Why Do Heart Doctors Favor Surgery and Drugs Over Diet?

Fully Consensual Heart Disease Treatment
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When he was a surgeon at the Cleveland Clinic, Dr. Caldwell Esselstyn Jr. published a controversial paper in the American Journal of Cardiology, highlighted in my video, Fully Consensual Heart Disease Treatment, noting that heart bypass operations carry significant risks including the potential to cause further heart damage, stroke, and brain dysfunction. Angioplasty isn’t much better, also carrying significant mortality and morbidity, and often doesn’t work (in terms of decreasing the risk of subsequent heart attack or death). “So,” he writes, “it seems we have an enormous paradox. The disease that is the leading killer of men and women in Western civilization is largely untreated.” The benefits of bypass surgery and angioplasty “are at best temporary and erode over time, with most patients eventually succumbing to their disease.” In cancer management, we call that palliative care, where we just kind of throw up our hands, throw in the towel, and give up actually trying to treat the disease.

Why does this juggernaut of invasive procedures persist? Well one reason he suggests is that performing surgical interventions has the potential for enormous financial reward. Conversely, lack of adequate return is considered one of the barriers to the practice of preventive cardiology. Diet and lifestyle interventions lose money for the physician.

Another barrier is that doctors don’t think patients want it. Physician surveys show that doctors often don’t even bring up diet and lifestyle options because they assume that patients would prefer to be on cholesterol-lowering drugs every day for the rest of their lives rather than change their eating habits. That may be true for some, but it’s up to the patient, not the doctor, to decide.

According to the official AMA Code of Medical Ethics, physicians are supposed to disclose all relevant medical information to patients. “The patient’s right of self-decision can be effectively exercised only if the patient possesses enough information to enable an informed choice. The physician’s obligation is to present the medical facts accurately to the patient.” For example, before starting someone at moderate risk on a cholesterol-lowering statin drug, a physician might ideally say something like:

“You should know that for folks in your situation, the number of individuals who must be treated with a statin to prevent one death from a cardiovascular event such as a heart attack or stroke is generally between 60 and 100, which means that if I treated 60 people in your situation, 1 would benefit and 59 would not. As these numbers show, it is important for you to know that most of the people who take a statin will not benefit from doing so and, moreover, that statins can have side effects, such as muscle pain, liver damage, and upset stomach, even in people who do not benefit from the medication. I am giving you this information so that you can weigh the risks and benefits of drugs versus diet and then make an informed decision.”

Yet, how many physicians have these kinds of frank and open discussions with their patients? Non-disclosure of medical information by doctors—that kind of paternalism is supposed to be a thing of the past. Today’s physicians are supposed to honor informed consent under all but a very specific set of conditions (such as the patient is in a coma or it’s an emergency). However, too many physicians continue to treat their patients as if they were unconscious.

At the end of this long roundtable discussion on angioplasty and stents, the editor-in-chief of the American Journal of Cardiology reminded us of an important fact to place it all in context. Atherosclerosis is due to high cholesterol, which is due to poor dietary choices, so if we all existed on a plant-based diet, we would not have even needed this discussion.

The lack of nutrition training in medical school is another barrier. See, for example, my videos Doctors’ Nutritional Ignorance and Doctors Know Less Than They Think About Nutrition.

Shockingly, mainstream medical associations actively oppose attempts to educate physicians about clinical nutrition. See my 4-part video series:

  1. Nutrition Education Mandate Introduced for Doctors
  2. Medical Associations Oppose Bill to Mandate Nutrition Training
  3. California Medical Association Tries to Kill Nutrition Bill
  4. Nutrition Bill Doctored in the California Senate

For more on why doctors don’t make more dietary prescriptions, see my video The Tomato Effect, Lifestyle Medicine: Treating the Cause of Disease, and Convincing Doctors to Embrace Lifestyle Medicine.

Heart disease may be a choice. See Cavities and Coronaries: Our Choice and One in a Thousand: Ending the Heart Disease Epidemic.

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Leandro Ciuffo / Flickr

  • Pamela

    This is horrifying, but not surprising. Before I started my MBA studies in finance, I worked in the business office of a hospital. Part of my job was delivering monthly income statements to the surgeons in our group. “From your hands to their hands” I was told. i.e. their income information was more confidential than anything else, certainly far more confidential than any patient information. Hospitals are under tremendous pressure to increase revenues. Unfortunately, medicine is all about money and not about effective treatment. Spend some time in the business office of any hospital and you will be convinced.

    • Pamela

      …also, keep yourself healthy so you can stay out of the hospital as a patient!

      • http://grokjs.com/ Alexander DiMauro

        Agreed. My one visit to the ER was the biggest nightmare of my life. They really don’t care one bit about you or anyone. It was one of the most inhuman experience of my life. I asked to leave, and they said if I left without the doctor’s consent that insurance would not cover it and I would have to pay the full costs myself. So, in other words, to get out you have to pay bail. How is that any different from a prison?

        • HBH

          Pamela is saying to stay out of the hospital by being health. She isn’t saying to avoid the hospital when you are sick. Just stay away from for-profit hospitals. It was also probably inhumane, because the nurses were poorly educated, arrogant, and bitter. A lot of nursing schools completely disregard teaching nurses on how to relate to patients.

        • V-stew

          Same thing happened to me. I waited 8 hours in the middle of the night to be treated… and was never seen by a Doctor. When I said I wanted to leave, they told me I would not be covered by insurance and would be charged up to $500 because I was seen by Triage!! They cleaned my would and put a band aid on it! $500 for a band aid!

  • http://grokjs.com/ Alexander DiMauro

    This is precisely the reason why the most harmful thing you can do for your health is to go see a doctor. Doctor’s like Dr. Greger are extremely rare. So, who do you trust? I have yet to meet a single local doctor who is anything but a big pharma sponsored drug dealer. It’s getting to the point where, if you want to save your health, the most important thing you can do is avoid doctors completely.

    • Joseph Gonzales R.D.

      Or perhaps find one’s like Dr. Greger? I have a list of a few. Let me know if you’d like more info :-) Thanks, Alexander

      • http://grokjs.com/ Alexander DiMauro

        Yes, I would like to see a list, because I have not been able to find a single one in my area. It’s not like you can even search for that, my insurance provider does not have ‘knows plant-based nutrition’ as a search criteria. They should, though.

        • Joseph Gonzales R.D.

          Cool! See if this list helps, or if in the DC area there is a brand new clinic that opened, the Barnard Medical Center. Here is a link for ​ Dr. McDougall’s list​.

          • G-man

            Joseph
            I have been counseling patients for over 10 years about nutrition and have been vegan for over 13 years. How do I get on Dr. Mcdougall’s list.I have personally prescribed Dr. Mcdougall’s recipe book
            more than 100 times in my practice.I practice Internal Medicine.

          • Joseph Gonzales R.D.

            Hey G-man so glad to know you counsel folks about nutrition! I have no idea how to make the list. Sorry about that. I suggest emailing Dr. McDougall or his staff.

          • Charzie

            Joseph, I have also been looking for a GOOD doctor here in Lehigh FL, (near Ft Myers). I am so disgusted with the state of medical practice, I don’t even know where to turn! Years ago I had a horrible reaction to a drug and ended up in the ER. My partner made it clear to them that I had just started taking a new medicine when he noticed I was totally disoriented and confused, (I have little memory of it) and the short story is they tested for everything but, including X-rays! I left there no different than when I arrived and since he couldn’t reach my doctor, made the executive decision to stop the drug…which eventually solved the issues. It was a very traumatic experience, all because of a simple UTI! Shortly after that, I saw Forks Over Knives, and alarm bells went off…time to make drastic changes, for a lot of reasons! I had recently been diagnosed with diabetes, so the timing couldn’t have been better to try a WFPB diet, (30 days was the plan) and never looked back! My doctor was amazed at the changes, but was very hesitant to take me off a slew of now unnecessary medications, despite the fact that everything had changed, so I told her that if she didn’t, I would do it myself. She was very distant when she found I didn’t actually need them, my numbers were great, but her whole manner changed. Maybe because she knew I wouldn’t have to come back every couple of months for her “services”, but I eventually left her practice. I would love to find someone who is nutrition based because I know first hand that it is the vital answer to so many issues! Dr. policy was prescribe something for a symptom, and side effects be damned, and never try to FIX or even discover the actual problem, never even considering diet, other than to tell me to lose weight and recommending an Atkins type diet! I honestly feel all the drugs I was taking only contributed to my problems…it seems every time I had an appointment, there was a new pill on the agenda! Now I cannot believe I fell into that black hole, because I feel better than I EVER have since making the all important dietary change! Still, it would be great to have a REAL doctor to trust with my health…that takes our insurance! Seems drugs and procedures are covered, but nutrition isn’t!

          • Joseph Gonzales R.D.

            Powerful story thanks for sharing! Any doctors pop-up from McDougall’s list? PCRM may have more information, too. I suggest contacting their team and the new Barnard Medical Center once open. Let me know how else I can help.

          • Charzie

            Just saw that, I will check it out, thanks so much!

        • nonyabizzz
          • http://grokjs.com/ Alexander DiMauro

            Thanks for the info! There were a couple not too far from me. I’ll have to contact them. Thanks!

      • guest

        A question to you Joseph: My understanding has been cholesterol is just one of the risk factors of atherosclerosis. There’re others, like lack of exercise, smoking, nutrient deficiencies (example: vit. D). Am I wrong?

        • Joseph Gonzales R.D.

          Yes, sounds right! I would say cholesterol is the biggest factor though, as lack of exercise and nutritional deficiencies (like lack of fiber) all promote factors that stimulate the build-up of atherosclerotic plaque.

        • Paul Spring

          These are all covered on this site – inflammation, oxidation, TMAO from animal protein, etc….

      • ElsieT

        Alexander, do you know any in Alabama or Georgia? Thanks!

        • Joseph Gonzales R.D.

          Maybe. Here is a link for ​ Dr. McDougall’s list​. Type in your zip and see who pops up! Good luck.

          • http://grokjs.com/ Alexander DiMauro

            That link doesn’t appear to be working anymore.

          • Benjamin VP

            Go to McDougall’s site, hover over “CONNECT”, and then click on “Find a Health Care Practitioner”. It’ll take you to the same link, but the page will work; not sure why.

          • Joseph Gonzales R.D.

            I saw that initially but I changed immediately after it works for me now.

        • http://grokjs.com/ Alexander DiMauro

          No, I’m in NJ. I know Dr. Furhman is in NJ, but he’s pretty far from me and I seriously doubt it would be easy to become his patient, with his busy schedule. There’s probably a huge waiting list for him, anyway.

    • HBH

      Your conclusion is so wrong. Doctors push drugs, because people demand drugs, and if they don’t get drugs they tend to write a bad review of that doctor. This can threaten a doctor’s career. In a patient’s eyes, the doctor did nothing if they did not prescribe or offer some treatment. Doctors are pressured into over-prescribing drugs by lousy and ignorant patients.

      It is also illegal for a doctor to receive money from a pharmacy. In fact, a pharm rep can’t even offer a doctor lunch. Whether or not you buy the drug from the store has absolutely no financial impact on the doctor. The worst thing you can do is avoid a doctor when you are sick.

  • curtis

    Hi Pamela: This book, written by a surgeon with a conscience, elaborates nicely on what you’ve observed: Unaccountable by M. Makary

    • Pamela

      thanks! Will take a look.

  • Dommy

    “Why . . .”

    Why else?
    Nutrition: $$
    Surgery: $$$$$$$$$$$$$$$$$$$$$$$$$!!!!!

  • Panchito

    Even diseases can be social constructions. For example, people give them names and categorize them from social interactions. If the diseases are discovered or treated by people seeking money, hospitals could become financial institutions. Knowledge could potentially save your life and damage their image. But there is a real need for hospitals/doctors like for example trauma.

    The Social Construction of Illness: Key Insights and Policy Implications

    http://hsb.sagepub.com/content/51/1_suppl/S67.full.pdf+html

  • nonyabizzz

    money

  • gtrdoc911

    I seem to recall reading in “You: the owner’s manual” by Dr’s Roizen and Oz a few years back that most cardiac surgeons take statins in a prophylactic manner for themselves. Any cardiac surgeons care to weigh in on that?

  • Coolcat

    Keep ’em sick, you can fleece money off patients as long as you keep them alive. Big bucks for Big Pharma. Not health care, but disease control. If your oil light in your car comes on, unplug the light, is their solution. Don’t address the cause of disease, just treat the symptoms. Too bad Medicare won’t cover alternate medicine and naturalistic medicine.

    • HBH

      The only people “keeping ’em sick” are the patients themselves. Doctors would love if you changed your diet, but they know that is not an option, because Americans are gluttonous pigs. Our culture would rather fix a problem, rather than prevent it. Also alternative medicine by definition is medicine that is unproven scientifically, if it actually worked it would be labeled mainstream medicine. At that point you would probably be against it. Do not pretend that the alternative medicine industry isn’t a multibillion dollar industry just like pharm companies. The difference is that the alt medicine industry is overtly lying to the customer.

      • Coolcat

        I’ll choose alternate medicine, supplements, and nutrition. Feeling a lot better since I dumped the doctors and their poisonest pills.

  • susad2985

    my man had a triple heart bypass in Oct 2014. We started to become vegan in June 2014. But we were cutting the red meat and going meatless meals for a few years. But now he is on the drugs so he doesn’t have another heart attack. But we keep wondering if he should come off of them.But in 2003 he had a heart angina and had for stents. All 4 stents were totally clogged, that is why he had the triple bypass. We went the the heart nutritionist who taught us how to stop the salt and eat more healthy. So we bought organic chicken breast and wild caught pacific salmon and organic yogurt and Almond Milk and thought we were doing OK. But we think we should keep the drugs up for a while until more blood tests can be taken

    • Dommy

      Susad2985,

      Please watch the first 5 minutes of Dr. Greger’s 2014 annual vid:
      http://nutritionfacts.org/video/from-table-to-able/

      (of course if that grabs you’re welcome to watch the rest!)

      Store bought almond milk isn’t all it’s cracked up to be, btw.

    • Thea

      susad2985: I hope your guy does very well for many years to come.

      Based on what you wrote, I question how much your nutritionist understands about heart disease. If your man wants to get off drugs, I highly recommend the book: Prevent and Reverse Heart Disease by Caldwell B. Esselstyn. The book is a powerful read, explaining the one diet proven to reverse heart disease. The book is also fast and easy. And the 2nd half of the book is recipes, so I also consider the book short. The book is pretty much in line with what Dr. Greger recommends, but gives you guidance for the specific condition you are talking about.
      http://www.amazon.com/Prevent-Reverse-Heart-Disease-Nutrition-Based/dp/1583333002/ref=sr_1_1_twi_1_pap?s=books&ie=UTF8&qid=1433287493&sr=1-1&keywords=prevent+and+reverse+heart+disease

      There are no guarantees once a disease progresses like this. But Dr. Esselsyn shows that there is every reason to hope. Good luck!

    • HBH

      I’m not seeing where you added exercise to your man’s daily life. Stents only unclog portions of your arteries, not all your arteries. You need exercise to benefit the entire heart.

  • Rebecca McDowell

    In clinical practice I have found that MOST people would rather take a pill than change their diet. When I instruct people how to loose weight to rid themselves of metabolic disease I hear “Easy for you to say. You’re skinny!”
    RIGHT! I’m VEGAN!

    • HBH

      Exactly, Americans do not like to diet. We love fast food and cheese. The entire reason a person gets to point of heart surgery is because of their poor diet. So of course American’s are going to choose surgery over changing their diet. We have the best medical care in the world, but we are so pathetic when it comes to preventative medicine. Our culture would rather fix a problem, than prevent a problem.

    • Jim Felder

      Treatment isn’t about what is easy, it is about what is effective. Chemotherapy for cancer isn’t easy, but it can be effective. What is really sad is that the standards of care for CVD are neither easy nor effective at actually curing the underlying disease. So for people with CVD, easy is simply not an option.

    • Vera

      It’s probably the easier path for many that look for magic solutions without effort (aka, take the pill). In my case, I wanted to get away from prescriptions as much as I could. For weight loss and other reasons, I switched to a vegan diet about 3-4 months ago. I had 2 blood works done so I could compare before/after. Among other benefits (like losing weight, lowering my blood pressure, etc.) my cholesterol went down from 213 to 140, JUST BY BEING VEGAN. It’s sad that people go for the magic solution (=pill) instead of realizing how much better they would be if they just change other habits!

  • HBH

    It is a false assumption to think doctors favor surgery over diet, its the fact that Americans are too gluttonous to bother with a diet. A doctor is just being realistic. Americans are far more likely to stuff their face with french fries and cake, as well as use a scooter at Walmart. The only realistic option is surgery.

    • Jim Felder

      The only realistic option is surgery

      If after the patient is given all relevant information and then makes an informed decision to ignore the very strong advice to change their diet, then, yes, surgery might indeed be a last resort. But for doctors to not completely inform the patient of options that have a high level of efficacy based on peer reviewed research regardless of whether it is their opinion that the patient will not follow the a given option is simply unethical, and in my opinion rises to the level of malpractice.

  • Brux

    The know damn well the power that brainwashing and the establishment of deep emotional habits have with people. No doctors that I have ever heard of will do anything more than raise their eyebrows when they mention “the standard American diet”. They as a group will not lobby or agitate for any kind of change as a group. Look at the AMA.

    The way we have set our whole economy and way of like up as a giant human-destroying machine that serves only a few … and to what purpose, is the biggest tragedy in history. All of our ancestors, crawled out of the oceans, raise themselves up from the slime, fight and died many times over to establish a better humanity, only to have it end as this disgusting inhuman system that uses people as a mean to an end for some end that is unsustainable and toxic anyway? Makes no sense to me.

  • dcv168

    I have been on a plant based diet (Well 98% )for a year after having two stents
    placed lost all the weight exercise eat no oil no sugar no dairy…I do
    eat two 3 ounce pieces of wild Alaskan salmon fresh from Alaska I have
    friends who live there…(Fish Oil made me have nose bleeds because of
    the blood thinner and aspirin combo)dropped 50 pounds dropped ldl
    77,cholesterol 134,and trigs 90 hdl 40…But had a Nmr lipid profile and mu apo-b was
    high 90 my ldl-p was high 1622 my small ldl-p high 855 was told eating
    way to many carbs and by the way the carbs I eat are ALL complex not a
    one refined(Bad) carb…told maybe family history(My Dad was the only one who died of heart disease none of his sisters and brothers or mom and dad and nobody on my moms side died from heart disease and he smoked heavily drank and ate a SAD diet so could that be the reason he died and I didnt eat a perfect diet either so is there a genetic link???). so was told a
    Mediterranean style diet might be better and has shown if the grains and starchy foods are dropped so will the particle count.and niacin.Any suggestions? The rest of my NMR test came back great except the things I mentioned.

    • dcv168

      Now Im being told the large douses of deoxidine i was supplementing
      caused my tsh number to go way high and that will contribute to the
      raise in particle count?

    • Joseph Gonzales R.D.

      Thanks for your post. I am not sure what dietary approach is best, but I can give some suggestions. Have you seen the research by Caldwell Esselstyn? We have so much good information about reducing cholesterol and heart disease risk on our site. Dr. Esselstyn published research showing how a plant-based diet can be “A way to reverse CAD”. Meat can cause inflammation and saturated fat appears to have other deleterious effects such as increasing the risk of heart disease. “A nutritionally poor dietary pattern, characterized by a high meat and alcohol consumption and low micronutrients intake, is related to an increased stiffening of large arteries.” Other foods that may help arterial stiffness are turmeric and coffee. Search Mediterranean diet on our site to see more about the research on that type of diet. Carbohydrates do not seem to be problematic, if anything, they are very healthful. Dr. Greger wrote an entire book about “carbs”, titled Carbophobia, which you can read for free here.

      • dcv168

        With the exception of the fish…I eat a completely plant based diet with no oil no dairy no sugar at all…No simple carbs at all…And i talked to Dr Esselstyn many times….He does not want me eating fish but as I said had nose bleeds from fish oil and blood thinner combo and I eat chia seed and flax seed I grind my own(Flax Seed),but from what I have read the conversion to EPA and DHA is not enough or is it? If it is and I cut out the fish then I am 100% plant based.I dont drink or smoke.

        This is my diet

        Breakfast-Different Meals On Different Days.

        1 cup Steel rolled oats or Quinoa or Buckwheat Organic Whole Grain or old fashioned rolled oats (Bob Mills)
        1 cup of unsweetened almond milk
        1 to 2 cups of mixed fruit.(Blackberries,Raspberries,Strawberries and Blue berries 2.5 ounces oif each fruit

        Lunch-Beans are rinsed also. Different Meals On Different Days.

        1 or 2 bags of miracle noodle or rice from shirataki with 1 cup of cooked raw portabela mushrooms or raw white mushrooms cooked in broth instead of oil and 1/2 to 1 cup of muir glen (no oil spaghetti sauce) or hunts no salt diced tomatoes and no salt hunts sauce.With Salad

        1/2 to 1 cup of no salt added beans(all Kinds)mixed with about 2 to 4 cups of carrots,celery,cucumber,tomato,bell pepper,onion, black olives,no salt banana peppers pieces and 2 to 4 pieces of 100% organic buckwheat crispbread.

        1/2 to 1 can of beans with 1/2 or 1 cup of Brown rice or Organic Wild rice or Pearl Barley or organic california basmati brown rice.

        1 or 2 cups of mushrooms and 1 cup of Brown rice or Wild rice or Basmati rice

        1 Large bag of spinach leaf or regular salad leaf or Cole Slaw and Kale, baby spinach and collards.With some vegetables added.

        Sometimes mixing in some raw vegetables with the beans and rice or the mushrooms and rice.

        All with no salt vinegar and lemon and 2 tablespoons of maple grove farms fat free balsamic no oil salad dressing, and minced garlic and no salt spices.

        Dinner- Different Meals On Different Days.

        Cabbage with mushrooms and onions and peppers cooked.
        3 or 4 ounces of copper river salmon once or twice a week with vegatables( omega 3 supplements made me have nose bleeds I’m on a blood thinner too have Heart diease with 2 stents)
        1 Bag of frozen vegetables all the vegetable types with salad or brown rice I just mix it up daily.

        I don’t eat this everyday… 2 cups Buckwheat,Quinoa,Rice and Corn spaghetti or 100% whole wheat some days mixed with 1 can of no salt added diced tomatoes and 1 can of no salt added tomato sauce and some days mixed with fresh vegetables and eaten over a 3 or 4 day period.

        Some days I grill or bake large Portabella mushroom head and put it on Ezekiel bread with a slice of onion and tomato or roasted red pepper for dinner with a salad or vegetable. With sweet potato or Purple or Red Potato…Cabbage and Mushrooms mixed together as a meal too.

        1 Gallon of water every day.No oil,No sugar except what is in the fruit No cheese and No dairy…)Very low salt I use black Himalayan salt not to often dont know if my iodine levels have been affected..Well under 1500 mg allowed daily with Coronary Artery Disease .

        Snacks
        oil free popcorn,granny smith apple,No oil corn tortillas made into chips.

  • jamfhall1

    When I have a dr office visit, my insurance is charged $175.00. My insurance pays $100.00. I pay the remaining $75.00. If I were a cash-only patient, who did not have insurance, my cash payment would be $65.00. I’d save $10.00, but the dr office would lose $110.00. I’ve tried being a cash-only patient but I’ve been told, “Nope, since you have insurance, we have to bill your insurance.” This is on top of the $241.00 monthly premium. No wonder people wait till the very end to go to the dr.