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Kiene H.,Institute for Applied Epistemology and Medical Methodology | Brinkhaus B.,Charite - Medical University of Berlin | Fischer G.,Hannover Medical School | Girke M.,General Hospital Havelhohe | And 10 more authors.
European Journal of Integrative Medicine | Year: 2010

The current debate on medical professionalism is challenged by situations of co-existent "conventional" and "complementary/alternative" medical approaches. The issue of this article is how to realize professional behaviour in such pluralistic context. Medical pluralism is presented as consequence of the inherent pluralistic feature of science. Both conventional and complementary medical approaches need to adhere to the ethical principles and commitments of the medical profession. Though questioning scientific mainstream models, professional pluralism means to comply with scientific attitude. It calls for an unfolding of the premises and consequences of the respective therapeutic concepts. Scientific orientation of individual therapy includes competence, rational assessment of the patient's situation, clinical experience, knowledge of external evidence, and a critical evaluation of the course of disease. Furthermore, shared decision making on individual therapy requires empathy and the consideration of the patient's perspective. © 2010.

Hamre H.J.,Institute for Applied Epistemology and Medical Methodology | Witt C.M.,Charite - Medical University of Berlin | Kienle G.S.,Institute for Applied Epistemology and Medical Methodology | Meinecke C.,Pediatric Consultant | And 4 more authors.
International Journal of General Medicine | Year: 2010

Background: Anthroposophic treatment for attention deficit hyperactivity disorder (ADHD) includes special artistic and physical therapies and special medications. Methods: We studied 61 consecutive children starting anthroposophic treatment for ADHD symptoms under routine outpatient conditions. Primary outcome was FBB-HKS (a parents' questionnaire for ADHD core symptoms, 0-3), and secondary outcomes were disease and symptom scores (physicians' and parents' assessment, 0-10) and quality of life (KINDL® total score, 0-100). Results: A total of 67% of patients fulfilled the DSM-IV criteria for ADHD, 15% had an exclusion diagnosis such as pervasive developmental disorders, while 18% did not fulfill ADHD criteria for another reason. Anthroposophic treatment modalities used were eurythmy therapy (in 56% of patients), art therapy (20%), rhythmical massage therapy (8%), and medications (51%). From baseline to six-month follow-up, all outcomes improved significantly; average improvements were FBB-HKS total score 0.30 points (95% confidence interval [CI]: 0.18-0.43; P < 0.001), FBB-HKS inattention 0.36 (95% CI: 0.21-0.50; P < 0.001), FBB-HKS hyperactivity 0.29 (95% CI: 0.14-0.44; P < 0.001), FBB-HKS impulsivity 0.22 (95% CI: 0.03-0.40; P < 0.001), disease score 2.33 (95% CI: 1.84-2.82; P < 0.001), symptom score 1.66 (95% CI: 1.17-2.16; P < 0.001), and KINDL 5.37 (95% CI: 2.27-8.47; P= 0.001). Improvements were similar in patients not using stimulants (90% of patients at months 0-6) and were maintained until last follow-up after 24 months. Conclusion: Children with ADHD symptoms receiving anthroposophic treatment had long-term improvement of symptoms and quality of life. © 2010 Hamre et al, publisher and licensee Dove Medical Press Ltd.

Hamre H.J.,Institute for Applied Epistemology and Medical Methodology | Witt C.M.,Charite - Medical University of Berlin | Glockmann A.,Institute for Applied Epistemology and Medical Methodology | Ziegler R.,Society for Cancer Research | And 3 more authors.
European Journal of Health Economics | Year: 2010

We studied costs of healthcare and productivity loss in 487 German outpatients starting anthroposophic treatment: Group 1 was treated for depression, Group 2 had depressive symptoms but were treated for another chronic disorder, while Group 3 did not have depressive symptoms. Costs were adjusted for socio-demographics, comorbidity, and baseline health status. Total costs in groups 1-3 averaged €7,129, €4,371, and €3,532 in the pre-study year (P = 0.008); €6,029, €3,522, and €3,353 in the first year (P = 0.083); and €4,929, €3,792, and €4,031 in the second year (P = 0.460). In the 2nd year, costs were significantly reduced in Group 1. This study underlines the importance of depression for health costs, and suggests that treatment of depression could be associated with long-term cost reductions.

Kienle G.S.,Institute for Applied Epistemology and Medical Methodology | Kiene H.,Institute for Applied Epistemology and Medical Methodology
Integrative Cancer Therapies | Year: 2010

Objective. To evaluate controlled clinical studies on the efficacy and effectiveness of Viscum album for quality of life (QoL) in cancer. Materials and methods. The authors conducted a search of 7 electronic databases and reference lists and had extensive consultations with experts. They carried out a criteria-based assessment of methodological study quality. Results. The authors identified 26 randomized controlled trials (RCTs) and 10 non-RCTs that investigated the influence of V album extracts (VAEs) on QoL in malignant diseases; 26 studies assessed patient-reported QoL. Questionnaires were mostly well established and validated. Half of the studies investigated VAEs concomitant with chemotherapy, radiotherapy, or surgery. Some studies were well designed, whereas others had minor or major methodological weaknesses. Among the 26 RCTs, 22 reported a QoL benefit, 3 indicated no difference, and 1 did not report any result. All the non-RCTs reported a QoL benefit. Of the studies with higher methodological quality, most reported a benefit, whereas 1 found no difference. Improvements were mainly in regard to coping, fatigue, sleep, exhaustion, energy, nausea, vomiting, appetite, depression, anxiety, ability to work, and emotional and functional well-being in general and, less consistently, in regard to pain, diarrhea, general performance, and side effects of conventional treatments. VAEs were well tolerated. Conclusions. VAEs seem to have an impact on QoL and reduction of side effects of conventional therapies (chemotherapy, radiation) in experimental trials as well as in routine daily application. The influence on fatigue especially should be investigated further. © The Author(s) 2010.

Kienle G.S.,Institute for Applied Epistemology and Medical Methodology | Albonico H.-U.,Union of Associations of Swiss Physicians for Complementary Medicine | Fischer L.,University of Bern | Frei-Erb M.,University of Bern | And 5 more authors.
Explore: The Journal of Science and Healing | Year: 2011

Complementary and alternative medicine (CAM) is becoming an integral part of modern medicine. Complementary and alternative medicine therapy systems include natural medicinal products, nonpharmacological treatments, and counselling on health and lifestyle issues. Complementary and alternative medicine concepts are often elaborate, transcending biophysical models and employing the principles of salutogenesis. Evaluations of CAM therapy systems need to be integrative and cover the dimensions of: (1) therapeutic professionalism; (2) patient perspective and public demand; (3) conceptuality; (4) safety, effectiveness, and costs. Complex research strategies are required, which reverse the phases of conventional drug assessment. The predominant use of randomized trials would introduce structural bias and create an artifical picture. Important are evaluations of the whole system in real-world conditions, and surveys on component evaluations. Systemic CAM assessments should consist of a broad array of high-quality research methods: well-conducted randomized and nonrandomized studies, cohort studies, qualitative research, high-quality case reports and case series, studies on patient perspective, safety analyses, economic analyses, etc. Good clinical judgement, a core epistemic element of medicine based on nonstochastic principles, should also be integrated and could reflect routine patient care. © 2011 Elsevier Inc. All rights reserved.

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