The intervention-oriented medical system in the United States leads physicians to think more in terms of treatment than prevention. But don't blame everything on the physician. After all, they're just following the lead of a society and its government that is addicted to the quick fix rather than long- term prevention. We want to control high cholesterol with drugs rather than prevent it; fix faulty hears with clot-busting drugs, bypass surgery, angioplasty, fiber-optic laser clot zappers and the like; develop "magic bullet" drugs to cure cancer.
Despite this, most cancers and heart disease result from diet and lifestyle factors that can be altered to prevent disease. Much of the risk (if not almost all) of coronary artery disease can be reduced with a proper diet, exercise, decreasing stress and moderate consumption of alcohol.
Likewise, controlling cancer is mostly in your hands. The Journal of the National Cancer Institute estimates that 35 percent of cancers can be attributed to diet and 30 percent to tobacco -- that means that you can prevent about two-thirds of all cancers.
Despite the billions of dollars spent on intervention, it remains an appallingly rotten alternative to prevention. Intervention:
-- comes too late for many people,
-- frequently doesn't work,
-- is frequently not permanent, and
-- often has serious side effects.
Intervention comes too late for 18 percent of people whose first symptom of heart disease is death.
Intervention frequently doesn't work. About 350,000 coronary artery bypass graft surgeries are performed in the U.S. each year and a like number of balloon angioplasties.
Bypass surgery involves taking an artery from one part of the body, usually the leg, and grafting it to the blocked artery to bypass the blockages. Angioplasty involves placing a tiny balloon at the site of the artery blockage and inflating it to increase the diameter.
The lack of success for cancer intervention varies with the type of cancer, but the death rate for smokers with lung cancer, even with treatment, is almost 100 percent.
Intervention frequently is not permanent. About 50 percent of
bypassed arteries clog up again after five years and 80 percent after seven years. One third of arteries treated with balloon angioplasty clog up within four to six months. The death rate from a second or third round of bypass surgery or angioplasty can be double or triple the first risk.
Five-year survival rates for cancer can be depressingly low, despite the pain and horrors of surgery, radiation and chemotherapy.
Intervention often has side effects. The drugs used to lower blood pressure have a wide range of side effects including impotence in men, depression, fatigue, and blood cell malfunctions. The commonly used cholesterol-lowering drugs can cause liver damage, gastrointestinal tract disorders, cataracts, nausea and other problems. Many drugs used to help prevent clots dramatically increase the risk of hemorrhagic strokes. The radiation and chemotherapy drugs used to treat many cancers can cause severe nausea and may themselves, years later, cause other types of cancer.
Intervention is enormously expensive. An uncomplicated coronary artery bypass operation can cost $30,000, an angioplasty, $7,500. Estimates from the government and from insurance companies vary, but in 1990, approximately $78 billion was spent treating heart disease and at least $8 billion of that was spent on bypass surgery alone.
Drug therapy also comes dearly: the most common cholesterol-lowering drug, Lovastatin, costs $2,000 to $3,000 per year for one person.
This represents an incredible drag on our economy and the health care system. A universal health care system for all Americans could be funded with the intervention treatment money spent on preventable heart disease and cancers.
The U.S. health care system is stacked against prevention. In his book, Reversing Heart Disease, Dr. Dean Ornish, M.D., states the problem eloquently. "The third-party reimbursement system (health insurance, Medicare etc.) encourages the use of drugs and surgery rather than health education ... If I perform a balloon angioplasty on a patient, the insurance company will pay at least $7,500. If I spend the same amount of time teaching a heart patient about nutrition and stress management techniques, the insurance company will pay no more than $150. If I spend that time teaching a well person how to stay healthy, the insurance company will not pay at all."