Not Just a Science But an Agenda: Nutrition and Whole Practice Ayurveda for Diabetes Care in the Recent Alternative Therapies

Summary:  This article reviews two sections from the recent Alternative Therapies in Health and Medicine (ATHM) (Sept/Oct 2006). First, a look at a whole practice approach to diabetes and second, the state of nutrition research, education and its uptake into practice via an interview with Jeffrey Blumberg, PhD. Both remind us that much of our best work is not merely a science, or a practice, but must, as Blumberg's mentor taught him, "be an agenda".

"Single-modality studies may not capture the potential synergistic or additive effects of a multi-modality program. Complementary medical systems also may offer alternative paradigms that could lend fresh insight into the etiology and management of the spiraling diabetes epidemic. CAM proponents maintain that holistic interventions offer non-specific quality of life benefits that are difficult to measure and often overlooked. Whole-systems research is an evolving discipline that seeks to rigorously evaluate complex multi-modality CAM interventions as they are authentically practiced."

Staff-model HMO - source of patients in the Ayurdeda study

• subjective improvements in general health and "overall well-being"
• no statistically significant differences on the clinical outcomes, though "trends favored the Ayurvedic group"
• outcomes were best among those with greater severity of their condition
  
• members of the control had higher incidence of adding new pharmaceuticals and or strengthening the pharmaceuticals in their regimes
  
• no study-related adverse events.
  

"On the other hand, because Ayurveda is actually practiced using a multi-modality paradigm, with the various modalities presumed working in synergy, the entire program's effectiveness remains the clinically relevant issue."

states: "Our program was not just academic but had to address much larger problems."

Yet, despite his early grasp of the importance of agenda, Blumberg's

• the continuing dismal state of nutrition education in conventional medicine
• the way researchers "readily embrace supplements as a research tool" rather than whole foods and diets, even if the agenda value (changing human health) is in the latter (and  knowing that supplement administration, in the whole practice of integrated care, is typically in the context of recommendations of dietary changes)
  
• the way that, even following positive studies, "there seems to be reluctance to adapt the actual evidence to practice"
• how practice and payment processes harm our outcomes since even those who value nutrition feel they "simply do not have the time to assess each patient's dietary pattern and nutritional status."
  
• the "false promise" that, if we hold out for "a single gold standard" on nutrition trials that "all the necessary trials will be done in our lifetime or even in our grandchildren's lifetimes."
  

ATHM editor-in-chief Mark Hyman, MD

Comment:

• suggestion of lower cost of conventional pharmacy
  
• potentially lower adverse effects, over time, if the pattern of fewer pharmaceuticals continues
  
• potentially lower costs, over time, from fewer additional complications associated with  associated with the emergent pattern of higher pharmacy
  
• potentially the benefits of new patterns of behavior, of eating, of exercise, of thought, spreading to influence other areas of morbidity
• potentially higher productivity and diminished absenteeism from the qualiy of life changes
  
• potentially broader positive side-effects of these patients spreading their new habits and learnings to their friends and colleagues through the examples they set.
  

Publisher of ATHM

In this light, with these potential benefits, the practice Hyman describes becomes a kind of clinical-public health, with value that reaches to communities. Ask an employer if these cost and quality of life outcomes may be meanignful?

Blumberg's perspectives on nutrition, alone, underscore how much pushing whole practice research models must not just be left to the researchers, but also extend to educators and policy makers. What CAM or IM discipline has issued a position paper on this topic? What group has promoting funding for this kind of research as part of its agenda? To what extent have we stood up for the "authenticity" of what people need against the reduction of what works, most easily, for a reductive researcher?

What we are about here, of course, is not just science but also an agenda.