01 Anthroposophic medicine (AM), therapies and health
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Publication Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine(2019) Kienle, Gunver S.; Ben-Arye, Eran; Berger, Bettina; Cuadrado Nahum, C.; Falkenberg, T.; Kapócs, G.; Kiene, Helmut; Martin, David; Wolf, Ursula; Szöke, H.Background: Whole medicine and health systems like traditional and complementary medicine systems (T&CM) are part of healthcare around the world. One key feature of T&CM is its focus on patient-centered and multimodal care and the integration of intercultural perspectives in a wide range of settings. It may contribute to good health and well being for people as part of the Sustainable Development Goals of the United Nations. The authentic, rigorous, and fair evaluation of such a medical system, with its inherent complexity and individualization, imposes methodological challenges. Hence, we propose a broad research strategy to test and characterize its possible contribution to health. Methods: To develop a research strategy for a specific T&CM system, Anthroposophic Medicine (AM), applying multimodal integrative healthcare based on a four-level concept of man, we used a three-phase consensus process with experts and key stakeholders, consisting of (1) premeeting methodological literature and AM research review and interviews to supplement or revise items of the research strategy and tailor them to AM research, (2) face-to-face consensus meetings further developing and tailoring the strategy, and (3) postmeeting feedback and review, followed by finalization. Results: Currently, AM covers many fields of medical specialties in varied levels of healthcare settings, such as outpatient and inpatient; primary, secondary, and tertiary care; and health education and pedagogy. It is by definition integrated with conventional medicine in the public healthcare system. It applies specific medicines, nursing techniques, arts therapies, eurythmy therapy, rhythmical massage, counseling, and psychotherapy, and it is provided by medical doctors, nurses, therapists, midwives, and nutritionists. A research strategy authentic to this level of complexity should comprise items with a focus on (I) efficacy and effectiveness, divided into (a) evaluation of the multimodal and multidisciplinary medical system as a whole, or of complex multimodal therapy concept, (b) a reasonable amount of methodologically rigorous, confirmatory randomized controlled trials on exemplary pharmacological and nonpharmacological therapies and indications, (c) a wide range of interventions and patient-centered care strategies with less extensive formats like well-conducted small trails, observational studies, and high-quality case reports and series, or subgroup analyses from whole-system studies, or health service research; (II) safety; (III) economics; (IV) evidence synthesis; (V) methodologic issues; (VI) biomedical, physiological, pharmacological, pharmaceutical, psychological, anthropological, and nosological issues as well as innovation and development; (VI) patient perspective and involvement, public needs, and ethics; (VII) educational matters and professionalism; and (IX) disease prevention, health promotion, and public health. Conclusion: The research strategy extends to and complements the prevailing hierarchical system by introducing a broad "evidence house" approach to evaluation, something many health technology assessment boards today support. It may provide transparent and comprehensive insight into potential benefits or risks of AM. It can serve as a framework for an evidence-informed approach to AM for a variety of stakeholders and collaborating networks with the aim of improving global health.Publication 100-Year Anniversary of Anthroposophic Medicine as an Integrative Medical System. EDITORIAL / VIEWPOINT(Karger, 2020) Martin, DavidAs I write this editorial, I am attending what may be the largest congress since the corona pandemic lockdown: over 800 health professionals are meeting for 1 week at the Goetheanum in Switzerland to celebrate “100 Years of Anthroposophic Medicine”.... From the beginning, AM was thought of as an integrative medicine that encompasses mainstream medicine. Steiner was striving to complement outer scientific cognition with inner scientific, intuitive cognition according to his epistemology and, from that basis, to inspire doctors to practice what he called in 1920 “intuitive medicine”....Publication Lessons Learned-The Impact of the Third Wave of the COVID-19 Pandemic on German Waldorf Parents' Support Needs and Their Rating of Children's Health-Related Quality of Life: A Cross-Sectional Online Survey.(MDPI, 2023-03-09) Vagedes, Jan; Michael, Karin; Sobh, Mohsen; Islam, Mohammad O A; Kuderer, Silja; Jeske, Christian; Kaman, Anne; Martin, David; Vagedes, Katrin; Erhart, Michael; Ravens-Sieberer, Ulrike; Zdražil, TomášBackground: COVID-19-related lockdowns and homeschooling have imposed a substantial burden on school-aged children and parents. Waldorf education is a reform-educational concept. Little is known about the situation of German Waldorf families under pandemic conditions. Methods: A cross-sectional, online, parent-proxy survey was conducted regarding the third pandemic wave. The primary outcome was parents’ support needs, assessed with questions from the German COPSY (COVID-19 and PSYchological Health) study; the secondary outcome was children’s HRQoL (KIDSCREEN-10, proxy version). Results: We analyzed questionnaires from 431 parents of 511 Waldorf students aged 7 to 17 years. While 70.8% of Waldorf parents (WPs) reported a general need for support in dealing with their children, 59.9% of COPSY parents (CPs) indicated this need. WPs’ support needs in dealing with their children’s academic demands were similar to CPs’ needs but relatively higher in terms of dealing with emotions and moods, behavior, and relationships within the family. WPs sought support mainly from school and teachers (65.6%). Support needs were high, although WPs rated their children’s HRQoL higher than CPs. Conclusions: Our results underline the substantial pandemic-related burden on families across school types. WPs participating in this survey gave evidence that supports should focus on academic demands as well as psychosocial issues. Keywords: COVID-19; pandemic; coronavirus; homeschooling; Waldorf school; child health-related quality of life; parent support needPublication Media Awareness and Screen Time Reduction in Children, Youth or Families: A Systematic Literature Review.(2023-06) Krafft, Hanno; Boehm, Katja; Schwarz, Silke; Eichinger, Michael; Büssing, Arndt; Martin, DavidExcessive use of screen media is a global public health issue and especially extensive screen exposure during very early childhood. This review was conducted in order to update previous reviews on the effectiveness of interventions to reduce screen time. An electronic literature search was carried out in MEDLINE, COCHRANE LIBRARY and CINAHL for articles indexed from June 2011 until October 2019. The search identified 933 publications of which 11 publications were included in this review. There are studies showing interventions with a positive influence on reduction of screen time and the participants' awareness and behavior concerning the use of screen media, as well as studies without such effects. No intervention was identified to be superior. This warrants further investigation of potentially effective combinations of intervention components and long-term follow-up.Publication Anthroposophische Medizin: Health Technology Assessment Bericht – Kurzfassung [Anthroposophic medicine: health technology assessment report - short version] ABSTRACT(2006) Kienle, Gunver S.; Kiene, Helmut; Albonico, Hans-UlrichBackground and objective: The aim of this Health Technology Assessment Report was to analyse the current situation, efficacy, effectiveness, safety, utilization, and costs of Anthroposophic Medicine (AM) with special emphasis on everyday practice. Design: Systematic review. Material and methods: Search of 20 databases, reference lists and expert consultations. Criteriabased analysis was performed to assess methodological quality and external validity of the studies. Results: AM is a complementary medical system that extends conventional medicine and provides specific pharmacological and non-pharmacological treatments. It covers all areas of medicine. 178 clinical trials on efficacy and effectiveness were identified: 17 RCTs, 21 prospective and 43 retrospective NRCTs, 50 prospective and 47 retrospective cohort studies/case-series without control groups. They investigated a wide range of AM-treatments in a variety of diseases, 90 x mistletoe in cancer. 170 trials had a positive result for AM. Methodological quality differed substantially; some studies showed major limitations, others were reasonably well conducted. Trials of better quality still showed a positive result. External validity was usually high. Side effects or other risks are rare. AM-patients are well educated, often female, aged 30-50 years, or children. The few economic investigations found less or equal costs in AM because of reduced hospital admissions and less prescriptions of medications. Conclusion: Trials of varying design and quality in a variety of diseases predominantly describe good clinical outcome for AM, little side effects, high satisfaction of patients and presumably slightly less costs. More research and more methodological expertise and infrastructure are desirable.Publication Search tips** Filter by typing first 2 or 3 letters of LAST NAMEAdvanced search using wildcards characters and boolean operators (AND, OR, NOT), Find tips on the Lyrasis DSpace wiki. Put your search in quotes if it contains non-letter characters (colon, dash, bracket). For example, "Anthroposophic Medicine: An Integrative Medical System Originating in Europe"Publication Modulation of Breast Cancer Cell Apoptosis and Macrophage Polarization by Mistletoe Lectin in 2D and 3D Models(2024-08) Hong, Chang-Eui; Lyu, Su-YunKorean mistletoe (Viscum album L. var. coloratum) is renowned for its medicinal properties, including anti-cancer and immunoadjuvant effects. This study aimed to elucidate the mechanisms by which Korean mistletoe lectin (V. album L. var. coloratum agglutinin; VCA) modulates breast cancer cell apoptosis and macrophage polarization. The specific objectives were to (1) investigate the direct effects of VCA on MCF-7 breast cancer cells and THP-1-derived M1/M2 macrophages; (2) analyze the impact of VCA on the paracrine interactions between these cell types; and (3) compare the efficacy of VCA in 2D vs. 3D co-culture models to bridge the gap between in vitro and in vivo studies. We employed both 2D and 3D models, co-culturing human M1/M2 macrophages with human MCF-7 breast cancer cells in a Transwell system. Our research demonstrated that M1 and M2 macrophages significantly influenced the immune and apoptotic responses of breast cancer cells when exposed to VCA. M1 macrophages exhibited cytotoxic characteristics and enhanced VCA-induced apoptosis in both 2D and 3D co-culture models. Conversely, M2 macrophages initially displayed a protective effect by reducing apoptosis in breast cancer cells, but this protective effect was reversed upon exposure to VCA. Furthermore, our findings illustrate VCA’s ability to modulate M1 and M2 polarization in breast cancer cells. Finally, the use of magnetic 3D cell cultures suggests their potential to yield results comparable to conventional 2D cultures, bridging the gap between in vitro and in vivo studies.Publication Anthroposophic Medicine: An Integrative Medical System Originating in Europe(Sage, 2013-11) Kienle, Gunver S.; Albonico, Hans-Ulrich; Baars, Erik W.; Hamre, Harald J.; Zimmermann, Peter; Kiene, HelmutAnthroposophic medicine is an integrative multimodal treatment system based on a holistic understanding of man and nature and of disease and treatment. It builds on a concept of four levels of formative forces and on the model of a three-fold human constitution. Anthroposophic medicine is integrated with conventional medicine in large hospitals and medical practices. It applies medicines derived from plants, minerals, and animals; art therapy, eurythmy therapy, and rhythmical massage; counseling; psychotherapy; and specific nursing techniques such as external embrocation. Anthroposophic healthcare is provided by medical doctors, therapists, and nurses. A Health-Technology Assessment Report and its recent update identified 265 clinical studies on the efficacy and effectiveness of anthroposophic medicine. The outcomes were described as predominantly positive. These studies as well as a variety of specific safety studies found no major risk but good tolerability. Economic analyses found a favorable cost structure. Patients report high satisfaction with anthroposophic healthcare.Publication Anthroposophic Medicine, an Introduction; and a Book Review of Anthroposophy and Science(2017-08) Bartelme, Ricardo R.Anthroposophic medicine (AM) is a complex, individualized, multimodal, and integrative system of medicine and an art of healing based on both natural science and the transformed, spiritual science as found in Rudolf Steiner’s anthroposophy. A careful and comprehensive study of anthroposophy and AM, as provided in Anthroposophy and Science: An Introduction, can be a new way to see science and the legitimacy of the new direction provided by anthroposophy. The clinical, scientific application of anthroposophy to the field of medicine is AM with its multidimensional diagnostic approach, its various natural remedies, and novel nonpharmacological modalities. These are all aimed at a direction of complete healing of the ill person in their 4-fold nature. Moreover, anthroposophy and AM may provide the approach and direction to begin to truly integrate the field of integrative medicine so that it is both scientific and fully human.Publication Efficacy of mistletoe extract as a complement to standard treatment in advanced pancreatic cancer: study protocol for a multicentre, parallel group, double-blind, randomised, placebo-controlled clinical trial (MISTRAL).(Biomed Central, 2020-09-11) Wode, Kathrin; Hök Nordberg, Johanna; Kienle, Gunver S.; Elander, Nils; Bernhardson, Britt-Marie; Sunde, Berit; Sharp, Lena; Henriksson, Roger; Fransson, PerMost pancreatic cancer patients present with advanced stage at diagnosis with extremely short expected survival and few treatment options. A multimodal palliative approach is necessary for symptom relief and optimisation of health-related quality of life. In a recent open-label trial of mistletoe extract for advanced pancreatic cancer patients not eligible for chemotherapy, promising results on improved overall survival and better health-related quality of life were reported. The objective of the present study is to assess the value of mistletoe extract as a complement to standard treatment (palliative chemotherapy or best supportive care) in advanced pancreatic cancer patients with regard to overall survival and health-related quality of life.Publication Pharmakokinetics of Mistletoe Lectins after Intravenous Application of a Mistletoe Product in Healthy Subjects.(MDPI, 2024-02-22) Lederer, Ann-Kathrin; Rieger, Sabine; Schink, Ph.D., Michael; Huber, RomanMistletoe lectins (ML) have cytotoxic and immunomodulating properties, and subcutaneously applied mistletoe products (MP) containing ML have approval for supportive cancer treatment. MP are also given off-label intravenously, but data about pharmacokinetics are widely lacking. Therefore, the aim of our phase I trial was to evaluate the pharmacokinetics and safety of intravenously applied natural ML. Initially, 12 healthy male volunteers were planned to receive a single infusion of 2000 mg Helixor P. We had to terminate the study prematurely after the inclusion of eight subjects due to elevation of all subjects' liver enzymes. ML was detected in all subjects after infusion. The mean half-life of serum ML was 7.02 ± 2.01 h. Mean alanine transaminase increased from 23 ± 6 to a maximum of 445 ± 260 U/L, and mean aspartate aminotransferase increased from 24 ± 3 to a maximum of 318 ± 33 U/L 72 h after infusion. Severity grading for drug-induced liver injury was mild. Participants did not suffer from any liver-specific symptoms and recovered completely. As a conclusion, the dose of 2000 mg Helixor P caused transient liver injury in healthy subjects and should, therefore, not be used for initial patient treatment. Liver enzymes should be monitored in patients receiving intravenous treatment with Helixor P.Publication Publication Publication Item COVID 19, mistletoe therapy and cancer [Helixor.de website, German language]Integrative oncology -- Cancer side effects -- Therapies and productsPublication Euphrasia D3 eye drops in children [abstract](2005) Toelg, MichaelAbstract - Euphrasia D3 eye drops in children
Efficacy and safety of WELEDA Euphrasia D3 eye drops in children with catarrhal or allergic conjunctivitis – a prospective multicentre observational study
By:Michael Toelg, Mediveritas, Institute for Medical Studies, Munich
Original title: Anwendungsbeobachtung zur Wirksamkeit und Verträglichkeit von WELEDA Euphrasia D3 Augentropfen bei Kindern mit katarrhalischer oder allergischer Bindehautentzündung. Der Merkurstab 2005;58(1):43-57.
DOI: https://doi.org/10.14271/DMS-18616-DE
This translation is published with the kind permission of the journal Der Merkurstab.
Aim: To assess efficacy and safety of WELEDA Euphrasia D3 eye drops in children with catarrhal or allergic conjunctivitis.
Methods: 121 children and adolescents up to the age of 16 received Euphrasia D3 eye drops either three times daily (1 drop per eye) or according to individual prescription by their physician. Before treatment and after up to 14 days, the progress of the catarrhal or allergic conjunctivitis was evaluated on the basis of 6 symptoms: conjunctival redness, eyelid swelling, purulent secretion, sticky eyes, burning/itching and foreign body sensation; intensity of
symptoms was classified according to a scale ranging from 0 (absent) to 3 (severe). For each symptom, mean values (symptom scores) before and after treatment were calculated. Duration of treatment until noticeable improvement and assessments of efficacy and safety by the physician as well as the patient/parent were recorded.
Results: 60% of patients were female, 40% male. Their age ranged from 6 days to 16 years (mean value 7 years).
Most frequently, the diagnoses were infectious conjunctivitis (in 65% of patients) and allergy (26%; multiple answers were possible). On average, the symptoms had persisted for 3 days before onset of treatment.
Main concomitant diseases were rhinitis (40%), flu (39%), allergic rhinitis (14%) and other allergies (13%). 81% of patients received the recommended dose of 3x1 drops daily. On average, the patients were observed for 10 days. For each of the 6 symptoms, definite improvement could be demonstrated.
Based on the number of patients reporting symptoms of at least mild intensity at the beginning, the percentages of patients reporting absence of symptoms at the end of treatment were: conjunctival redness: 66%; eyelid swelling: 83%; purulent secretion: 90%; sticky eyes: 85%; burning/itching: 81% and foreign body sensation: 90%. 119 patients (98%) rated themselves or were rated by their parents as symptom-free or nearly symptom-free.
On average, a noticeable improvement was observed after 5 days of treatment. For each patient, a score was computed based on intensities for all 6 symptoms. Before treatment, the score was 9.4; after treatment it was reduced to 1.1 (mean values); in 58% of patients no symptoms persisted (score = 0). One adverse event was reported (eye irritation after administration of drops). 95% of physicians and 93% of patients/parents rated efficacy as “very good” or “good”; safety was rated “very good” or “good” by all physicians and by 99% of patients/parents.
Conclusion: The results demonstrate efficacy and safety of treatment with WELEDA Euphrasia D3 eye drops in children with catarrhal or allergic conjunctivitis.Publication Iscador Qu for chronic hepatitis C: an exploratory study [abstract](2001) Tusenius, K.J.; Spoek, J.M.; Kramers, C.W.Abstract
Five patients with chronic hepatitis C were treated for one year with the herbal immunomodulatory agent Iscador (Weleda, Schwäbisch Gmünd Germany). Two patients showed 6–20 fold decreases in viral load and normalisation of liver inflammation. The treatment was well tolerated; no serious side effects were observed. The quality of life improved on average. Iscador may have potential as a non toxic therapy for chronic hepatitis C treatment.
Citation: Tusenius, K. J., Spoek, J. M., & Kramers, C. W. (2001). Iscador Qu for chronic hepatitis C: An exploratory study. Complementary Therapies in Medicine, 9(1), 12–16. https://doi.org/10.1054/ctim.2000.0408
[not open access]
Publication Integration of complementary and alternative medicine into family practices in Germany(2011) Joos, Stefanie; Musselman, Berthold; Szesceny, JoachimAbstract: More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physiciansor non-medical practitioners (“Heilpraktiker”). There is little information about the number of family physicians (FPs) providingCAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned.
Citation: Joos, S., Musselmann, B., & Szecsenyi, J. (2010). Integration of Complementary and Alternative Medicine into Family Practices in Germany: Results of a National Survey. Evidence-Based Complementary and Alternative Medicine, 2011, enep019. https://doi.org/10.1093/ecam/nep019
Publication Anthroposophical therapy for children with chronic disease(2009) Hamre, Harald J.; Witt, Claudia M.; Kienle, Gunver S.; Meinecke, Christoph; Glockmann, Anja; Willich, Stefan N.; Kiene, HelmutBackground: Many children with chronic disease use complementary therapies. Anthroposophic treatment for paediatric chronic disease is provided by physicians and differs from conventional treatment in the use of special therapies (art therapy, eurythmy movement exercises, rhythmical massage therapy) and special medications. We studied clinical outcomes in children with chronic diseases under anthroposophic treatment in routine outpatient
settings.Citation: Hamre, H. J., Witt, C. M., Kienle, G. S., Meinecke, C., Glockmann, A., Willich, S. N., & Kiene, H. (2009). Anthroposophic therapy for children with chronic disease: A two-year prospective cohort study in routine outpatient settings. BMC Pediatrics, 9(1), 39. https://doi.org/10.1186/1471-2431-9-39
Published 2009.
