Your Comments: 3 on Group Services/Chrysler; COCSA/AMI Partnership; Suggestions for an Integrated Asthma Pathway; and More on Hurley's Campaign Against Supplements

Summary: The story on the success of a group-focused services clinical strategy for a Chrysler employee population led by Robert Levine, PhD, for Henry Ford Health Systems (HFHS), prompted a number of responses. Lisa Rohleder, LAc, with the Community Acupuncture Network (CAN) notes of stimulating a dialogue and real-time link with Levine in the CAN Blog. The HFHS outcomes promoted Adrian Langford, who runs a patient-focused program with a Medicaid population with Alternative Medicine Integration Group, to comment on what promotes the positive patient outcomes. Taylor Walsh wondered at the use by Karlo Berger, ABT, LMT, of "collective healing" to describe some of the power of these setting ... In other notes, the COCSA-AMI relationship stimulated a note from COCSA executive director Janet Jordan ... Chris Huson, LAc opens a dialogue about a suggested integrated pathway for asthma and Rik Cederstrom, DC, responds to another attack on supplements by author Michael Hurley, this one broadcast for Medscape. And Integrator adviser Michael Levin adds a comment on the latest Hurley blast.

Community Acupunture Network

"Thanks for the plug! I posted a link from CAN's blog and it turns out that a CAN member is located very close to the Henry Ford project. You can see it in the comments on this post.

"She's going to get in touch with them. I love the Internet...

Lisa Rohleder, LAc
Portland, Oregon

"I just read with interest the pilot from Henry Ford Health Systems administered by Robert Levine. 

"I think his findings are similar to ours in terms of outcomes and effectiveness. The one area that is often overlooked is the value of dialogue for the patients. Our case managers provide significant opportunities for patients to vent as well as dialogue about more holistic approaches to healing. When a patient experiences some form of validation and recognition of the pain from another party who promotes self management and holistic exploration there seems to be a corollary with positive outcomes.

"I think the group experience provides opportunities for dialogue and thus increased positive outcomes."

Adrian Langford
Vice President
Alternative Medicine Integration of Florida, LLC

Entrepreneur Taylor Walsh

"The only problem I have with Karlo's compelling piece is in some wording.  A word: 'collective.'   In America it might sell better if it were called 'team healing.'  

"We love teams and their inherent purposeful action. Just a thought."

Taylor Walsh, Publisher
LifePages

" ... Interestingly enough, our announcement about AMI generated more response from our members than usual. We are very excited at the possibilities this initiative will bring to COCSA, our member associations, their doctors and the chiropractic profession in general."

Janet Jordan, Executive Director
COCSA

Chris Huson, LAc

"According to the Centers for Disease Control and Prevention, 'Over 9 million U.S. children under 18 years of age (13%) have ever been diagnosed with asthma, and 6.5 million (9%) still have asthma.' (p4. Summary Health Statistics for U.S. Children: National Health Interview Survey, 2005, U.S.Department of Health and Human Services) Most children with asthma in the United States are 'managed' by conventional medical care. However, a treatment plan integrating conventional medicine (CM) and Traditional Chinese Medicine (TCM) may prove to be more economical than stand-alone CM care. By using the outcomes measurements designed for the assessment of conventional medicine we can compare the long- and short-term effects of including TCM in the treatment model. 

"The western medical approach to pediatric asthma is well-established. Children’s asthma is 'managed' by the use of bronchodilators to treat acute attacks, and corticosteroids for 'control' of symptoms during chronic (remission) periods. Allergic triggers in diet and environment are identified and avoided. TCM’s approach to pediatric asthma is also well-established: patients are assessed through differential diagnosis and treated with a combination of acupuncture, herbal medicine, medical massage, dietary therapy, and exercise.

"It appears there may be enough similarity between the two (TCM/CM) systems’ differential diagnosis and treatment of pediatric asthma to allow for the development of an integrative clinical treatment pathway featuring both TCM and CM. Comparative efficacies can be determined by existing standards of outcomes measurement. These include: peak expiratory flow metering, pulse oximetry, spirometry, use of asthma-related health care services, use of anti-inflammatory medications, changes in functional status, quality of life assessment, measurement of total or asthma-related school days lost. 

"The American healthcare marketplace measures medical efficiency through cost-effectiveness. Integrative approaches for the treatment of knotty public health dilemmas are not only being defined, they’re being funded! If, through the development of an integrative clinical pathway for the treatment of pediatric asthma, we can prove that it is beneficial to employ both TCM and CM together, this may prove to be beneficial both to our children and our profession."

6.    Chiropractor responds to another Hurley blast against supplements from Medscape

Rik Cederstrom, DC

The Integrator has covered the attacks author Dan Hurley has leveled against dietary supplements and carried in the New York Times, together with some astute commentary by Michael Levin and a strong response to the Times from US Senators Orrin Hatch (R-UT) and Tom Harkin (D-IA). Rik Cederstrom, DC, encountered a July 30, 2007 editorial by Hurley in Medscape and sent this letter to the Integrator which was his response to Medscape. I asked Integrator advisor Levin for his comments on both. His are attached below.

"There are lies, damned lies and statistics. That doesn’t necessarily target Mr. Hurley’s clear bias in writing on Vitamins and Supplements, but it comes close.

"As a chiropractor it has come to my attention that philosophy matters. I had a patient for whom I recommended glucosamine sulfate. His M.D. promptly told him not to take it because 1) It has a glucos(e) group, that might aggravate your diabetes 2) It thins the blood and may not work well with the Warfarin. Let’s skip the M.D.s obvious ignorance on glucosamine and Diabetes (it’s not a problem) and go to the blood thinning. Yes, an all natural nutritional lifestyle will naturally 'thin the blood.' My primitive natural philosophy would suggest that thinning blood with nutrition would mean that you don’t need the drug. Measuring platelet aggregation is one of the easiest lab tests done. If you can do it naturally, then skip the drug! My experience tells me that most M.D.s don’t understand this concept or disagree with it. 

"Research is not gospel and it does not lead. It follows clinical judgement. It only answers the question asked and that only if the study design is good. It is subject to editorialized interpretation by experts who presume that others won’t be able to find the holes in their logic.

"I have several references on glucosamine and arthritis, not including my old file cabinet and a couple books in my library. One summary of recent research is “Current Role of Glucosamine in the Treatment of Osteoarthritis” J.-Y. Reginster; O. Bruyere; A. Neuprez Rheumatology.  2007;46(5):731-735.  ©2007 Oxford University Press. Clearly, there is benefit for Degenerative Osteoarthritis and perhaps some other forms of arthritis with the use of glucosamine. Not every study shows the potential of a therapy. That does not mean it isn’t there. Mr. Hurley carefully “cherry picks” negative studies and cites them as the final authority.

"I have never been taught that Echinacea would prevent a cold. I have been taught that it can be helpful to strengthen immune function. Mr Hurley carefully phrases the comment to evade the benefit. He does this repeatedly.

"It would take considerable time to expand on every misrepresentation that Mr. Hurley makes to present his agenda. I assume that [Medscape gives] him editorial space as a policy of free speech. In the interests of responsible journalism, perhaps you will make sure that the other side is presented. Few things are as safe as the vitamin and supplement consumption in America and elsewhere. That doesn’t mean that there is no room for improvement. Medical doctors with no education on these topics are not the experts to be deciding the appropriate steps to take. The case could be made that naturopaths (and pharmacists) are the experts in this arena and that you need their expert input." 

Dr. Rik Cederstrom D.C.

Added Note; "P.S. I have nothing against the concept of evidence based medicine,” however, in practice it seems to be primarily a strategy for Insurance Companies to deny payment."

Integrator adviser Michael Levin

Michael Levin responded promptly to my request for a response to this exchange. He chose to target Hurley's commentary.

"Biased and continuous misrepresentation of the dietary supplement knowledge base serves no useful purpose. In its fear-mongering devisiveness, it puts the public health at risk.

"Perhaps in one of the more egregioius of his many contentious claims, Mr. Hurley ignores the US Dept of Agriculture as a credible source for nutrient content recommendations. The USDA NHANES survey reports that, due to poor eating habits, a significant portion of the total US population was found deficient in five essential nutrients across all ages and it's even worse in kids: among schoolage children, 37% were predicted to be deficient in magnesium, 51% were predicted to be deficient in folate, and 79% were predicted to be deficient in vitamin E. (http://www.health.gov/dietaryguidelines/dga2005/report/HTML/D1_Tables.htm) 

"Like Hurley, I strongly support evidence-based medicine - and acknowledge both it's strengths (extent of objective measurable experience in specific populations) and it's limitations (patients are individuals, some things are not easily measurable). However, I recoil when hearing his assertions that there is no evidence supporting nutritional interventions (there's a ton). I am reminded of the gastroenterologist at Mayo who injected a now-illegal, carcinogenic gasoline additive (MTBE - methyl tert butyl ether) through a trans-hepatic percutaneous cather into the gallbladders of hundreds of patients seated in an explosion-proof room in order to disslove their cholesterol-rich gallstones. That was evidence-based. MTBE is a great cholesterol solvent! (think I'm kidding?: chech http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=2384985&dopt=AbstractPlus_ But I digress....

"Though some might argue to simply ignore Hurley's comments in the hope he'll fade away, I disagree. I encourage all nutritional scholars to publicly challenge Medscape and Mr. Hurley. Why? For free speech to be a pathway to truth, it must be a two-way street. Left unchallenged, physicians viewing this advertorial will not have the benefit of responsible, factual counterbalance. The public health deserves better. Please speak up."