Urgent: Support the
Proposed New Law in
California Requiring Doctors to Provide Patients with
Information on Diabetes and Heart Disease
often receive inadequate and/or incorrect information from
their doctors on diabetes and heart disease. For example, on
heart disease, inadequate information is received on these
three important issues:
are told surgery (angioplasty and bypass) for chronic
coronary artery disease is usually lifesaving, when the
scientific research says otherwise.
receive almost no education about the role of the rich
Western diet in the cause of coronary artery disease and
about the right way to eat to prevent it.
are rarely told that changing to a healthy, low-fat,
plant-food based diet will relieve symptoms of heart
disease, including chest pain, and reverse the underlying
introduced by California state assembly member Tom Ammiano,
representing the 13th District, to require that a physician
obtain a patient's written acknowledgment confirming the
receipt of information, as specified, regarding treatment
through medical nutrition therapy prior to delivering
nonemergency treatment for heart disease. My supporting
letter on this matter is provided below. Next month’s
newsletter will have a similar letter from me about diabetes
treatment and a request for your support.
Please send letters to members of the Business &
Professions Committee (who are initially reviewing
this bill) asking them for their support of AB
1478. A sample letter is provided at the end of
this article. Here are their e-mail addresses:
Letter of Support for AB 1492:
Requirement to Inform Patients in
Writing about the Limitations of Heart Surgery (CABG
and angioplasty) and the Benefits of Nutritional
Therapies for Heart Disease
The Patients’ Right to Informed
Informed consent is a patient right guaranteed by
the bylaws of most hospitals. California law
requires that a patient’s consent be obtained in
writing for several specific procedures and
treatments, including: sterilizations, hysterectomy,
breast cancer, prostate cancer, gynecological
cancers, psychosurgery, and electroconvulsive
therapy, but not for heart surgery.1c
California patients with heart disease need to be
informed in writing about the lack of benefits and
the real harms of current therapies with bypass
surgery and angioplasty. They also need to be told
that the cause of their heart disease is the rich
Western diet, and that their condition is reversible
with a change in diet, exercise, and judicious use
of inexpensive medications.
Heart Surgery for Coronary Artery
Disease of the arteries supplying the heart muscle
(called atherosclerosis) affects the majority of the
adult population of California. According to the
American Heart Association 16,800,000 people alive
today in the US have a history of heart attack, angina
pectoris or both.1a The cause of this
disease is well recognized as due to the meat- and
dairy-centered Western diet.
Faced with pictures of the shadows of blockages in
their coronary arteries (angiogram x-rays), nearly
two million people in the US annually undergo heart
surgeries, most patients believing that these
procedures will prevent heart attacks and prolong
their lives. Coronary revascularization by coronary
artery bypass grafting (CABG) and angioplasty (percutaneous
coronary intervention or PCI) are among the
common major medical procedures performed in North
and Europe. In the US in 2006 there were about 1.314
million angioplasties and 448,000 bypass operations
performed.1b Many hospitals derive 80% of
their income from the treatment of heart disease.
The average total healthcare cost after five years
is $100,522 for bypass surgery and $81,790 for
angioplasty per patient.1
Heart Surgery Lacks Benefits for
Survival, Heart Attack Prevention, or Quality of
More than 28 studies have been done to try to
determine real life benefits from heart surgery for
people with chronic blockages of their heart
arteries. Results of angioplasty have consistently
shown no survival or heart attack prevention
benefits over standard medical care. Studies, all
performed before 1990, showed a small survival
benefit in highly selected small subgroups for
bypass surgery (approximately 3%) over medical
Two recent studies, the OAT (Occluded Artery Trial)
and COURAGE (Clinical Outcomes Utilizing
Revascularization and Aggressive Drug Evaluation)
studies have been especially revealing about the
failures of angioplasty. The conclusion of the OAT
study of 2166 patients treated with angioplasty and
medications or medications alone was: “PCI did not
reduce the occurrence of death, reinfarction, or
heart failure, and there was a trend toward excess
reinfarction during 4 years of follow-up in stable
patients with occlusion of the infarct-related
artery 3 to 28 days after myocardial infarction.”2,3
The most recent follow up of the OAT study found at
2 years medical therapy was less expensive with
better survival than angioplasty.4 The
conclusion of the COURAGE study of 2287 patients
was, “As an initial management strategy in patients
with stable coronary artery disease, PCI did not
reduce the risk of death, myocardial infarction, or
other major cardiovascular events when added to
optimal medical therapy.”5
recent analysis of 28 studies comparing heart
surgery with medical therapy, performed by doctors
with a vested interest, cardiologists and bypass
surgeons, found less than a 2% absolute improvement
in survival achieved from heart surgery over no
operation.6 And for the most part these
major treatments continue to be performed without
any questioning by the patients, their doctors,
their health insurance providers, and anyone from
the government of California.
Surgical Interventions Fail to Treat
Doctors understand why heart surgeries do not save
lives. The aim of heart surgery is to by pass around
(bypass surgery) or rupture (angioplasty) hard,
stable, large plaques found inside the heart
arteries. However, these plaques are not the ones
that cause heart attacks or death. A heart attack
occurs when a small volatile plaque, better pictured
as a tiny festering sore, located on the inside of
an artery ruptures and causes the blood to suddenly
form a clot (thrombus).5,7,8 The event is
known as a coronary artery thrombosis, or a heart
attack. The reason lives are not saved by bypass
surgery and angioplasty is these surgeries
completely ignore the dangerous part of the artery
disease, the tiny volatile plaques (sores).
Inexpensive Diet-therapy and/or
Medications Reverse Heart Disease
Beginning in the 1950s investigators from the
University of Pennsylvania treated their heart
patients with a low-fat diet and obtained excellent
relief of chest pain (angina) in only a few days.9-12
In 1983 results published in the Journal of the
American Medical Association showed a healthy
diet and lifestyle could cause a 91.0% mean
reduction in frequency of chest pain episodes in
less than 3 weeks.13 Chest pain (angina)
is the primary legitimate reason for recommending
surgery. The next level of benefit from dietary
therapy was established when a healthy diet was
found to reverse the underlying disease
(atherosclerosis) in 82% of patients in one year.14-16
The addition of cholesterol lowering medications and
aspirin offers further advantages for heart
Cost Savings to the
State of California
Actual figures for the number of heart surgeries for
California are not available. However, assuming
California has one-tenth the population of the
United States, then extrapolated figures for heart
surgery (131,400 angioplasties and 44,800 bypass
surgeries) performed annually can be made using the
average total healthcare cost after five years of
$100,522 for bypass surgery and $81,790 for
angioplasty per patient.
This extrapolation suggests the potential for
savings is nearly $11 billion for angioplasty
surgeries and $5 billion for bypass surgery
annually—money spent every year, over the next 5
years after the procedure.
comparison diet-therapy can be taught with
outpatient classes for a few hundred dollars.
Intensive medically supervised live-in programs are
also available for between $2000 and $4000. A
cost-benefit analysis published in the
October-December 2006 issue of the University of
California’s California Agriculture journal
has determined that every dollar spent on nutrition
education in California saves between $3.67 and
$8.34 in future medical costs.18
Letter to Assembly Member
Assembly Member (their name):
writing to ask you to vote for AB 1478. Chronic diseases
like heart disease and diabetes are epidemic in America and
California. From my personal experience I know that while
drug medication can be of value in emergency situations,
drugs ultimately never cure the disease – they only suppress
the symptoms of the disease. This is an expensive way to
treat diseases. Our state cannot anymore afford the high
cost of treating patients with drugs and surgery alone. Diet
and lifestyle changes have been found to be helpful in
arresting and even curing heart disease and diabetes, and is
very inexpensive compared to drugs and surgery. I feel
doctors should give their patients the option to be referred
out for diet or nutrition therapy for their non-emergency
heart disease or diabetic condition.
very much for your support for AB 1478.
address, and e-mail
Stroupe KT, Morrison DA, Hlatky MA, Barnett PG, Cao L,
Lyttle C, Hynes DM, Henderson WG; Investigators of Veterans
Affairs Cooperative Studies Program #385 (AWESOME: Angina
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Lipemia in patients with coronary heart disease. Treatment
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J Am Diet Assoc. 1957 Jan;33(1):22-5.
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