Your Comments: Group IntegrativeServices, AOM Integrated Asthma Guidelines, Hurley/Medscape, plus
Written by John Weeks
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.
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1. Group outcomes at Chysler provoke discussion in the Community Acupuncture Network
Community Acupunture Network
In my comments on the success of group-focused complementary services provided for Chrysler employees noted that one place where group services are embraced by the integrative and complementary healthcare community is in the Community Acupuncture Network (CAN). Lisa Rohleder, LAc, co-founder, sent in this note.
"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
2. Similar outcomes to Chysler program in Medicaid integrative therapies project
Adrian Langford is an executive with Alternative Medicine Integration Group (AMI) for which he developed and runs an integrative therapies pilot project for a Medicaid population. I have interviewed Langford for a story, which will be published in September, on the pilot. The AMI's case managed program has some over-laps in the patient-focused approach.
"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
3. "Collective healing" - what do we call the power of the group process?
Entrepreneur Taylor Walsh
Karlo Berger responded to Levine's work with a Guest Column and used the phrase "collective healing." This brought a suggestion from Taylor Walsh, the publisher of Life Pages.
"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
4. Provider group's endorsement of CAM managed care organization generates strong response
The Integrator recently carried an article on the surprising decision of a practitioner organization, the Council of Chiropractic State Associations, to endorse a managed care organization, Alternative Medicine Integration Group. Janet Jordan, COCSA's executive director sent along a note:
" ... 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
5. Acupuncture leader suggests "Integrated Pathway for Treatment of Asthma"
Chris Huson, LAc
Chris Huson, LAc is a past president of the Washington Acupuncture and Oriental Medicine Association and a colleague in the Clinician Workgroup on the Integration of CAM. I had the opportunity to help Lori Bielinski, LMT organize this group for former Washington State Insurance Commissioner Deborah Senn. Huson sent the following "Integrated Pathway for the Treatment of Asthma," unsolicited.
"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."
Comments: Ideas on this proposal? Send them to the Integrator or to Huson at
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 Medscapeand 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 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."