Dear 42nd President William Jefferson Clinton:
With all their good intentions, and the use of sophisticated, expensive technologies, your doctors are allowing your heart disease to progress as if it were a runaway train destined for a wreck. Your cardiologist, Dr. Allan Schwartz, at New York Presbyterian Hospital is telling you further blockage is the normal course of your disease, and your diet and lifestyle are not involved. Medical experts expressing their opinion in the news since your surgery are misleading the public into believing that the proper management of this disease is through constant surveillance and repeated surgical interventions. This is big business talking, and in addition to mismanagement of your personal care, one result will be an increase in the already more than one million angioplasties and 500 thousand bypass surgeries performed annually in the US.
Recall your first painful encounter with the heart surgery business on September 3, 2004 when you were hospitalized following an episode of chest pain. You had quadruple bypass surgery three days later. A couple of days ago, on Thursday, February 11, 2010, you needed the heart surgeons again. You had two bare metal stents placed in your heart following a few days of mild chest discomfort. This history will continue to repeat itself until you seriously change your eating habits and get these meddling doctors out of your life. You are missing another "teaching moment" and bypassing another chance to change health and healthcare in America.
In a letter I sent to you the day following your hospitalization in 2004, I pleaded with you to refuse bypass surgery. I told you that bypass surgery does not save lives in most cases, and I warned you of the brain damage you would suffer from being on the heart-lung bypass machine. Likely you did not read that letter. Following your quadruple bypass you were a noticeably different man. Your sometimes-irrational behavior during Hillary Clinton's campaign was in part due to your surgically-induced mental decline. I sent another letter in the spring of 2008 apologizing for the harm my colleagues caused you and their failure to offer you intensive medical therapy founded on a healthy diet. I believe you received that letter or read the Wall Street Journal article that followed about your brain damage. Since you became aware of your functional loss you have seemed to me to be in much better control when before the public.
I am taking the opportunity in this letter to try to help you again. By helping one of our country's greatest statesmen, I may be able to help other heart patients (which happens to include most adults following the Western diet). This is my third attempt, but likely not my last, because, after all, your heart doctors (Dean Ornish, MD being an outstanding exception) believe your disease is unstoppable. Remember what they said: they are going to manage your future health by constant surveillance and repeated surgical interventions. These well-educated professionals are dead wrong on how to care for a patient such as you.
In order for you to stop having false hope you need to be told that heart surgery, including bypass surgery and angioplasty with or without stents, does not save lives in the vast majority of cases. You have not been fixed by either procedure. The reason for this is that the bypass surgeons and cardiologists are operating on the stable hard fibrous plaques that do not kill people. Why do they operate on nonlethal lesions? Because they can. These large fibrous stable plaques, which have been present for years if not decades, are visible by technologies like angiograms and heart scans. Once visualized, they become targets for knives, grafts, sutures, and catheters.
The disease that really kills is largely invisible to your doctors. Tiny festering sores that rupture cause heart attacks, and the deaths that follow these heart attacks in nearly half the cases. In order to understand the underlying problem, think about pustules or pimples rupturing on a teenager's face, but in this case the deadly activity is inside your arteries. In medical terminology, these tiny sores are called "volatile plaques." When they pop, substances generally referred to as "products of injury" are released. The body's response is to form a blood clot to cover up the wound (similar to the blood clot that forms when you cut your hand with a knife). If the blood clot (called a thrombus) is large enough, then the flow in the entire heart artery can be blocked off. The heart muscle that lies distal to this sudden blockage usually dies--and that is how a heart attack occurs.
Why do heart surgeons not operate on the killing part of this disease? Because they can't. They cannot see these tiny festering sores with current technology. Even if they could see these "silent killers," they have no surgical techniques to stop them from exploding. The only solution is to allow the body to heal your steadily-progressing disease by making serious dietary changes. (Medications, such as aspirin and statins, when judiciously used, can be of benefit as well.)
I realize you were frightened by the chest discomfort on both occasions (2004 and 2010). Fortunately, changing to a healthy low-fat diet (like the Pritikin, McDougall, Ornish, or Esselstyn Diets) reduces the intensity and/or stops the chest pains very quickly. Improvement in blood flow begins with the first good meal. In a matter of hours the blood naturally thins and a blood clot is less likely to form if a volatile plaque does rupture (aspirin helps too). Spontaneous healing is a powerful force -- within the first week the risk of pustule rupture is greatly reduced. In a matter of months, reversal of artery disease can be seen by current technologies (angiograms and PET scans).
The truths I have given you are indisputable and most of your doctors are well aware of the solid research behind what I have told you. Your problem now is the same as everyone else's: making the change. This is not easy, especially when you have almost no conservative medical support. If you do not change you can expect your future to be more like the past, but probably worse, because you are getting older. So for your sake, and all those who benefit from your work, I invite you to attend the next 10-day, live-in, McDougall Program in Santa Rosa, California, March 19 to 28, 2010. You can call me at (800) 941-7111. In this short time together, I promise we will change your life dramatically for the better. When that happens I will stop writing you these cautionary letters, which so far have accurately predicted your future.
John McDougall, MD