Monday, April 29, 2013

Michael Pollan: Cooked

We’re off on a bit of a tangent this week. All of us are engaged in helping to train chiropractors. Part of that involves working with patients to help them modify their dietary habits, in order to help reduce obesity, hypertension, diabetes and the risk that comes with having those conditions. Thus, we include courses in nutrition in our curriculum, and we look at interventions designed to help patients improve their health naturally. All this by way of suggesting that we look carefully at Michael Pollan’s new book, “Cooked.”

Pollan reports on the changing nature of food delivery in the United States. In his earlier book “The Omnivore’s Dilemma,” he focused on the growth of the factory farm and the implications for the long-term health of US citizens. In this book, I can reduce his core argument down to a sound bite, but it is a very important sound bite: Cook more by yourself, using natural products, and have family meals each day.  Pollan finds that the average person spends no more than 27 minutes a day in food preparation, uses corporate products to make meals, and often does not have family dinners.
Confession: I am marries to a woman who spent many years of her life as a professional chef. She worked initially in a gourmet grocery and later owned her own h9igh-end catering business, where she often cooked for celebrities and politicians in the Chicago area. In fact, she once made a dinner for the president of McDonald Corporation. And she still cooks, and loves to cook. So, we don’t go out to dinner (except when we travel), and we make dinner every day, using the best produce we can find.

But this puts us at odds with the vast majority of Americans now. I often look at the grocery carts of people checking out at the same time we are, and I often see pre-made foods in high abundance, and I still see lots of white bread, sugared pop, and prepared foods. Pollan wants to change this, and this book is a broadside against the current state of the American food industry.
In the book, Pollan looks at what he calls Fire, Water, Air and Earth. In the section devoted to Fire, he discusses barbecue- not the kind of barbecue you might think about when I say the word, but about how fire transforms meat, how historically this meant something significant in human evolution, and how today’s pit masters harness the power of wood to make something spectacular. In Water, he examines braising food, using boiling water to create sauces and make the inedible edible. Air is about baking bread; how yeasts cause flour to rise, to allow air to enter, and to help then create a variety of bread styles. And in Earth, the focus in on fermentation, of which there is now an entire movement, one that my wife and I are members of. We were introduced to fermentation by our son, who was making not just beer, but also sauerkraut, kimchee, and kombucha. All are fermented products. And all are pretty easy to make, none more so than sauerkraut.

Here is how easy. To make sauerkraut, shred a couple of cabbages. We use red cabbage. Put in a clean glass jar, and liberally salt the cabbage. Place a weight on top- we use a plate with a baggie of water on it. Cover with a towel, and stick it in your basement. Come back in three weeks. When you do, and when you look at the jar, you will see all the bubbles of fermentation taking place. We then put the kraut in smaller storage vessels and stick them in the fridge. It is ready to eat. And the first time scares you because you know this is a controlled rotting process- but it’s great.
So, I recommend this book to you, and suggest it provides a pathway to a better and more sustainable food lifestyle. Well worth the read.

Monday, April 22, 2013

TED Talks

TED, which stands for Technology, Entertainment and Design, is an annual conference put on by the Sapling Foundation, and which is designed to allow for “ideas worth spreading.” Most of us have seen one or two TED presentations, but all of them are interesting, unique and informative.  If you have never seen a TED talk, I am offering here some which I think are best.

1.       Eric Dishman: Health care should be a team sport:

2.       Barry Schwartz: The paradox of choice:

3.       Stephen Hawking: Questioning the universe:

4.       Hans Rosling: Stats that reshape your worldview:

5.       Jill Bolte Taylor: Stroke of insight:

6.       Elizabeth Gilbert: Your elusive creative genius:

7.       Ken Robinson: Schools kill creativity:

8.       Dan Pink: The puzzle of motivation:

9.       Chimamanda Adichie: The danger of a single story:

10.   Roger Ebert: Remaking my voice:

In particular the speech by Roger Ebert, whom I considere the greatest critic in any field, is quite moving. I highly recommend spending time with TED.

Monday, April 15, 2013

Evidence in Action

As part of our R25 initiative, one of the desires we had was to demonstrate how to use evidence, in the form of information available to readers in scientific articles, as a means to resolve clinical scenarios. Dr. Christine Goertz and I had, initially sort of unknown to each other, been in conversation with leadership in the American Chiropractic Association to provide articles for the Journal of the American Chiropractic Association. We hoped to raise the profile of Palmer College faculty members while at the same time providing ACA members with information they could apply in practice. From this the idea of the Evidence-in-Action column was born.

In brief, we invited faculty from all three campuses to write short articles in which the author initially sets out a clinical scenario- often drawn from a real case, sometimes from a “created’ scenario- and then show how a piece of literature was then used to provide guidance in managing the patient. By doing so, we could begin to introduce the reader to core concepts in evidence-based practice: sensitivity and specificity, likelihood ratios, odds and risk ratios, and so on. Each article concentrated on a single core concept, so that this was done slowly and sensitively. And in each article, we highlighted the skills and knowledge of individual Palmer faculty.
According to the editor of JACA, this column has been one of the most well-received changes of the past few years. It has generated positive press and numerous compliments. We have committed to continuing this for the future, and at present have at least 3 new columns in preparation. To date, we have provided 18 such columns to the journal. This newsletter will link to past articles, and as new ones come on line, we will add them as well.

We hope that you find these articles interesting and informative and that you also take pride in the work of your fellow faculty members. And we invite you to consider preparing one as well. If you are interested, please contact Dr. Dana Lawrence at and he will help you get started.


Monday, April 8, 2013

The Signal and the Noise

Question: A single die has been rolled 4 times in a row and 4 heads have come up. Would you bet $100 that a tails will come up on the next roll?

Question: A new study has been published which shows a strong positive effect for the use of chiropractic adjusting to treat a specific orthopedic problem. The consensus is that this is methodologically a very strong and sound paper. Would this paper lead to you to change your behavior if you are a chiropractor who treats people with that condition?
Question: A new study has been published which demonstrates, using very stringent and rigorous methods that by consensus leads people to say this is a methodologically  very strong and sound paper, that there is no link between vaccination and autism. Would this paper lead you to change your behavior with regard to vaccinating your children?

I ask these questions as a form of mind exercise. I recently completed reading a new book by Nate Silver, titled “The Signal and the Noise: Why So Many Predictions Fail and Some Don’t.” Silver is the author of the 538 Blog, and he came to fame for his predications related to the past 2 presidential elections as well as the recent senatorial contests- he predicted Obama’s win and by the percentage he won, as well as 49 out of 50 senate contests. His book looks at how Americans have difficulty understanding prediction, whether in economics, earthquake forecasting, weather, health care or politics. He proposes a model for prediction that is based on just a few principles: (1) Think probabilistically, (2) Today’s forecast is the first forecast of the rest of your life, and (3) Look for consensus. And some of the book looks at how our personal beliefs and biases color how we look at data. We can see this perhaps most clearly in the echo chambers of politics and political news casting- where one can go to either Fox news or MSNBC to hear information that is already in accord with what you believe, so that you can filter out anything that is not in tune with your fundamental beliefs. You are not exposed to differing viewpoints.
All Silver asks that we do is to acknowledge the uncertainty in our predictions, update our forecasts as facts change, and see the wisdom of looking at the world from different viewpoints. For example, I try very hard not to read books that tell me what I already believe. Let’s get rid do the biases that color our thinking. This is a great book and I highly recommend it.

Tuesday, April 2, 2013

In Honor of Dr. Christine Goertz

Few people have had as productive a past couple of years as our own Dr. Christine Goertz. Not only does she manage the full gamut of Palmer College research, but she also plays a significant role in the Patient Centered Outcomes Research Institute, or PCORI, in Washington, DC. With the publication last week of the TACT study, which has received national attention, I thought it might be interesting to see what Dr. Goertz has published recently.

1.      Lamas GA, Goertz C, Boineau R, Mark DB, Rozema T, Nahin RL, Lindblad L, Lewis EF, Drisko J, Lee KL, TACT Investigators. Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial.  JAMA 201;309(12):1241-50. doi: 10.1001/jama.2013.2107.

2.      Goertz CM, Salsbury SA, Vining RD, Long CR, Andresen AA, Jones ME, Lyons KJ, Hondras MA, Killinger LZ, Wolinsky FD, Wallace RB. Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA): study protocol for a randomized controlled trial. Trials 201;14:18. doi: 10.1186/1745-6215-14-18.

3.      Goertz C, Marriott BP, Finch MD, Bray RM, Williams TV, Hourani LL, Hadden LS, Colleran HL, Jonas WB. Military report more complementary and alternative medicine use than civilians. J Altern Complement Med 2013 Jan 16

4.      Martin BI, Gerkovich MM, Deyo RA, Sherman KJ, Cherkin DC, Lind BK, Goertz CM, Lafferty WE. The association of complementary and alternative medicine use and health care expenditures for back and neck problems. Med Care 2012;50(12):1029-36. doi: 10.1097/MLR.0b013e318269e0b2.

5.      Goertz CM, Long CR, Hondras MA, Petri R, Delgado R, Lawrence DJ, Owens EF, Meeker WC. Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: the results of a pragmatic randomized comparative effectiveness study. Spine 2012 Oct 10

So, in this mix from the past year, there is a major multi-center trail of EDTA involving 1708 patients in 300+ centers, a protocol for an RCT, a health services research paper looking at the use of CAM in the military, an actual RCT set in a military setting, and an economic analysis. Few people are that much of a polymath, and this is one of the broadest pallets in chiropractic research our profession has ever seen.
We should all be proud. It’s good work with significant implications for our profession. Exciting to see!