First the good news: medicare and medicaid, the US Governmetal organizations that deliver free health care to the elderly and poor, will pay for lifestyle programs that diet is one of their cornerstones. This shows that a government organization is willing to considered the available evidence that proves that nutrition can be used successfully for the treatment of illness.
In my first paragraph, I eluded that Dr. Ornish approach goes in-line with orthodox approach. This is not totally fair. Dr. Ornish approach is a bit of a departure. He advocates the use of nutrition and lifestyle as a central tool for the treatment of illness, which most of orthodox medicine do not agree with. He conducted randomised controlled trial that was published in the Lancet in 1990 with a follow up published in JAMA in 1998, that shows reversal of coronary artery atherosclerosis with nutrition. Publishing of his papers in these two reputable medical journals speaks to the quality of Dr. Ornish work. It is actually surprising that not enough attention is paid to his work.
The problem that I see with Dr. Ornish approach is in the scientific methodology or in other words the thinking process. Listening to Dr. Ornish and going quickly over one of his papers, it is obvious that Dr. Ornish is using the same scientific methodology used in orthodox medicine and applies it to nutritional therapy. However, I see the reason for our poor state of health is this scientific methodology. Having said that, if Dr. Ornish would have used a different method, his papers would not have been published in such reputable papers, and medicare and medicaid would continue to refuse to reimburse for nutritional therapy.
In science, if we have the correct starting point and then have the correct approach to move forward, or in other wards the correct scientific methodology, science would evolve in the right direction. Having the wrong starting point or the wrong scientific methodology (wrong reasoning) would lead to the current state of medical science.
I have two criticism to the work of Dr. Ornish :
First diet interventions are complex interventions. this is quite different than simple intervention as those of testing drugs. The number of variables is tremendous and even worse these change over time. I’ve written a post in 2008 on the subject. The post was comments I’ve written on Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement presentation. The presentation was titiled: Eating Soup with a Fork. Yes, Dr. Berwick sees using randomised controlled trials for complex interventions as eating soup with a fork.
Second, I do not think Dr. Ornish went far enough in the selection of the proper diet. Here there are multiple issues. Does one dietary approach fits all? Probably not. But then, if Dr. Ornish varied the diet, he would not be able to call it a randomised controlled trial and it would not have been neither funded nor published. The other point that needs to be addressed is that the knowledge we now have about fat types was available in the 1980’s when Dr. Ornish started his research. This point should be considered seriously if Dr. Ornish program is to be applied.
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