Preventive Medicine and Technology: Interview with Dean Ornish, MD
In last month's Health Tech column I wrote about the medical innovation conference, FutureMed, and how exponential technologies may soon transform the field of cardiology. At FutureMed's closing dinner, in the America's tech-center heart—Silicon Valley—I met University of California, San Francisco Professor and Founder/President of the Preventive Medicine Research Institute, Dean Ornish, MD. I was admittedly surprised to see him there because much of his work focuses on low-tech, low-cost lifestyle modifications. These interventions, such as eating healthier and engaging in physical activity, are usually not thought of as cutting-edge or innovative. After all, as far back as 400 BC, Hippocrates said, "Walking is man's best medicine."
More recently Dr. Ornish and colleagues have conducted randomized controlled trials showing that lifestyle-based interventions can be not only more efficacious but also more cost-effective than high-tech invasive procedures or drug regimens, and can even reverse heart disease and other chronic illnesses. Medicare is now covering Dr. Dean Ornish's Program for Reversing Heart Disease as a named program. I spoke with Dr. Ornish to learn more about his views on technology and preventive medicine.
What do you view as the role of technology in personal health?
When I began studying the effects of lifestyle modification 36 years ago, I designed my programs to deliberately avoid using high-tech interventions. Not because I did not think that technology would be able to help my patients, but rather because I wanted to make sure that whatever interventions I found to be effective would be available to all, regardless of socioeconomic status. I did not want my patients' health to be dependent on high-tech, and often high-cost, tools. Really, the tools most people need to live healthier are a good pair of walking shoes and maybe a yoga mat.
Technology, however, has clearly been useful in many cases. In addition to advancing our understanding of the science of medicine, technology can raise patient awareness of personal health status. For example, wireless weight scales and blood pressure cuffs can show patients the extent of their problems with obesity or hypertension. Awareness of the problem is the first step to making positive changes to one's behavior, and technology can certainly play this role. However, it's important to recognize that, as is the case with pills, technology is not a magic bullet. The awareness that technology can help provide is necessary but information alone is not usually sufficient to motivate people to make changes in their behavior. Take smoking as an example: people know that it is harmful yet millions across the globe continue to do it.
So how can we motivate patients to adopt—and sustain—healthier lifestyle behaviors?
What really motivates people to make change is not numbers, but feelings. Not the fear of dying, but the love for living. Fear is not a sustainable motivator in any domain, particularly in health. Conversely, the joy of living is a sustainable motivator. A common story I hear from people is that once they make positive lifestyle changes they start feeling so much better so quickly that they decide to permanently adopt those changes not as a means to an end but as an end in themselves—not just to live longer, but to feel better. A few years ago I gave a short TED talk, titled "Your Genes Are Not Your Fate," in which I presented evidence that lifestyle changes can alter gene expression; for example, telomerase expression increases within 3 months of adopting healthier lifestyle behaviors.
Do you personally use any technologies for self-tracking of your health?
I've used many of the popular consumer gadgets to some extent. Some people have told me they're useful, but there's a fine line between whether the devices feel nagging or intrusive versus helpful and nurturing. Another issue that self-tracking technologies need to take into account before they become mainstream is privacy of the data; when I was chair of the Google Health Advisory Council that was something we realized patients valued highly.
I have found self-tracking technologies to be most useful for reducing the friction of collecting data—data that may be applied to connect the dots between what we do and how we feel as a result. This being said, I personally am not so much of a "Quantified Self" person who wants to keep track of everything. What I've found to matter most is balance and our overall way of living and eating. If you indulge yourself one day, eat healthier the next. If you forget to exercise one day, do a little more the next. In all of our studies, we found that the more you change your lifestyle, the more you improve in ways we can measure and the better you feel—at any age. This is the core idea behind my Spectrum program, which focuses on nutrition, fitness, stress management, and love and support. (For more information, visit www.ornish.com.)
Many health care providers themselves find it difficult to adopt such changes. Should health care professionals lead by example?
The best teacher leads by example. As a professional group, clinicians tend to die younger than many of our counterparts. We also have higher rates of divorce and suicide. There is clearly much room for improvement and self-healing.
[An aside: While I was speaking to Dr. Ornish he was exercising on his treadmill. Here's a doctor who not only talks the talk, but quite literally walks the walk.]
So how did it all begin? That is, how did you personally get interested in preventive medicine?
When I was a freshman in college I became profoundly depressed and through that struggle I found that lifestyle changes were enormously helpful. Later, when I was in medical school at Baylor, I realized how many patients were dealing with similar problems—problems that could often be resolved through healthy lifestyle changes. I was learning heart surgery with Dr. Michael DeBakey and noticed that many of the patients whom he thought were "fixed" through technically impressive bypass surgery were returning because they had not changed the underlying lifestyle factors that had caused their heart disease in the first place. I took time off from medical school to begin a series of research studies showing that when we treat the underlying causes—which are predominantly the lifestyle choices we make each day—that our bodies often have a remarkable capacity to begin healing. In our studies, we use high-tech, state-of-the-art scientific measures to prove the power of low-tech, low-cost lifestyle interventions.
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