At his week-long 'Life Choice' retreats in California, heart disease patients and their partners pay dollars 2,500 to eat a rigorous high-fibre diet containing only 10 per cent fat (akin to that of a Third World peasant), to learn to meditate, to practise yoga, and to share their innermost fears with total strangers. In return, they believe, their heart disease will abate and they will achieve peace of mind. With some justification, let it be said: in four-year trials at the
University of California, Ornish's patients have shown a steady improvement without drugs or surgery, compared to a deterioration in control groups receiving surgery and routine dietary advice.
Jack Sartisky, a financial planner from New York, suffered from occluded arteries and anginathat he claims rendered him breathless after walking 20 yards. Now he covers this distance with ease. After a week at an Ornish retreat last year, he and his wife Ruth are confirmed admirers of America's latest health guru, whose recent book Eat More, Weigh Less has followed its predecessor, Dr Dean Ornish's Programme for Reversing Heart Disease, into the American bestseller lists.
They speak of his charm, his solicitude, his integrity. At bi-monthly support-group meetings with similar couples in Manhattan, they gossip about Ornish's private life, exchange anecdotes of de-furred arteries, swap low-cholesterol recipes and wrestle with the difficulties of emptying their minds. Meditation, confesses Ruth, has been the hardest part of the package to adopt. 'The diet is a challenge we enjoy and there are a lot of fat-free products available, but yoga and meditation is a bit strange, especially when life is hectic.'
Ornish's insistence on the combination of diet, exercise and stress-
management techniques is arguably his major contributionto the heart disease debate, according to Michael Marmot, professor of epidemiology and public health at University College London, whose own study of civil servants shows that relaxation can lower blood pressure. It's just that the language Ornish uses is rather more colourful than most British doctors would care to employ in public. 'The real epidemic in our culture is not just physical heart disease,' Ornish says. 'It's what I call emotional or spiritual heart disease, the sense of loneliness and isolation that's so common, and the breakdown of the social networks that provide people with a sense of connection and security.'
People might join his programme, he says, lose weight or unclog their arteries, 'but they sustain it because it's improving the quality of their lives in so many other ways. Even more than being healthy people want to feel they're in control and that they're free.'
''Quality of life', 'spiritual growth', with such phrases Ornish joins advocates of the popular new mind-body medicine. These scientists argue not only that our thoughts and feelings influence our health, but that we all possess inner resources of self-healing if only we can learn to tap them. It's an attractive premise, especially for individuals who want to take an active role in their own health care, and when delivered by medically qualified writers such as Ornish, cancer surgeon Bernie Siegel or physicians Larry Dossey and Deepak Chopra acquires an irresistible authority. In the US, these doctors are the stars of television talk shows and the subjects of countless articles; with sales of their books running into hundreds of thousands, the roar of media adulation is loud enough to drown any squeals from the medical establishment.
What sells in the United States has a way of washing up on British shores, and the kind of self-help and holistic medicine that these practitioners espouse is cornering a growing market here. Interest in complementary therapies rises in almost direct proportion to the public's disenchantment with the National Health Service. Michelle Pilley of Waterstone's booksellers estimates a 100 per cent growth in so-called 'mind, body and spirit' titles over the past five years. 'They offer a very positive approach that gives people the feeling they can take control of their lives,' she explains.
As simple as that? Bernie Siegel, for example, is a New England
cancer surgeonwho teaches at Yale University and has developed a form of individual and group therapy that helps cancer patients improve their quality of life and in some cases seems to arrest the progress of the disease. His books are full of uplifting case histories.
Erica Smith, editor at Thorsons, the UK publishers of Siegel's books, whose titles - Love, Medicine and Miracles; Living, Loving and Healing and Peace, Love and Healing - give away something of the tone of their contents, describes his appeal as inspirational. 'It's an easy read, you think 'yeah, this will change my life,' and he's a successful surgeon who has turned to alternative therapies without throwing conventional medicine out the window.' The compassionate and accessible style of his writing has much to do with his success, she adds. 'Most people, let alone doctors, aren't able to write like that even if they want to.'
Sue Boyd, an educational development officer with the Bristol Cancer Help Centre, compares his anecdotal style with that of traditional storytellers, the builders of mythology. 'They're the same kind of truth-revealing parables,' she says. 'It's very powerful.'
Ornish, too, hasan easy way with words and, like Siegel, is not afraid to relate his own experiences and emotions, as well as those of his patients. Meeting an Indian spiritual teacher, Swami Satchidananda, it transpires, saved the youthful Ornish from suicide, and the guru's teachings have since guided his work. Paradoxically, the more clay-like humanity these doctors expose, it seems, the more god-like they become to their followers. The more responsibility they hand back to patients, the more they are revered.
'Revealing yourself has a lot to do with the mutual respect established between practitioner and client,' says Dr Stephen Wright, a health psychologist at Leicester General Hospital. 'What is true of the therapeutic relationship between four walls is true of that between author and reader.'
Inspiring, too, is the faith they have in our ability to change habits that may be contributing to ill health. The link between heart disease, cholesterol and fatty foods is well-known, but few nutritionists in the US or Britain believe that Westerners can sustain a seriously low-fat diet. But 'we're finding it's actually easier to make big changes than smaller ones', declares Ornish. 'People are not afraid to make big choices if they understand the reason and the benefit, and the benefit is big enough and occurs quickly enough.'
Why have so few British doctors achieved the kind of personality status enjoyed by Americans? Psychiatrist Anthony Clare, oncologist Karol Sikora and gynaecologist Robert Winston are about as exciting as we get. Not only do American health professionals show a greater tolerance of so-called fringe therapies, points out Dr Ian Fussey, also a health psychologist at Leicester General Hospital, but they handle public appearances and the media with relative ease. Here, too much limelight can inspire suspicion. 'An appearance on Kilroy is the kiss of death,' remarks a British consultant who wishes to remain anonymous. 'The establishment will shoot you down as a crank.'
'America is a 'can do' culture,' says Dr David Peters, chair of the British Holistic Medical Association. 'If you've discovered a better way for people to deal with illness, then you want it to be widely known. Sit down with Siegel and you meet a quiet, rather overworked, shy man, but when he gets up to speak he allows his charisma free rein.'
Ornish, too, is initially unassuming (and undeniably lean) with the abstracted manner of a busy man. In exposition mode, however, he delivers a forceful argument for his programme. 'It's no good finding out information that saves people's lives if they don't know about it,' he points out cogently. Seventeen years ago he was a young doctor with cranky ideas; now six American hospitals are training staff to run his heart disease reversal programme, at least one insurance company covers it as a cost-effective alternative to open-heart surgery, and a major food manufacturer plans a new line of Life Choice fat-free food.
Ultimately, the respect of the book-buying middle classes may simply be another form of the awe in which patients hold those who are trained in the mysteries of life and death. The white-coated authority figure in the local hospital or surgery probably wields as much influence in their own sphere as any media star. Take Ian Fussey's attempt to replicate in Leicester the benchmark study of another American health hero, Dr David Spiegel, who found that women with secondary breast cancer survived longer when they belonged to an emotional support group. (Dr Spiegel's book, Living Beyond Limits, yet another bestseller in the US, was published here last month by Vermillion, pounds 9.99.) British women were reluctant to volunteer unless their local consultant virtually ordered them to do so.
'But once we got them in the group and in the habit of talking about themselves they were very proficient,' he adds. 'They took more control of their condition and started asking their doctors why they weren't getting certain treatments.' There's a lesson in that somewhere.
Anne Woodham's 'Guide to Complementary Medicineand Therapies' is published this week by the Health Education Authority at pounds 6.99.
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