Whole system of Anthroposophic Medicine
Clinical Research on Anthroposophic Medicine as a Whole Medical System
Anthroposophic medicine (AM) is a whole medical system (WMS) (1). AM treatment includes specific AM therapy modalities (special medications; counselling; special artistic, movement and physical therapies; special nursing techniques, diet) which can be administered alone or together with conventional treatment and sometimes other, non-AM complementary or alternative treatment modalities (2). The AM conception of the human being includes a number of typologies relevant for diagnostics and therapy, such as two (upper and lower) poles, three dynamic systems, four levels of formative forces, and seven planetary or metal qualities (3). Accordingly, different patients with the same diagnosis according to conventional medicine may have different typological profiles, each requiring a different, i.e. individualised AM treatment. On the other hand, AM treatment can also be standardised.
For practical purposes, research of AM as a WMS (AM-WMS research) can be defined as research where the AM intervention
- is either complex, involving a combination of more than one AM therapy modality (e.g. physician counselling + eurythmy therapy),
- or it involves individualised medication treatment (that is, two or more AM medications that are not administered in the same combination to all patients).
According to this definition, research where the intervention is one nonmedication AM therapy modality administered in an individualised fashion (e.g. all patients have eurythmy therapy but the selection of eurythmy exercises is individualised) is not classified as AM-WMS research.
- Clinical studies of AM-WMS have been performed on a range of indications, including
- acute respiratory or ear infections (4,5), pneumonia (6)
- asthma (7,8)
- stroke (9), migraine (10)
- cancer (11-16)
- rheumatoid arthritis (17,18) and other inflammatory rheumatic disorders (17)
- pain conditions (19) including trigeminal neuralgia (20) and low back pain (21,22)
- anxiety disorders, (23) depression,(24) attention-deficit/hyperactivity disorder (25)
- mixed/various conditions (26-31)
The AM interventions were delivered in inpatient (6,9,11-15) or outpatient settings (remaining studies).
The AM interventions included the following AM therapy modalities (administered to at least 5 patients in the study analysis):
- individualised AM medication treatment (4-12,14-20,23-25,28,32)
- eurythmy therapy (5,7,8,10-12,14,15,18,23,25,28,32)
- AM art therapy (5,7,8,10-12,14,15,18,28,32)
- coloured light therapy (14,15)
- rhythmical massage therapy (5,10-12,23,28)
- external applications of substances of botanical origin (e.g. ginger, mustard, horseradish) or dairy products (quark) (4,6,14,15,17)
- hydrotherapy (11,12,14,15)
- prolonged consultations with AM physicians (5,8,10-12,14,15,17,23,25,32)
- dietary counselling (11,12,17,18,28)
Most AM-WMS studies or study publications included clinical outcomes such as disease symptoms or quality of life, while some focused on clinical outcome predictors,(33) medication safety,(30,31,34-36) antibiotic use,(5) patient satisfaction,(26,37) aspects of self-care(13) or health costs.(29,32,38,39)
Further data on AM-WMS studies published up till 2010 can be found in a systematic review.(40,41) The European Scientific Cooperative on Anthroposophic Medicinal Products (ESCAMP, http://www.escamp.org) is currently preparing an updated systematic review of clinical studies of individualised AM medication therapy.
Dr. med. Harald J. Hamre
IFAEMM Freiburg at the Witten/Herdecke University
(1) Baars EW, Hamre HJ. Whole medical systems versus the system of conventional biomedicine: a critical, narrative review of similarities, differences, and factors that promote the integration process. Evidence-based complementary and alternative medicine : eCAM 2017; 2017: 4904930. https://doi.org/10.1155/2017/4904930
(2 )Kienle GS, Albonico HU, Baars E, Hamre HJ, Zimmermann P, Kiene H. Anthroposophic medicine: an integrative medical system originating in Europe. Glob Adv Health Med 2013; 2(6): 2031. https://doi.org/10.7453/gahmj.2012.087
(3) Girke M. Internal Medicine: Foundations and therapeutic concepts of Anthroposophic Medicine. Berlin: Salumed-Verlag; 2012.
(4) Hamre HJ, Fischer M, Heger M, et al. Anthroposophic vs. conventional therapy of acute respiratory and ear infections: a prospective outcomes study. Wien Klin Wochenschr 2005; 117(7-8): 256-68. https://doi.org/10.1007/s00508-005-0344-9
(5) Hamre HJ, Glockmann A, Schwarz R, et al. Antibiotic use in children with acute respiratory or ear infections: prospective observational comparison of anthroposophic and conventional treatment under routine primary care conditions. Evid Based Complement Alternat Med 2014: Article ID 243801. http://dx.doi.org/10.1155/2014/243801
(6) Geyer U, Diederich K, Kusserow M, Laubersheimer A, Kramer K. Inpatient treatment of community-acquired pneumonias with integrative medicine. Evid Based Complement Alternat Med 2013; 2013: 578274. http://dx.doi.org/10.1155/2013/578274
(7) Andriashwili L, Karseladze R, Ulrich B. Anthroposophische Behandlungsaspekte des Asthma bronchiale im Kindesalter [Anthroposophic aspects of bronchial asthma treatment in childhood]. Georgian Med News 2007; 144(3): 43-8.
(8) Hamre HJ, Witt CM, Kienle GS, et al. Anthroposophic therapy for asthma: a two-year prospective cohort study in routine outpatient settings. J Asthma Allergy 2009; 2: 111-28.
(9) Wilkens J, Lüdtke R, Stein F, Schuwirth W, Karenovic A. Vergleichende Untersuchung zur Behandlung des Schlaganfalls mit homöopathischen und anthroposophischen Arzneimitteln in einergeriatrischen Reha-Klinik. In: Albrecht H, Fruhwald H, eds. Jahrbuch der Karl und Veronica CarstensStiftung, Band 8. Essen: KVC Verlag; 2001: 31-45.
(10) Hamre HJ, Witt CM, Kienle GS, et al. Anthroposophic therapy for migraine: a two-year prospective cohort study in routine outpatient settings. Open Neurol J 2010; 4: 100-10.
(11) Carlsson M, Arman M, Backman M, Flatters U, Hatschek T, Hamrin E. Evaluation of quality of life/life satisfaction in women with breast cancer in complementary and conventional care. Acta Oncol 2004; 43(1): 27-34. http://dx.doi.org/10.1080/02841860310020339
(12) Carlsson M, Arman M, Backman M, Flatters U, Hatschek T, Hamrin E. A five-year follow-up of quality of life in women with breast cancer in anthroposophic and conventional care. Evid Based Complement Alternat Med 2006; 3(4): 523-31. http://dx.doi.org/10.1093/ecam/nel042
(13) Arman M, Hok J. Self-care follows from compassionate care - chronic pain patients' experience of integrative rehabilitation. Scand J Caring Sci 2016; 30: 374–81. http://dx.doi.org/10.1111/scs.12258
(14) Heusser P, Braun SB, Ziegler R, et al. Palliative in-patient cancer treatment in an anthroposophic hospital: I. Treatment patterns and compliance with anthroposophic medicine. Forsch Komplementarmed 2006; 13(2): 94-100. doi.org/10.1159/000091694
(15) Heusser P, Braun SB, Bertschy M, et al. Palliative in-patient cancer treatment in an anthroposophic hospital: II. Quality of life during and after stationary treatment, and subjective treatment benefits. Forsch Komplementarmed 2006; 13(3): 156-66. https://doi.org/10.1159/000092448
(16) Seifert G, Rutkowski S, Jesse P, et al. Anthroposophic supportive treatment in children with medulloblastoma receiving first-line therapy. J Pediatr Hematol Oncol 2011; 33(3): e105-e8.
(17) Simon L, Schietzel T, Gärtner C, Kümmell HC, Schulte M. Ein anthroposophisches Therapiekonzept für entzündlich-rheumatische Erkrankungen. Ergebnisse einer zweijährigen Pilotstudie. [An anthroposophic therapy concept for inflammatory rheumatoid disorders. Results of a two-year pilot study]. Forsch Komplementärmed 1997; 4: 17-27. https://doi.org/10.1159/000210288
(18) Hamre HJ, Pham VN, Kern C, et al. A 4-year non-randomized comparative phase-IV study of early rheumatoid arthritis: integrative anthroposophic medicine for patients with preference against DMARDs vs. conventional therapy including DMARDs for patients without preference. Patient Preference and Adherence 2018; 12: 375-97. https://doi.org/10.2147/PPA.S145221
(19) Simon L. Schmerztherapie mit homöopathisch potenzierten Heilpflanzen. Eine klinischtherapeutische Studie unter besonderer Berücksichtigung des chirurgischen Fachgebietes. Heidelberg: Karl F. Haug Verlag; 1987.
(20) Astrup C, Astrup S, Astrup S, Pedersen PA. Die Behandlung von Gesichtsschmerzen mit homöopathischen Heilmitteln. Eine prospektiv geplante Nachuntersuchung. [Treatment of facial pain with homeopathic remedies. A prospective follow-up study]. Erfahrungsheilkunde 1976; (3): 89-96.
(21) Hamre HJ, Witt CM, Glockmann A, et al. Anthroposophic vs. conventional therapy for chronic low back pain: a prospective comparative study. Eur J Med Res 2007; 12(7): 302-10. http://www.daignet.de/site-content/die-daig/fachorgan/2007-1/european-journal-of-medicalresearch-2007-vol-12-nr.7
(22) Hamre HJ, Witt CM, Kienle GS, et al. Long-term outcomes of anthroposophic therapy for chronic low back pain: A two-year follow-up analysis. J Pain Res 2009; 2: 75-85.
(23) Hamre HJ, Witt CM, Kienle GS, et al. Anthroposophic therapy for anxiety disorders: a twoyear prospective cohort study in routine outpatient settings. Clin Med Psychiatr 2009; 2: 17-31. https://doi.org/10.4137/CMPsy.S2791
(24) Hamre HJ, Witt CM, Glockmann A, Ziegler R, Willich SN, Kiene H. Anthroposophic therapy for chronic depression: a four-year prospective cohort study. BMC Psychiatry 2006; 6(57).
(25) Hamre HJ, Witt CM, Kienle GS, et al. Anthroposophic therapy for attention deficit hyperactivity: a two-year prospective study in outpatients. Int J Gen Med 2010; 3: 239-53.
(26) Esch BM, Marian F, Busato A, Heusser P. Patient satisfaction with primary care: an observational study comparing anthroposophic and conventional care. Health Qual Life Outcomes 2008; 6(1): 74. https://doi.org/10.1186/1477-7525-6-74
(27) Greeson JM, Rosenzweig S, Halbert SC, Cantor IS, Keener MT, Brainard GC. Integrative medicine research at an academic medical center: patient characteristics and health-related qualityof-life outcomes. J Altern Complement Med 2008; 14(6): 763-7.
(28) Hamre HJ, Kiene H, Glockmann A, Ziegler R, Kienle GS. Long-term outcomes of anthroposophic treatment for chronic disease: a four-year follow-up analysis of 1510 patients from a prospective observational study in routine outpatient settings. BMC Res Notes 2013; 6(269). http://dx.doi.org/10.1186/1756-0500-6-269
(29) Baars EW, Kooreman P. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs. BMJ Open 2014; 4(8). https://doi.org/10.1136/bmjopen-2014-005332
(30) Hamre HJ, Glockmann A, Heckenbach K, Matthes H. Use and safety of anthroposophic medicinal products: an analysis of 44,662 patients from the EvaMed Pharmacovigilance Network. Drugs - Real World Outcomes 2017; 4(4): 199-213. https://doi.org/10.1007/s40801-017-0118-5
(31) Süsskind M, Thürmann PA, Luke C, et al. Adverse drug reactions in a complementary medicine hospital: a prospective, intensified surveillance study. Evid Based Complement Alternat Med 2012; 2012: 320760. http://dx.doi.org/10.1155/2012/320760
(32) Hamre HJ, Witt CM, Glockmann A, et al. Health costs in patients treated for depression, in patients with depressive symptoms treated for another chronic disorder, and in non-depressed patients: a two-year prospective cohort study in anthroposophic outpatient settings. Eur J Health Econ 2010; 11(1): 77-94. https://doi.org/10.1007/s10198-009-0203-0
(33) Hamre HJ, Witt CM, Kienle GS, Glockmann A, Willich SN, Kiene H. Predictors of outcome after 6 and 12 months following anthroposophic therapy for adult outpatients with chronic disease: a secondary analysis from a prospective observational study. BMC Res Notes 2010; 3(218). http://dx.doi.org/10.1186/1756-0500-3-218
(34) Hamre HJ, Witt CM, Glockmann A, Tröger W, Willich SN, Kiene H. Use and safety of anthroposophic medications in chronic disease: a 2-year prospective analysis. Drug Saf 2006; 29(12): 1173-89. https://doi.org/10.2165/00002018-200629120-00008
(35) Hamre HJ, Glockmann A, Fischer M, Riley DS, Baars E, Kiene H. Use and safety of anthroposophic medications for acute respiratory and ear infections: a prospective cohort study. Drug Target Insights 2007; 2: 209-19. http://insights.sagepub.com/article.php?article_id=358
(36) Jong MC, Jong MU, Baars EW. Adverse drug reactions to anthroposophic and homeopathic solutions for injection: a systematic evaluation of German pharmacovigilance databases. Pharmacoepidemiol Drug Saf 2012; 21(12): 1295-301. http://dx.doi.org/10.1002/pds.3298
(37) Arman M, Hammarqvist AS, Kullberg A. Anthroposophic health care in Sweden - a patient evaluation. Complement Ther Clin Pract 2011; 17(3): 170-8.
(38) Hamre HJ, Witt CM, Glockmann A, Ziegler R, Willich SN, Kiene H. Health costs in anthroposophic therapy users: a two-year prospective cohort study. BMC Health Serv Res 2006; 6(65). https://doi.org/10.1186/1472-6963-6-65
(39) Kooreman P, Baars EW. Patients whose GP knows complementary medicine tend to have lower costs and live longer. Eur J Health Econ 2012; 13(6): 769-76. https://doi.org/10.1007/s10198011-0330-2
(40) Kienle GS, Kiene H, Albonico HU. Anthroposophic medicine: effectiveness, utility, costs, safety. Stuttgart, New York: Schattauer Verlag; 2006.
(41) Kienle GS, Glockmann A, Grugel R, Hamre HJ, Kiene H. Klinische Forschung zur Anthroposophischen Medizin - Update eines Health Technology Assessment-Berichts und Status Quo [Clinical research on anthroposophic medicine: update of a health technology assessment report and status quo]. Forsch Komplementmed 2011; 18(5): 269-82. http://dx.doi.org/10.1159/000331812