The China Study (49 page)

BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING?                 323
surgeons. In addition, Ess's own father was a distinguished physician
with a national reputation. But, as Ess remembers, despite being "health
experts," all four of these men were "ravaged by cardiovascular dis-
ease." His own father had a heart attack at age forty-two and Dr. Brook
had a heart attack at age fifty-two.
These were the men he looked up to, and when it came to cardiovas-
c u l a r disease, all of them were helpless. Shaking his head, Ess said, "You
can't escape this disease. These people, who were giants in the prime of
their years, just withered." As he took a moment to remember his father,
he said, "It was the last year or two of my dad's life, and we were just
strolling along one day. He was saying, 'We are going to have to show
people how to lead healthier lives.' He was right on it. He was intensely
interested in preventive medicine, but he didn't have any information."
His father's interest has been a driving influence in Ess's life.
Following in these men's footsteps, Ess went on to amass an extraor-
dinarily impressive list of awards and credentials: an Olympic gold
medal in rowing; a Bronze Star for military service in Vietnam; President
of the Staff, member of the Board of Governors, chairman of the Breast
Cancer Task Force, and head of the Section of Thyroid and Parathyroid
Surgery at the Cleveland Clinic, one of the top-ranked medical institu-
tions in the world; president of the American Association of Endocrine
Surgeons; over 100 professional scientific articles; and inclusion on a
list in 1994-95 of the best doctors in America. 2 He remembers, "For
about a ten- to fifteen-year period I was the top earner in the depart-
m e n t of general surgery. As Dr. Crile's son-in-law, I was panicked about
not pulling my weight. I didn't get home until late at night, but I had
a position that was secure." When the then-president of the American
Medical Association needed thyroid surgery, he wanted Ess to be the
one to operate.
But despite the accolades, the titles and the awards, something was
not right. So often, Ess~ patients did not regain their health, even after his
best efforts. As Ess described it, he had "this haunting feeling that was
really beginning to bother me. I kept looking at how the patients were
doing after these operations." Slightly exasperated, he said, "What is
the survival rate for cancer of the colon? It's not so great!" He recounted
the operation for colon cancer on one of his best friends. During sur-
gery, they saw that the cancer had spread throughout the intestines. Ess
lowered his voice ever so slightly in remembering this, saying, "You get
there after the horse has left the barn." In thinking about all the breast

324                           THE CHINA STUDY
surgery he had done, the lumpectomies and mastectomies, he expressed
disgust at the idea of "disfiguring somebody when you know that you
haven't changed their chances for recovery. "
He began to do some soul searching. "What is my epitaph going to
be? Five thousand mastectomies! You've disfigured more women than
anybody else in Ohio!" Dropping the sarcasm, he said with sincerity, "I
think everybody likes to leave the planet thinking that maybe ... maybe
you've helped a little."
Dr. Esselstyn began studying the literature on the diseases he com-
m o n l y treated. He read some of the popular work of Dr. John McDou-
gall, who had just written a best-selling diet and health book called The
McDougall Plan. 3 He read the scientific literature that compared inter-
n a t i o n a l disease rates and lifestyle choices, and a study by a University
of Chicago pathologist showing that a low-fat, low-cholesterol diet fed
to nonhuman primates could reverse atherosclerosis. He came to the
realization that the diseases that so often plagued his patients were due
to a diet rich in meat, fat and highly refined foods.
As mentioned in chapter five, he got the idea to treat heart patients
with a low-fat, plant-based diet, and in 1985 went to the head of the
Cleveland Clinic to discuss his study. She said that nobody had ever
shown that heart disease in humans could be reversed by using dietary
treatment. Still, Ess knew he was on the right track and went about qui-
etly conducting his study over the next several years. The study he pub-
lished, of eighteen patients with heart disease, demonstrated the most
dramatic reversal of heart disease in the history of medicine, simply by
using a low-fat, plant-based diet and a minimal amount of cholesterol-
r e d u c i n g medication.
Esselstyn has become a champion of dietary treatment of disease, and
he has the data to prove his case. But it hasn't been easy. Rather than
recognizing him as a hero, some in the medical establishment would
rather he disappear. Somewhere in this transition from top-ranked,
self-described "macho, hard-ass surgeon" to dietary advocate, he has
become known, behind his back, as Dr. Sprouts.
A DAUNTING TASK
What's interesting about this story is that a man who had reached the
pinnacle of a highly respected profession dared to try something dif-
ferent, succeeded, and then quickly found himself on the outside of

81G MEDICINE : WHOSE HEALTH ARE THEY PROTECTING?                325
the establishment looking in. He had threatened the status quo by his
circumvention of standard treatments.
Some of Ess's colleagues have disparaged his treatment as being too
"extreme. " Some doctors have dismissed it by saying, "I think the re-
search in this area is pretty soft," which is an absurd comment consider-
ing the breadth and depth of the international studies, the animal stud-
ies and the intervention studies. Some doctors have said to Ess, "Yeah
okay, but nobody is going to eat like that. I can't even get my patients
to stop smoking." Ess's response was, "Well, you really have no training
in this. This requires just as much expertise as doing a bypass. It takes
three hours for me to counsel a patient," not to mention the diligence
required for the constant follow-up and monitoring of the patient's
health. One patient told his cardiologist that he wanted to see Ess and
commit to a dietary program to reverse his heart disease. The cardiolo-
gist responded, "Now you listen to me. There is no way to reverse this
disease." You'd think that doctors would be more excited about healing
their patients!
In talking about doctors and their unwillingness to embrace a whole
foods, plant-based diet, Ess says, "You can't get frustrated. These aren't
evil people. There are sixty cardiologists [at the Cleveland Clinic] , any
number of whom are closet believers in what I do , but they're a little
afraid because of the power structure."
For Ess, however, it has been impossible to avoid his share of frustra-
tion . Early on, when he was first suggesting dietary treatment of heart
disease, colleagues greeted the idea with caution. Ess figured that their
attitude was born out of the fact that scientific research showing effec-
tive dietary intervention of heart disease in humans wasn't yet strong
enough. But later, scientific results of unparalleled success, including
Esselstyn's, were published. The data have been strong, consistent and
deep, yet Ess still encountered reluctance to embrace this idea:
You take a cardiologist and he's learned all about beta blockers, he's
learned about calcium antagonists, he's learned about how to run
this catheter up into your heart and blow up balloons or laser it or
stent it without killing you and it's very sophisticated. And there's all
these nurses and there's lights out and there's drama. I mean it's just,
oh my god, the doctor blows up the balloon in his head. The ego of
these people is enormous. And then someone comes along and says,
"You know, I think we can cure this with brussels sprouts and broc-

326                           THE CHINA STUDY
coli." The doctor's response is, "WHAT? I learned all this crap, I'm
making a freakin' fortune, and you want to take it all away?"
Then when that person comes along and actually cures patients with
brussels sprouts and broccoli, as Esselstyn did, and gets better results
than any other pill or procedure known, you've suddenly announced
that something works, hands down, better than what 99% of the profes-
s i o n is doing. Summarizing his point, Ess says:
Cardiologists are supposed to be expert in diseases of the heart-
a n d yet they have no expertise in treating heart disease, and when
that awareness strikes them, they get very defensive. They can
treat the symptoms, they can take care of arrythmias, they can get
you interventions, but they don't know how to treat the disease,
which is a nutritional treatment .... Imagine a dietitian training a
heart surgeon!
Esselstyn has found that merely saying that patients can have control
over their own health is a challenge to many. These experts, after all,
are built up to be the dispensers of health and healing. "Intellectually
it's very challenging to think that the patient can do this with greater
alacrity, dispatch, safety, and it's something that's going to endure." With
all of the doctor's gadgets, technologies, training and knowledge, noth-
i n g is more effective than gUiding the patient to make the right lifestyle
choices.
But Ess is qUick to point out that doctors are not malicious people
engaged in a conspiracy:
The only person that likes change is a newborn, and it's natural,
it's human nature. Anywhere you go, 99% of the people are eating
incorrectly. The numbers are against you, and it's very hard for
those 99% to look at you in the 1% and say, "Yes, he's right, we are
all wrong."
Another obstacle: lack of nutrition knowledge amongst physicians.
Ess has had his share of interaction with ignorant doctors, and his im-
p r e s s i o n is that "it's absolutely daunting, the lack of physician knowl-
edge that there is about the fact that disease can be reversed. You won-
der, what is the literature that these guys read?"
Physician knowledge often involves only the standard treatments:
pills and procedures. "What does the twentieth century of medicine

BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING?                 327
have to offer? We have pills and we have procedures. Right?" Esselstyn
leans forward and, with a slight grin, as if he's about to tell us the em-
p e r o r has no clothes, he says, "But who ever says, 'Maybe we ought to stop
disease'?" In Dr. Esselstyn's experience, stopping disease does not figure
prominently into the status quo.
LACK OF TRAINING
The medical status quo relies heavily on medication and surgery, at the
exclusion of nutrition and lifestyle. Doctors have virtually no training in
nutrition and how it relates to health. In 1985 the United States National
Research Council funded an expert panel report that investigated the
quantity and quality of nutrition education in U.s. medical schools. 4
The committee's findings were clear: "The committee concluded that
nutrition education programs in U.s. medical schools are largely inad-
e q u a t e to meet the present and future demands of the medical profes-
sion."4 But this finding was nothing new. The committee noted that
in 1961 the "American Medical Association Council on Foods and
Nutrition reported that nutrition in the U.S. medical schools received
'inadequate recognition, support and attention.'''4.5 In other words, over
forty years ago, the doctors themselves said that their nutrition training
was inadequate. Nothing had changed by 1985, and up to the present
time, articles continue to be written documenting the lack of nutrition
training in medical schools. 6 • 7
This situation is dangerous. Nutrition training of doctors is not merely
inadequate; it is practically nonexistent. In 1985, the National Research
Council report found that physicians receive, on average, only twenty-
o n e classroom hours (about two credits) of nutrition training during
their four years of medical schoo1. 4 The majority of the schools surveyed
actually taught less than twenty contact hours of nutrition, or one to
two credit hours. By comparison, an undergraduate nutrition major at
Cornell will receive twenty-five to forty credit hours of instruction, or
about 250-500 contact hours; registered dietitians will have more than
500 contact hours.
It gets worse. The bulk of these nutrition hours are taught in the first
year of medical school, as part of other basic science courses. Topics
covered in a basic biochemistry course may include nutrient metabo-
lism and/or biochemical reactions involving certain vitamins or miner-
als. In other words, nutrition is often not taught in relation to public health
problems, like obeSity, cancer, diabetes, etc. In conjunction with the 1985

328                          THE (HINA STUDY
government report, the president of the American Medical Students As-
sociation , William Kassler, writes8 :
Most nutrition in the formal curriculum is incorporated into
other courses. Biochemistry, physiology and pharmacology are the
courses most often alleged to contain some nutrition instruction.
Too often in such courses, nutrition is touched on briefly, with the
primary emphasis on the major discipline. It is quite possible to fin-
ish such a course and not even realize that nutrition was covered [my
emphasisl. Nutrition taught by those whose interest and expertise
lie elsewhere simply doesn't work.
It gets even worse! When nutrition education is provided in rela-
t i o n to public health problems, guess who is supplying the "educa-
tional" material? The Dannon Institute, Egg Nutrition Board, National
Cattlemen's Beef Association, National Dairy Council, Nestle Clinical
Nutrition, Wyeth-Ayerst Laboratories, Bristol-Myers Squibb Company,
Baxter Healthcare Corporation and others have all joined forces to
produce a Nutrition in Medicine program and the Medical Nutrition
Curriculum Initiative.9 • 1o Do you think that this all-star team of animal
foods and drug industries representatives is going to objectively judge
and promote optimal nutrition, which science has shown to be a whole
foods, plant-based diet that minimizes the need for drugs? Or might
they try to protect the meat-centered, Western diet where everyone
expects to pop a pill for every sickness? This organization is creating
nutrition curricula, involving CD-ROMS, and giving them away to
medical schools for free. As of late 2003, 112 medical schools were
using the curriculum. l l According to their Web site, "Plans are un-
derway for developing versions for undergraduate nutrition students,
continuing medical education and other health professions audiences."
(http://www.med.unc.eduinutr/nimlFAQ.htm#anchor197343)
The dairy industry has also funded research investigations into nu-
t r i t i o n education in medical schools12 and has funded "prestigious"
awards. 13 , 14 These efforts show that industry is well prepared to promote
its monetary interests whenever the opportunity presents itself.
You should not assume that your doctor has any more knowledge
about food and its relation to health than your neighbors and cowork-
ers. It's a situation in which nutritionally untrained doctors prescribe
milk and sugar-based meal-replacement shakes for overweight diabet-
ics, high-meat, high-fat diets for patients who ask how to lose weight