Health for life

Nothing like academic fisticuffs to capture the Disease Management Care Blogs interest. The well timed punch that exposes a methodologic weakness.  The counter punch that quotes past research.  The bob and weave of spin and framing.  Misquoting blows below the belt. Statistical pokes in the eye.  The DMCB says its better than foreign politicians brawling, Kill Bill sword fights and lurid professional wrestling.

Which is why its enjoying a big dust-up over the Community Care of North Carolinas medical home initiative in the "Letters to the Editor" section of the January 2013 issue of American Journal of Managed Care (AJMC).

Regular readers may recall this early 2009 DMCB alert about the CCNCs actuarially derived claims of savings with its medical home.  Al Lewis of the Disease Management Purchasing Consortium eventually caught-up the the DMCB with his own three-fold roundhouse of a punch directed at CCNC that was published in August 2012 AJMC:

1. Claims of $250 million in avoided hospitalization costs on a baseline 2006 cost of $114 million is very unlikely,

2. Outside data indicate that Medicaid admissions in the state only fell from 36 to 34 per thousand, which also makes any claim of hundreds of millions in savings suspect, and

3. Two neighboring states without a medical home initiative experienced the same modest declines in hospitalizations without the same savings.

Well, the actuaries involved in the original Community Care report have jabbed back:

1. The baseline that was used was an actuarial projection of what costs would have been, based on prior trends, not 2006

2. The observed savings were never ascribed to avoided hospitalizations

3. The medical home initiative had been in place for many years, which could explain its impact.

The CEO of Community Care also penned his own counter-strike.  He argues:

"Evaluating complex programs is a difficult and evolving science, but [the] approach to estimating CCNC’s impact is reasonable, measured, and up to the latest standards in the field. Its analysis plays by the same actuarial rules as everyone else—including disease management vendors calculating a return on investment and insurance companies setting rates."

.The rest of the letter uses terms like "disturbing," "facile" "erroneous" "mistakes" "misrepresents" "circular erences." Ouch.

The DMCB fully expects the spat to continue and looks forward to enjoying its ringside seat.  In the meantime, its sticking to its original point from more than 3 years ago: the CCNC analysis was an opaque actuarial analysis that was never subjected to the scrutiny (and editing) from independent peer review.  If it had been, the reviewers would have spotted many of Mr. Lewis concerns and forced the authors to be more transparent with their methods.

Lesson learned.

The way you prepare broccoli and related vegetables can alter their potentially cancer-fighting powers, new research shows.

Broccoli and other cruciferous vegetables are a good source of sulforaphane, a phytochemical (naturally occurring plant compound) that has shown strong anti-cancer properties in lab studies.

However, the enzyme myrosinase in broccoli is needed for sulforaphane to form. If the myrosinase is destroyed, sulforaphane cannot form.

Researchers compared boiled, microwaved and steamed broccoli, and found that steaming broccoli for up to five minutes was the best way to retain its myrosinase. Boiling and microwaving broccoli for one minute or less destroyed the majority of the enzyme, according to Elizabeth Jeffery, a researcher at University of Illinois at Urbana-Champaign.

Jeffery also found that if you do eat well-cooked broccoli, you can still get sulforaphane to form by adding raw foods containing myrosinase to your meal. Study participants ate a broccoli supplement with no active myrosinase. When some of them ate a second food with myrosinase, their blood and urine levels of sulforaphane were significantly higher than those who did not eat the second food with myrosinase.

The findings were presented Thursday at the annual meeting of the American Institute for Cancer Research in Bethesda, Md. Findings presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

"Mustard, radish, arugula, wasabi and other uncooked cruciferous vegetables such as coleslaw all contain myrosinase, and weve seen this can restore the formation of sulforaphane," Jeffery said in an institute news release.

Previous research has found that:

* Crushing or chopping garlic, and then waiting 10 to 15 minutes before exposing it to heat allows its inactive compounds to convert into the active, protective phytochemical known as allicin.
* Cooking tomatoes and other foods that contain lycopene allows our body to more easily absorb the beneficial phytochemical.
* Boiling vegetables for a long time means you lose water-soluble vitamins, such as vitamin C, folate and niacin that leach into the water.

"As were learning, food processing isnt just what happens to food before it reaches the grocery shelves," AICR associate director of nutrition programs Alice Bender said in the news release. "This research highlights that what you do in your kitchen can make those fruits and vegetables on your plate even more cancer-protective."

Onions, a key ingredient in recipes around the globe, come in a tearless version that scientists are now reporting could pack health benefits like its close relative, garlic, which is renowned for protecting against heart disease. They published their laboratory analysis, which suggests a similar heart-friendly role for the tearless onions, as well as a possible role in managing weight gain, in ACS Journal of Agricultural and Food Chemistry.

Colin C. Eady and colleagues note that the onion has a unique chemistry that leads to its tear-inducing effects when cut. Its pungency has driven cooks to don goggles, clench wooden spoons in their mouths and try other usually futile techniques to prevent crying at the cutting board. An answer could arrive in the form of a new type of onion that makes less of the protein blamed for making eyes burn and tear up. Eadys team has developed such a version, which instead makes a sulfur compound similar to one found in cut garlic that may be the key to its cardiovascular benefits. Many people eat garlic cloves or take it as a nutritional supplement in pill form to reduce the clumping of platelets in the blood, which can lead to blood clots and clogged arteries. Garlic also has been shown to reduce weight gain. They wanted to know whether the new onion might also have similar positive effects on health.

The scientists found that in lab tests, extract from the tearless onion significantly reduced platelet clumping, compared to regular onions or even garlic. Other results showed that the new onion had about the same anti-inflammatory properties as the original. Also, preliminary testing in rats showed that the tearless onion could help control weight gain — more so than regular onions or garlic.

Widely-used fish oil supplements modestly increase amounts of a hormone that is associated with lower risk of diabetes and heart disease, according to a study accepted for publication in The Endocrine Societys Journal of Clinical Endocrinology & Metabolism (JCEM).

Fish oil supplements, also called omega 3 fatty acid capsules, raise levels of adiponectin in the bloodstream. Adiponectin is an important hormone that has beneficial effects on metabolic processes like glucose regulation and the modulation of inflammation. In long-term human studies, higher levels of adiponectin are associated with lower risks of type 2 diabetes and coronary heart disease.

"While prior animal studies found fish oil increased circulating adiponectin, whether similar effects apply in humans is not established," said the studys lead author, Jason Wu, PhD, of the Harvard School of Public Health. "By reviewing evidence from existing randomized clinical trials, we found that fish oil supplementation caused modest increases in adiponectin in the blood of humans."

The meta-analysis reviewed and analyzed results from 14 randomized, placebo-controlled clinical trials. In total, 682 subjects were treated with fish oil, and 641 were given placebos – most commonly olive and sunflower oils. In those taking fish oil, adiponectin levels increased by 0.37 ug/mL. The results also suggested the effect of fish oil on adiponectin differed substantially across the trials, suggesting that fish oil supplementation may have stronger influence on adiponectin in some populations and weaker effects in others.

This is the first study to pool data from previous trials to suggest that fish oil consumption increases adiponectin in humans. The findings quantify the potential impact of fish oil on adiponectin level, and highlight the need to further investigate populations that may particularly benefit from fish oil supplementation.

"Although higher levels of adiponectin in the bloodstream have been linked to lower risk of diabetes and coronary heart disease, whether fish oil influences glucose metabolism and development of type 2 diabetes remains unclear," said Wu. "However, results from our study suggest that higher intake of fish oil may moderately increase blood level of adiponectin, and these results support potential benefits of fish oil consumption on glucose control and fat cell metabolism."

Despite the uncertainty about the effectiveness of fish oil on cardiovascular and metabolic diseases, about 37 percent of adults and 31 percent of children nationwide use omega-3 supplements, according to the 2007 National Health Interview Survey from the National Institutes of Healths National Center for Complementary and Alternative Medicine (NCCAM).

Bromelain is a natural digestive enzyme extracted from pineapples. The nutrient is rapidly taking its place aside many of the most powerful natural agents in the war on cancer and other chronic conditions that take the lives of millions each year.