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Follow the money: hospitals vs. heart-healthy diets

Last week, I wrote about being angry that my local hospital had offered such weak and incomplete nutritional advice to a friend recovering from a cardiac event:

The hospital's nutritionist focused exclusively on choosing better processed foods and making better choices at fast-food restaurants, with no idea how to advise vegetarian patients.

I'd assumed that the incident was due to that nutritionist's poor training. But it turns out that she may have been implementing the hospital's business strategy. As Mandy Locke points out in a brilliant story in today's News and Observer, cardiac care provides the income to keep today's hospitals in business.

My friend had been at Rex Hospital, which neighboring WakeMed is trying to acquire in a hostile takeover. Turns out the takeover was triggered by the cash-cow cardiologists leaving WakeMed for Rex. Locke writes:

WakeMed was the charity care hospital, and cardiology had been its saving grace.

While many people choose to go to WakeMed, it also serves those who have no choice. Medicare, Medicade, and uninsured patients. People who can pay less or not at all. So how does the hospital pay its bills? Pay starting doctors $350,000 a year in salary alone? With its heart business, which produced $24 million in profits last year, "accounting for the hospital's operating margin of $20 million and offsetting $4 million of its charity care." A founding member of the cardiologists leaving WakeMed says:

It was a co-dependency. We needed the hospital and they needed us.

With reduced payments from Medicare and changes coming with health-care reform,

Senior partners studied the books weekly. They whispered about the worst: Bankruptcy? Splitting the practice?

An even bigger threat to profitability for hospitals and cardiologists?

What this article doesn't cover is a possible quick and dramatic drop in the need for cardiologists at all. As the Campbells write in The China Study (emphasis theirs):

If you remember nothing else in this chapter, remember the forty-nine to zero score; forty-nine coronary events [for 18 people over 8 years] prior to a whole foods, plant-based diet and zero events for those [17 of those same people over 11 years] who adhered to a whole food, plant-based diet. Dr. Esselstyn had done what "Big Science" had been trying to do, without success, for over fifty-five years: he defeated heart disease.

I like to remember something else in that chapter, though (emphasis mine):

By comparing the patients who underwent the lifestyle program with those patients who underwent the traditional route of surgery, Dr. Ornish and his colleagues demonstrated that the lifestyle intervention program cut costs by an average of $30,000 per patient.

Lifestyle intervention sounds pretty scary and dramatic. What is Dr. Ornish's program? A low-fat, plant-based diet, plus stress management, moderate exercise, and social support.

So what might be scarier for hospitals and physicians who get most of their income from heart patients? Defeating heart disease through diet and lifestyle choices. Maybe that's why Rex's online heath assessment for heart disease does not ask about diet. It does ask about height, weight, and cholesterol levels, but not about whether your diet is based on plants or animals or the amount of fiber, fat, or processed foods you consume. When I filled out the survey, I got this scary message:

Once I provided my contact information, I was able to see the results from the survey, which said:

You have a 1% chance of developing cardiac disease within the next 10 years.

Only my family history raised a red flag.

I was pleased to see diet finally mentioned, even if only among five pages of recommendations:

  • Limit consumption of animal food products (meat, fish, poultry, etc.) or any food products derived from animals (such as dairy products).
  • Eat foods low in fat, especially saturated fats.
  • Read the "Nutrition Facts" information provided on most food packages to monitor your diet.

Although the last bullet above doesn't say what you should look for in the nutritional facts, the dietitian running the in-person training session focused on sodium per serving in packaged food, with no mention of avoiding meat, fish, and dairy.

So hospitals and some doctors stand to lose a lot of money if heart disease becomes rare again. But why aren't big corporations and our own government carvorting with joy over such an effective, inexpensive way to reduce disease? A way that is available right now? One that will also slow global warming and bring other environmental benefits?

These choices could redirect the flow of money in many ways, affecting nearly every type of business:

  • Reducing health-care costs for related diseases of affluence such as diabetes and stroke
  • Increasing opportunities in treating whatever ailments we'll die from with heart disease, cancer, and diabetes on the decline
  • Shifting money from animal-based and processed foods to whole, plant-based foods, cutting profits for Big Ag, Big Food, and Big Oil
  • Shifting money from cars, couches, and drive-throughs to bikes, backyard vegetable gardens, and healthy kitchens
  • Keeping older employees healthy longer, making it harder to replace them with less-expensive younger employees
  • Keeping older retirees healthy and alive longer, reducing their medical expenses but increasing the length of time they get retirement benefits
  • Keeping citizens healthy and alive longer, reducing their medical expenses but increasing the length of time they get Medicare and Social Security

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