Doctor Fights Heart Disease Procedures
What could be worse than the disease that kills more Americans each year than any other cause?
The methods most doctors use to treat it, says Dr. Julian Whitaker, medical director of the Whitaker Wellness Institute in Newport Beach.
The disease is cardiovascular disease, which claims more than a million lives a year in the United States. More than half those deaths come from coronary artery disease, in which the blood vessels that supply oxygen to the heart muscles are partially or totally blocked with fatty deposits. Whitaker, who is a medical doctor but not a cardiologist (“When I am asked if I am ‘board certified’ in cardiology I say, ‘Hell, no! And if I were I would be ashamed to admit it,’ ” he says) is waging a war against such commonly used treatments as coronary bypass surgery and angioplasty.
His reasoning?
“For the majority of people who are candidates for these procedures, the risk of dying from the treatment is as bad or greater than the risk of dying from the disease,” he says.
Not only that, but neither procedure has been scientifically proven to reverse heart disease in the long run significantly better than less-risky, non-invasive medical treatment involving diet, exercise and medication, he says.
Bypass surgery, which last year was performed on nearly 300,000 patients, involves the grafting of vessels from other parts of the body to form detours around blocked coronary arteries. Angioplasty, a newer, less-complicated procedure that was used on more than 250,000 patients last year, involves the use of a balloon-tipped catheter. The tiny balloon is maneuvered to the site of a coronary artery blockage, then inflated, flattening out the fatty material along the artery walls to make more room for blood to flow.
Whitaker’s most potent ammunition against bypass surgery includes two landmark studies published in 1978 and 1983, both of which found that in scientifically controlled, randomized trials, heart patients who underwent bypass surgery did not fare significantly better than those who received other medical treatment. Numerous other studies have concluded that many bypass operations are unnecessary.
He also cites the death rate for bypass operations--4.9% of bypass patients in California died last year as a result of the surgery--compared to a 1.9% annual death rate for coronary artery disease itself.
For angioplasty, the overall death rate is about 2%, according to Whitaker, although separate statistics for Medicare patients, who are likely to be older than the average angioplasty patient, show a death rate of 4%. Meanwhile, no controlled studies of the procedure’s safety and effectiveness have been published so far.
The first randomized trials, comparing angioplasty with bypass surgery and non-invasive medical treatment, began in 1988 and will take years to produce results. And according to the Johns Hopkins Medical Letter, 35% of blockages cleared by angioplasty return within the first six months.
One study of the use of angioplasty in acute heart attack patients “failed to demonstrate that the procedure was helpful,” Whitaker says.
After that, he says, “I read that a group of invasive cardiologists took a ‘straw poll’ and decided to shelve (the study) and rely on their ‘clinical experience’ as to which acute (heart attack) patients should receive angiograms and angioplasty.”
Whitaker also objects to diagnostic angiograms, which doctors often use to determine whether a patient has coronary blockages. Although the death rate from angiograms is low--he estimates it at anywhere from 0.1% to 0.5% annually nationwide, he calls those “excess deaths,” citing a 1984 study published in the New England Journal of Medicine which found that angiograms were highly inaccurate in assessing the extent of coronary artery blockage. “A million angiograms are done every year in this country,” he says, “and 90% of them are unnecessary.”
The author of three books, “Reversing Heart Disease” (Warner Books, 1985), “Reversing Diabetes” (Warner Books, 1987) and “Reversing Health Risk” (Putnam, 1988), Whitaker prefers taking a non-invasive approach in treating heart disease. He uses electrocardiograms and stress tests, both low-risk procedures. “In some rare cases, I have referred patients for bypass surgery,” he says. “For them, it was the best choice. But those are rare cases.”
Whitaker recommends dietary changes, modeled after the low-fat, high-complex-carbohydrate diet developed in the early 1970s by Nathan Pritikin, and regular aerobic exercise, to reverse heart disease. “The only thing that can take a risk of 1 in 100 down to 1 in 400 is diet and exercise,” he says. He also recommends nutritional supplements.
Whitaker worked with Pritikin at the Pritikin Longevity Center in Santa Monica during the 1970s and was co-founder, with Nobelist Linus Pauling--known for his advocacy of aVitamin C--of the California Orthomolecular Medical Society. He originally planned to go into orthopedics, then became interested in nutrition while working as an emergency room physician.
After reading several of Pritikin’s monographs on nutrition and heart disease, he went to work with him and was amazed at the “total improvement” he saw in patients. “Everything about them improved. It wasn’t just a pill that brought down their blood presure. I never saw anything like that in the hospital, and I decided that was the way I wanted to practice.”
He moved to Orange County and set up his own live-in treatment program in 1979. Patients now come from all over the world to attend the one-week program, conducted at Le Meridien hotel in Newport Beach.
Whitaker has become more and more vocal over the years as the number of bypass surgeries and angioplasties has grown. Angioplasties, he says, were originally expected to reduce the number of bypass surgeries, but instead both are increasing. At the same time, he says, “the death rate from heart disease is dropping, in spite of the explosion in these procedures.”
“It’s like trying to stop a train going downhill with no brakes,” he says. “The industry has so much momentum going.” But he’d like to install brakes, in the form of a mandatory second-opinion program for bypass surgeries and angioplasties, and he has enlisted the aid of the doctors who conducted the cautionary studies. Some have responded with encouragement; others haven’t.
He also believes that new medical procedures should be subject to the same kind of scrutiny as new drugs before they can be implemented. “If angioplasty were a drug, it would never have been approved,” he says. “But it isn’t, so it didn’t even have to go through that process.”
Whitaker knows that his nonconformity can cause problems. Last year, a doctor in another state who had not even examined the patient in question complained about Whitaker to the California Board of Medical Quality Assurance. Although the board took no action against him, Whitaker says he still worries about criticism from other physicians. He worries that: “If I don’t go along, I’m a marked man.”
But the history of medicine includes many popular medical techniques that were later abandoned. “Dr. Benjamin Rush believed in bleeding,” Whitaker says. “He bled George Washington to death. Washington didn’t want to be bled, but his family said, ‘We want you to have the best, and the doctor says this is what you should do.’ ”
