Panel backs coverage for diet, lifestyle change: advisory committee wants Medicare to pay for programs designed to prevent and reverse heart disease.(Clinical Rounds)

BALTIMORE -- There might not have been thunderous applause at a January meeting of the Medicare Coverage Advisory Committee, but the quiet approval was quite enough for Dean Ornish, M.D.

The committee, which advises Medicare on coverage issues, voted to recommend that Medicare cover the use of physician-supervised intensive diet and lifestyle change programs for preventing and reversing heart disease--programs such as the one developed by Dr. Ornish.

"I'm pleased by the opportunity to have all the evidence considered," he said after the panel approved the recommendation, adding that he hoped that the evidence was compelling enough for Medicare to make this type of lifestyle intervention a part of its benefits package.

Medicare is not obligated to accept the recommendation of its advisory committee.

Dr. Ornish, president of the Preventive Medicine Research Institute, Sausalito, Calif., outlined his program, which consists of putting patients on a very low-fat diet (about 10% fat), getting them on a moderate exercise program, teaching them stress management techniques such as stretching and meditation, and enrolling them in support groups.

In a 1-year study of 28 patients who took part in the program and 20 controls, he found that the average percentage diameter stenosis regressed from 40% to 37.8% in the experimental group, compared with an average progression from 42.7% to 46.1% in the control group. In addition, there was a 91% reduction in angina in the intervention group, compared with a 165% increase in the control group.

Dr. Ornish also investigated whether other providers could be trained to implement his program, so he set up demonstration projects in other sites with more than 2,000 patients.