RE: Full Liquid Diet? Evidence based? (reply 2)

[Guest guest]

Where would be the best place to publish initial findings?

I'm working on this

Michal Hogan, RD, LD, CLT

NUTRITIONRESULTS.COM

Helping patients, doctors and dietitians with the serious business of

helping folks with IBS, fibromyalgia, migraine and other effects of delayed

food hypersensitivities

In a message dated 6/20/2011 1:35:53 P.M. Eastern Daylight Time,

drowell@... writes:

The most beautiful words I have heard from one of my LEAP patients was a

tearful, " Thank you! I have my little (autistic) girl back again! " (From

violent and very severe acting out.) Science? Sorry, not a lot there. But she

has her little girl back to " normal " (slightly retarded) after being very

compliant with the LEAP diet. Another from a middle aged man's wife who told

me, " I'm sorry he did not keep his final follow up appointment with you.

He's just too busy living a normal life for the first time in ... years!

Thank you! " Many, many stories like that without the expensive and time

consuming EBM yet.

W. Rowell, RD, LN

Montana State Hospital, Warm Spring, MT

Consultant Dietitian, Long Term Care

Certified LEAP Therapist

Owner, InfoSites: Content-rich Website Development

From: _rd-usa _ (mailto:rd-usa )

[mailto:_rd-usa _ (mailto:rd-usa ) ] On Behalf Of

_Dineright4@..._ (mailto:Dineright4@...)

Sent: Monday, June 20, 2011 10:43 AM

To: _rd-usa _ (mailto:rd-usa )

Subject: Re: Full Liquid Diet? Evidence based? (reply 2)

Hi Merav and others!

Thank you all for coming to my defense. But, truly, I have REALLY thick

skin, or I wouldn't be doing what I do or posting as I do! ;-)

(I'm guessing Pam knows that, since I didn't take any offense at all to her

post! We'll probably think each other is really nice when we finally do

meet! ha Maybe others out there should know I'm a Marine wife! Those of

you who are, know, if you want to be happily married to a Marine (Recon at

that) - you probably have thick skin!)

Pam writes:

It is not only RDs who " insist " on using EBM. We have a healthcare

> system that can no longer afford to pay for treatments and therapies

just

> because one clinician " gets good results " (that's my favorite pet peeve

these

> days; > > RDs who say " I get good results when I ....... " My question is

" good

> results compared to what? " ).

This really exactly what I'm getting at. I do NOT " insist " on EBM. Just

because a group of people get together and review a body of research and

ignore other research and put out a " concensus statement " and suggest it's

EBM -

it's not. We have a very broken health care system that basically pays for

sick care, not well care.

So, you're insisting that people should continue with their current care?

Going from doctor to doctor to ER for their migraines or IBS or fibro

without relief of symptoms, then have to stop working and go on welfare

and

medicaid/medicare? And HOW can we afford that?

I've had SO many people that have spent TENS OF THOUSANDS of their own

private money and years of insurance money to get well - but they're still

sick. They find me, or another CLT or a physician that recommends

LEAP/MRT, and

a few hundred dollars later, they are well, and STOP going to the ER

monthly or the doctor on a weekly/monthly basis and stop all/most of their

expensive drugs.

Sadly, many GOOD physicians, that " get people well " are dropping out of

practice, because of government harassment. (Esp in Texas.)

Your question: " Good results compared to what? "

Well, good results compared to the lack of results they've experienced

prior to trying LEAP/MRT as a last resort. Yes, we need to get case

studies

published. We have hundreds of briefly written cases.

Compared to what? Well, the migraineur that has had migraines 3-4x/week

for 15 years and ALL therapies and medications tried have not eliminated

them. Then, 3 weeks into their LEAP diet they are migraine free and off

meds,

and stay that way, if they're motivated to continue their LEAP diet

changes.

Compared to what? Compared to the person that has not left their home for

over 2 years, EXCEPT for doctor visits, due to chronic diarrhea and IBS GI

pain. The person that has been to 10 docs and they finally resort to " see a

psychiatrist, it must be in your head. " And, 2 weeks into their LEAP

diet, they are 100% diarrhea and pain free!

Compared to what? Compared to the 20 something RD that has tachycardia

attacks frequently and the only solution the physicians have is to put her

on a

beta-blocker for the rest of her life. She tries LEAP and the tachycardia

attacks stop, 100%, unless she eats a trigger food, without meds.

Compared to what? Compared to the 66 y/o woman with IBS pain, diarrhea,

sinusitis and arthritis that has been to MANY different physicians looking

for a solution - they put her on meds that don't work and make her feel

crappy besides. 4 weeks into her LEAP diet, she's pain and nearly symptom

free,

and angry that her docs never found a solution when it was right in my

hands, but not on his horizon.

Every LEAP therapist that has worked with more than 5 LEAP clients has

similar stories, maybe hundreds of them.

Need research to prove what we all know? You bet! But, it's not a drug.

There's no big bucks in it for ANYBODY but the owners of the company (AFTER

15-20 years of sacrifice for employees that could make a LOT more money in

another company) even when the research is done. Just because an insurance

company could save MILLIONS if they used this isn't enough incentive to

invest in research - they'd rather spend it on TV advertisements.

Well, if you've lasted this long, thanks! ;-)

Jan Patenaude, RD, CLT

Director of Medical Nutrition

Signet Diagnostic Corp.

Telecommuting Nationwide

(Mountain Time)

Fax:

_DineRight4@..._ (mailto:DineRight4@...)

<mailto:DineRight4%40aol.com>

Certified LEAP Therapist and specialist in food sensitivity for IBS,

migraine, fibromyalgia and multiple inflammatory conditions. Co-author of

the

Certified LEAP Therapist (CLT) Training Course.

In a message dated 6/20/2011 4:05:22 A.M. Mountain Daylight Time,

_rd-usa _ (mailto:rd-usa )

<mailto:rd-usa%40yahoogroups.com> writes:

> On Thu, Jun 16, 2011 at 1:45 PM, Merav Levi <__meravls@..._

(mailto:_meravls@...) <mailto:_meravls%40msn.mer>_

(mailto:_meravls@..._ (mailto:meravls@...)

<mailto:meravls%40msn.com>) > wrote:

>

> >

> >

> >

> > Pam,I am sorry to be the one who says that, but I am very surprised how

> > harsh and " personal " your response was. these kind of responses hold

many

> on

> > the list from participating in active discussion. We are not all

informed

> > 100% on 100% of the topics, and no one should be expected to be an

expert

> on

> > every single topic. It is impossible and very unhealthy,

professionally,

> to

> > anyone,to assume they " know all " .Sometimes clear liquid or full liq

diets

> > are the only thing pts can tolerate and its better then NPO, and it

> should

> > not be used more then few days bc it is nutritionally lacking. But

with

> all

> > do respect to EBM - textbook and studies are not case study and real

> > practice. Pts are not textbook nor a study, and even in EMB there is a

> value

> > to case studies. Respected journals publish them all the time. thats

why

> > they are called case studies. and to say that clear of full liq diet is

> just

> > wrong all across the board is wrong too.

> > Pam, your knowledge and experience are priceless and greatly

appreciate,

> > but we need to leave room for ppl to ask freely, without the fear of

> being

> > scrutinized by others.

> > Merav Levi, RD, MS, CDNA dietitian, not the food police.

> > __http://www.linkedinhttp://www.linkeh__

(http://www.linkedinhttp//www.linkeh_) <_http://www.linkedinhttp:/www.linkeh__

(http://www.linkedinhttp/www.linkeh_) >

(_http://www.linkedin.com/in/meravlevi_

(http://www.linkedin.com/in/meravlevi) )

> >

> > " Life is not measured by the number of breath you take, but by the

> moments

> > that take your breath away. " - Carlin " People don't forget the

> truth,

> > they just become better in lying " (Revolutionary Road)

> >

> >

> > > To: __rd-usa@..._ (mailto:_rd-usa@...)

<mailto:_rd-usa%40yahoogroups.rd>-_ (mailto:_rd-usa _

(mailto:rd-usa ) <mailto:rd-usa%40yahoogroups.com>)

> > > From: __pcharney@..._ (mailto:_pcharney@...)

<mailto:_pcharney%40mac.pch>_ (mailto:_pcharney@..._

(mailto:pcharney@...)

<mailto:pcharney%40mac.com>)

> > > Date: Thu, 16 Jun 2011 09:10:24 -0700

> >

> > > Subject: Re: Full Liquid Diet? Evidence based?

> > >

> > > ly, Jan, I'm surprised that someone as sharp as you would be so

> > uninformed about evidence-based medicine and that you select one

instance

> in

> > one facility in order to justify an anti-science bias. There are so

many

> > unfounded rumors surrounding use of evidence to support practice.

> > >

> > > Please take a look at the many outstanding resources and tutorials on

> EBM

> > that are available, such as the Centre for Evidence Based Medicine,

> > Bandolier, and others. Have you looked at the Cochrane Library for

> > systematic reviews?

> > >

> > > The full liquid diet has been shown in several studies to not be

> useful.

> > I would argue that it is not the physician who is leading the charge to

> keep

> > it, rather it's the RD who does not have the gumption to stand up to

the

> > physician and explain that full liquid diets are not useful, nor are

they

> > evidence-based. In fact, there is a trend to longer hospitalization

when

> > regular diets are withheld.

> > >

> > > It is not only RDs who " insist " on using EBM. We have a healthcare

> system

> > that can no longer afford to pay for treatments and therapies just

> because

> > one clinician " gets good results " (that's my favorite pet peeve these

> days;

> > RDs who say " I get good results when I ....... " My question is " good

> results

> > compared to what? " ). CMS is moving towards paying for treatments that

are

> > evidence-based. Where the evidence does not exist, strong cohort

studies,

> > case series, etc can stand in until the research is done.

> > >

> > > EBM also does not mean that everything we do must have tons of

> research.

> > Look at insulin. When insulin was first isolated and produced in the

> 1920s,

> > there were no cries for randomized controled trials. Rather, at that

time

> > type 1 diabetes had a 100% fatality rate. Lacking insulin, patients

died.

> > Thus, knowing that insulin was the hormone that lowered blood sugar,

> human

> > use began. I sort of liken that to the use of parachutes in airplanes.

We

> > don't need a trial to know that parachutes prevent fatal plummets to

the

> > earth.

> > >

> > > The history of EBM is fascinating. The first known randomized

> controlled

> > trial was that done by Lind in the Royal Navy when he determined

> that

> > there was some factor in citrus fruits that prevented scurvy. In the

> > mid-1800s, Semmelweis proved that hand washing was a strong preventive

> > factor for puerperal fever. In both cases, it took over 50 years for

> > practice to change. In fact, we still fight the handwashing battle.

Why?

> > There are many theories and change management is a relatively new area

of

> > science. Basically, change is easy..... if the change is easy.

> > >

> > > Evidence based medicine, or evidence based practice, simply says that

> > before you try something new or different on real people you should

have

> > some evidence that you will not hurt them Do no harm. I'm not sure

anyone

> > would be opposed to that?

> > >

> > > Pam Charney, PhD, RD

> > > Author, Consultant

> > > __pcharney@..._ (mailto:_pcharney@...)

<mailto:_pcharney%40mac.pch>_ (mailto:_pcharney@..._

(mailto:pcharney@...)

<mailto:pcharney%40mac.com>)

> > >

> > > " Lead, follow, or get out of the way! "

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

Hi Merav and others!

Thank you all for coming to my defense. But, truly, I have REALLY thick

skin, or I wouldn't be doing what I do or posting as I do! ;-)

(I'm guessing Pam knows that, since I didn't take any offense at all to her

post! We'll probably think each other is really nice when we finally do

meet! ha Maybe others out there should know I'm a Marine wife! Those of

you who are, know, if you want to be happily married to a Marine (Recon at

that) - you probably have thick skin!)

Pam writes:

It is not only RDs who " insist " on using EBM. We have a healthcare

> system that can no longer afford to pay for treatments and therapies

just

> because one clinician " gets good results " (that's my favorite pet peeve

these

> days; > > RDs who say " I get good results when I ....... " My question is

" good

> results compared to what? " ).

This really exactly what I'm getting at. I do NOT " insist " on EBM. Just

because a group of people get together and review a body of research and

ignore other research and put out a " concensus statement " and suggest it's EBM

-

it's not. We have a very broken health care system that basically pays for

sick care, not well care.

So, you're insisting that people should continue with their current care?

Going from doctor to doctor to ER for their migraines or IBS or fibro

without relief of symptoms, then have to stop working and go on welfare and

medicaid/medicare? And HOW can we afford that?

I've had SO many people that have spent TENS OF THOUSANDS of their own

private money and years of insurance money to get well - but they're still

sick. They find me, or another CLT or a physician that recommends LEAP/MRT, and

a few hundred dollars later, they are well, and STOP going to the ER

monthly or the doctor on a weekly/monthly basis and stop all/most of their

expensive drugs.

Sadly, many GOOD physicians, that " get people well " are dropping out of

practice, because of government harassment. (Esp in Texas.)

Your question: " Good results compared to what? "

Well, good results compared to the lack of results they've experienced

prior to trying LEAP/MRT as a last resort. Yes, we need to get case studies

published. We have hundreds of briefly written cases.

Compared to what? Well, the migraineur that has had migraines 3-4x/week

for 15 years and ALL therapies and medications tried have not eliminated

them. Then, 3 weeks into their LEAP diet they are migraine free and off meds,

and stay that way, if they're motivated to continue their LEAP diet

changes.

Compared to what? Compared to the person that has not left their home for

over 2 years, EXCEPT for doctor visits, due to chronic diarrhea and IBS GI

pain. The person that has been to 10 docs and they finally resort to " see a

psychiatrist, it must be in your head. " And, 2 weeks into their LEAP

diet, they are 100% diarrhea and pain free!

Compared to what? Compared to the 20 something RD that has tachycardia

attacks frequently and the only solution the physicians have is to put her on a

beta-blocker for the rest of her life. She tries LEAP and the tachycardia

attacks stop, 100%, unless she eats a trigger food, without meds.

Compared to what? Compared to the 66 y/o woman with IBS pain, diarrhea,

sinusitis and arthritis that has been to MANY different physicians looking

for a solution - they put her on meds that don't work and make her feel

crappy besides. 4 weeks into her LEAP diet, she's pain and nearly symptom free,

and angry that her docs never found a solution when it was right in my

hands, but not on his horizon.

Every LEAP therapist that has worked with more than 5 LEAP clients has

similar stories, maybe hundreds of them.

Need research to prove what we all know? You bet! But, it's not a drug.

There's no big bucks in it for ANYBODY but the owners of the company (AFTER

15-20 years of sacrifice for employees that could make a LOT more money in

another company) even when the research is done. Just because an insurance

company could save MILLIONS if they used this isn't enough incentive to

invest in research - they'd rather spend it on TV advertisements.

Well, if you've lasted this long, thanks! ;-)

Jan Patenaude, RD, CLT

Director of Medical Nutrition

Signet Diagnostic Corp.

Telecommuting Nationwide

(Mountain Time)

Fax:

DineRight4@...

Certified LEAP Therapist and specialist in food sensitivity for IBS,

migraine, fibromyalgia and multiple inflammatory conditions. Co-author of the

Certified LEAP Therapist (CLT) Training Course.

In a message dated 6/20/2011 4:05:22 A.M. Mountain Daylight Time,

rd-usa writes:

> On Thu, Jun 16, 2011 at 1:45 PM, Merav Levi <_meravls@..._

(mailto:meravls@...) > wrote:

>

> >

> >

> >

> > Pam,I am sorry to be the one who says that, but I am very surprised how

> > harsh and " personal " your response was. these kind of responses hold

many

> on

> > the list from participating in active discussion. We are not all

informed

> > 100% on 100% of the topics, and no one should be expected to be an

expert

> on

> > every single topic. It is impossible and very unhealthy,

professionally,

> to

> > anyone,to assume they " know all " .Sometimes clear liquid or full liq

diets

> > are the only thing pts can tolerate and its better then NPO, and it

> should

> > not be used more then few days bc it is nutritionally lacking. But

with

> all

> > do respect to EBM - textbook and studies are not case study and real

> > practice. Pts are not textbook nor a study, and even in EMB there is a

> value

> > to case studies. Respected journals publish them all the time. thats

why

> > they are called case studies. and to say that clear of full liq diet is

> just

> > wrong all across the board is wrong too.

> > Pam, your knowledge and experience are priceless and greatly

appreciate,

> > but we need to leave room for ppl to ask freely, without the fear of

> being

> > scrutinized by others.

> > Merav Levi, RD, MS, CDNA dietitian, not the food police.

> > _http://www.linkedinhttp://www.linkeh_

(http://www.linkedin.com/in/meravlevi)

> >

> > " Life is not measured by the number of breath you take, but by the

> moments

> > that take your breath away. " - Carlin " People don't forget the

> truth,

> > they just become better in lying " (Revolutionary Road)

> >

> >

> > > To: _rd-usa@...-_ (mailto:rd-usa )

> > > From: _pcharney@..._ (mailto:pcharney@...)

> > > Date: Thu, 16 Jun 2011 09:10:24 -0700

> >

> > > Subject: Re: Full Liquid Diet? Evidence based?

> > >

> > > ly, Jan, I'm surprised that someone as sharp as you would be so

> > uninformed about evidence-based medicine and that you select one

instance

> in

> > one facility in order to justify an anti-science bias. There are so

many

> > unfounded rumors surrounding use of evidence to support practice.

> > >

> > > Please take a look at the many outstanding resources and tutorials on

> EBM

> > that are available, such as the Centre for Evidence Based Medicine,

> > Bandolier, and others. Have you looked at the Cochrane Library for

> > systematic reviews?

> > >

> > > The full liquid diet has been shown in several studies to not be

> useful.

> > I would argue that it is not the physician who is leading the charge to

> keep

> > it, rather it's the RD who does not have the gumption to stand up to

the

> > physician and explain that full liquid diets are not useful, nor are

they

> > evidence-based. In fact, there is a trend to longer hospitalization

when

> > regular diets are withheld.

> > >

> > > It is not only RDs who " insist " on using EBM. We have a healthcare

> system

> > that can no longer afford to pay for treatments and therapies just

> because

> > one clinician " gets good results " (that's my favorite pet peeve these

> days;

> > RDs who say " I get good results when I ....... " My question is " good

> results

> > compared to what? " ). CMS is moving towards paying for treatments that

are

> > evidence-based. Where the evidence does not exist, strong cohort

studies,

> > case series, etc can stand in until the research is done.

> > >

> > > EBM also does not mean that everything we do must have tons of

> research.

> > Look at insulin. When insulin was first isolated and produced in the

> 1920s,

> > there were no cries for randomized controled trials. Rather, at that

time

> > type 1 diabetes had a 100% fatality rate. Lacking insulin, patients

died.

> > Thus, knowing that insulin was the hormone that lowered blood sugar,

> human

> > use began. I sort of liken that to the use of parachutes in airplanes.

We

> > don't need a trial to know that parachutes prevent fatal plummets to

the

> > earth.

> > >

> > > The history of EBM is fascinating. The first known randomized

> controlled

> > trial was that done by Lind in the Royal Navy when he determined

> that

> > there was some factor in citrus fruits that prevented scurvy. In the

> > mid-1800s, Semmelweis proved that hand washing was a strong preventive

> > factor for puerperal fever. In both cases, it took over 50 years for

> > practice to change. In fact, we still fight the handwashing battle.

Why?

> > There are many theories and change management is a relatively new area

of

> > science. Basically, change is easy..... if the change is easy.

> > >

> > > Evidence based medicine, or evidence based practice, simply says that

> > before you try something new or different on real people you should

have

> > some evidence that you will not hurt them Do no harm. I'm not sure

anyone

> > would be opposed to that?

> > >

> > > Pam Charney, PhD, RD

> > > Author, Consultant

> > > _pcharney@..._ (mailto:pcharney@...)

> > >

> > > " Lead, follow, or get out of the way! "

[Guest guest]

Hi Merav and others!

Thank you all for coming to my defense. But, truly, I have REALLY thick

skin, or I wouldn't be doing what I do or posting as I do! ;-)

(I'm guessing Pam knows that, since I didn't take any offense at all to her

post! We'll probably think each other is really nice when we finally do

meet! ha Maybe others out there should know I'm a Marine wife! Those of

you who are, know, if you want to be happily married to a Marine (Recon at

that) - you probably have thick skin!)

Pam writes:

It is not only RDs who " insist " on using EBM. We have a healthcare

> system that can no longer afford to pay for treatments and therapies

just

> because one clinician " gets good results " (that's my favorite pet peeve

these

> days; > > RDs who say " I get good results when I ....... " My question is

" good

> results compared to what? " ).

This really exactly what I'm getting at. I do NOT " insist " on EBM. Just

because a group of people get together and review a body of research and

ignore other research and put out a " concensus statement " and suggest it's EBM

-

it's not. We have a very broken health care system that basically pays for

sick care, not well care.

So, you're insisting that people should continue with their current care?

Going from doctor to doctor to ER for their migraines or IBS or fibro

without relief of symptoms, then have to stop working and go on welfare and

medicaid/medicare? And HOW can we afford that?

I've had SO many people that have spent TENS OF THOUSANDS of their own

private money and years of insurance money to get well - but they're still

sick. They find me, or another CLT or a physician that recommends LEAP/MRT, and

a few hundred dollars later, they are well, and STOP going to the ER

monthly or the doctor on a weekly/monthly basis and stop all/most of their

expensive drugs.

Sadly, many GOOD physicians, that " get people well " are dropping out of

practice, because of government harassment. (Esp in Texas.)

Your question: " Good results compared to what? "

Well, good results compared to the lack of results they've experienced

prior to trying LEAP/MRT as a last resort. Yes, we need to get case studies

published. We have hundreds of briefly written cases.

Compared to what? Well, the migraineur that has had migraines 3-4x/week

for 15 years and ALL therapies and medications tried have not eliminated

them. Then, 3 weeks into their LEAP diet they are migraine free and off meds,

and stay that way, if they're motivated to continue their LEAP diet

changes.

Compared to what? Compared to the person that has not left their home for

over 2 years, EXCEPT for doctor visits, due to chronic diarrhea and IBS GI

pain. The person that has been to 10 docs and they finally resort to " see a

psychiatrist, it must be in your head. " And, 2 weeks into their LEAP

diet, they are 100% diarrhea and pain free!

Compared to what? Compared to the 20 something RD that has tachycardia

attacks frequently and the only solution the physicians have is to put her on a

beta-blocker for the rest of her life. She tries LEAP and the tachycardia

attacks stop, 100%, unless she eats a trigger food, without meds.

Compared to what? Compared to the 66 y/o woman with IBS pain, diarrhea,

sinusitis and arthritis that has been to MANY different physicians looking

for a solution - they put her on meds that don't work and make her feel

crappy besides. 4 weeks into her LEAP diet, she's pain and nearly symptom free,

and angry that her docs never found a solution when it was right in my

hands, but not on his horizon.

Every LEAP therapist that has worked with more than 5 LEAP clients has

similar stories, maybe hundreds of them.

Need research to prove what we all know? You bet! But, it's not a drug.

There's no big bucks in it for ANYBODY but the owners of the company (AFTER

15-20 years of sacrifice for employees that could make a LOT more money in

another company) even when the research is done. Just because an insurance

company could save MILLIONS if they used this isn't enough incentive to

invest in research - they'd rather spend it on TV advertisements.

Well, if you've lasted this long, thanks! ;-)

Jan Patenaude, RD, CLT

Director of Medical Nutrition

Signet Diagnostic Corp.

Telecommuting Nationwide

(Mountain Time)

Fax:

DineRight4@...

Certified LEAP Therapist and specialist in food sensitivity for IBS,

migraine, fibromyalgia and multiple inflammatory conditions. Co-author of the

Certified LEAP Therapist (CLT) Training Course.

In a message dated 6/20/2011 4:05:22 A.M. Mountain Daylight Time,

rd-usa writes:

> On Thu, Jun 16, 2011 at 1:45 PM, Merav Levi <_meravls@..._

(mailto:meravls@...) > wrote:

>

> >

> >

> >

> > Pam,I am sorry to be the one who says that, but I am very surprised how

> > harsh and " personal " your response was. these kind of responses hold

many

> on

> > the list from participating in active discussion. We are not all

informed

> > 100% on 100% of the topics, and no one should be expected to be an

expert

> on

> > every single topic. It is impossible and very unhealthy,

professionally,

> to

> > anyone,to assume they " know all " .Sometimes clear liquid or full liq

diets

> > are the only thing pts can tolerate and its better then NPO, and it

> should

> > not be used more then few days bc it is nutritionally lacking. But

with

> all

> > do respect to EBM - textbook and studies are not case study and real

> > practice. Pts are not textbook nor a study, and even in EMB there is a

> value

> > to case studies. Respected journals publish them all the time. thats

why

> > they are called case studies. and to say that clear of full liq diet is

> just

> > wrong all across the board is wrong too.

> > Pam, your knowledge and experience are priceless and greatly

appreciate,

> > but we need to leave room for ppl to ask freely, without the fear of

> being

> > scrutinized by others.

> > Merav Levi, RD, MS, CDNA dietitian, not the food police.

> > _http://www.linkedinhttp://www.linkeh_

(http://www.linkedin.com/in/meravlevi)

> >

> > " Life is not measured by the number of breath you take, but by the

> moments

> > that take your breath away. " - Carlin " People don't forget the

> truth,

> > they just become better in lying " (Revolutionary Road)

> >

> >

> > > To: _rd-usa@...-_ (mailto:rd-usa )

> > > From: _pcharney@..._ (mailto:pcharney@...)

> > > Date: Thu, 16 Jun 2011 09:10:24 -0700

> >

> > > Subject: Re: Full Liquid Diet? Evidence based?

> > >

> > > ly, Jan, I'm surprised that someone as sharp as you would be so

> > uninformed about evidence-based medicine and that you select one

instance

> in

> > one facility in order to justify an anti-science bias. There are so

many

> > unfounded rumors surrounding use of evidence to support practice.

> > >

> > > Please take a look at the many outstanding resources and tutorials on

> EBM

> > that are available, such as the Centre for Evidence Based Medicine,

> > Bandolier, and others. Have you looked at the Cochrane Library for

> > systematic reviews?

> > >

> > > The full liquid diet has been shown in several studies to not be

> useful.

> > I would argue that it is not the physician who is leading the charge to

> keep

> > it, rather it's the RD who does not have the gumption to stand up to

the

> > physician and explain that full liquid diets are not useful, nor are

they

> > evidence-based. In fact, there is a trend to longer hospitalization

when

> > regular diets are withheld.

> > >

> > > It is not only RDs who " insist " on using EBM. We have a healthcare

> system

> > that can no longer afford to pay for treatments and therapies just

> because

> > one clinician " gets good results " (that's my favorite pet peeve these

> days;

> > RDs who say " I get good results when I ....... " My question is " good

> results

> > compared to what? " ). CMS is moving towards paying for treatments that

are

> > evidence-based. Where the evidence does not exist, strong cohort

studies,

> > case series, etc can stand in until the research is done.

> > >

> > > EBM also does not mean that everything we do must have tons of

> research.

> > Look at insulin. When insulin was first isolated and produced in the

> 1920s,

> > there were no cries for randomized controled trials. Rather, at that

time

> > type 1 diabetes had a 100% fatality rate. Lacking insulin, patients

died.

> > Thus, knowing that insulin was the hormone that lowered blood sugar,

> human

> > use began. I sort of liken that to the use of parachutes in airplanes.

We

> > don't need a trial to know that parachutes prevent fatal plummets to

the

> > earth.

> > >

> > > The history of EBM is fascinating. The first known randomized

> controlled

> > trial was that done by Lind in the Royal Navy when he determined

> that

> > there was some factor in citrus fruits that prevented scurvy. In the

> > mid-1800s, Semmelweis proved that hand washing was a strong preventive

> > factor for puerperal fever. In both cases, it took over 50 years for

> > practice to change. In fact, we still fight the handwashing battle.

Why?

> > There are many theories and change management is a relatively new area

of

> > science. Basically, change is easy..... if the change is easy.

> > >

> > > Evidence based medicine, or evidence based practice, simply says that

> > before you try something new or different on real people you should

have

> > some evidence that you will not hurt them Do no harm. I'm not sure

anyone

> > would be opposed to that?

> > >

> > > Pam Charney, PhD, RD

> > > Author, Consultant

> > > _pcharney@..._ (mailto:pcharney@...)

> > >

> > > " Lead, follow, or get out of the way! "

[Guest guest]

The most beautiful words I have heard from one of my LEAP patients was a

tearful, " Thank you! I have my little (autistic) girl back again! " (From violent

and very severe acting out.) Science? Sorry, not a lot there. But she has her

little girl back to " normal " (slightly retarded) after being very compliant with

the LEAP diet. Another from a middle aged man's wife who told me, " I'm sorry he

did not keep his final follow up appointment with you. He's just too busy living

a normal life for the first time in ... years! Thank you! " Many, many stories

like that without the expensive and time consuming EBM yet.

W. Rowell, RD, LN

Montana State Hospital, Warm Spring, MT

Consultant Dietitian, Long Term Care

Certified LEAP Therapist

Owner, InfoSites: Content-rich Website Development

From: rd-usa [mailto:rd-usa ] On Behalf Of

Dineright4@...

Sent: Monday, June 20, 2011 10:43 AM

To: rd-usa

Subject: Re: Full Liquid Diet? Evidence based? (reply 2)

Hi Merav and others!

Thank you all for coming to my defense. But, truly, I have REALLY thick

skin, or I wouldn't be doing what I do or posting as I do! ;-)

(I'm guessing Pam knows that, since I didn't take any offense at all to her

post! We'll probably think each other is really nice when we finally do

meet! ha Maybe others out there should know I'm a Marine wife! Those of

you who are, know, if you want to be happily married to a Marine (Recon at

that) - you probably have thick skin!)

Pam writes:

It is not only RDs who " insist " on using EBM. We have a healthcare

> system that can no longer afford to pay for treatments and therapies

just

> because one clinician " gets good results " (that's my favorite pet peeve

these

> days; > > RDs who say " I get good results when I ....... " My question is

" good

> results compared to what? " ).

This really exactly what I'm getting at. I do NOT " insist " on EBM. Just

because a group of people get together and review a body of research and

ignore other research and put out a " concensus statement " and suggest it's EBM -

it's not. We have a very broken health care system that basically pays for

sick care, not well care.

So, you're insisting that people should continue with their current care?

Going from doctor to doctor to ER for their migraines or IBS or fibro

without relief of symptoms, then have to stop working and go on welfare and

medicaid/medicare? And HOW can we afford that?

I've had SO many people that have spent TENS OF THOUSANDS of their own

private money and years of insurance money to get well - but they're still

sick. They find me, or another CLT or a physician that recommends LEAP/MRT, and

a few hundred dollars later, they are well, and STOP going to the ER

monthly or the doctor on a weekly/monthly basis and stop all/most of their

expensive drugs.

Sadly, many GOOD physicians, that " get people well " are dropping out of

practice, because of government harassment. (Esp in Texas.)

Your question: " Good results compared to what? "

Well, good results compared to the lack of results they've experienced

prior to trying LEAP/MRT as a last resort. Yes, we need to get case studies

published. We have hundreds of briefly written cases.

Compared to what? Well, the migraineur that has had migraines 3-4x/week

for 15 years and ALL therapies and medications tried have not eliminated

them. Then, 3 weeks into their LEAP diet they are migraine free and off meds,

and stay that way, if they're motivated to continue their LEAP diet

changes.

Compared to what? Compared to the person that has not left their home for

over 2 years, EXCEPT for doctor visits, due to chronic diarrhea and IBS GI

pain. The person that has been to 10 docs and they finally resort to " see a

psychiatrist, it must be in your head. " And, 2 weeks into their LEAP

diet, they are 100% diarrhea and pain free!

Compared to what? Compared to the 20 something RD that has tachycardia

attacks frequently and the only solution the physicians have is to put her on a

beta-blocker for the rest of her life. She tries LEAP and the tachycardia

attacks stop, 100%, unless she eats a trigger food, without meds.

Compared to what? Compared to the 66 y/o woman with IBS pain, diarrhea,

sinusitis and arthritis that has been to MANY different physicians looking

for a solution - they put her on meds that don't work and make her feel

crappy besides. 4 weeks into her LEAP diet, she's pain and nearly symptom free,

and angry that her docs never found a solution when it was right in my

hands, but not on his horizon.

Every LEAP therapist that has worked with more than 5 LEAP clients has

similar stories, maybe hundreds of them.

Need research to prove what we all know? You bet! But, it's not a drug.

There's no big bucks in it for ANYBODY but the owners of the company (AFTER

15-20 years of sacrifice for employees that could make a LOT more money in

another company) even when the research is done. Just because an insurance

company could save MILLIONS if they used this isn't enough incentive to

invest in research - they'd rather spend it on TV advertisements.

Well, if you've lasted this long, thanks! ;-)

Jan Patenaude, RD, CLT

Director of Medical Nutrition

Signet Diagnostic Corp.

Telecommuting Nationwide

(Mountain Time)

Fax:

DineRight4@...<mailto:DineRight4%40aol.com>

Certified LEAP Therapist and specialist in food sensitivity for IBS,

migraine, fibromyalgia and multiple inflammatory conditions. Co-author of the

Certified LEAP Therapist (CLT) Training Course.

In a message dated 6/20/2011 4:05:22 A.M. Mountain Daylight Time,

rd-usa <mailto:rd-usa%40yahoogroups.com> writes:

> On Thu, Jun 16, 2011 at 1:45 PM, Merav Levi

<_meravls@...<mailto:_meravls%40msn.mer>_

(mailto:meravls@...<mailto:meravls%40msn.com>) > wrote:

>

> >

> >

> >

> > Pam,I am sorry to be the one who says that, but I am very surprised how

> > harsh and " personal " your response was. these kind of responses hold

many

> on

> > the list from participating in active discussion. We are not all

informed

> > 100% on 100% of the topics, and no one should be expected to be an

expert

> on

> > every single topic. It is impossible and very unhealthy,

professionally,

> to

> > anyone,to assume they " know all " .Sometimes clear liquid or full liq

diets

> > are the only thing pts can tolerate and its better then NPO, and it

> should

> > not be used more then few days bc it is nutritionally lacking. But

with

> all

> > do respect to EBM - textbook and studies are not case study and real

> > practice. Pts are not textbook nor a study, and even in EMB there is a

> value

> > to case studies. Respected journals publish them all the time. thats

why

> > they are called case studies. and to say that clear of full liq diet is

> just

> > wrong all across the board is wrong too.

> > Pam, your knowledge and experience are priceless and greatly

appreciate,

> > but we need to leave room for ppl to ask freely, without the fear of

> being

> > scrutinized by others.

> > Merav Levi, RD, MS, CDNA dietitian, not the food police.

> > _http://www.linkedinhttp://www.linkeh_<http://www.linkedinhttp:/www.linkeh_>

(http://www.linkedin.com/in/meravlevi)

> >

> > " Life is not measured by the number of breath you take, but by the

> moments

> > that take your breath away. " - Carlin " People don't forget the

> truth,

> > they just become better in lying " (Revolutionary Road)

> >

> >

> > > To: _rd-usa@...<mailto:_rd-usa%40yahoogroups.rd>-_

(mailto:rd-usa <mailto:rd-usa%40yahoogroups.com>)

> > > From: _pcharney@...<mailto:_pcharney%40mac.pch>_

(mailto:pcharney@...<mailto:pcharney%40mac.com>)

> > > Date: Thu, 16 Jun 2011 09:10:24 -0700

> >

> > > Subject: Re: Full Liquid Diet? Evidence based?

> > >

> > > ly, Jan, I'm surprised that someone as sharp as you would be so

> > uninformed about evidence-based medicine and that you select one

instance

> in

> > one facility in order to justify an anti-science bias. There are so

many

> > unfounded rumors surrounding use of evidence to support practice.

> > >

> > > Please take a look at the many outstanding resources and tutorials on

> EBM

> > that are available, such as the Centre for Evidence Based Medicine,

> > Bandolier, and others. Have you looked at the Cochrane Library for

> > systematic reviews?

> > >

> > > The full liquid diet has been shown in several studies to not be

> useful.

> > I would argue that it is not the physician who is leading the charge to

> keep

> > it, rather it's the RD who does not have the gumption to stand up to

the

> > physician and explain that full liquid diets are not useful, nor are

they

> > evidence-based. In fact, there is a trend to longer hospitalization

when

> > regular diets are withheld.

> > >

> > > It is not only RDs who " insist " on using EBM. We have a healthcare

> system

> > that can no longer afford to pay for treatments and therapies just

> because

> > one clinician " gets good results " (that's my favorite pet peeve these

> days;

> > RDs who say " I get good results when I ....... " My question is " good

> results

> > compared to what? " ). CMS is moving towards paying for treatments that

are

> > evidence-based. Where the evidence does not exist, strong cohort

studies,

> > case series, etc can stand in until the research is done.

> > >

> > > EBM also does not mean that everything we do must have tons of

> research.

> > Look at insulin. When insulin was first isolated and produced in the

> 1920s,

> > there were no cries for randomized controled trials. Rather, at that

time

> > type 1 diabetes had a 100% fatality rate. Lacking insulin, patients

died.

> > Thus, knowing that insulin was the hormone that lowered blood sugar,

> human

> > use began. I sort of liken that to the use of parachutes in airplanes.

We

> > don't need a trial to know that parachutes prevent fatal plummets to

the

> > earth.

> > >

> > > The history of EBM is fascinating. The first known randomized

> controlled

> > trial was that done by Lind in the Royal Navy when he determined

> that

> > there was some factor in citrus fruits that prevented scurvy. In the

> > mid-1800s, Semmelweis proved that hand washing was a strong preventive

> > factor for puerperal fever. In both cases, it took over 50 years for

> > practice to change. In fact, we still fight the handwashing battle.

Why?

> > There are many theories and change management is a relatively new area

of

> > science. Basically, change is easy..... if the change is easy.

> > >

> > > Evidence based medicine, or evidence based practice, simply says that

> > before you try something new or different on real people you should

have

> > some evidence that you will not hurt them Do no harm. I'm not sure

anyone

> > would be opposed to that?

> > >

> > > Pam Charney, PhD, RD

> > > Author, Consultant

> > > _pcharney@...<mailto:_pcharney%40mac.pch>_

(mailto:pcharney@...<mailto:pcharney%40mac.com>)

> > >

> > > " Lead, follow, or get out of the way! "

[Guest guest]

Then why not stop all EBM - let's waste money on chiros imaginary

subluxation theory and homeopathy (there is no reliable research for that

IMHO). Or why not stop continuing to study gastric bypass surgery and CABG

and lots of drugs that appear to work in so called " traditional medicine " .

But we do keep studying in case there is more data and unknown side effects

.. We thought we had diets and treatments for bleeding ulcers - remember Type

A personalities. No we kept studying to be sure there weren't other reasons

- then they discovered H pylori. Remember the old cardiac diets where we

actually pushed PUFA's and margarine - what if we had stopped there? I

would love to see LEAP research actually go under scrutiny because I would

love to see diet work. But we have to r/o placebo and other 'hidden " changes

not always so obvious. Michal, I hope you can do it because if you can

publish even a small study others may study it even further. Good Luck!! I

am rooting for LEAP.

I remember when I worked Oncology telling my patient and his wife that XRT

to her husband's neck could be very painful but we discussed ways to lessen

it. She told me just my words helped her get through it and to encourage

him to do the right thing. Just my words for hope!!! To be perfectly honest

I don't remember saying anything different that I didn't discuss with my

other H/N patients.

Just a few thoughts!!

> **

>

>

> Where would be the best place to publish initial findings?

> I'm working on this

>

> Michal Hogan, RD, LD, CLT

> NUTRITIONRESULTS.COM

>

> Helping patients, doctors and dietitians with the serious business of

> helping folks with IBS, fibromyalgia, migraine and other effects of delayed

>

> food hypersensitivities

>

> In a message dated 6/20/2011 1:35:53 P.M. Eastern Daylight Time,

> drowell@... writes:

>

> The most beautiful words I have heard from one of my LEAP patients was a

> tearful, " Thank you! I have my little (autistic) girl back again! " (From

> violent and very severe acting out.) Science? Sorry, not a lot there. But

> she

> has her little girl back to " normal " (slightly retarded) after being very

> compliant with the LEAP diet. Another from a middle aged man's wife who

> told

> me, " I'm sorry he did not keep his final follow up appointment with you.

> He's just too busy living a normal life for the first time in ... years!

> Thank you! " Many, many stories like that without the expensive and time

> consuming EBM yet.

>

> W. Rowell, RD, LN

> Montana State Hospital, Warm Spring, MT

> Consultant Dietitian, Long Term Care

> Certified LEAP Therapist

> Owner, InfoSites: Content-rich Website Development

>

> From: _rd-usa _ (mailto:rd-usa )

> [mailto:_rd-usa _ (mailto:rd-usa ) ] On

> Behalf Of

> _Dineright4@..._ (mailto:Dineright4@...)

> Sent: Monday, June 20, 2011 10:43 AM

> To: _rd-usa _ (mailto:rd-usa )

> Subject: Re: Full Liquid Diet? Evidence based? (reply 2)

>

> Hi Merav and others!

>

> Thank you all for coming to my defense. But, truly, I have REALLY thick

> skin, or I wouldn't be doing what I do or posting as I do! ;-)

>

> (I'm guessing Pam knows that, since I didn't take any offense at all to her

> post! We'll probably think each other is really nice when we finally do

> meet! ha Maybe others out there should know I'm a Marine wife! Those of

> you who are, know, if you want to be happily married to a Marine (Recon at

> that) - you probably have thick skin!)

>

> Pam writes:

> It is not only RDs who " insist " on using EBM. We have a healthcare

> > system that can no longer afford to pay for treatments and therapies

> just

> > because one clinician " gets good results " (that's my favorite pet peeve

> these

> > days; > > RDs who say " I get good results when I ....... " My question is

> " good

> > results compared to what? " ).

>

> This really exactly what I'm getting at. I do NOT " insist " on EBM. Just

> because a group of people get together and review a body of research and

> ignore other research and put out a " concensus statement " and suggest it's

> EBM -

> it's not. We have a very broken health care system that basically pays for

> sick care, not well care.

>

> So, you're insisting that people should continue with their current care?

> Going from doctor to doctor to ER for their migraines or IBS or fibro

> without relief of symptoms, then have to stop working and go on welfare

> and

> medicaid/medicare? And HOW can we afford that?

>

> I've had SO many people that have spent TENS OF THOUSANDS of their own

> private money and years of insurance money to get well - but they're still

> sick. They find me, or another CLT or a physician that recommends

> LEAP/MRT, and

> a few hundred dollars later, they are well, and STOP going to the ER

> monthly or the doctor on a weekly/monthly basis and stop all/most of their

> expensive drugs.

>

> Sadly, many GOOD physicians, that " get people well " are dropping out of

> practice, because of government harassment. (Esp in Texas.)

>

> Your question: " Good results compared to what? "

>

> Well, good results compared to the lack of results they've experienced

> prior to trying LEAP/MRT as a last resort. Yes, we need to get case

> studies

> published. We have hundreds of briefly written cases.

>

> Compared to what? Well, the migraineur that has had migraines 3-4x/week

> for 15 years and ALL therapies and medications tried have not eliminated

> them. Then, 3 weeks into their LEAP diet they are migraine free and off

> meds,

> and stay that way, if they're motivated to continue their LEAP diet

> changes.

>

> Compared to what? Compared to the person that has not left their home for

> over 2 years, EXCEPT for doctor visits, due to chronic diarrhea and IBS GI

> pain. The person that has been to 10 docs and they finally resort to " see a

> psychiatrist, it must be in your head. " And, 2 weeks into their LEAP

> diet, they are 100% diarrhea and pain free!

>

> Compared to what? Compared to the 20 something RD that has tachycardia

> attacks frequently and the only solution the physicians have is to put her

> on a

> beta-blocker for the rest of her life. She tries LEAP and the tachycardia

> attacks stop, 100%, unless she eats a trigger food, without meds.

>

> Compared to what? Compared to the 66 y/o woman with IBS pain, diarrhea,

> sinusitis and arthritis that has been to MANY different physicians looking

> for a solution - they put her on meds that don't work and make her feel

> crappy besides. 4 weeks into her LEAP diet, she's pain and nearly symptom

> free,

> and angry that her docs never found a solution when it was right in my

> hands, but not on his horizon.

>

> Every LEAP therapist that has worked with more than 5 LEAP clients has

> similar stories, maybe hundreds of them.

>

> Need research to prove what we all know? You bet! But, it's not a drug.

> There's no big bucks in it for ANYBODY but the owners of the company (AFTER

> 15-20 years of sacrifice for employees that could make a LOT more money in

> another company) even when the research is done. Just because an insurance

> company could save MILLIONS if they used this isn't enough incentive to

> invest in research - they'd rather spend it on TV advertisements.

>

> Well, if you've lasted this long, thanks! ;-)

>

> Jan Patenaude, RD, CLT

> Director of Medical Nutrition

> Signet Diagnostic Corp.

> Telecommuting Nationwide

> (Mountain Time)

> Fax:

> _DineRight4@..._ (mailto:DineRight4@...)

> <mailto:DineRight4%40aol.com>

>

> Certified LEAP Therapist and specialist in food sensitivity for IBS,

> migraine, fibromyalgia and multiple inflammatory conditions. Co-author of

> the

> Certified LEAP Therapist (CLT) Training Course.

>

> In a message dated 6/20/2011 4:05:22 A.M. Mountain Daylight Time,

> _rd-usa _ (mailto:rd-usa )

> <mailto:rd-usa%40yahoogroups.com> writes:

>

> > On Thu, Jun 16, 2011 at 1:45 PM, Merav Levi <__meravls@..._

> (mailto:_meravls@...) <mailto:_meravls%40msn.mer>_

> (mailto:_meravls@..._ (mailto:meravls@...)

> <mailto:meravls%40msn.com>) > wrote:

> >

> > >

> > >

> > >

> > > Pam,I am sorry to be the one who says that, but I am very surprised how

> > > harsh and " personal " your response was. these kind of responses hold

> many

> > on

> > > the list from participating in active discussion. We are not all

> informed

> > > 100% on 100% of the topics, and no one should be expected to be an

> expert

> > on

> > > every single topic. It is impossible and very unhealthy,

> professionally,

> > to

> > > anyone,to assume they " know all " .Sometimes clear liquid or full liq

> diets

> > > are the only thing pts can tolerate and its better then NPO, and it

> > should

> > > not be used more then few days bc it is nutritionally lacking. But

> with

> > all

> > > do respect to EBM - textbook and studies are not case study and real

> > > practice. Pts are not textbook nor a study, and even in EMB there is a

> > value

> > > to case studies. Respected journals publish them all the time. thats

> why

> > > they are called case studies. and to say that clear of full liq diet is

> > just

> > > wrong all across the board is wrong too.

> > > Pam, your knowledge and experience are priceless and greatly

> appreciate,

> > > but we need to leave room for ppl to ask freely, without the fear of

> > being

> > > scrutinized by others.

> > > Merav Levi, RD, MS, CDNA dietitian, not the food police.

> > > __http://www.linkedinhttp://www.linkeh__

> (http://www.linkedinhttp//www.linkeh_) <_

> http://www.linkedinhttp:/www.linkeh__

> (http://www.linkedinhttp/www.linkeh_) >

> (_http://www.linkedin.com/in/meravlevi_

> (http://www.linkedin.com/in/meravlevi) )

> > >

> > > " Life is not measured by the number of breath you take, but by the

> > moments

> > > that take your breath away. " - Carlin " People don't forget the

> > truth,

> > > they just become better in lying " (Revolutionary Road)

> > >

> > >

> > > > To: __rd-usa@..._ (mailto:_rd-usa@...)

> <mailto:_rd-usa%40yahoogroups.rd>-_ (mailto:_rd-usa _

> (mailto:rd-usa ) <mailto:rd-usa%40yahoogroups.com>)

> > > > From: __pcharney@..._ (mailto:_pcharney@...)

> <mailto:_pcharney%40mac.pch>_ (mailto:_pcharney@..._ (mailto:

> pcharney@...)

> <mailto:pcharney%40mac.com>)

> > > > Date: Thu, 16 Jun 2011 09:10:24 -0700

> > >

> > > > Subject: Re: Full Liquid Diet? Evidence based?

> > > >

> > > > ly, Jan, I'm surprised that someone as sharp as you would be so

> > > uninformed about evidence-based medicine and that you select one

> instance

> > in

> > > one facility in order to justify an anti-science bias. There are so

> many

> > > unfounded rumors surrounding use of evidence to support practice.

> > > >

> > > > Please take a look at the many outstanding resources and tutorials on

> > EBM

> > > that are available, such as the Centre for Evidence Based Medicine,

> > > Bandolier, and others. Have you looked at the Cochrane Library for

> > > systematic reviews?

> > > >

> > > > The full liquid diet has been shown in several studies to not be

> > useful.

> > > I would argue that it is not the physician who is leading the charge to

> > keep

> > > it, rather it's the RD who does not have the gumption to stand up to

> the

> > > physician and explain that full liquid diets are not useful, nor are

> they

> > > evidence-based. In fact, there is a trend to longer hospitalization

> when

> > > regular diets are withheld.

> > > >

> > > > It is not only RDs who " insist " on using EBM. We have a healthcare

> > system

> > > that can no longer afford to pay for treatments and therapies just

> > because

> > > one clinician " gets good results " (that's my favorite pet peeve these

> > days;

> > > RDs who say " I get good results when I ....... " My question is " good

> > results

> > > compared to what? " ). CMS is moving towards paying for treatments that

> are

> > > evidence-based. Where the evidence does not exist, strong cohort

> studies,

> > > case series, etc can stand in until the research is done.

> > > >

> > > > EBM also does not mean that everything we do must have tons of

> > research.

> > > Look at insulin. When insulin was first isolated and produced in the

> > 1920s,

> > > there were no cries for randomized controled trials. Rather, at that

> time

> > > type 1 diabetes had a 100% fatality rate. Lacking insulin, patients

> died.

> > > Thus, knowing that insulin was the hormone that lowered blood sugar,

> > human

> > > use began. I sort of liken that to the use of parachutes in airplanes.

> We

> > > don't need a trial to know that parachutes prevent fatal plummets to

> the

> > > earth.

> > > >

> > > > The history of EBM is fascinating. The first known randomized

> > controlled

> > > trial was that done by Lind in the Royal Navy when he determined

> > that

> > > there was some factor in citrus fruits that prevented scurvy. In the

> > > mid-1800s, Semmelweis proved that hand washing was a strong preventive

> > > factor for puerperal fever. In both cases, it took over 50 years for

> > > practice to change. In fact, we still fight the handwashing battle.

> Why?

> > > There are many theories and change management is a relatively new area

> of

> > > science. Basically, change is easy..... if the change is easy.

> > > >

> > > > Evidence based medicine, or evidence based practice, simply says that

> > > before you try something new or different on real people you should

> have

> > > some evidence that you will not hurt them Do no harm. I'm not sure

> anyone

> > > would be opposed to that?

> > > >

> > > > Pam Charney, PhD, RD

> > > > Author, Consultant

> > > > __pcharney@..._ (mailto:_pcharney@...)

> <mailto:_pcharney%40mac.pch>_ (mailto:_pcharney@..._ (mailto:

> pcharney@...)

> <mailto:pcharney%40mac.com>)

> > > >

> > > > " Lead, follow, or get out of the way! "

>

>