Thursday, August 28, 2014

Dean Ornish on lifestyle medicine

The idea behind lifestyle medicine, that a multifaceted program of hygienic (non pharmacologic) measures can help prevent or even treat many chronic diseases, though not new, continues to gain traction. It's an area of great interest to me and recently Dean Ornish's piece in Medpage Today caught my eye. From the post:

We tend to think of advances in medicine as a new drug, laser, or surgical device, something high-tech and expensive. Yet, the simple choices we make in what we eat and how we live have a powerful influence on our health and well-being.

True as that may be there are questions that need to be addressed about the science behind lifestyle medicine. First, lifestyle medicine represents a bundle of interventions. There are many bundles in medicine. If a bundle is proven to work we still may not know about the efficacy of its individual components until we study them individually. Some components may even prove to be harmful. A very recent example of this was the unbundling of early goal directed therapy. We'll never succeed in unbundling something so complex as lifestyle, yet we need to learn more about which of its individual components are most helpful and which ones are not so helpful or even harmful.

In the case of Ornish, a good deal of his work is beset with small numbers, methodologic issues and questionable assumptions. Despite these concerns I read his post with great enthusiasm until I came to this stopping point:

These lifestyle changes include:
A whole foods, plant-based diet (naturally low in fat and sugar)
stress management techniques (including yoga and meditation)

Hmmm, so yoga is part of the Ornish bundle. But this takes us way beyond scientific concerns about bundling into a whole new arena. Yoga is a complex philosophical and religious system that makes certain supernatural claims. If Ornish had merely mentioned its material aspects (stress management, low impact exercise, etc) without mentioning yoga itself my reaction would have been different. But to promote yoga as a specific system with benefits beyond the generic effects of exercise and relaxation, as Steve Novella once pointed out, implies magic. When magic is mixed with science you get pseudoscience. Apparently Ornish's interest in the magic arts doesn't stop with yoga.

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