions, is because if one person is not in charge
of it, if it becomes some additional task you throw at an
individual who has got 15 other things to be graded on, it
seems to fall through the cracks over and over again.
Having one individual--and by the way, you could make a
separate office. You could also empower the surgeon general to
do this and make it their job description, as much as anything
else, to make sure that transportation is talking to health and
health is talking to education. So that elements of this
cascade that you are so aware of, but many of us on the outside
don't see, become force. Because it doesn't make any sense to
have a community without a playground.
I know the challenges you face in the agricultural
committee. We have spoken about them on the show. It is
difficult to envision how complex it must be if there is a
health cost to these decisions that often gets ignored because
no one is sort of on top of that as their primary task. I think
unifying that and having that person reportable to you, to the
Senate, to the White House would make it on the front burner.
Senator Harkin. Well, I am going to go ahead and introduce
the rest of the panel, and at least we can start. I assume my
two people will be coming back very soon.
I welcome all of you, and I will just go by the list--Dr.
Mark Hyman, Dr. Dean Ornish, Dr. Andrew Weil.
Dr. Mark Hyman, I will start with you first. Editor-in-
chief of Alternative Therapies in Health and Medicine, one of
the most prestigious journals in the field of integrative
medicine. Dr. Hyman is the medical editor of Natural Solutions.
He is on the editorial board of Body and Soul and Integrative
Medicine: A Clinician's Journal.
Dr. Hyman collaborates with Harvard Medical School's Center
for Complementary and Integrative Medicine and other leading
medical schools. I don't need to introduce you any further than
that because everyone knows who all of you are, as a matter of
fact, around the country.
I will say this, that all of your written testimonies will
be made a part of the record in their entirety. I didn't
mention that earlier, Dr. Oz. Perhaps if you could just
summarize your testimony, Mark. Then we will move on then to
Dr. Ornish and then to Dr. Weil.
Welcome, Mark.
STATEMENT OF MARK HYMAN, M.D., FOUNDER AND MEDICAL DIRECTOR,
THE ULTRAWELLNESS CENTER, LENOX, MA
Dr. Hyman. Thank you. Thank you, Senator Harkin and
committee, for this opportunity to share the dramatic changes
in medical thinking and practice that must be the center of
healthcare reform.
Is solving the problems of reimbursement, improving
delivery of care, implementing electronic medical records
enough for successful healthcare reform? Is providing access to
the uninsured enough to improve the health of our population? I
don't think so.
We must also change the content of care. We must move from
19th to 21st century medicine.
My name is Dr. Mark Hyman, and as a practicing functional
medicine physician, I am on the front lines of a scientific
medical revolution.
You are all painfully aware of the problems on healthcare
today. Today, I will provide effective solutions embedded in
the stories of real patients.
Cris Scoufos, a 40-year-old woman, came to see me with 5
years of uncontrolled ulcerative colitis with bloody diarrhea,
joint pain arthritis, cystic acne, which started after four
rounds of antibiotics for respiratory infections. She was
treated unsuccessfully at the Mayo Clinic with the most
advanced, dangerous, and expensive immunosuppressive therapies.
Just before returning to Mayo Clinic to start a new
investigational drug, she saw me. We didn't treat her disease,
but we optimized her function, her immune and digestive
function, by eliminating the triggers of inflammation and
supporting her digestive function with real food, nutrients,
enzymes, and healthy bacteria.
After just 6 weeks of treatment, she went back to the Mayo
Clinic and was found to have a completely normal bowel. Her
joint pain, fatigue, and cystic acne resolved completely by
treating the upstream triggers instead of the downstream
symptoms.
Can we get to the solution for chronic disease with our
current methods of diagnosis and treatment? I don't think so.
Enclosed within my testimony is her e-mail to me shortly
after her visit to Mayo Clinic. With permission, here is her
before and her after photographs.
My testimony will show that the current medical and
scientific paradigm of acute care medicine has been unable to
effectively address the epidemic of chronic disease and
associated costs and that there is a new paradigm of systems or
functional medicine, which addresses the fundamental underlying
causes of chronic disease and can form the basis for a more
effective model of medical education, practice, and research
that, over time, will generate dramatic cost savings and
improved health outcomes.
Also that there are specific initiatives and strategies
based on this new paradigm that can help quickly transform our
sick care system into a healthcare system.
Even if we get everything else right in healthcare reform,
it won't matter unless we address the underlying causes of
illness that drive both costs and the development of chronic
disease. If we improve the wrong type of care, then we will
simply be doing the wrong things better.
We must change not only the way we do medicine, but the
medicine we do. This new paradigm or functional medicine is a
system of personalized, patient-centered care based on how our
environment and lifestyle choices impact on our genes to create
imbalances in our core biologic systems. Those imbalances show
up as the signs and symptoms we call disease.
It is the best solution for our healthcare crisis. The
solution is not our current acute care model, which, though
extremely effective for acute disease, leads to worse outcomes
and higher costs when applied to chronic disease because it
doesn't address why people are sick. Functional medicine is not
a new specialty. It is not a new test or treatment or
procedure, but a new operating system, a method of problem
solving and thinking and processing complex clinical
information.
It is a fundamentally different way of thinking about the
origins and the mechanisms of disease, and it encompasses all
the tools of healing and medicine, both conventional and
integrative. It provides a common language, a map, or GPS
system for navigating through the puzzle of chronic illness.
Let me show how this works with real people. At the
University of Minnesota, Dr. Anne Kelly developed a model of
care based on functional medicine called ``U Special Kids''
program. It was for the 5 percent of the sickest children with
asthma, multiple medical conditions, who generated 60 percent
of the costs, mostly from unplanned hospitalizations.
In 1 year, the costs incurred by that population dropped
from $4 million to $250,000, $50,000 per enrollee or a 16-fold
reduction in cost. Yet the program was canceled in November
2008 after 1 year because less than 10 percent of the high-
science, low-tech, high-touch approach was reimbursable.
We cannot control costs by reducing access to effective
programs. We must increase access to integrated healthcare
teams that include a variety of health professionals, including
health educators or coaches, all of whom are trained in the
appropriate chronic disease model. Both the science and
technology exist to utilize functional medicine for such teams
on a wide scale.
Now I also saw a little boy, Clayton Lampert, to illustrate
another case. He was 12 years old, on Ritalin for severe ADD.
He also had behavior problems, severe handwriting difficulties,
as you can see here. He also had other unrelated symptoms--
asthma, stomach aches, headaches, anxiety, muscle cramps,
frequent antibiotics, and infections.
He had seen five specialists, on seven medications, and yet
no one asked how was everything connected or how his diet of
junk food and sugar made him sick. His immune system was
activated, his digestive system not working, and he was
nutritionally deficient. We simply restored his normal biologic
function by removing the impediments to health and providing
the ingredients necessary for optimal function.
In 2 months, he returned without any physical or
psychiatric symptoms, was off all his medications, and with
permission, here is his handwriting sample before and 2 months
after. You can see the changes, and it illustrates dramatic
change in his functioning without necessarily occupational
therapy or any other treatment, but simply by affecting his
biological function.
How many children suffer needlessly when we have the
solutions to these problems? What is the social and financial
cost of not changing the medicine we do?
Now there are some key avenues for change and
recommendations that I am going to make. There are three. Now
while there are many questions still to be answered and
research to be done, it is time to act. Based on the changes in
the medical paradigm, I submit that public investment must be
made in the following areas.
No. 1, we must retool medical education and research to
match the science of systems medicine. I recommend the
immediate establishment of a sustainably funded institute for
lifestyle and systems or functional medicine that would be the
national center and prototype for the development of a scalable
training program for medical schools, residencies, as well as
postgraduate certification and training in functional medicine
for existing practitioners as well as ancillary health
professionals and health coaches.
No. 2, I recommend the creation of functional medicine
demonstration projects in Federally Funded Community Health
Centers, with integrated healthcare teams focusing on treating
chronic disease and providing education about lifestyle and
wellness.
And No. 3, I support the establishment of a White House
and/or congressional office for health and wellness to
coordinate all efforts in this area, as detailed in the WIN
proposal submitted by Dr. Wayne Jonas. I would be glad to
provide the committee with more information at your request.
Here is a white paper on 21st century medical education and
practice that provides the blueprint for a new kind of
medicine, which I will submit along with my testimony.
Thank you.
[The prepared statement of Dr. Hyman follows:]
Prepared Statement of Mark Hyman, M.D.
Executive Summary
effective health care reform: addressing the drivers of costs
and chronic disease
The current medical and scientific paradigm of acute care
medicine has been unable to effectively address the epidemic of chronic
disease and its associated costs.
There is a new paradigm which addresses the fundamental
underlying causes of chronic disease, and can form the basis for a more
effective model of medical education, practice, and research that over
time will generate dramatic cost savings.
There are specific initiatives and strategies based on
this new paradigm that can help transform our sick care system into a
health care system.
the right solution for the problem of chronic disease
This new paradigm is personalized, preventive,
participatory, predictive, and patient centered. It is proactive rather
than reactive. It is based on addressing the causes of disease and
optimizing biologic function in the body's core physiologic systems,
not only treating the symptoms.
It is based on systems biology or medicine. That model
exists today, and is called Functional Medicine.
Functional Medicine is a system of personalized care, a
new ``operating system'' that directly addresses how environment and
lifestyle influence our genes to create imbalances in our core biologic
systems that, over time, manifest as disease. It is this kind of
medicine that is needed to create real successes in 21st century
medicine.
Even if we get everything else right in health care
reform, it won't matter unless we address the underlying causes of
illness that drive both costs and the development of chronic disease.
clinical examples: systems medicine in the clinic
Case examples of Functional Medicine in chronic disease in
autoimmune, digestive, behavioral, and hormonal disorders illustrating
the power and implications for transforming the quality of our health
care and reducing the economic burden of chronic disease.
Report on pilot program for children using functional
medicine showing a 16-fold reduction in costs from dramatically better
health outcomes with integrated health care teams based on Functional
Medicine.
key avenues for change: recommendations
1. Re-tooling medical education and research to match the science
of systems medicine. This would involve funding the development of
training programs in medical schools and residencies, and supporting
initiatives for certification and training in functional medicine for
existing practitioners through establishing a fully funded university-
affiliated Institute for Lifestyle and Systems Medicine.
2. Creation of Functional Medicine demonstration projects in
federally-funded community health centers, with integrated health care
teams focusing on treating chronic disease and providing education
about lifestyle and wellness. These would form the foundation for the
development of clinical practice networks of Functional Medicine for
education and research.
______
Chairman Kennedy, Ranking Member Enzi and distinguished members of
the committee, thank you for this opportunity to share the dramatic
changes in medical thinking and practice that must be the central focus
of health care reform. My name is Dr. Mark Hyman. I am a practicing
physician and vice chair of the board of directors of the Institute for
Functional Medicine. As a practicing functional medicine physician, I
am on the front lines of a scientific medical revolution.
effective health care reform: addressing the drivers of costs
and chronic disease
My testimony will show that:
The current medical and scientific paradigm of acute care
medicine has been unable to effectively address the epidemic of chronic
disease and its associated costs.
There is a new paradigm which addresses the fundamental
underlying causes of chronic disease, and can form the basis for a more
effective model of medical education, practice, and research that over
time will generate dramatic cost savings and improved health outcomes.
There are specific initiatives and strategies based on
this new paradigm that can help quickly transform our sick care system
into a health care system.
Even if we get everything else right in health care reform, it
won't matter unless we address the underlying causes of illness that
drive both costs and the development of chronic disease. This
innovative approach to chronic disease cannot only prevent but also
more effectively TREATS chronic disease.
We must change not only the WAY we do medicine, but also the
medicine we DO. We must improve not only financing and delivery of
health care, but also our fundamental scientific approach to chronic
disease--an epidemic that now affects 133 million Americans and
accounts for 78 percent of health care costs.
This way of doing medicine, or Functional Medicine, is a system of
personalized, patient-centered care based on how our environment and
lifestyle choices act on our genes to create imbalances in our core
biologic systems. Those imbalances show up as the signs and symptoms we
call disease.
It is the best solution for our health care crisis. The solution is
not our current acute care model, which though extremely effective for
acute disease, leads to worse outcomes and higher costs when applied to
chronic disease because it doesn't address WHY people are sick.
This new paradigm is personalized, preventive, participatory,
predictive, prospective, and patient-centered. It is proactive rather
than reactive. It is based on addressing the causes of disease and
optimizing biologic function in the body's core physiologic systems,
not only treating the symptoms. It is based on systems biology or
medicine. That model exists today, and is called Functional Medicine.
the right solution for the problem of chronic disease
Our current model of medicine is unsustainable because it cannot
stem the rising tide of chronic disease. Relying only on reforms in
access, financing, electronic records, malpractice, reduction in
medical errors, coordination of care, and research on new drug
therapies--while retaining the acute-care model--will be untenable.
These reforms are necessary but not sufficient to avoid the collapse of
our health care system that may soon mirror our current financial
crisis. These reforms do not alter the fundamental approach to
prevention and treatment. If we focus on improving the way we practice
the medicine of the past, we will still have the medicine of the past.
If we improve the wrong type of care, then we will simply be doing the
wrong things better.
Acute-care medicine is designed for acute illness, trauma, and end-
stage disease for which it is the best in the world. It is disease-,
drug- and procedure-based. Our current medical education focuses on
sickness rather than health; journals publish about disease management
not causality. Disease-based acute care medicine is the WRONG model to
address chronic illness, because it doesn't address WHY people are
sick, or the underlying mechanisms and biologic causes. That is why we
spend more than any other industrialized nation and are near the bottom
of the list for all major health outcomes, and are witnessing a decline
in life expectancy for the first time in history.
Functional Medicine is not a new treatment, test, or procedure but
a new ``operating system'' or method for problem solving and processing
complex clinical information. It is a fundamentally different WAY OF
THINKING about the origins and mechanisms of illness. It encompasses
all the TOOLS of healing and medicine, both conventional and
integrative. And it provides a common language, a map or GPS system for
navigating through the puzzle of chronic illness. A growing coalition
of practitioners, educators, and scientists is dedicated to advancing
this model. We have introduced 20,000 physicians and health care
providers to functional medicine since 1991, and we wrote the Textbook
of Functional Medicine in 2005 to describe both the underlying science
and the practical clinical strategies and tools that comprise this new
model.
We have begun a certification program in functional medicine and
are building key educational programs for residencies throughout the
country. We are partnering with Harvard in strategic research to
document the extent and scope of practice as well as the efficacy of
this model as a better roadmap for chronic disease.
Through a scholarship program funded by one of my patients, we have
trained over 50 academic faculty and fellows from major institutions
who are part of the Consortium of Academic Health Centers for
Integrative Medicine (funded by the Bravewell Collaborative) including
Harvard, Yale, Duke, Johns Hopkins, USCF, and the University of
Arizona. We are also collaborating with the American Academy of Family
Practice and the American Dietetic Association. We collaborate and
advance the foundational work of James Gordon, M.D. at the Center for
Mind Body Medicine and Dean Ornish, M.D. at the Preventive Medicine
Research Institute.
clinical examples: systems/functional medicine in the clinic
Let me illustrate how this works with real people.
A Pilot Program For Functional Medicine: Reducing Costs 16-Fold in Sick
Children
At the University of Minnesota, Dr. Anne Kelly developed a model of
care based on Functional Medicine called the U Special Kids program. It
was for 5 percent of the sickest children who generated 60 percent of
the total costs, mostly from unplanned hospitalizations. In 1 year, the
costs incurred by that population dropped from $4 million to $250,000,
or more than $50,000 per enrollee, or a 16-fold decrease in costs. Yet
the program was cancelled in November 2008 after 1 year because less
than 10 percent of the high-science, low-tech, and high-touch approach
was reimbursable.
We cannot control costs by reducing access to effective programs.
We must increase access to integrated health care teams that include a
variety of health professionals, all of whom are trained in the
appropriate chronic disease model. Both the science and methodology
exist to utilize functional medicine for such teams on a wide scale.
Reform must also encompass re-structuring financing and financial
incentives to prioritize health care, not just sick care. We cannot
afford incremental change. The health of our Nation, our future
generations, and the health of our economy depend on addressing the
explosion of chronic disease and associated health care costs.
A Woman With Treatment Resistant Autoimmune Disease
Cris Scoufos, a 40-year-old woman came to see me after 5 years of
uncontrolled ulcerative colitis with bloody diarrhea, joint pain and
cystic acne, which started after 4 rounds of antibiotics for
respiratory infections. She was treated unsuccessfully at the Mayo
Clinic with the most advanced, dangerous and expensive
immunosuppressive therapies. Just before returning to Mayo to start a
new investigational drug, she saw me. We simply eliminated common food
sensitivities, treated yeast infections, and normalized the function of
her digestive tract with probiotics, digestive enzymes, fish oil, and
vitamin D. After just 6 weeks of treatment she went back to Mayo and
was found to have a completely normal bowel, and her joint pain,
fatigue, and cystic acne resolved by treating the upstream triggers
instead of the downstream symptoms. We cannot get to the solution for
chronic disease with our current methods of diagnosis and treatment.
Here is her e-mail to me shortly after her visit to Mayo Clinic.
Her before and after photos are attached.
Dear Dr. Hyman: I am so thankful for all that you are helping me
with. I prayed for God to guide me to someone who could show me how to
properly care for my body so that I could heal and that the honor and
glory would belong to Him. Instead of asking for God to just heal me,
like I had for 4\1/2\ years, I asked for guidance on what I needed to
do.
After failing all conventional drug treatments I was told I would
have to go into an investigational drug study next. My trip to Mayo
Clinic had been planned and I was nervous about the choices I was going
to have to make. My colonoscopy in April 2008 showed 45 cm of
ulceration.
The trip to see you the last week of August was planned in 1 week
and everything fell together so easily. It seems like it was meant to
be. I started following your recommendations right away, even though I
haven't incorporated all of the supplements in yet, the change has been
amazing.
My colonoscopy at the Mayo Clinic in Rochester, MN was last Monday,
October 13. My physician, Dr. Sandborn, who is highly regarded in the
gastroenterology field as one of the best in the country, told me that
there is no ulceration left in my large intestine and there was only
some scarring. I have completely healed! It is amazing! I was still
bleeding just 2 months ago and now I am completely healed. It has been
a very long 5 years and I thought you would want to know just how much
your help has made in my life. Thank you very much. You have been the
instrument that God has sent into my life for healing.
Unending blessings to you and your loved ones,
Cris Scoufos.
A Doctor With Autoimmune Arthritis
A 57-year-old vascular surgeon was seen with debilitating
autoimmune psoriatic arthritis that had been unsuccessfully treated
with Humira, methotrexate, and NSAIDs; he also had migraines, reflux,
constipation, and fatigue. He was symptom free and off all medications
only 6 weeks after changing his diet, fixing nutritional deficiencies,
and addressing imbalances in his digestive system, which is home to
more than 70 percent of the immune system.
A Woman With Multiple Chronic Diseases
A 46-year-old woman, having seen a dozen doctors over a dozen
years, came to me with 29 different diagnoses, including depression,
hypertension, obesity, polycystic ovarian syndrome, migraines, heavy
uterine bleeding, asthma, sinusitis, irritable bowel syndrome,
fibromyalgia, osteoarthritis and psoriasis. Each disease was treated
with the best available conventional treatment. But she was still sick,
despite nine medications.
Of course, she didn't have 29 separate diseases. She had imbalances
in a few core networks of physiologic function--digestive, immunologic,
and hormonal--that gave rise to all her symptoms. The underlying cause
of all her ``diseases'' was an autoimmune response to gluten, leading
to autoimmune thyroid disease and severe vitamin D deficiency because
of malabsorption. Six weeks after eliminating gluten, improving her
diet, replacing thyroid hormone and vitamin D, her 29 diseases were
completely gone, along with 21 pounds.
A Boy With Attention Deficit Disorder and Asthma and Allergies
Clayton Lampert was a 12-year-old boy with severe attention deficit
hyperactivity disorder, behavior problems, and poor school performance
on Ritalin for years. He also had illegible handwriting or dysgraphia.
He also had apparently ``unrelated'' problems of asthma, allergies,
hives, stomach aches, headaches, insomnia, muscle cramps, and anxiety.
He had a history of frequent infections and antibiotics. He had seen
five specialists (lung, GI, allergist, psychiatrist and neurologist)
and was on seven medications for allergies, asthma, pain, and ADHD. No
one asked how everything was connected, or how his diet of junk food
and sugar made him sick.
His immune system was activated, his digestion not working and he
was nutritionally deficient in zinc, omega 3 fats, magnesium and
vitamin B6. We simply normalized his function by removing impediments
to health (junk food diet, food sensitivities, overgrowth of yeast, and
lead) and providing the ingredients necessary for optimal biologic
function--whole foods diet, additional nutrients including B6,
magnesium, zinc, omega 3 fats and probiotics. In 2 months he returned
without any physical or psychiatric symptoms and was off all his
medication. How many children suffer needlessly when we have the
solutions to these problems? Here is his mother's e-mail to me about
his progress. Below is his handwriting sample before and 2 months after
treatment.
Dear Dr. Hyman: We had a 504 meeting at Clayton's school this
morning (where the teachers, school counselor, parents, and principal
all get together to review ``the plan'' for kids with special
educational needs--in Clayton's case prompted by the ADHD diagnosis).
This was the first time in his entire schooling history that everything
seems to be going well. The input from his teachers was that he is ``a
different kid'' than they saw in the first half of the year and that
they're amazed by the difference. The school nurse hasn't seen him
since March (and he used to be in her office several times a week). The
school psychologist said his social skills are very good, age
appropriate, and that she sees no problems at all. She also noted that
Clayton seems very proud of himself and his new health and that he's
taking good ownership of all the changes in his diet. He even seems to
be shrugging it off when the other kids at school tell him he's an
``alien'' because he doesn't drink soda.
This was just such a fantastic meeting and I wanted to pass along
the good news and say, Thank You!
Recovery From Dementia
The power of this approach is that it can be often applied without
the intervention of a trained professional. Below is the story of a
woman's whose husband recovered from dementia by following the
principles of Functional Medicine. This recovery was likely due to a
reversible nutritional cause. Other causes of dementia, which is not a
homogenous disease, may respond differently, however the social and
economic impact of this method can no longer be ignored.
Eight years ago, at the age of 42, I met and married the love of my
life, Robert Foster. We both have felt that ``we'' were absolutely
``meant to be together.'' Two years ago I began worrying whether or not
the ``moments'' of forgetfulness meant the beginning of dreaded
Alzheimer's disease. I began to educate myself obsessively, and came to
the conclusion that the traditional route of pharmaceutical drugs was
the wrong approach to combat this beast. I would not accept that the
``only'' outcome was a horrible death sentence. My beloved husband's
cognitive function took a sudden and alarming spiral downward this past
fall. The formal diagnosis of ``Alzheimer's'' was no less
heartbreaking, but I felt lucky to have had those 2 years to do the
precious research and reading, where I was given the extraordinary gift
of awareness and respect for Functional Medicine.
Knowing instinctively that this was the only answer to the war we
needed to fight--it was here that I sought help. I was made aware of
Dr. Hyman by another Functional Medicine doctor a couple of years ago,
and have followed his work and have read several of his books. Having a
program to follow, was the answer to a prayer . . . literally. The
actual ``turnaround'' has been so dramatic that I have been hesitant to
share the results, not wanting to offer unwarranted ``hope'' to others,
as it sounds ``too good to be true.'' I do not want this to sound like
``hype''--or as the ``magic pill'' that cured Alzheimer's, but I do
think it would be irresponsible not to share our astounding results.
The bottom line--5 days after starting the program, my husband had
gone from not being able to hold a thought, constantly misplacing any
number of objects, repeating questions and thoughts, and not being able
to drive (as he would get lost), to the normal functioning man I
married. The ``comeback'' is NOT 100 percent--it IS over 90 percent. He
is able to hold his concentration on a project for hours at a time. He
is able to get into the car and run errands flawlessly. He carries out
a conversation and relates to it hours or days later. He is able to
recall telephone numbers and addresses. I have my husband back. I have
no doubt the change in diet, addition of specific supplements, the
detox program, and the addition of regular exercise, are responsible
for these results. I pray that the miraculous results are multiplied a
million times over, and others feel the joy and relief that I have had.
Dr. Hyman--our eternal thanks and gratitude.
key avenues for change: recommendations
While there are many questions still to be answered, and research
to be done, it is time to act. Based on the aforementioned
considerations, I submit that public and private sector investment must
be made in the following areas:
1. Re-tooling medical education and research to match the science
of systems medicine. I recommend the establishment of a sustainably
funded university affiliated Institute for Lifestyle and Systems
Medicine/Functional Medicine. This would be the national center and
prototype for the development of training programs in medical schools,
residencies, and postgraduate certification and training in Functional
Medicine for existing practitioners and ancillary health professionals.
Sixty-seven percent of the 250,000 primary care doctors are currently
dissatisfied with medicine and 80 percent are seeking new ways to
practice based on this emerging model of medicine. The goal should be
20,000 fully trained practitioners in 5 years.
2. Creation of Functional Medicine demonstration projects in
federally-funded community health centers, with integrated health care
teams focusing on treating chronic disease and providing education
about lifestyle and wellness. These would form the foundation for the
development of clinical practice networks of Functional Medicine for
education and research.
3. The establishment of a White House and/or Congressional Office
for Health and Wellness to coordinate all efforts in this area as
detailed in the WIN proposal submitted by Dr. Wayne Jonas.
conclusion
Most chronic disease today is not necessary. While conventional
medicine has been great for acute disease, Functional Medicine is the
model for easing the heavy burden of chronic disease from which our
society--indeed, the whole world--suffers today.
Thank you.
Mark Hyman, M.D.,
Institute for Functional Medicine.
Senator Harkin. Well, thank you very much, Dr. Hyman.
Now, I will turn to Dr. Ornish. I am kind of embarrassed to
try to introduce all of you. Since you are so famous anyway, I
don't know what I can say.
Dr. Dean Ornish, founder and president of the nonprofit
Preventive Medicine Research Institute in California, clinical
professor of medicine at the University of California--San
Francisco.
For over 30 years, Dr. Ornish has directed clinical
research demonstrating, and I was witness to this in New York
many years ago, for the first time that comprehensive lifestyle
changes may begin to reverse--not just stop, but reverse even
severe coronary heart disease without drugs or surgery.
And as I said, I can list all the books that all of you
have written and everything. But you are much better known than
what I could add to here at this hearing.
Dr. Ornish, again, welcome. Thank you for all that you have
done, and please proceed.
STATEMENT OF DR. DEAN ORNISH, M.D., FOUNDER AND PRESIDENT,
PREVENTIVE MEDICINE RESEARCH INSTITUTE, SAUSALITO, CA
Dr. Ornish. Well, Senator, thank you for all you have done.
I am very grateful to be here with such distinguished
colleagues and the pioneering vision that you have shown.
First, I want to thank you for what you have done and what you
are doing.
I just came from speaking at the summit on integrative
medicine at the Institute of Medicine and the National Academy
of Sciences. I think this represents a watershed event. I think
the world is catching up with the kinds of things that you and
I and my distinguished colleagues have been saying now for some
time.
As you have talked about very eloquently, our healthcare
system is really a disease care system. We spent over $2
trillion last year on medical care, but 95 cents out of every
dollar has gone for treating disease after it has already
occurred. It is not the most efficient way to spend our money.
It turns out that just four diseases--heart disease,
diabetes, breast or prostate cancer, and obesity--account for
75 to 80 percent of all these costs, all of which are
preventable and, as we have shown, even reversible simply by
making simple changes in diet and lifestyle.
If we want to make affordable healthcare, true healthcare
available to the 45 million Americans who don't have it, then
we need to address the more fundamental causes of illness
rather than just literally or figuratively bypassing it.
At the Institute of Medicine, I just showed a slide of
doctors busily mopping up the floor around a sink that is
overflowing, but nobody is turning off the faucet. That is the
problem. The same problem keeps coming back again, or we get a
new set of problems where we have painful choices.
Many people tend to think of breakthroughs in medicine as
being a new drug or a laser, something really high tech and
expensive, and they have a hard time believing that these
simple choices that we make in our lives each day can make such
a powerful difference. But they do.
In our studies for the last 32 years, we have used very
high-tech, expensive, state-of-the-art measures to prove how
powerful these very simple and low-tech and low-cost
interventions can be. We have shown that, for example, you can
reverse heart disease, as you mentioned earlier. We have also
shown that we can reverse early prostate cancer and, by
extension, breast cancer.
We have shown that people with diabetes and high blood
pressure and elevated cholesterol can often, under their
doctor's supervision, get off of these medications that they
are told that they have to take for the rest of their lives.
It is like if you don't turn off the faucet, we give you
all these mops to keep mopping up the floor. If we can treat
the cause, your body has, on many cases, a remarkable capacity
to begin healing itself and much more quickly than people had
once realized if we turn off the faucet, if we treat the cause.
These causes are largely the lifestyle choices that we make
each day.
Now as you know, heart and blood vessel diseases kill more
Americans now almost in every country in the world each year
than virtually everything else combined. Yet studies have shown
that it is completely preventable today for 95 percent of
people, knowing what we know now. We don't need to wait for a
breakthrough. We just need to put into practice what we already
know just by changing our lives.
You can say, ``Well, how is heart disease generally
treated?'' It is treated with things like angioplasties and
stents and bypass surgery. Yet with all this talk about
evidence-based medicine, what does the evidence really show?
The randomized trials of angioplasty show that they don't,
unless you are in the middle of having a heart attack, which 95
percent of the people who get them are not, they don't prolong
your life. They don't even prevent heart attacks.
We spent $60 billion in this country last year for an
intervention that is dangerous, invasive, expensive, and
largely ineffective. Again, unless we have really severe heart
disease, which most people that get bypass surgery don't--the 2
percent to 3 percent of people who have left main disease or
equivalent and left ventricular dysfunction--they don't prolong
life either.
You say, ``Well, they make your angina go away.'' We found
over 90 to 95 percent reduction in the frequency of angina or
chest pain in weeks just by changing lifestyle. It is dramatic,
and people who literally are riding a wheelchair around Wal-
Mart or can't get to their mailbox or can't make love with
their wife, you know, within weeks are generally pain free.
That is why I am so passionate about doing this work. I
have seen this over and over again. These approaches are not
only medically effective, they are usually cost-effective. We
have done three demonstration projects, as you know, many of
which you have helped us with.
One of which was we have trained, through our nonprofit
institute, hospitals throughout the country, and we have
trained now tens of thousands of people in this program since
1983. Because I thought if we just did good science, that would
change medical practice. Then I realized that was naive. It
wasn't enough to change science. We had to change
reimbursement.
The first demonstration we did with Mutual of Omaha. We
found that most of the people who were told they needed a
bypass or angioplasty were able to safely avoid it by changing
lifestyle, and they saved $30,000 per patient in the first
year.
The second study was done with Highmark Blue Cross Blue
Shield of Pennsylvania. We found that compared to a matched
control group that they cut their costs in half in the first
year and by an additional 20 to 30 percent in subsequent years,
again just by changing lifestyle.
We have developed--like Dr. Oz has developed his healthcare
model, which is beautiful and inspiring--we have developed a
model that works in hospital. We have learned how to train
teams of people, as Senator Mikulski was talking about, not
only just doctors, but nurses, social workers, clinical
psychologist, yoga teachers, exercise physiologists, registered
dieticians.
They all work together in a team approach, where the doctor
is the quarterback, but he or she doesn't have to spend as much
time as working with these other people, as Mehmet was talking
about. We found that it works.
We have done a demonstration project with Medicare that you
helped us with and Senator Mikulski helped us with. It took us
14 years to finally get Medicare to cover this, but they are
now paying for interventions like this, which we are now and
others are training people in how to do this.
We have a model that works. It works because it is based on
joy of living, rather than fear of dying. It is medically
effective, and it is cost-effective, and we want to get it out
to Americans at a time when the limitations of high-tech
medicine are becoming so clear.
The power of these very simple and low-tech and low-cost
interventions can transform people's lives for the better, save
tens of thousands of dollars in the first year, and provide a
new model for healthcare that is both more caring and
compassionate as well as more cost-effective and competent.
Thank you.
[The prepared statement of Dr. Ornish follows:]
Prepared Statement of Dean Ornish, M.D.
Executive Summary
Our ``health-care system'' is primarily a disease-care system. Last
year, $2.1 trillion were spent in this country on medical care, or 16.5
percent of the gross national product, and 95 cents of every dollar
were spent to treat disease after it had already occurred. Heart
disease, diabetes, prostate/breast cancer, and obesity account for 75
percent of health care costs, and yet these are largely preventable and
even reversible by an integrative medicine program of comprehensive
lifestyle changes.
If we want to make affordable health care available to the 45
million Americans who do not have health insurance, then we need to
address the fundamental causes of illness, and provide incentives for
healthy ways of living rather than reimbursing only drugs and surgery.
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.
We used high-tech, state-of-the-art measures to prove the power of
simple, low-tech, and low-cost interventions. We showed that
integrative medicine approaches may stop or even reverse the
progression of coronary heart disease, diabetes, hypertension, obesity,
hypercholesterolemia, and other chronic conditions. We also published
the first randomized controlled trial showing that these lifestyle
changes may slow, stop, or even reverse the progression of prostate
cancer, which may affect breast cancer as well.
Our latest research shows that changing lifestyle changes our genes
in only 3 months--turning on hundreds of genes that prevent disease and
turning off genes and turning off oncogenes associated with breast
cancer and prostate cancer as well as genes that cause heart disease,
oxidative stress, and inflammation. We also found that these lifestyle
changes increase telomerase, the enzyme that lengthens telomeres, the
ends of our chromosomes that control how long we live. Even drugs have
not been shown to do this.
The choices are especially clear in cardiology. In 2006, 1.3
million coronary angioplasty procedures were performed at an average
cost of $48,399 each, more than $60 billion; and 448,000 coronary
bypass operations were performed at a cost of $99,743 each, more than
$44 billion--i.e., more than $100 billion for these two operations.
Despite these costs, angioplasties and stents do not prolong life or
even prevent heart attacks in stable patients (i.e., 95 percent of
those who receive them). Coronary bypass surgery prolongs life in less
than 2-3 percent of patients who receive it. Studies have shown that
changing lifestyle could prevent at least 90 percent 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.
Finally, it's worth pointing out that what's good for your personal
health is good for the planet's health; what's personally sustainable
is globally sustainable. For example, eating a diet high in red meat
increases the risk of heart disease and many forms of cancer. It also
increases global warming: livestock cause more global warming than all
forms of transportation combined due to methane production, which is 21
times more powerful a greenhouse gas than carbon dioxide.
As Senator Harkin said, ``To date, prevention and public health
have been the missing pieces in the national conversation about health
care reform. It's time to make them the centerpiece of that
conversation. Not an asterisk. Not a footnote. But the centerpiece of
health care reform.''
______
Chairman Kennedy, Ranking Member Enzi, Senator Harkin, Senator
Mikulski, distinguished colleagues--thank you very much for the
privilege of being here today. My name is Dr. Dean Ornish, founder and
president of the non-profit Preventive Medicine Research Institute and
Clinical Professor of Medicine at the School of Medicine, University of
California, San Francisco (UCSF). I appreciate the opportunity to
appear today before this committee.
I just came from speaking at the ``Summit on Integrative Medicine
and the Health of the Public'' convened by the Institute of Medicine of
the National Academy of Sciences and the Bravewell Collaborative. This
represents a watershed event in recognizing the power of integrative
medicine and the synergy of systems approaches in enhancing health and
preventing illness.
The theme of my presentation is this: if we want to make affordable
health care available to the 45 million Americans who do not have
health insurance, then we need to address the fundamental causes of
health and illness, and provide incentives for healthy ways of living
rather than reimbursing only drugs and surgery. Otherwise, the
Congressional Budget Office indicated last week that this number is
likely to rise to 54 million in the next 10 years, if not before.
President Barack Obama and Senator Harkin understand this. As
Senator Harkin recently said, ``We don't have a health care system in
America; we have a sick care system. The problem is that this current
system is all about patching things up after the fact. We spend untold
hundreds of billions on pills, surgery, hospitalization, and
disability. But we spend peanuts--about 3 percent of our health-care
dollars--for prevention.''
Last year, $2.1 trillion were spent in this country on medical
care, or 16.5 percent of the gross national product, and 95 cents of
every dollar were spent to treat disease after it had already occurred.
Heart disease, diabetes, prostate/breast cancer, and obesity account
for 75 percent of these health care costs, and yet these are largely
preventable and even reversible by changing diet and lifestyle.
Our research, and the work of others, have shown that our bodies
have a remarkable capacity to begin healing, and much more quickly than
we had once realized, if we address the lifestyle factors that often
cause these chronic diseases. Medicine today focuses primarily on drugs
and surgery, genes and germs, microbes and molecules, but we are so
much more than that.
For the past 32 years, I have directed a series of research studies
showing that changes in diet and lifestyle can make such a powerful
difference in our health & well-being, and how quickly these changes
may occur, and how dynamic these mechanisms can be.
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.
We used high-tech, state-of-the-art measures to prove the power of
simple, low-tech, and low-cost interventions. We showed that
integrative medicine approaches may stop or even reverse the
progression of coronary heart disease, diabetes, hypertension, obesity,
hypercholesterolemia, and other chronic conditions. Four years ago, we
published the first randomized controlled trial showing that these
lifestyle changes may slow, stop, or even reverse the progression of
prostate cancer, which may affect breast cancer as well.
In our randomized controlled trials, published in the Journal of
the American Medical Association, The Lancet, and other major medical
and scientific journals, we found that 99 percent of people with severe
coronary heart disease were able to stop or reverse it by making
comprehensive lifestyle changes, without drugs or surgery. There was
some reversal of coronary atherosclerosis after 1 year and even more
improvement after 5 years, and there were 2.5 times fewer cardiac
events. Most of the patients with severe angina (chest pain) became
pain-free within only a few weeks, and quality of life improved
dramatically.
In June of last year, the Proceedings of the National Academy of
Sciences published our newest study showing, for the first time,
changing our lifestyle changes our genes. We found that improved
nutrition, stress management techniques, walking, and psychosocial
support changed the expression of over 500 genes in men with early-
stage prostate cancer. We found that oncogenes associated with breast
cancer and prostate cancer as well as genes that cause heart disease,
oxidative stress, and inflammation were downregulated or ``turned off
'' whereas protective genes were upregulated or ``turned on.''
In September, we published a study in The Lancet Oncology showing
that these integrative medicine changes increased telomerase, the
enzyme that lengthens telomeres, which are the ends of our chromosomes
that control how long we live. We found that telomerase, and thus
telomere length, increased by almost 30 percent in only 3 months. Even
drugs have not been shown to do this.
These findings are capturing the imaginations of many people.
Often, people believe, ``Oh, it's all in my genes, there's not much I
can do.'' Now, we understand how dynamic these mechanisms are, even on
a genetic level. These findings are giving many people new hope and new
choices.
Incentives are often perverse. For example, insurance companies pay
more than $30,000 to amputate a diabetic foot even though most
amputations are preventable by scrupulous foot care which is usually
not covered by insurance. A RAND study projected nearly $81 billion in
annual national health expenditure savings due to prevention and
disease management programs.&
These choices are especially clear in cardiology. In 2006, for
example, according to the American Heart Association, 1.3 million
coronary angioplasty procedures were performed at an average cost of
$48,399 each, or more than $60 billion; and 448,000 coronary bypass
operations were performed at a cost of $99,743 each, or more than $44
billion. In other words, Americans spent more than $100 billion in 2006
for these two procedures alone.
Despite these costs, a randomized controlled trial published in
April 2007 in The New England Journal of Medicine found that
angioplasties and stents do not prolong life or even prevent heart
attacks in stable patients (i.e., 95 percent of those who receive
them). Coronary bypass surgery prolongs life in less than 2-3 percent
of patients who receive it, those with the most severe disease.
In contrast, the INTERHEART study, published in September 2004 in
The Lancet, followed 30,000 men and women on six continents and found
that changing lifestyle could prevent at least 90 percent of all heart
disease.
That bears repeating: The disease that accounts for more premature
deaths and costs Americans more than any other illness is almost
completely preventable simply by changing diet and lifestyle. The same
lifestyle changes that can prevent or even reverse heart disease also
help prevent or reverse many other chronic diseases as well. The only
side-effects are good ones.
So, Medicare and other insurers and individuals pay billions for
surgical procedures like angioplasty and bypass surgery that are
usually dangerous, invasive, expensive and largely ineffective. Yet
they pay very little--if any money at all--for integrative medicine
approaches that have been proven to reverse and prevent most chronic
diseases that account for at least 75 percent of health-care costs.
When I lecture, I often begin by showing a slide of doctors busily
mopping up the floor around an overflowing sink, but no one is turning
off the faucet. Similarly, Dr. Denis Burkitt (who discovered Burkitt's
lymphoma) once described that paying for ambulances and a hospital at
the base of a cliff is not as smart as building a fence at the top to
keep cars from falling off.
It's important to treat not only the problem but also its
underlying causes. Otherwise, the same problem often recurs (for
example, bypass grafts or angioplastied arteries often clog up again),
a new set of problems may occur (such as side-effects from
medications), or there may be painful choices.
President Obama's health plan states, ``This nation is facing a
true epidemic of chronic disease. An increasing number of Americans are
suffering and dying needlessly from diseases such as obesity, diabetes,
heart disease, asthma and HIV/AIDS, all of which can be delayed in
onset if not prevented entirely.'' Senator Ron Wyden has sponsored the
Healthy Americans Act, which emphasizes prevention and has bipartisan
support.
For example, most people can significantly lower their cholesterol
levels and blood pressure by making comprehensive lifestyle changes
that are free rather than by taking a lifetime of drugs that are
costly.
In our research, we found that comprehensive lifestyle changes
caused a 40 percent average reduction in harmful LDL-cholesterol levels
in men and women during the course of a year without drugs. This
randomized controlled trial was published in the Journal of the
American Medical Association in 1998. Last year, over $20 billion were
spent in this country on cholesterol-lowering drugs such as Lipitor, so
the potential cost savings would be very significant if more people
made comprehensive lifestyle changes in lieu of drugs. While
cholesterol-lowering drugs have clear therapeutic benefits, patients
should also be offered more intensive diet and lifestyle interventions
that have been proven to lower LDL-cholesterol by approximately the
same amount at a fraction of the costs and with similar therapeutic
benefits.&
Cost savings can be greatest and can be seen most quickly in those
who are at highest risk or who have chronic diseases. For example, my
colleagues and I at the non-profit Preventive Medicine Research
Institute conducted a demonstration project in collaboration with eight
hospitals to determine if comprehensive lifestyle changes could be a
safe and effective alternative to bypass surgery or angioplasty in
those who were eligible to receive it.
After 1 year, almost 80 percent of people were able to safely avoid
heart surgery or angioplasty, and Mutual of Omaha calculated saving
almost $30,000 per patient in the first year. This study was published
in the American Journal of Cardiology. In a second demonstration
project with Highmark Blue Cross Blue Shield, these comprehensive
lifestyle changes reduced total health care costs in those with
coronary heart disease by 50 percent after only 1 year and by an
additional 20-30 percent when compared to a matched control group.
In our third demonstration project of more than 2,000 patients
enrolled in our lifestyle intervention at 22 hospital sites, we showed
dramatic improvements in angina in more than 83 percent of patients
reporting angina symptoms, and most became completely pain-free. This
study was also published in the American Journal of Cardiology. These
reductions are even greater than those achieved by coronary bypass
surgery or angioplasty/stents. Direct health care costs of angina alone
cost over $1 million per person over a lifetime. Clearly, if relatively
simple lifestyle changes achieve similar or even greater reductions in
angina pain than costly invasive surgical procedures, the potential
savings are enormous.
An ounce of prevention really is worth a pound of cure.
The rapid growth of companies offering personalized genetic testing
such as Navigenics, 23&Me, and deCODE Genetics, makes it possible to
identify people who are at highest risk for chronic disease and to
tailor prevention prescriptions to those who most need it. Finding out
that you are at higher risk for illnesses such as heart disease or
diabetes is a powerful motivator for making comprehensive lifestyle
changes. Also, those at high risk are more likely to show cost savings
from prevention.
Prevention is also cost-effective in healthier people, although the
cost savings per person are not as high. For example, 3 years ago,
Steve Burd (CEO of Safeway) realized that health care costs for his
employees were exceeding Safeway's net income--clearly, not
sustainable. We discussed redesigning the corporate health plan for his
employees in ways that emphasized prevention and wellness, provided
incentives for healthful behaviors, and paid 100 percent of the costs
of preventive care.
Overall health care costs decreased by 15 percent in the first year
and have remained flat since then. Many other worksite wellness
programs have shown cost savings as well as a happier and more
productive workforce. This approach is bringing together Democrats and
Republicans, labor and management.
In each of these studies, significant savings occurred in the first
year--medically effective and cost-effective. Why? Because there is a
growing body of scientific evidence showing how much more dynamic our
bodies are than had previously been believed.
Many patients say that there is no point in giving up something
that they enjoy unless they get something back that's even better--not
years later, but weeks later. Then, the choices become clearer and, for
many patients, worth making. They often experience that something
beneficial and meaningful is quickly happening.
The benefit of feeling better quickly is a powerful motivator and
reframes therapeutic goals from prevention or risk factor modification
to improvement in the quality of life. Concepts such as ``risk factor
modification'' and ``prevention'' are often considered boring and they
may not initiate or sustain the levels of motivation needed to make and
maintain comprehensive lifestyle changes.
In our experience, it is not enough to focus only on patient
behaviors such as diet and exercise; we often need to work at a deeper
level. Depression, loneliness, and lack of social support are also
epidemic in our culture. These affect not only quality of life but also
survival. Several studies has shown that people who are lonely,
depressed, and isolated are many times more likely to get sick and die
prematurely than those who are not. In part, this is mediated by the
fact that they are more likely to engage in self-destructive behaviors
when they feel this way, but also via mechanisms that are not well-
understood. For example, many people smoke or overeat when they are
stressed, lonely, or depressed.
What is sustainable is joy, pleasure, and freedom, not deprivation
and austerity. When you eat a healthier diet, quit smoking, exercise,
meditate, and have more love in your life, then your brain receives
more blood and oxygen, so you think more clearly, have more energy,
need less sleep. The latest studies have shown that your brain may grow
so many new neurons that it may get measurably bigger in only a few
months--this was thought to be impossible only a few years ago. Your
face gets more blood flow, so your skin glows more and wrinkles less.
Your heart gets more blood flow, so you have more stamina and can even
begin to reverse heart disease. Your sexual organs receive more blood
flow, so you may become more potent--the same way that drugs like
Viagra work. For many people, these are choices worth making--not just
to live longer, but also to live better.
In other words, the debate on prevention often misses the point:
the mortality rate is still 100 percent, one per person. So, it's not
just how long we live but also how well we live. Making comprehensive
lifestyle changes significantly improves the quality of life very
quickly, which is what makes these changes sustainable and meaningful.
Finally, it's worth pointing out that what's good for your personal
health is good for the planet's health; what's personally sustainable
is globally sustainable. For example, eating a diet high in red meat
increases the risk of heart disease and many forms of cancer. It also
increases global warming: livestock cause more global warming than all
forms of transportation combined due to methane production, which is 21
times more powerful a greenhouse gas than carbon dioxide. This causes
acid rain, damaging the external environment, as well as causing your
blood to be more acidic, which damages our internal environment and
promotes inflammation and chronic diseases. Livestock cause rain forest
deforestation due to clear cutting for grazing land at a time when the
rain forest survival is at a tipping point. This also creates water
shortages at a time when water is increasingly scarce.
Sometimes, our problems seem overwhelming. Many people find that
knowing that the personal choices we make in our lives each day have
such a powerful effect on our external environment as well as our
internal environment make it more meaningful and thus more motivating
to make more healthful choices.
In summary, integrative medicine approaches bring together liberals
and conservatives, Democrats and Republicans, because they are both
medically effective and, important in our current economic climate,
cost-effective. These approaches emphasize both personal responsibility
and the opportunity to make affordable, quality health care available
to those who most need it. They can be an important part of health
reform.
As Senator Harkin said in our recent Newsweek interview, ``To date,
prevention and public health have been the missing pieces in the
national conversation about health care reform. It's time to make them
the centerpiece of that conversation. Not an asterisk. Not a footnote.
But the centerpiece of health care reform.''
Senator Harkin. Thank you very much, Dr. Ornish.
Now, we will turn to Dr. Andrew Weil. At present, Dr. Weil
is the director of the Arizona Center for Integrative Medicine
at the University of Arizona, where he holds the Lovell-Jones
Endowed Chair in Integrative Rheumatology and is clinical
professor of medicine and professor of public health.
The center is the leading effort in the world to develop a
comprehensive curriculum in integrative medicine. Graduates
serve as directors of integrative medicine programs around the
United States, and through its fellowship, the center is now
training doctors and nurse practitioners around the world.
It was Dr. Weil who first told me a long time ago, and it
stuck with me ever since, that the natural state of the human
body is to be well. Most times, we interfere with that rather
than helping it along, and I have always remembered that advice
you gave me many years ago.
There is nothing more I can say. As I said, you are all so
well known around this country and around the world, I wouldn't
add anything other than just to thank you again, Dr. Weil, for
your great leadership, welcome you to the committee, and please
proceed.
STATEMENT OF ANDY WEIL, M.D., DIRECTOR, ARIZONA CENTER FOR
INTEGRATIVE MEDICINE, UNIVERSITY OF ARIZONA, VAIL, AZ
Dr. Weil. Thank you, Mr. Chairman, Senator Mikulski. Thank
you for giving me the opportunity to testify here today.
Even before the current financial meltdown, people were
predicting that the healthcare crisis had the potential to sink
our whole economy. This is a very high priority.
All of this is even before the baby boomers get into the
age ranges where they develop the diseases of aging and become
the major burden on our healthcare system, or the generation of
fat kids that we are raising, something entirely of our own
creation, develop the long-term complications of obesity,
especially of type 2 diabetes.
We are likely to see an epidemic of coronary heart disease
in young men, something we have never had to deal with. I think
these two things coming at the same time give us very little
hope unless we do things very differently.
Now I think it is common knowledge today that we have got
to move in the direction of disease prevention and health
promotion. The reason that our healthcare costs have become
unbearable is that we are locked into a system of disease
management, and most of the disease that we deal with, as Dr.
Ornish said, is lifestyle related and, therefore, preventable.
I think it is less obvious, and I am very happy to hear you
articulate this today, that we also have to have a
transformation of medicine as part of real healthcare reform.
Unless we change the nature of the kind of medicine that we do
today, there is no way that we can pay for healthcare in the
future because the high-tech interventions that medicine depend
on are simply too expensive.
Also, those high-tech interventions, in my experience, are
really appropriate only for a minority of cases of disease.
When we are dealing with life-threatening illness, with disease
involving vital organs, with trauma, with medical crises,
surgical crises, I think there is nothing finer in the world
than American medical technology.
We are trying to use this for everything that comes in the
door, and that is why we have these unbearable costs. The root
problem, as I see it here, is that our physicians and allied
health professionals are not trained to use low-tech methods of
interventions that are cheaper, safer, and that I think can
produce, in many cases, outcomes as good or better than those
of conventional medicine.
Let me just give you two examples of what I mean by low-
tech approaches. I mean aside from the obvious ones of dietary
change and lifestyle change and so forth. There is an awful lot
else out there that is not even on the radar screen of
conventional medicine that I think we can identify and use.
Over the years, I have become known as an unusual physician
who teaches breathing techniques to patients, and I did not
learn this at Harvard Medical School. I learned this from two
sources. One was from studying yoga, because there is a whole
division of yoga that places great emphasis on breath, and I
learned it from working with old osteopathic physicians, old-
timers who did manipulation as their main technique and also
place great emphasis on breathing.
There is a simple breathing method that I teach to most
patients that takes all of about 30 seconds twice a day to do.
I think this is the single most powerful medical intervention I
have ever come across in my studies in many cultures over many
years.
I have seen--I now have five cases of people who have
stopped atrial fibrillation with it, something I wouldn't have
thought was possible. People who have had chronic digestive
diseases who are now cured, just by working with this breathing
technique. People who have stopped the most severe forms of
panic disorder and other forms of anxiety disorder, and there
are people who have solved insomnia problems.
This is a technique that uses no equipment. It is
absolutely free, makes use of something right under your nose,
and nobody thinks of using it. Just imagine if we brought this
one method into mainstream medicine how much money this could
save in terms of drugs that didn't have to be prescribed,
adverse reactions to drugs that wouldn't have occurred, and so
forth.
There has been essentially no research on breathing as a
health intervention. Why? It is not taken seriously. When I try
to talk to colleagues about it, it seems too simple. There is
no drug involved. It doesn't use a device. It is just too
simple.
I will mention another intervention that I have become
fascinated with. You may have heard of a technique called
``laughter yoga'' developed by an internist in India. We are
calling it--laughter therapy--to dissociate it from yoga. This
man's discovery was that there is an easy way to induce
laughter in groups of people by having them simulate laughter.
There is interesting research showing that real laughter, I
mean laughter where people tear and it becomes involuntary,
lowers levels of serum cortisol, stabilizes blood glucose
levels, has a powerful antidepressant effect.
A colleague of mine, Dr. Gulshan Sethi--a cardiothoracic
surgeon in Tucson, is a recent graduate of our integrative
medicine fellowship--and I are proposing a research project
with a group of Iraq war veterans in the VA hospital out there
who suffer from posttraumatic stress disorder to look at this
intervention, which I think holds great promise of success to
deal with that terrible condition, which is now so costly to
manage.
These are examples of kinds of things that integrative
medicine can discover and bring into mainstream medicine to
help us lower costs.
Now I am an educator, and so I have great faith in
education as something that can save us. The model of
integrative medicine that I and my colleagues have developed at
the University of Arizona, which is now recognized as the
international standard of training in this field, I think holds
tremendous potential for us.
We need a new generation of health professionals. We need a
new generation of doctors. We need a new generation of nurses
and nurse practitioners, a new generation of pharmacists and
allied health professionals. For example, you said that I once
told you long ago that the body wants to be well, that this is
its natural condition. I was taught nothing about health and
very little about healing in my medical school education.
The fundamental principle of integrative medicine is that
there is this tremendous innate healing capacity that we all
have. When I sit with a person who is sick, always at the back
of my mind is the question, what is blocking healing here? What
is preventing it? What can I do from outside that can
facilitate that process?
That perspective is missing from the training of our health
professionals, and that is where it has to start. In addition,
we have to look at patients as more than physical bodies. We
are also mental, emotional beings. We are spiritual entities.
We are community members. Those other dimensions of human life
are very relevant to health and illness.
If we cut ourselves from them and only focus on the
physical body not only do we miss out on understanding the real
causes of health and illness, but we cut ourselves off from all
these interventions that may be cheaper, safer, and more
effective than those just directed at the physical body, like
pharmaceutical drugs.
Integrative medicine also insists that we pay attention to
all aspects of lifestyle and understanding health. I know this
is certainly centered on Dr. Ornish's and Dr. Oz's work. I
think an educated body of health professionals can be great
allies to you and people in Government in bringing about the
kinds of changes that are necessary if our society is going to
make these choices easier for people rather than harder for
people.
Let me just give you an example. If you look at the success
we have had with smoking reduction. This is an interesting case
to look at because if you go back to the 1920s and 1930s, there
was a totally different cultural value placed on smoking. This
was the year in which everybody who was anybody smoked.
Athletes smoked. Artists smoked. Physicians smoked. All movie
stars smoked.
Just rent a movie from the 1930s and look at how everyone
on the screen smokes all the time. How could you have grown up
in America at that time and not wanted to smoke? If you were an
unfortunate person who didn't smoke and didn't like being
exposed to it, not a chance. Smoking was considered a nuisance,
not anything that was dangerous.
Of all the things that we have tried to reduce--we have
raised taxes on cigarettes. There have been lawsuits against
cigarette companies. We have restricted sales of cigarettes.
There have been incessant public service messages about it.
What has worked, and what hasn't?
We have significantly reduced smoking in some groups. We
still have a ways to go because it is up in other groups. We
have made a lot of progress.
It seems to me that the lawsuits are irrelevant. Attempts
to restrict tobacco advertising I don't think are very
successful because if you block the companies in one area, they
find other ways around that to do it in other areas. I think
raising taxes has had an effect, and that is something to
consider in looking at changing food behavior.
To me, the single most important thing that has made
progress is a consistent, informed message coming from the
healthcare community about the hazards, the health hazards of
cigarettes. It is that which has enabled us to pass laws
getting smoking out of public places. Because as long as
smoking was just considered a nuisance, there was no chance of
progress. Now that people realize that this is a real health
hazard to people, it is possible to legislate against it.
I can't overemphasize the importance of having on your side
an informed community of health professionals who understand
the lifestyle influences on health and can really work as
powerful social/political agents to bring about the changes in
priorities that we have to have in the society if we are to be
working to facilitate people making the right lifestyle
choices, not the wrong ones.
My bottom line is that we must have a transformation of
medicine as part of real healthcare reform, and I would say
that having new educational models, such as the integrative
medicine training that we offer at the University of Arizona,
which, by the way, we are scaling up to really make a required
accredited part of all residency training and all medical
specialties. This is fundamental to the kinds of changes that
we have to see.
Thank you.
[The prepared statement of Dr. Weil follows:]
Prepared Statement of Andrew Weil, M.D.
Mr. Chairman and members of the committee, thank you for the
opportunity to speak to the committee about the vitally important issue
of health care reform. My name is Andrew Weil, and I am founder and
director of the Arizona Center for Integrative Medicine at the
University of Arizona's College of Medicine, where I am also the
Lovell-Jones Professor of Integrative Rheumatology, Clinical Professor
of Medicine & Professor of Public Health.
Everyone agrees that functional, cost-effective health care must be
built on a foundation of disease prevention and health promotion. The
main reason for the impending collapse of the American health care
system is its lopsided focus on intervention in established disease,
much of which is lifestyle-related and therefore preventable.
It is less obvious that meaningful health care reform also requires
a transformation of medicine. The high-tech interventions that
conventional medicine primarily uses, including pharmaceutical drugs,
are simply too expensive. American health professionals are not trained
to use low-tech, cost-effective treatments that work well for many
common disease conditions.
Integrative Medicine (IM) can solve both of these problems. As
developed and taught by the University of Arizona Center for
Integrative Medicine, it addresses all aspects of lifestyle to promote
health and alleviate illness. Our national educational models are
taught online and can be scaled to deliver training to large numbers of
physicians, nurse practitioners, and allied health professionals to
make them agents of lifestyle change. Furthermore, by identifying and
employing a range of therapies from dietary adjustment to breathing
exercises to carefully selected methods currently outside the medical
mainstream (for example, acupuncture and osteopathic manipulation), IM
can offer low-cost alternatives to pharmaceutical drugs and surgery for
many conditions that now drain our health care resources. We emphasize
proven, low-risk, low-cost interventions to treat disease, progressing
to high-cost, high-tech interventions only when the severity of
conditions demands them or after simpler measures have failed.
For practitioners of IM, preventing disease is not an afterthought,
it is the cornerstone of our practice--the physician and patient form
an ongoing partnership to maintain health, rather than fight illness,
and IM practitioners are trained to be agents of lifestyle change. We
treat illness promptly and aggressively when appropriate, but always
seek to maximize the body's innate capacity to stay healthy and resist
disease and injury.
My message today is that this system, integrative medicine, must be
a key part of American health care reform.
Here is why: The citizens of the United States spend more per
capita on health care than do the citizens of any other nation in the
world--by a long shot. Costs of medical care have spiraled out of
control, rising at such an accelerating rate that they are now a
leading cause of personal bankruptcy. Every 30 seconds, an American
files for bankruptcy as a result of health care costs.
Despite the magnitude of this crisis, when I listen to discussions
about health care reform, I hear next to nothing about the real causes
of the crisis or the real changes required to solve it. Most
commentators assume that the root problems are (a) how to give more
people access to the present system and (b) how to pay for it. I
strongly disagree.
Why? If we were the healthiest people in the world, perhaps our
massive expenditures for health care would be justified. The sad fact
is that by virtually every measure of health outcomes--including
longevity, infant mortality, fitness, and rates of chronic diseases--
the United States is at or near the bottom compared to other developed
countries. We are paying more and more for health care, and have less
and less to show for it. Clearly, we are spending all that money in
wrong ways.
Please consider the following myths, and the realities that they
conceal:
Myth #1: Because America has the most expensive health
care in the world, it must have the best.
Reality: The World Health Organization recently rated America 37th
in health outcomes, on a par with Serbia.
Myth #2: American technology makes it possible for us to
achieve medical excellence.
Reality: We have powerful technology, but we misuse it and overuse
it, driving up costs and worsening health outcomes. To choose just one
small example, expensive cholesterol-lowering statin medications, which
may have serious side effects, are being recommended for millions of
healthy women and healthy men over 69 years of age, but an analysis in
the January 2007 issue of the medical journal, The Lancet, concluded
that such medications did not reduce total deaths in those groups.
[source: The Lancet, Volume 369, Issue 9557, Pages 168-169, 20 January
2007, http://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(07)60084-1/fulltext]
Myth #3: Our medical schools and scientific facilities
produce the world's finest physicians and conduct the most productive
research.
Reality: Our medical and scientific infrastructure is extensive,
but it is controlled by an almost fundamentalist orthodoxy that limits
our ability to understand and promote health and to prevent disease.
Medical education today omits whole subject areas of great relevance to
those ends, including nutrition, mind/body interactions, and
environmental effects on health. We train researchers to think
simplistically and focus narrowly on single interventions directed at
the physical body, especially pharmaceutical drugs. (The manufacturers
of those drugs strongly influence researchers, practitioners, and the
journals that report research results.)
In short, we do not have a ``health care'' system at all. Instead
we have a disease management system that is deeply dysfunctional and
getting more so by the day. Our national health is deteriorating, and
we have the highest percentage of uninsured citizens of any democratic
society; no other nation is close. With unemployment rising at an
alarming rate, great numbers of Americans are losing their health
insurance along with their jobs, further swelling the ranks of the
uninsured. This is unacceptable.
So what must we do?
Let me say again: The challenge is not figuring out how to give
more people access to the present collapsing system. The challenge is
to envision what we can create to replace it.
I have long taught that health is an individual responsibility. It
is up to you to learn how to maintain it and to protect your body's
potential for self-healing as you go through life. No doctors, no
treatments, no system can do this for you or force you to do it on your
own.
Medical professionals and institutions can help, however, by
improving your understanding of health. They can inform you about the
influence of lifestyle choices on your risks of disease. They can
provide preventive medical services to protect you from common, serious
conditions, for instance, by immunizing you against infectious
illnesses and screening you for forms of cancer that are curable if
detected early. They can identify and explain problems that require
expert diagnosis and treatment, then guide you in selecting the best
therapy. They can help you if you are a victim of trauma or suffer a
heart attack or need other emergency medical or surgical attention.
I believe--strongly and passionately--that every American has a
right to good health care that is effective, accessible, and
affordable, that serves you from infancy through old age, that allows
you to go to practitioners and facilities of your choosing, that offers
a broad range of therapeutic options. Your health care system should
also help you stay in optimum health, not just take care of you when
you are sick or injured. You should expect and demand this of your
country, whether you are rich or poor, whatever the circumstances in
which you live. A free, democratic society must guarantee basic health
care to its citizens--all of them--just as it guarantees them basic
security and safety. It is in society's interest to do so: the
healthier our population, the stronger and more productive we will be
as a nation.
It comes down to this: Our long-term goal must be to shift our
health care efforts from disease intervention to health promotion and
disease prevention. That does not mean withholding treatment from those
who need it; those with existing conditions need to be treated
effectively and compassionately. My concept of prevention goes well
beyond immunization, sanitation, and diagnostic screenings. I am
suggesting that the time has come for a new paradigm of preventive
medicine and a society-wide effort to educate our citizens about health
and self care.
Breaking dependence on costly high-tech medical interventions will
require fundamental changes in medical education and practice, as well
as rethinking the nature of health and healing, the role of treatment,
and our expectations of medicine. Without a transformation of medicine
we cannot have the health care we so desperately need: health care that
is effective, serves everyone, and does not bankrupt us individually or
collectively.
It can happen. It is happening. Federal mandates can only serve to
speed an ongoing, natural evolution that is well underway. I lead an
effort at the University of Arizona to train doctors in integrative
medicine, which, as I have said, values inexpensive, safe and
effective, low-tech treatments as alternatives to outrageously priced
pharmaceutical drugs. In fact, my work to advance this new field has
provided part of the inspiration to testify here today, because its
early success makes me absolutely certain that it is the key to getting
American health care back on course.
Consider: Integrative medicine is quickly gaining momentum. I
founded the first integrative medicine training program at the
University of Arizona in 1992. Today, 42 academic health centers,
including those at Harvard, Duke, Johns Hopkins, and the University of
California as well as the Mayo Clinic, have IM initiatives. [source:
http://www.imconsortium.org/about/home.html] At the University of
Arizona alone, we have trained over 400 physicians, nurse
practitioners, and medical residents, many of whom are now leading
their own programs at other institutions in this country and around the
world. We are expanding our trainings as quickly as we can, because
demand for them is increasing rapidly, and are working to make a
comprehensive curriculum in IM a required, accredited part of all
residency training in all medical specialties. I can assure you, that
more and more doctors and allied health professionals want to practice
this kind of medicine, because they see it as the medicine of the
future: cost-effective medicine that can revitalize American health
care and make it truly the best in the world.
Consumers have already embraced integrative medicine, but skeptics
still question whether it really works. We need good outcomes studies
to convince them, but we already have data showing that patients do
indeed achieve better outcomes and are more satisfied with their care
when treated by integrative physicians. For example, a 2008 study of
patient experiences at the University of Michigan's Integrative
Medicine Clinic showed that over 62 percent of responding patients
called the clinic's care either ``excellent'' or ``best care ever.'' An
amazing 81.2 percent of respondents reported partial or full
effectiveness of their patient plan in achieving their primary
objective. [source: http://www.liebertonline.com/doi/pdf/10.1089/
acm.2008
.0154] That is a success rate most conventional clinics could not
match.
Health care reform can and should extend beyond the clinic. It must
also include the creation of incentives and disincentives to encourage
people to make better lifestyle choices in their daily lives that
reduce risks of the chronic diseases that now absorb so many of our
health care dollars. This is a tall order, requiring that the
government, private sector, and individuals all pull together and move
in the same direction. It must be done.
Thank you again for inviting me to testify today. I would be happy
to assist the committee as it considers health care reform and suggest
that the Arizona Center for Integrative Medicine is well positioned to
reach out to other health care leaders who share our belief in the
importance of transforming medicine in order to secure the health and
future of our society.
Senator Harkin. Thank you very much, Dr. Weil. Thank you,
all.
I guess what I think about listening to all of you is that
here we have in four individuals real pioneers, each one of
you. You have written many books. You are very famous.
Americans know your names. They have read your books. They have
read your articles. They have seen you on television.
We are right now trying to reform, healthcare reform. As
Senator Enzi said, the President just sent up his budget
proposal for this reserve fund and all that. I am just
wondering how do we harness you all in advising us and advising
the President and moving us in the direction you have all
talked about? I mean, there isn't a hair's width of difference
between what any of you are talking about.
How can I put you in great positions of power so that you
can dictate changes in our system? I am so frustrated with
this. You have such a great following among the American
people, and you are doing wonderful things.
How do we take this and then move all the things you are
talking about into this sphere here of healthcare reform so
people start thinking, yes, this is what we have got to do?
Rather than just, as many of you mentioned, we are going to
jiggle a little bit on the repayment and jiggle a little here
and that kind of thing.
Dr. Weil. There is so much that has to change, though. Look
at the whole--the mindset that prevails in this culture on the
part of both doctors and patients that the only legitimate way
to treat disease is by giving drugs.
Senator Harkin. Yes.
Dr. Weil. You know, you can blame the pharmaceutical
companies, but they are just capitalizing on this deeply
established mindset. You could talk to a patient until you are
blue in the face about lifestyle change and so forth, but if
they had a chance to buy a pill that they thought would help
them lose weight, they would go for that.
Senator Mikulski. Absolutely.
Dr. Weil. Again, to me, this is a matter of education, and
the education has to start--it has got to be K through 12. I
would also love to see, in the Department of Education, an
Office of Health Education that would be well-funded, that
could really work to get creative health education beginning in
kindergarten.
I think there is huge possibilities today of using, for
example, this new generation of interactive videogames and
harnessing this for real health education. It has got to be
throughout society. I am focused on education of physicians and
health professionals, but we need education of the general
public to change a lot of this underlying mindset.
Senator Harkin. Dean.
Dr. Ornish. First of all, I appreciate the question. The
answer is how can you get us involved? Ask us. Because we have
all seen what a powerful difference these changes can make, how
they can transform people's lives. We have been looking for
leverage, how can we make this available?
We have learned because we have trained, now, hospitals
around the country. Senator Mikulski, I want to make sure that
I honored you, now that you are back, to talk about the major
difference you made in Medicare doing the demonstration
projects so that we could demonstrate that we can work with
teams of people, with social workers like yourself, with
clinical psychologists, dieticians, yoga teachers, exercise
physiologists, nurses, and doctors working together as a team.
We have shown that we didn't know if it would work as well
in Omaha or Columbia, SC, where they told me gravy is a
beverage. You know, this will be a big change for lifestyle.
[Laughter.]
As it would in New York or San Francisco or Boston. But it
did. We were able to train teams of people to do it. Just like
Dr. Oz is doing with HealthCorps, we are doing this in a
parallel way. We have been doing it now for 16 years, and we
have shown that it works.
We have learned what works to motivate people to make
sustainable changes. We have shown we can motivate people to
make bigger changes in lifestyle, get better clinical outcomes
and even larger cost savings.
Now it is a little like people say, ``Well, why would you
mess around with all this touchy-feely stuff? Why don't you
just take a pill?'' It is like that scene from Raiders of the
Lost Ark, when the guy comes out and does all his martial arts
and kung fu, and Indiana Jones just takes out a gun and shoots
him. Like, why don't you just take a pill? It is going to do
it.
The idea that taking a pill is easy and everybody will do
it, but changing lifestyle is impossible is not really what we
are finding. You might say, ``Well, why is that?'' It is
because we normally try to scare people into change. You know,
use fear of dying. If you don't quit smoking, you are going to
get lung cancer.
That doesn't work because it is too scary to think about,
and people don't want to think that something bad may happen to
them. So they don't. Taking a pill to lower your cholesterol
doesn't make you feel better. You are taking something today to
prevent something really awful like a heart attack or a stroke
that you don't want to think about. So you don't.
When you change your lifestyle, when you change what you
eat and how you live, most people--your brain gets more blood.
You think more clearly. You have more energy. Your brain can
actually grow so many new brain neurons your brain gets bigger
in just a few months.
Your sexual organs get more blood flow, the same way that
Viagra works. Smoking actually is marketed to make you look
beautiful and sexy, and it makes your skin, the vessels
constrict. So you wrinkle faster. Half of the guys who smoke
are impotent. It makes you ugly and impotent. How fun is that?
In fact, the most effective anti-smoking ad was when the
Department of Health Services had these billboards that dressed
the guy up like the Marlboro Man, and the headline was
``Impotence'' and had a limp cigarette hanging out of his
mouth.
Part of what we are learning is that if we really want to
make sustainable changes, we need to talk about the feeling
that there is no point in giving up something that you enjoy
unless you get something back that is better. Because these
mechanisms are so dynamic, most people find they feel so much
better so quickly it reframes the reason from changing from
fear of dying to joy of living.
Senator Harkin. Yes.
Dr. Hyman. I think your question, Senator Harkin, was very
important, which was how do you take advantage of the science
that we know and put it into practice? How do you make science
policy?
I think what we are talking about is really based on new
evidence that shows that lifestyle is the most effective, and
these therapies are the most effective and cost-effective to
create change.
A way to do that is partly in Dr. Jonas's proposal to
create a White House office or a congressional office. More
importantly, within that was to create an advisory council of
leaders who can advise Congress and advise the White House on
these approaches and how to implement them into policy.
We are fighting a huge uphill battle. There is $30 billion
spent by pharma educating physicians, ``educating'' on the use
of medications through direct marketing and other sources. That
accounts to $30,000 per doctor in this country to educate them
on how to use medications.
There is $30 billion spent by the food industry to educate
people about how to eat junk food. That is $60 billion. If we
took a fraction of that, we could make enormous impact in
changing consciousness and putting in programs that are
effective and demonstrate benefits. Based on the work of Dr.
Ornish and Dr. Oz and Dr. Weil, these are the kinds of things
that can make enormous impact, and providing the
infrastructures to do that is key.
It doesn't take a lot of money. We are talking about small
amounts of money for demonstration projects, maybe $5 to $10
million per demonstration project in three or four centers
around the country in different demographics to implement this
model and show that training integrated healthcare teams works
in this way to deal with chronic disease. Implementing not just
the way we do medicine now better, but a different way of doing
medicine.
We really need to foster and develop the things that Andy
has developed and other kinds of institutions that extend the
education. I completely agree with Andy that we have to train a
new generation of practitioners. Because if we just have the
ones that we have now doing what they do better, that is not
going to solve the problem.
I think putting funding on that, and that could be a small
amount, relatively, to the budget. A hundred million dollars
could establish a really profound change in medical education.
Dr. Ornish. Just to build on what they are saying, Andy is
completely right--Dr. Weil--that we doctors do what we get
trained to do and we get paid to do what we get trained to do.
So, if we change reimbursement, we change medical practice and
medical education.
Most doctors are not happy with the current model. The
studies show that most doctors wouldn't recommend medicine as a
career for their kids because it is not fun to practice
medicine when you have to see a new sick patient every 6
minutes. It doesn't work.
If we change reimbursement and we reimburse these kinds of
integrative approaches, the kind of programs that we have shown
in hospitals are much more cost effective than using drugs and
surgery, that will change the practice of medicine. We could do
a million studies with 10 million patients, and it will always
remain on the fringes unless we change reimbursement.
Dr. Weil. Again, I just see education as the fundamental
here. At the moment, our physicians, other health professionals
are not trained in practical nutrition. They are not trained in
mind-body interactions. They are not trained in the use of
botanicals. They are not trained in the use of dietary
supplements.
There are huge areas of omission here. The education of
pharmacists, because they are not trained in the use of natural
therapeutic agents, they have abandoned all this territory to
health food store clerks. As an assignment, I used to send
medical students to health food stores, and I asked them to
loiter and listen to the conversations that went on and observe
the extent to which health food store clerks have replaced
pharmacists as practical dispensers of health information.
I have met some very intelligent health food store clerks.
As a group, they have no standardized training, and they often
dispense information that comes to them from the manufacturers
and distributors of products. The pharmacists need to take this
territory back.
So, this is something again. At our center, we work with
our College of Pharmacy to develop educational modules in these
areas that are now omitted. Similarly, we go around to all the
allied health professions, and these big defects need to be
corrected.
Dr. Oz. I could offer just one quick thought and that is we
sort of need a martial arts approach to this. A small effort
with a big impact. I think one of the benefits of health
coaches movement or HealthCorps, which deals with young kids,
is that you take people whose basic instinct is going to be
lifestyle based, and you get them to touch the lives of 50
people around them. So you leverage it.
The first recommendation becomes, don't have the procedure
on your heart, do the lifestyle approach. The three other
members of this panel have the technology, the know-how to
build the system. If we build it and we have the knowledge base
of people incentivized to think about it, they will come.
I think you have got the raw material here to change
education. We have to have that leverage element to make it
into a movement. I think the things we have talked about are
inexpensive ways of doing that.
Senator Harkin. Is HealthCorps getting any Federal funds at
all?
Dr. Oz. We get moneys that are given from the Federal
Government to States and then to us. It goes through Federal
grants, although we are, as I mentioned, working with one
Federal agency, which we will hopefully get some funding from.
But you know what? I am a pretty good fundraiser. I will
raise money for HealthCorps for now. What we really need is the
opportunity to do what you offered earlier, was to play a role.
It is hard to help sometimes.
When I had this discussion with Mayor Bloomberg of New York
City, ironically, they want people to help the school system.
The average citizen who lives in New York City, where I work,
doesn't know how to help. I think we sort of feel that way
sometimes.
Dean, over dinner with beer, will tell me it took him 14
years to get his project into Medicare.
Dr. Ornish. We had a discussion with the head of Medicare,
the administrator, I guess it was now 10 years ago. And he
said, ``Well, we will do a demonstration project, but you have
to get a letter from the head of the National Heart, Lung, and
Blood Institute saying that your program is safe.''
I said, ``You mean safe as an alternative to having your
chest cut open?'' And he said, ``No, that it is safe.'' I said,
``You want me to get a letter from the head of the NHLBI saying
it is safe for older people to walk, meditate, quit smoking,
and eat vegetables?'' And he said, ``yes,'' and that is what we
had to do.
With all this talk about evidence-based medicine, I mean,
even knowing, for example, the studies, the randomized trials
that have shown that angioplasties for 95 percent of people
don't prolong life or prevent heart attacks has not diminished
the rate at which angioplasties are done because it is
reimbursable.
You have cited, Senator Harkin and Senator Mikulski, the
diabetic foot. They will pay the $10,000 to amputate it, but
not the few hundred to prevent it.
We have just published some studies showing that when you
change your lifestyle, it changes your genes. It turns on the
disease preventing genes and turns off the genes that cause
heart disease and breast and prostate cancer.
Dr. Hyman. That is right. Quickly.
Dr. Ornish. The point is that if we can change
reimbursement, we are all here to serve in whatever way you
think we can be helpful to you. And the time is now.
Dr. Hyman. Yes. I would just emphasize the whole aspect of
health coaching. I think the things that Dean has done for
almost two decades, training teams of people to work together,
and what HealthCorps does has also amplified other programs
that are existing.
For example, like first-line therapy, based on the NIH
recommendations for therapeutic lifestyle changes, already
trained 12,000 lifestyle educators in over 7 years in 50 States
that are implementing this program. They are able to do this
within doctors' offices and practitioners.
There is no model for reimbursement. There are actually
practitioners who are sending their staff to go get trained in
this so they can be lifestyle educators, and they are sucking
up the cost from their practice because they believe in this. I
think that kind of effort needs to be amplified and expanded on
and funded.
Senator Harkin. Have any of you ever met with Peter Orszag?
Dr. Ornish. Well, Peter Orszag was instrumental when he was
the head of the CBO in doing a thorough review, looking at our
program for reversing heart disease, and determining that, in
fact, it was cost-effective, because that is always the
concern.
I am a great fan of Peter Orszag. I think he is brilliant,
and I am glad he is in the position that he is in now.
Senator Harkin. The reason I ask that is because,
unfortunately, and I have talked with him, as I talked with
Senator Daschle about this, the problem is the scoring that we
have here.
Dr. Ornish. Yes.
Senator Harkin. The CBO does not give us any savings for
anything like this, and so it is always just a cost additive.
Dr. Ornish. Well, we have actually shown that it does save
money, and that is what is interesting. Because these
mechanisms are so dynamic, you don't have to wait years to see
the payoff. In the first year, we found we cut costs in half.
Blue Cross Blue Shield of Pennsylvania had a very skeptical,
hostile head of informatics, was sure that this wouldn't save
money. And compared to a matched control group, in the first
year it cut their costs in half.
Now you multiply that by the $2 trillion or whatever it is
that we are spending on healthcare, that is a lot of money. It
adds up quickly.
Dr. Hyman. That is right.
Senator Harkin. Free flowing.
Dr. Ornish. We just want to say how much we are so grateful
to be here, and we--I know, speaking for all of us, we really
appreciate what you are doing. We know how hard it is.
Senator Harkin. Well, we appreciate what you are doing out
there. We have just got to figure out how we--if you will
excuse the phrase, how we integrate you----
[Laughter.]
Senator Harkin [continuing]. Into this health reform
debate.
Senator Mikulski.
Senator Mikulski. Well, first of all, I, too, want to be
enthusiastic in my welcome of all of you who are here. Senator
Harkin and I have had a reputation for being reformers and also
not reformers of, again, the status quo or the stagnant quo,
but really bringing new thinking in. His work is well known.
I know, of course, Dr. Ornish personally. We had this
discussion 15 years ago at a renaissance weekend.
Dr. Ornish. That is right.
Senator Mikulski. All this is like an overnight, a 20-year
overnight success.
Dr. Ornish. We love you.
[Laughter.]
Senator Mikulski. First, I just want to say a word about
language because language can be determinative, and also even
the way these three working groups have been established within
this committee reflects a dated paradigm.
We have something called coverage. So what are we covering?
Something called prevention. Something called quality in
systems. You can't separate the two out because you can't have
quality unless it is prevention. You can't have prevention
without quality.
That is why my little working group is called ``Quality:
The Pathway to Saving Lives and Saving Money.'' So that is
dated.
The second thing is that we focus, if I could, using the
term ``prevention,'' it is the prevention of disease. That is
dated. The real word is the promotion of wellness.
Dr. Ornish. That is right because people don't really want
to think about prevention because it means that something bad
might happen to them. It is about joy of living, not fear of
dying.
Dr. Hyman. Most of our prevention is early detection, which
doesn't really understand the mechanisms of disease and how to
promote health and create health. Most doctors are not trained
in what is health or how to create health. That is what these
new concepts and principles that we are all talking about teach
us to do, and that is a teachable, scalable thing that can be
taught to a new generation of physicians.
Dr. Weil. Can I just mention that as an example of starting
to do this, the Integrative Medicine in Residency Program is
now being piloted at eight residency programs around the
country--in New York, Maine, Arizona, Connecticut, Texas,
Minnesota, North Carolina. This is a 200-hour curriculum. All
residents are required to take it. The goal is to extend this
to all residency programs in all medical specialties.
Senator Mikulski. Well, we want to be sure that when they
are trained, they have a place to practice, which----
Dr. Weil. Right. Sure.
Senator Mikulski [continuing]. I want to come back to where
I am heading with what I just said.
First of all, the vocabulary is dated.
Dr. Ornish. Yes.
Senator Mikulski. So, if Senator Harkin chaired the working
group on wellness, it would be viewed as woo-woo. He chairs the
working group on prevention, and everybody thinks they get it.
What the purpose of the hearing is if you get it, you have got
to get a new way of talking.
That is our job here, and we could also go to quality. I
can tell you, when I was given this assignment, quality was
viewed as see what you are going to do with health IT, even
though we are going to dump a lot of money and the technology
won't talk to each other, like we all don't talk with each
other.
And second, go to the IOM famous study on quality. You
know, that is a great beginning. But we are extending this
beyond that.
Dr. Ornish. Well, God bless you for that.
Senator Mikulski. Well, but--and we are going to need God.
[Laughter.]
We are going to need spirit, and we are going to need a lot
of deep breathing. We are going to be spirit-filled, and we
will wait for the air to come.
I want to go to some of the principles, if we could,
because we have to be very pragmatic. There is an urgency that
is being created, thanks to the presidential leadership of
President Obama.
I would say, first, what you are recommending is that as we
fashion health reform--and it is not health insurance reform.
Get rid of the word ``insurance,'' though you have to have
sound fiscal underpinnings. Think about health and health
outcomes and health promotion.
Second, there needs to be an ongoing place, particularly at
the White House level, that really influences the thinking of
the President, the Cabinet, and, therefore, the Congress.
Dr. Ornish. Absolutely.
Senator Mikulski. One would be, and that is what came out
also in our hearing on Monday, that there be--if there is going
to be a health czar, that that health czar has to have an
integral part of being a czar, that part of it has to be the
wellness and prevention aspect of it.
And then the second, there is a lot of talk going on about
the so-called medical or health home. If we look at that, this
is where we could bring the principles of integrative
healthcare in it. So we get the best of Western medicine.
Dr. Ornish. Yes.
Senator Mikulski. We do need the mammogram test. We might
need surgical intervention. That is where comparative
effectiveness research comes in. So you have got that coming
in.
As you go through the best of that and even where there is
a pharmaceutical aspect to that, when that person is going to
be living their life in their home, their family, and their
community, there has to be ongoing support. It is not only a
new healthcare nanny that says, ``Have you gone to your
ophthalmologist,'' if you are a diabetic. You do need that
prompting, but that is all part of it.
Because, again, whether we are talking about the big
killers--heart disease, diabetes, the other chronic
conditions--that the way to deal with a chronic condition is
either to mitigate its progressiveness or also to mitigate
frequent acute care episodes.
That then takes the health coach, which really needs to
have a substantial body of knowledge because, as we know from
our work on complementary medicine--and again, Senator Harkin
is the guru status on this--is, that where there is need, there
is greed. Where there is need and greed, there are quacks. So
we want to deal with that.
Do you agree with this? Are these the basic principles
that, as we look at healthcare reform, we have to do that? And
then really go back into the community because I would really
like to ask a question about children, children, children.
Dr. Ornish. Yes, well, if I can just respond to that? First
of all, I think you very eloquently and beautifully stated--I
agree with everything you have said. I would also include
online. I chair Google's health advisory board. There are
tremendous opportunities using some of the new technologies to
provide people in the home these kinds of things that can
highly leverage people that it gives the illusion that there is
a health coach or there is a real person, but it can be done
through software that makes it much more economically available
at the push of a button.
The four of us here and many of the other people in the
room have, in a way, done the hard part already. We have shown
scientifically that these programs can reverse and prevent the
diseases that kill more people and account for 75 to 80 percent
of the costs--the diabetes, heart disease, prostate and breast
cancer, obesity, and so on.
We have shown that it can save money. We have each
developed our own way. Andy--Dr. Weil has developed the leading
education system. Dr. Oz has developed the leading HealthCorps
in terms of his approach. Dr. Hyman has developed--is the
leader in functional medicine. We have shown in now 50
hospitals where we have trained around the country, from the
most prestigious academic to community hospitals, that we have
learned what motivates people to make and maintain these
changes.
We know how to do this. We just need to work with you guys
to develop systems that make what we have shown in our own work
in different ways available to people throughout the country.
Senator Mikulski. That is going to be the hard part about
what these systems are. I would like now, if I could, to talk
about the children?
Dr. Ornish. Yes.
Senator Mikulski. Which I know is very special to the
members of this committee. We talked about the stopping of
smoking, and Dr. Weil, you spoke about the interventions, etc.
Well, one of the ways that we stopped smoking in this
generation was to start with significant public education of
the younger generation. From cartoon books, the kind of stuff
even Joe Califano did, going back to the Carter days, etc.
Dr. Ornish. That is right.
Senator Mikulski. Those children now are 40 years old, and
they don't smoke.
Dr. Ornish. One of the most powerful ways of getting
parents to smoke is to realize that the most powerful----
Senator Mikulski. Stop smoking.
Dr. Ornish [continuing]. Predictor of whether their kids
are going to smoke is if they smoke. You know, I would jump in
front of a train for my son, my 8-year-old, if I thought it
would help him. Any parent would. It is not a red State or blue
State issue. It is a human issue.
When people realize the impact they have on their kids,
sometimes that can be a powerful motivator.
Senator Mikulski. Let me go to interventions, though--let
me get to my questions. We are now going to talk about a new
healthcare--universal healthcare, but we already do healthcare.
We do it through the Children's Health Initiative, and we
do it through Medicare, and we control that. Just like we
control the VA, and there is a lot of lessons to learn in the
VA. I wonder even if today, if you could turn your thinking--
because there is going to be a lot of talk about Medicare--we
are the insurance company for Medicare.
Dr. Ornish. Yes.
Senator Mikulski. It is not like you have got to get
Hartford and Aetna and all to go along with it. Also we just
expanded the Children's Health Initiative. To me, these are
cornucopias of opportunity because these are ``health
insurances that the Federal Government controls.''
Dr. Ornish. Yes.
Senator Mikulski. We already control the reimbursement. We
don't have to negotiate with a lot of people. We are it. Oh,
yes, the States and the governors. I don't mean to minimize
that. Also something that has had a moat around it, CMS, as you
know, Dr. Ornish.
[Laughter.]
What I would like, as you go back and you are working on
the summit and even among yourselves, if you would think about
those interventions. While we are talking about the universal
system, which, hopefully, we will do in the next several
months, to where we could begin right now, right now with the
expansion of the SCHIP.
Also then go, particularly with children. Children are a
captive audience in the school system.
Dr. Ornish. That is right.
Senator Mikulski. Not a captive, but we have--it is almost
like----
Dr. Hyman. It is an ecological problem.
Senator Mikulski. It is a place where we can enter, where
we can actually have intervention and be able to draw upon
community resources as well.
Dr. Ornish. Part of the issue I find with kids is if you
tell kids they are going to live longer if they don't smoke,
that doesn't mean anything because kids think they are
immortal. Teenagers even more so.
Providing information is important, but not sufficient. If
it were, nobody would smoke. It is on every pack of cigarettes.
It is not like people who smoke don't know it is bad for them.
It is almost like riding a motorcycle. It is like it is cool
because it is risky.
What we try to do is to take it out of the context of what
might happen in the future and put it as what happens to you
now. Do you want to taste like an ash tray when your girlfriend
kisses you? That makes it much more meaningful than thinking
you might get a heart attack or lung cancer or emphysema 30
years down the road.
And finally, we also found that we need--particularly for
older people, we need to focus not only on the behavior like
smoking, but the deeper issues. I would ask people, ``Why do
you smoke or overeat or drink too much or work too hard or
abuse substances? These behaviors seem so maladaptive to me.''
They would say, ``They are not maladaptive. You don't get
it. They are very adaptive because they help us get through the
day.'' They talk about, ``I have got 20 friends in this pack of
cigarettes. They are always there for me, and nobody else is.
You are going to take away my 20 friends'' What are you going
to give me?''
Or they use food to fill the void or alcohol to numb the
pain. Part of what we are all saying in our different ways is
that we need to look at these deeper issues that really
motivate us, both kids and grown-ups, and work at that level.
Dr. Weil. I think when you are talking about kids, you have
to realize there are tremendous societal pressures on them to
make the wrong health decisions. How do you combat that? How do
you deal with the vested interests who are making a lot of
money selling unhealthy products to kids, for example?
Another problem is that healthy choices aren't cool to many
kids. How do you change that? How do you make healthy behavior
cool?
I would again say that creative education is the key here.
If you think about the kind of health education you got in
school, which I am sure was the same kind that I got in school,
it was----
Senator Mikulski. Thou shalt not.
Dr. Weil. Thou shalt not.
Dr. Ornish. That doesn't work.
Senator Mikulski. Then we went out and did.
[Laughter.]
Dr. Weil. Exactly. That is right. Exactly. It was also
really boring. Who taught it? In my memory, it was often
physical education teachers who were presenting rote material
they weren't interested in. I mean, it was a real bore for
everybody, and then it was the ``thou shalt not.''
We can do a lot better than that. Here again is why I think
that the creative use--I am just fascinated by videogame
technology, these new games like the Sims and Spore in which
people can really learn the consequences of behavioral choices.
You can show them that one dietary choice leads to greater
success, to chance of better jobs, more affluence, more
girlfriends. I mean, this is stuff that can be modeled. People
can learn the consequences of behavioral choices in that way.
I would love to see us create an Office of Health Education
in the Department of Education that would explore this and
other technologies for presenting the kind of information we
have in creative ways.
Senator Mikulski. Well, I think we could. You know we are
going to conclude now, and you have been so generous of your
time.
Dr. Hyman, though, did you want to add----
Dr. Hyman. Yes, I just had three things related to the
children that I think are really key. No. 1, I think we need to
leverage our influence in public schools to change nutrition in
those schools, and we need to do it today.
No. 2, we need to enroll some type of sports and media
figures in the campaign rather than promoting Pepsi and Coke
and junk food.
And No. 3, we need to deal with the advertising that allows
advertising of these foods to kids. In most other civilized and
industrialized nations, this type of advertising, like
cigarette advertising, is not allowed. We cannot fight the
battle when a kid sees 10,000 ads for junk food every year,
even if we talk to our kid three times a day at every meal. We
need to change that.
Senator Mikulski. Well----
Dr. Hyman. I know it won't be easy.
Senator Mikulski. No, it won't be easy. I was just reading
the New York Times yesterday, where a well-known baked potato
chip company--I won't use the name--is going to repackage
itself to women because it seems women--both younger women and
women of a certain age don't eat these baked chips or whatever.
They have just spent all kinds of research money on
neuromotivation research, but the big ad campaign is going to
be repackaged. It is going to say we are repackaged so you can
have the kind of package you want. Well, there we go. Isn't
this fantastic?
I am only saying that because look at all that work and all
of that money and all of that. So, if you want baked potato
chips, I am not going to tell you not to do it. What I am going
to say is that we need to think differently, and we can't wait
for Government to do this.
I don't believe that trickle-down economics works. Like our
President, I am a grassroots community organizer. All of you,
with these brilliant Western credentials you have, you have all
been part of what is already a social movement.
See, the history of social movements are it always starts
from the bottom. It meets a compelling need that is then
organized and harnessed. When Government comes in, it is to
institutionalize what you have started. We don't start
anything. We are the benefit of what comes from the bottom up.
That is what we are getting today. That is what we got on
Monday and, hopefully, going on at the summit.
What I really hope to work with my colleagues on, and I
really encourage you and anyone listening, is to harness what I
am calling the ``Obama effect,'' and it is not in any way to be
disparaging to our colleagues from the other party. We have a
President that is committed to a healthy lifestyle.
Dr. Ornish. Yes.
Senator Mikulski. That works out every day. A commitment by
the first lady of the United States on healthy food and
nutrition. Their own personal devotion to their children I
think is going to have a tremendous cultural effect.
Dr. Ornish. I agree.
Senator Mikulski. It will now be cool to be like the
Obamas, and being like the Obamas is pretty healthy. Maybe the
campaign wasn't, with 19 hours of this and so on. I wish those
19 debates were aerobic. I would have signed up for the
primary.
[Laughter.]
I think what the President offers is not only the
opportunity for healthcare reform, but a very important
cultural moment.
Dr. Ornish. Totally agree.
Senator Mikulski. And to make it cool. Also with the
Cabinet people, we can start a lot of this, particularly with
children, through executive order and executive leadership,
whether it is Secretary Vilsack on food and nutrition in
schools, and I would like to bring that also to the Office on
Aging.
You know, every county has these Eating Together programs,
and the impact there, but also our dynamic Secretary of
Education Arne Duncan. I think we could already start that
activity now without even any legislative reform and because so
much of what would be done is through Senator Harkin's Labor/
HHS.
We got the Office of Women's Health in NIH because we
worked together, an idea that could have only happened because
Senator Harkin put it in the appropriations because of the
hearings. I held hearings. He got into it. We all got into it
and so on.
We don't have to wait for big, massive legislative change.
I think the moment is now. I think the moment is now, and we
must seize the moment and not wait for this ``Jell-O thing.''
Dr. Ornish. How can we help? How can we be of service to
you both?
Senator Mikulski. Well, how do you think you can help? That
is a good--didn't I go to social work school?
[Laughter.]
Dr. Ornish. This is like when I was an intern, and they
said, ``Well, what do you think, Dr. Ornish?'' I thought,
``Well, gosh, if I knew, I wouldn't have asked.''
[Laughter.]
I think we can help in a number of ways because I think for
each of us we see the time is now. The world has caught up with
us. I think there is a health summit next week. I am sure each
of us would be happy to be part of that.
We are all happy to get on a plane at any time if you have
any people that you think----
Senator Mikulski. Actually, what I would like you to do,
based on what we have heard, what you have heard, and also if
we could share with you some other of the hearings that we have
already had on some of this, is to think about the specific
principles that, no matter what, you would want incorporated in
legislation.
Also if you would think about the Cabinet as we have it,
which I think is a very impressive group of people. Very
impressive. That what are the initiatives the Cabinet could
take without waiting for legislation that we could support
through our mutual appropriations?
Dr. Hyman. I think the demonstration projects is a key,
easy to implement idea that can easily show changes in health
outcomes and costs and be done in community health centers to
serve underserved populations. If it works there, it is going
to work everywhere.
Senator Mikulski. Well, I am thinking of Dr. Sharfstein in
Baltimore, our commissioner of health, teaming up with our
superintendent of education, who is already bringing fresh
fruits and vegetables into our public schools. Well, we have a
dynamic educational reformer, and Dr. Sharfstein has been a
leader in the kind of negative things around cough medicine.
By those two guys getting into a room, actually doing it,
Baltimore is shifting. We could do this and that. We don't have
to wait for--demonstration projects, to me, are like clinical
trials. You will do it incrementally.
I think what this moment, this Obama effect----
Dr. Ornish. Totally agree.
Dr. Weil. As I said, create an Office of Health Education
in the Department of Education and fund it well, and I would
love to have input into that. I have lots of ideas.
Dr. Ornish. Well, when you have been asked to be put in
charge of health reform in these different areas, in prevention
and wellness and so on, what does that really mean in terms of
what is your influence here?
Senator Mikulski. Well, we don't quite know that yet.
[Laughter.]
That is one of my big questions. Because what we know is
that the President wants health reform, and there is going to
be leadership out of the White House, and there is.
Senator Baucus has done a white paper from the standpoint
of the Finance Committee, and each one of us have been busy
holding our hearings. Now it is a question of how we are going
to put the benefit of each one of ours together and actually
forge a direction. This is why it was so important that we two
do this together.
Dr. Ornish. Yes.
Senator Mikulski. Senator Bingaman does coverage. This is
not about pomp and circumstances here. Over the years, it has
been us that have focused on health.
Dr. Ornish. Yes.
Senator Mikulski. Senator Harkin, even during very dark
days, kept a lot going through his Appropriations Committee
when we had no leadership. This is where the moment is. The
point of the hearing is to gather the ideas and, quite frankly,
create the excitement.
Dr. Ornish. Good.
Senator Mikulski. We were so pleased that Senator Enzi came
and is excited. Now, based on this, if you could think in terms
of specific principles that we could incorporate,
recommendations, but even where through conversations we could
get the Cabinet going on some of this, like food and nutrition
in the schools.
Dr. Ornish. Yes. Perfect. Thank you.
Senator Harkin. It just seems that, first of all, I just
want to correct one thing that Senator Mikulski said. Even
though I was chair of the Appropriations Subcommittee on NIH, I
had the usual male blindness that we grow up with until she
came to me and pointed out how little we were doing in terms of
women's health at NIH.
All of the trials and stuff were always men. It was Senator
Mikulski who spearheaded that operation. As I said, I had the
usual male blindness on that issue.
Senator Mikulski. It was take an aspirin a day, keep a
heart attack away. And it was only men. Now we have included
women. Now we take an aspirin a day. We are going to go on to
fruits and vegetables.
[Laughter.]
I sure wish that good works were aerobic because then Oprah
and I would be in better shape in more ways than one.
At each point, we learn and do something different. This is
why I think the moment is here. Everything you have been doing,
this is culminating for you. Again, you all have been really
the bottom-up and at times facing a lot of criticism and
naysayers.
Senator Harkin. Maybe I will make one suggestion here that
we always think about it in terms of the big picture and
healthcare reform and what we do there. We have appropriations
process every year, supposedly. We do reauthorize certain
bills.
For example, this year is the reauthorization, as I think I
mentioned earlier, of the child nutrition bill.
That happens to come under my Committee on Agriculture
here, but it is on the Education and Labor Committee in the
House. That is the school lunch, school breakfast, and the
WIC--the Women, Infants, Children supplemental feeding program.
We need to start looking at it from a health standpoint.
Dr. Ornish. That is right.
Senator Harkin. What is it, how do we want to change? If
you want me to ask how you could be involved is to start taking
a look at this. Giving us your advice, using your platforms--
all of you have very big platforms out there--to start
informing the public that we have an opportunity this year in
the reauthorization of this child nutrition bill so that we can
get healthier foods in schools and that type of thing.
Dr. Ornish. Well, kids, as you know, perform better, as do
many people, especially lower socioeconomic kids. That is their
main meal of the day. That is their good nutrition meal of the
day, and they perform better. We should get physical education
back in schools. We have got one State that mandates physical
education--Illinois.
Dr. Oz. The issue, though, Dean--and I think we all agree--
is not what to do, it is how to do it. So, if I am
understanding your request, we all have folks that we dialogue
and should be dialoguing with, with your teams to understand
what our action step is.
If I get a message from you saying there is a big vote
happening on agriculture, you need to run a show again
emphasizing that we have zero fiber in school lunch programs.
We will do that. Everyone here, I think, has a platform to get
that word out. Whether it is through the Web, television, or
through professional educational programs, we can do that.
I think maybe one concrete action step would be for each of
us to provide contact information to a member of your staff
that could tell us what to do because, frankly, I can't keep up
with the sometimes serpentine, often Byzantine-appearing
process by which decisions are made.
If we actually get those messages clearly, we want to get
out in front of the train for you.
Dr. Ornish. Yes. We are your army.
Senator Harkin. We have education. We have transportation
that we talked about. Every time we think about transportation,
we ought to be thinking about how do we change some of the
structure so that people have bike paths, walking paths, ways
of exercising, taking stairs?
I remember one little thing. I shouldn't go off on these
stories. Tommy Thompson was Secretary of Health, and I went to
visit him one day down at the department. I noticed when I went
to the elevator, there was a sign by the elevator. It said,
``The stairs are this way. If you climb one flight of stairs,
you will burn calories.'' I don't remember how many.
I talked to him about this, and he said it is amazing that
once he did that, people started taking the stairs. We are just
creatures of habit. You go to the elevator, you punch a button,
you get on it. People started climbing the stairs.
Well, I thought that was a pretty good idea. I called in
the GSA, the General Services Administration. They run all of
the Federal buildings in the United States. I said, ``Why don't
we start doing this in our Federal buildings around the
country?'' And they have, some better than others.
So, I put a little thing in legislation to try to get the
Federal buildings at least to put different things in to
encourage people to take the stairs rather than taking the
elevator every day. I am thinking about just little things like
that.
If people think, well, I don't have an hour a day to
exercise. Well, we didn't say you had to exercise 1 solid hour.
You could exercise 10 minutes here, 10 minutes there.
Dr. Ornish. Absolutely.
Senator Harkin. Five minutes here, and that kind of thing.
Climbing stairs may take you 5 or 7 minutes, but that is pretty
good exercise.
I guess what I am getting at is thinking about all the
little things that we do here to keep focusing on wellness and
how we promote it. It has transportation, education, and
health.
How about Department of Defense? Look at all the money we
put in there. What are we doing there in the department to
encourage wellness among our service people, but also among
those that are returning? I dare say not very much. Not very
much.
I am just thinking. Elderly programs. I don't know, maybe
it was one of you. I don't know. I talked to you so many times
in the past. Someone said once that this Medicare Part D is
both a blessing and a curse. Yes, we have gotten more drugs to
elderly people, but the problem is elderly people are on too
many drugs.
Dr. Hyman. That is right. The problem is they are getting
them.
Senator Harkin. What?
Dr. Hyman. The problem is they are getting them. I saw a
patient the other day had 21 medications when she was
discharged from the hospital. I was like ``whoa.''
Senator Harkin. Mark, I have seen practitioners, mostly
integrative practitioners or alternative practitioners, that
take some elderly people, if they give them a better diet, give
them exercise, sociability, you can get them off----
Dr. Ornish. We have proven that. We have published it in
peer-reviewed journals. In almost every case, we can reduce or
get people off of most of these pills if they change the cause
of what caused it in the first place.
Then it empowers them. Instead of three or four times a day
they are reminded they are sick, they get off. Instead of
saying these are blood pressure pills, cholesterol-lowering
drugs, diabetes medications you have to take the rest of your
life. The diabetes study published in the New England Journal a
few years ago showed that lifestyle changes not only work as
well as Metformin, one of the major drugs, but even better. The
only side effects are good ones.
Dr. Hyman. Yes, I am agnostic when it comes to the tool. I
think we need to use the best tool, and most often, the best
tool is diet and lifestyle therapies to not just prevent
disease, but actually to treat it and reverse it.
Senator Harkin. I guess I am thinking of getting all these
targets and just keeping at it. Keeping at all these targets
that we do every year, and then maybe that they will start to
add up and people will start doing things differently.
That is sort of one way of looking at it rather than just
thinking, well, we are just going to do this whole great big
thing all at one time. I ask you to think about that. As we do
these bills and things that come up, how do we keep focusing on
health?
Senator Mikulski. Well, Senator Harkin, I think we were
talking about that. I think you might have been out of the
room. In the sense of let us go to the--which means even among
ourselves is the culture of wellness and health promotion, and
that every opportunity should be an opportunity.
For example, you are going to be doing the child nutrition
bill. What a great opportunity for health promotion.
Dr. Ornish. Yes.
Senator Mikulski. We are going to be doing the national
service bill, which would be a great way to begin to
incorporate this, including even into what will be a ``green
corps'' because that goes to agriculture. It goes to the
HealthCorps. It goes to lessons learned and service learning
and so on.
If we could have essentially even among ourselves this
consciousness because that is what a cultural change is,
consciousness----
Dr. Ornish. Yes, brilliant.
Senator Mikulski [continuing]. That whatever we have before
us, how can we bring this thinking into that action? For
national service, it would be how do we harvest that effect
that young people want to participate? They are the ones that
are going to be edgy and communicate with that.
The work that you will be doing in agriculture--it is
really determinative--would be one of the opportunities. We
could look at what is before the committee while we are also
working on healthcare.
The other is, maybe we ought to go back and take a fresh
look at what we have done in SCHIP and see how taking both what
we are funding for health insurance, but also thinking about
our public schools and--really, the wonderful work I think that
Arne
Duncan can promote.
We pass a bill, and what we have essentially done is
provide access for children to physicians, an important thing.
It is an important first step. But, if that is the only step,
maybe we need to look at SCHIP and how we could do a medical
home for children?
As Dean Ornish and everyone in this room said, people will
climb mountains barefoot over glass for their children.
Dr. Ornish. That is right.
Senator Mikulski. And so, that would be to look to the
children, for they will be your best teachers.
Dr. Ornish. Absolutely.
Senator Mikulski. I think that is what the culture is. And
we can be the cultural leaders here. You could be a cultural
icon.
Senator Harkin. I have never thought about being an icon.
[Laughter.]
Dr. Ornish. It is a serious problem.
Senator Harkin. I am from Iowa.
[Laughter.]
Dr. Ornish. What about the farm subsidies? As you have
talked about so eloquently so many times, instead of
subsidizing junk food and fat, salt, and sugar, to subsidize
healthy food? You know, make that available.
Senator Mikulski. Aw, that salt and sugar.
Senator Harkin. That is right. That is right.
Dr. Oz. Can I offer one radical thought? Just because I
know when we grew our program----
Senator Mikulski. As compared to everything else you have
said today?
[Laughter.]
Dr. Oz. Yet another radical thought.
Dr. Hyman. What we are now talking is really common sense.
Dr. Oz. I know when we started the integrative medicine
program at Columbia, we ran into a lot of resistance because
many of my colleagues who were trained with typical test tube
approaches to this experience were resistant to it because it
was so difficult to prove it in a double-blind randomized
fashion.
We actually changed the culture primarily by making it
experiential. How many people do the deep breathing and
laughter therapy? To get functional medicine analysis, to
understand in a whole different way what lifestyle change could
be. That it is actually something that you would crave because
it is about vitality.
I don't do day-to-day--I do heart surgery. I don't do
functional medicine and behavior modification. There are people
on this panel who do. I think it might be worth having members
of the Senate, House of Representatives, key decision leaders
experience some of this, perhaps through some of these
individuals or others that we could help recommend. I know this
is a commentary that might not be received well by all, but it
would be done altruistically.
If someone has a health problem, instead of going to an
off-tackle approach of, let us say it is cancer, chemotherapy,
surgery, and then radiation, and then we do it again. Maybe
they experience it through one of these paths, and then you
have more advocates like yourselves because they have been down
the path.
Dr. Ornish. Well, 15 years ago, we actually did a day-long
retreat for Members of Congress, and it was cosponsored by Dan
Burton and Charlie Rangel, which is about--in fact, they joked
that this was the only thing they ever agreed on.
You are absolutely right. It is a brilliant idea because if
people get the experience of it, then they understand it. It is
not just a ``yes, but.'' They really understand it from their
own experience.
Senator Harkin. Mm-hmm.
Dr. Ornish. I think that would be a really good idea.
Dr. Hyman. It works quickly. It doesn't take long.
Senator Harkin. Yes.
Dr. Hyman. I would just add two things. I think there are
two areas of leverage that you have already in the stimulus
package, which is the comparative research for effectiveness
and the EMR.
I think just two points about that.
Senator Mikulski. That is the electronic medical record.
Dr. Hyman. Right. No. 1, what are we comparing things to?
Compare drug-to-drug, procedure-to-procedure? Or are we
comparing the current medical practice with the best available
things that we are talking about?
Senator Harkin. You are right on. See, I believe, and we
already tried to put that comparative effectiveness, and
believe me, they wanted to yank all that out, and what has this
got to do with stimulus and stuff like that.
I share your fear that it is going to be comparative
analysis between this treatment and the other allopathic----
Dr. Hyman. Within the old model.
Senator Harkin. Right. In the old model. That is right.
Dr. Hyman. The second thing is I am very fearful about
using electronic medical records to replicate a 19th century
medical practice model. We need to make it match current
thinking in systems medicine and integrative care. If we don't,
we are going to be missing an enormous opportunity. It is
wasting billions of dollars. That is a huge fear of mine.
I think the solutions are there. There are people like
Kaiser who have done these kinds of things. There are other
people like Google looking at this and HealthVault. I think we
need to really seriously look at this because if we simply
replicate this, it is a problem.
Dr. Ralph Snyderman has written a lot about this. He is the
chairman emeritus of Duke Health, and he has written about the
prospective care in terms of a medical record and changing our
medical record that was designed in the early 19th century and
20th century to 25th century needs of science and medicine.
Senator Mikulski. Much of this has to be done in the
community, and you asked what you could do. I think, first of
all, promote the concepts of public health and not only as an
agency, but really what public health is. That is food, air,
and so on.
We can do all this, but if those little children in
Washington, DC or anywhere, like even in parts of my own
hometown of Baltimore, if children are living in housing
saturated with lead paint, breathing deeply is the worst thing
you want them to do. Or drinking water that has got lead in it.
One is really the promotion of public health and having
strong leadership at that. Then the other is the concept of
living in a community.
Dean Ornish, I think that is where you have talked about
it, with the ``Healing Heart.''
Dr. Ornish. Yes.
Senator Mikulski. Dr. Oz and everyone here, the
HealthCorps, because all of that is really in the community.
You do not live alone.
Dr. Ornish. Absolutely. Study after study have shown that
people who don't feel that sense of community are many times
more likely to get sick and die prematurely, in part because
you are more likely to abuse yourself, in part through direct
mechanisms.
The other thing you might consider is bringing together
some of the heads of the big food companies. I have been
consulting with people there, and they get it. They are
starting to get it.
They are in the behavioral modification business, too. As
you have pointed out, they can do it in negative ways. They
know better than anybody how to make something fun and sexy and
hip and cool and crunchy and convenient.
If they can use all that advertising and celebrities and
marketing to make healthy food fun and convenient, to get away
from this idea of, is it fun for me or is it good for me to say
why can't it be both? To market to kids healthy types of foods
and healthy lifestyles, I think there is a willingness now to
do that because that is where they are finding their revenue
growth.
Two-thirds of the revenue growth of Pepsico last year came
from their healthier foods. Then it is really sustainable when
it is good business, and I think there is a tipping point here
that we can build on.
Senator Mikulski. We also have got some class issues here.
If our water has lead in it, I can go buy water. But that
single mother can't.
Dr. Ornish. Right. I totally agree.
Senator Mikulski. I think when we talk about software and
hardware, the fact is, a lot of families don't have computers
in their home.
Dr. Ornish. That is true.
Senator Mikulski. Then how are they going to do that? We
also have to make sure that whatever we do is available for all
Americans.
Dr. Ornish. Everyone. Totally agree.
Senator Mikulski. That is why we are looking at things that
are public institutions and what we can do. I am thinking,
first of all, like public schools would be an area. First of
all, it is community and so on.
Senator Boxer chairs the Environment and Public Works
Committee. She is part of the healthcare team.
Dr. Ornish. That is right.
Senator Mikulski. Senator Harkin chairs the Agricultural
Committee. He is part of the health team. I mean not only
excellent work here on this committee and Labor/HHS. We could
go through what each and every one of us do.
I think that is what we need to do, think about how we are
all part of the healthcare team. We cannot also create
something new that changes the paradigm that only changes it
for the upper middle class.
Dr. Ornish. I totally agree. The lifestyle choices that we
found that could prevent and reverse disease, it is essentially
a Third World diet. You know, it is fruits, vegetables, whole
grains, legumes, soy products. It is only because of these
perverse incentives that it is cheaper to eat junk food than
eat healthy food.
This food inherently is not expensive. Walking doesn't
require any special equipment. Doing yoga and meditation
doesn't require any special equipment. Quitting smoking saves
you money.
These are things that we have found in our studies--that
this idea is just for a bunch of rich white people, is not at
all true. The people in our studies, in our hospitals that we
have trained that often benefited the most are the ones who
have the least access. Ninety-two percent of bypass surgery
last year was done on white upper middle class men.
Of course, heart disease is declining in that group. It is
rising in women, minorities, and lower socioeconomic groups who
are the ones who can benefit most from these kinds of
approaches because they don't require high-tech, expensive
drugs and surgery. They are things that people can do
essentially for free.
Dr. Weil. If you want to come back to talking about
changing these subsidies, as you know, Senator Harkin, it was
not until last year in all the history of the Farm bill that
any effort was made to have input from the healthcare community
about the health consequences of those subsidies.
To me, that, again, comes back to the lack of education,
that we have a nutritionally illiterate medical profession and
allied health professionals. If they understood the
relationship between diet and health, they could weigh in as a
powerful counterweight to the vested interests that now
determine how that money flows.
Senator Harkin. Well, I will tell you that I labored long
and hard on this, and the 2001 Farm bill, I was privileged to
be chairman for a brief span of time there, thanks to Senator
Jim Jeffords. You may remember he came over and joined us, and
we had a one-vote margin then. I was chairman during that Farm
bill debate on this side.
That is when I started this program of the free fruits and
vegetables in schools. Small. It started with $5 million. In
this Farm bill, I got my chairmanship back again last year, and
we boosted it from $5 million to $1 billion. We got $1 billion
in this last Farm bill for free fruits, fresh fruits and
vegetables to kids in schools.
Now that is going to ramp up. That is once it ramps up.
Within 5 years, we will cover about 90 percent or more of all
of the kids in free and reduced price schools, low-income
areas.
The second thing we did in this Farm bill is the first time
ever--in this last Farm bill, we put fruits and vegetables in,
especially crops in the Farm bill. Never been in the Farm bill
before.
There is one other hurdle we have in this. I don't know, I
shouldn't go off like this--but in the child nutrition bill.
You know, in the school lunch program, there is a prohibition
against buying local foods.
[Laughter.]
It is very true. I know it sounds ridiculous, but it is.
Dr. Hyman. Many of the kitchens don't have anything but
fryers and microwaves. How can they cook real food?
Senator Harkin. They have got to get big packaged foods
that are processed and all that kind of stuff.
Dr. Ornish. Senator, can you share with everyone the story
that you told me about when you put the fruits and vegetables
in school how the kids reacted to it?
Senator Harkin. It was incredible, Dean. First of all, I
have got to tell you a funny story when I first started on
this. I had a hearing and I remember because I wanted it not in
the lunchroom, but in the classroom. When kids get the
growlies, when they get hungry, they go get a fresh piece of
fruit or a vegetable or something like that.
I remember I had testimony from the head of the principals
association, who sat at the table and was talking about this.
This is my interpretation of what he said, OK--``Harkin, you
are crazy.''
[Laughter.]
Don't you understand? These kids will be throwing apple
cores at each other and banana peels, and we will have a mess
in the classroom. If you are going to do anything like this,
you have got to do it in the lunchroom.
Well, I said, ``Look, it is all voluntary. Any school that
wants to join, can join. If they want to drop out the next day,
they can drop out the next day. So we started it. We picked 100
schools, 25 schools in each of four States and one Indian
reservation.
Most of them came in in 2003. I can tell you, as of last
year, not one of those schools asked to drop out, not one. I
went and visited some of these schools in Ohio and Michigan.
Iowa was one of those--strange. Anyway, the kids were
incredible.
If kids have to put money in the vending machine, it will
buy something sweet or sugary or a soda or something. If they
get something free, that is something else. They were getting
these free fruits and vegetables. I saw these kids eating kiwi
fruit, never had kiwi fruit. Very high in vitamin C.
They were eating--I actually saw with my own eyes third
grade kids eating fresh spinach. They were getting these little
packages of spinach, and they liked it. Now they might have
gotten a little dip with it. OK, fine. They got a little
something with it. Eating carrots and broccoli, eating fresh
stuff in these schools. These little kids, third, fourth, and
fifth grade.
I remember I visited a school once in Michigan, low-income
area in Detroit, and fifth grade kids in Detroit. They were
having fresh oranges. Oranges. They had some device how to peel
it, too. Anyway, the teacher said that some of these kids have
never had a fresh orange in their lives. Fifth grade kids have
never had a fresh orange.
They don't get fresh apples. When they come in, they are
gone. They are just gone. One school I remember that they got
the strawberries in before the school was out for the summer.
The first crop of strawberries came in, and by 10 a.m., there
wasn't a strawberry left in the school.
Dr. Ornish. You know they get their taste preferences when
they are young, too.
Senator Mikulski. Well, could I talk about taste
preferences? I have a question because I think this story is so
poignant and so to the point.
Dr. Ornish. Absolutely.
Senator Mikulski. It is a question that I have had for some
time which is about the introduction of fructose. Because it is
not only what you eat, what you know, and what you see, but it
is what you don't see. Because one of the things you learn in
any kind of genuine and authentic nutrition counseling program
is that which is hidden from you, hidden fats and hidden
sugars. And you read labels.
Everywhere I turn, when I read the labels, I see fructose,
fructose, fructose. There are some who really raise the
question about the metabolic impact of fructose and also just
the overall impact, particularly on children in their foods,
etc, etc. Could you share with us----
Dr. Hyman. Yes.
Senator Mikulski. Even there have been some who said when
fructose was introduced so mainstream, that is when type 2
diabetes went up, particularly among children.
Dr. Hyman. That is right. In 1980 was really when it found
widespread introduction, and now we have gone from almost none
to 66 pounds of high-fructose corn syrup consumed by the
average American.
Senator Mikulski. Is that every year?
Dr. Hyman. That is every year. That has been associated
temporally, maybe not causally, with the increase in diabetes
and obesity in children. What is concerning about it also is
that it has different metabolic effects.
Now when fructose is part of fruit, it is different. It is
with fiber, nutrients, and other things that slow its
metabolism and so forth. Fructose doesn't have the same
regulatory capacities as sugar, regular glucose, because it
doesn't need insulin to enter the cells. It doesn't send back
signals of leptin to the brain to say you are satisfied. So you
remain hungry.
It increases triglycerides in cells that causes fatty
liver. There are 70 million Americans with fatty liver from
eating sugar and high-fructose corn syrup in this country now.
It is an epidemic, which I didn't see when I was in training
just 20 years ago.
We also have found recently in the environmental health
perspectives that part of the processing of high-fructose corn
syrup, and Michael Pollan wrote about this, he wasn't allowed
by Archer Daniels Midland to go into the factories to see how
it was processed. I think this may be why. This was through an
FDA study. They looked at the way they process high-fructose
corn syrup, and they use caustic soda, which comes from chlor-
alkali plants, which are sources of mercury.
They found in many high-fructose corn syrup products
relatively high levels of mercury, and in the small amounts, it
may not be an issue. When you sort of say the average person
has 66 pounds a year, what are the implications of that? That
was just published a few weeks ago.
We also look at these foods and their impact on the brain.
Dr. Kelly Brownell from Yale University has done work looking
at the role of junk food and processed foods on brain function
and found that there are the same addictive properties to these
foods with high-fructose corn syrup, trans fats, and high
sugars and fats as heroin or cocaine. The addictive property is
huge.
Studies have been done on rats showing that artificial
sweeteners actually slow metabolism and increase weight.
Studies have shown on high-fructose corn syrup that these foods
actually drive behavior that leads to eating more.
These are really important things to understand and deal
with.
Dr. Weil. The overwhelming concern about high-fructose corn
syrup is, it is not mercury contamination, it is not addiction.
It is, it will be proved to be the single most potent provoker
of insulin resistance in people who are genetically programmed
to develop that, which is a substantial number of our
population.
I would say there are two chief culprits in the American
diet at the moment. One is high-fructose corn syrup. The other
is refined soybean oil, which is the major reason why our diets
are so overloaded with pro-inflammatory Omega-6 fatty acids
that creates huge consequences for chronic disease.
Both of these products, both of these ingredients are
ubiquitous in manufactured, refined, and processed food because
they are cheap. They are cheap because the Federal Government
subsidizes them. That has to change.
The issue of insulin resistance and the role of high-
fructose corn syrup in that, I think this will be proved to be
a chief culprit in the childhood obesity epidemic and in all of
the health consequences that follow from childhood obesity.
Dr. Ornish. When parents hear the statistics, I am sure you
have heard repeated that this may be the first generation which
our kids live shorter lives than some of their parents. That
really gets people's attention, and there is an opportunity.
Then they start to listen, as you were saying, Senator.
Senator Harkin, I just want to emphasize again, the story
you told about getting fresh fruits and vegetables and giving
them away to kids--think of it as an investment because you are
not saying ``Eat your fruits and vegetables'' and wagging your
finger. You are saying, ``Hey, this is really fun. This is
cool. It tastes good.''
You don't have to tell them to eat the food. They love it.
There is none left. Then they get it from their own experience
because what I have learned in 32 years of doing this work is
what is sustainable is pleasure and fun.
If it tastes good and people start to learn that these
foods taste good, they start to eat that way, and then they
continue to eat that way throughout their life. It is not
because they think it is good for them because it just tastes
good.
Senator Harkin. The one thing, though--now that we have all
looked at high-fructose corn syrup, refined soybean oil--would
you address yourself to the huge amounts of sodium chloride,
NaCL, that is put into all of our foods everywhere you go. I
mean the sodium is just----
Dr. Hyman. That is the way it tastes good, salt and sugar.
That is the way it makes it taste good, sugar and salt and fat.
Senator Harkin. I didn't hear that.
Dr. Hyman. The way things taste good is salt, sugar, and
fat.
Dr. Ornish. They are modifiable. Studies have shown anybody
who has ever tried to eat less salt, at first it doesn't taste
good. Then it may taste fine. You go out to dinner. Suddenly,
the food tastes too salty. The same is true if you switch from
whole milk to low-fat or skim milk. At first, it doesn't taste
good. Then it tastes fine. You go out to dinner. Suddenly, the
taste----
Dr. Weil. The bottom line nutritional advice that I give
people, if I have just one sentence to tell them what to do, is
to try to stop eating refined, processed, and manufactured
food. It is, however, discouraging to see how popular that kind
of food is wherever it gets put down in the world.
I know there was mention made here of Okinawa and longevity
studies there. I made three trips to Okinawa to study healthy
aging in the past 10 years, and in the short time that I made
those visits, Okinawan longevity began to plummet. Okinawan men
and women were the longest-lived people in the world. Okinawan
men no longer are.
That change principally happened because of the
introduction of American-type fast food, which instantly became
popular. The New York Times had a front-page article about that
a few years ago. I remember a quote in there from a middle-aged
Okinawan man who said the first time he tasted a McDonald's
hamburger, he thought he had died and gone to heaven.
I mean, how could that be? These people have one of the
most interesting diets I have ever encountered in the world. I
mean, filled with the most amazing fruits and vegetables and
sea vegetables and fish and herbs. You see this everywhere,
whether it is Russia, China, South America. Whenever this kind
of food becomes available, people go for it.
It suggests to me that these big food corporations have
invested a lot of time, money, and effort in figuring out basic
combinations of fat, salt, sugar, crunch that are universally
appealing. I think this food is addictive.
Dr. Ornish. Yes, we are globalizing chronic disease. Other
countries are starting to eat like us and live like us and die
like us. It has all happened within one generation. There is an
opportunity to do preventive medicine on a global scale if we
can change that.
Dr. Hyman. I think what is not recognized is that insulin
resistance affects over 100 million Americans, and it is not
just about obesity. It leads to hypertension. It causes cancer.
Alzheimer's is called ``type 3 diabetes.'' It is connected to
depression, which is going to be the leading cause of
disability very soon in this country.
These are problems that are directly related to our diet,
and they are not going to be solved by finding the pill or
magic cure for it.
Dr. Ornish. When you figure the cost of what it costs to
give free fruits and vegetables to kids, counterbalance that by
what you are saving from all these costs that are directly tied
to that, both directly and indirectly.
Dr. Hyman. We are not passionate about this at all, you can
see.
[Laughter.]
Dr. Ornish. We are so grateful to be here.
Senator Harkin. Speaking for myself, I am just so grateful
to all of you. I don't mean to be pandering or anything like
that, but you are all my heroes. You really are, every single
one.
Dr. Ornish. Back at you.
Senator Harkin. You have led the way. I read your books. I
think, my God, why don't people get this? Why don't we start
changing these structures and things like that?
We keep trying to do what we can and try to change these
things. We really need you. I mean we need you badly to really
be involved in this new healthcare reform process, looking at
all the different aspects of it.
I don't know how. That is why I asked you earlier how we
could use you and the platforms you have and the expertise you
have, the knowledge base you have to really start getting this
thing moved.
I don't think that we can change it overnight. But by gosh,
we can make some changes that over the next several years will
really start moving us in a different direction.
Again, thank you for all the great work you have done. I
just can't tell you how much I appreciate each and every one of
you.
Witnesses. Thank you, Senator Harkin and Senator Mikulski.
[Applause.]
Senator Harkin. Thank you very, very much.
[Additional material follows.]
ADDITIONAL MATERIAL
Statement of Senator Kennedy
The American health care system urgently needs repair and
reform. Today as a Nation, we spend 16 percent of our gross
domestic product on health care, more per capita than any other
country in the world. Yet health outcomes of Americans are
ranked 37th in the world by the World Health Organization. Our
system is often called a ``sick care'' system, not a health
care system, because it is designed to treat diseases and
illnesses, instead of promoting good health and wellness over
the lifespans of our people.
Genuine health reform therefore requires a major
transformation in our national mindset on how we care for
ourselves and others. It must incorporate and encourage disease
prevention activities and lifestyle changes that promote long-
term health and well-being. The current incentives in our
health care system that lead to over-treatment and mistreatment
must be changed to promote high-quality, appropriate, and
coordinated health care. The Nation's alarmingly high and
growing rates of obesity and chronic disease today are a clear
call to action. By preventing diseases before they start and
adopting a broader approach to medicine, we will actually
reduce costs in the long run, and we will extend and improve
the quality of life as we do it.
To achieve this fundamental shift in our Nation's health
care mindset, it will be necessary to reform how medicine is
practiced. Low-cost or even free health screenings and
vaccinations will encourage individuals to take part in
preventive medicine. Patient-centered and coordinated care that
addresses the whole person--from genetic predispositions, to
life-style choices to potentially harmful conditions--is
essential for treating acute diseases and managing chronic
conditions. We must also adopt a more integrated approach to
medicine, through health care that addresses the mental,
emotional, and physical aspects of the healing process in order
to improve the depth, breadth, and patient choice in clinical
practice.
Further, we must incorporate prevention, wellness, and more
patient-centered approaches as fundamental components of
medical education and the training of health providers. In
order to reach the patient effectively, integrative practices
must be accepted throughout our health care system, and
especially in the education of health care providers and the
consumers who will benefit.
Finally, we can look beyond the traditional health care
system to the community itself--to local environments, where we
can build sidewalks and bike lanes; to workplaces, where
wellness programs can help employees include healthy nutrition
and exercise in their lives; and to schools, where we can
provide preventive screenings and lay a strong foundation for
students to lead healthy lifestyles from an early age.
Americans deserve a health care system that provides this
kind of high-quality, patient-centered care, and encourages
individuals' choices and control over their health. The result,
as I have said, of this new focus on prevention and health
promotion will be lower health care costs and longer, healthier
lives.
I commend Senators Harkin and Mikulski for their continuing
leadership on this important issue, and I look forward to
working closely with my colleagues on the HELP and Finance
Committees and with President Obama to achieve our fundamental
goal of improving the quality of health care, expanding access
to such care for all our people, and reducing the financial
burden of such care.
[Whereupon, at 12:30 p.m., the hearing was adjourned.]