1. The German model - a best practice example?“
"The value of Integrative Oncology in medicine:
The German model - a best practice example?“
Peter Zimmermann MD, PhD
Thomas Breitkreuz, MD
Lunch Meeting with Dr.Thomas Ulmer, MEP
10th May 2011
European Parliament Strasbourg, Salon LOW
IVAA, European Parliament, Strasbourg,

2. 36 Akademische Zentren für Integrative Medizin in den USA

University of Arizona

Stanford University 

University of California , Los Angeles 

University of California, San Francisco

University of Colorado at Denver School of Medicine 

University of Connecticut
Yale University 

University of Hawaii-Manoa

John A. Burns School of Medicine 

Northwestern University Feinberg School of Medicine

University of Illinois at Chicago School of Medicine

University of Kansas 

Johns Hopkins University

University of Maryland
Boston University School of Medicine

Harvard Medical School 

Massachusetts Medical School

University of Michigan 

Mayo Clinic

University of Minnesota 

University of Medicine and Dentistry of New Jersey 

University of New Mexico

Albert Einstein College of Medicine of Yeshiva University

Carolina Duke University

Forest University School of Medicine 

The Ohio State University

George Washington University 



University of Wisconsin-Madison
Oregon Health and Science University 

Thomas Jefferson University 
of Pittsburgh

Vanderbilt University

University of Texas Medical Branch 

University of Vermont College of Medicine 

University of Washington 

George Washington University 

University of Wisconsin-Madison
36 Akademische Zentren für Integrative Medizin in den USA
2009: NIH mit 294 Mill. USD Forschungsförderung für CAM i.S. der IM
Deutschland: AM seit 20-er Jahren integrative Medizin!

3. 2009: NIH mit 294 Mill. USD Forschungsförderung für CAM i.S. der IM
Deutschland: AM seit 20-er Jahren integrative Medizin!

4. Integrative Medicine: what should be integrated?
PATHOGENETIC CONCEPT
focusses on pathogenesis
physical / biochemical intervention
biochemic blockade
analytic / quantitatively orientated
substance and space
ideal: precise intervention
addition von single factors
“as much as necessary”
SALUTOGENETIC CONCEPT
focusses on healing process
constitution / life style
stimulation of processes
holistic / qualitatively orientated
process and time
ideal: global dynamic
combination / composition of effects
„as much as possible“
Physikalische Intervention: OP /Koro / Vermeidung flachen Liegens bei Reflux..
Heilungsprozess: bedarf eines Begriffs der Gesundheit!
Integrative Medizin: wesentlich ist die Integration von pathogenetisch orientierten und salutogenetisch orientierter Therapie
Kardiovask: Mißverhältnis von salutogenet. Wissen und pathogenet. Praxis;
Diskussion: wie genau bei welcher Erkrankung (Stellenwert)
IVAA, European Parliament, Strasbourg,

5. Mrs A. J., 54 years, breast cancer
Case history
Mrs A. J., 54 years, breast cancer
History:
Suffered breast cancer 4 years ago pT1b pN1 M0, PR+, ER+
 Operation
 Chemotherapy
 Radiotherapy
 Hormone therapy (Tamoxifen) – stopped due to side effects
Presentation:
Weakness / Fatigue
Shortness of breath
Weight loss: 7,5 kg / 5 months
Case study from every day life in an anthroposophic hospital
Aggressive treatment, common problem = fatigue (stays for years after chemotherapy)
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6. Comes to our hospital. Looks for another treatment because of her long lasting fatigue from her first chemotherapy, feels to weak for a new one.
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7. Why does she adress herself to an anthroposophic hospital
Why does she adress herself to an anthroposophic hospital? - Shown here: front page of the magazine of the german anthroposophic hospitals.
Well known for oncologic treatment. - Patient´s support group.
Looking for two features: double competence / experience in oncology. Problem of „oncologist and practitioner“
IVAA, European Parliament, Strasbourg,

8. http://www.anthromed.de/ Anthromed = hospital group.
Quality standards / quality control system.
Transparent criteria offered to patients: what is AM?
Fully integrated in health insurance system – all hospitals can admit every patient in germany and has to follow normal admission criteria.
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9. Back to our patient – outpatient´s clinic.
Tretment starts with patient´s history – not only medical, but biographical.
What is important for the patient? What does he or she suffers from? Patient´s preferences for treatment? Body and soul, biography?
Start with diagnostic procedures
IVAA, European Parliament, Strasbourg,

10. Mrs A. J., 54 years, relapse of breast cancer
Case history
Mrs A. J., 54 years, relapse of breast cancer
Findings in outpatient setting:
Liver metastasis
Elevated tumour markers
Hospital admission:
Examinations (radiographs, computer tomography, endoscopy...)
Start constitutional (salutogenic) anthroposophic treatment
(fatigue, appetite, anxiety / depression)
Case study from every day life in an anthroposophic hospital
Aggressive treatment, common problem = fatigue (stays for years after chemotherapy)
IVAA, European Parliament, Strasbourg,

11. IVAA, European Parliament, Strasbourg, 10.5.11

12. IVAA, European Parliament, Strasbourg, 10.5.11

13. IVAA, European Parliament, Strasbourg, 10.5.11

14. Multimodal approach I: Medical intervention / Diagnostic tools
Intensive Care
Endoscopy, catheterization, diagnostic interventions (i.e. biopsy techniques..)
Oncology: Surgery provided, chemotherapy provided
No difference to other hospitals
Staff is well-trained with „double competences“
AM as an integrative, not „alternative“ medicine
AM with 2 central features I want to point out:
- Integrative treatment + multimodal approach

15. Mrs A. J., 54 years, relapse of breast cancer
Case history
Mrs A. J., 54 years, relapse of breast cancer
Findings in physical examinations:
Liver metastases
Pleural effusion causing shortness of breath
Lymph node metastases (chest, abdomen)
Other findings:
Vitality: weakness / fatigue; disturbed sleep; difficulty to stand up and move; loss of appetite; disturbed circulation and heart rate
Psychological: anxienty / depression
Biographical: excessive demands at work / job strain; family conflicts; deep questions on meaning of life
Increased fluid in the pleural space that sorrounds the lungs
IVAA, European Parliament, Strasbourg,

16. Tumour board: as in other oncology departments and breast centres
AM: individualized recommendations, not only therapy standards; conventional AND AM treatment
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17. Prognosis and treatment is discussed with patients and relatives
AM hospitals: rooms designed for dialogue / discussion about treatment / attandance / what it means to the family
Palliative care!
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18. Mrs A. J., 54 years, relapse of breast cancer
Case history
Mrs A. J., 54 years, relapse of breast cancer
Medical Treatment:
Start with mistletoe therapy (first intravenously, continue with injections)
Strengthen vitality with AM medicines (Levico comp. injections, Stibium met praep D6 intravenously, Hepatodoron Tablets
Puncture of pleural effusion / mistletoe pleurodesis
Start with hormone treatment (Femara)
Nursing and physical therapies:
Liver compresses with milfoil (common yarrow) extract
Rhythmic massage
Increased fluid in the pleural space that sorrounds the lungs
IVAA, European Parliament, Strasbourg,

19. Most common salutogenic treatment for cancer in germany
As much as 70-80% of patients with breast cancer
Problems with randomisation in studies; problems with large studies (cost of 20 million €)
Here: homepage of doctor´s association with informations for patients and scientific information for doctors; independent from industry; HON-certified
IVAA, European Parliament, Strasbourg,

20. Study data: overview of prospective studies (10/2010)
Prospective comparative studies
30 RCT´s, Σ = 3396 patients
18 N-RCT´s, Σ = 4068 patients
Results: ✔ survival (OS) : 16 studies: significantly positive studies: positive trend studies without significant results
✔ QoL : 13 studies: significantly positive
2 studies: positive trend
IVAA, European Parliament, Strasbourg,

21. Study data: overview of retrospective studies (10/2010)
Retrospective comparative studies
42 studies, Σ = 7571 patients
parameter examinded: survival, QoL, remission / PFS, reduction of adverse effects of Cx / Rx
Results:
✔ advantage mistletoe „overall“: 39/42 studies
✔ advantage mistletoe in high quality studies: 12/13 studies
IVAA, European Parliament, Strasbourg,

22. Multimodal approach II: AM Medication
Wide range of AMP´s (>2000)
Parenteral application of particular impor- tance (about 25% of total prescriptions)
AM pharmaceuticals used in intensive care as well as for chronic disease
Indication / selection:
medical condition
affected organs
individual constitution
process-related
 „individualized therapy“

23. Pluralistic system in medicine: homgepage of the Federal institute....
Kommission C: market authorisation / pharmacovigilance / drug safety for AM (Homeopathy, Phytotherapy). NOT for Ayurveda / NOT for TCM (standards of production)
IVAA, European Parliament, Strasbourg,

24.
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25. Multimodal approach III: Nursing and physical therapies
Compresses
Medical washings / medicinal baths
(whole body, foot bath)
Rhythmic massage (oil, ointment)
Inhalation
specific AM techniques
AM pharmaceuticals for external use
very effective in acute medical conditions
differentiated therapy, not wellness!

26. Ingredients: sometimes teas / effusions, sometimes natural substances as bee wax
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27. Externals for compresses.
AMP´s needed for external use! Lack of regulation of externals in the EU.
Externals for compresses.
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28. Externals for massage. Highly differentiated therapeutic system!
In our hospital: every day use of about 80 different external AMPs
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29. Mrs A. J., 54 years, relapse of breast cancer
Case history
Mrs A. J., 54 years, relapse of breast cancer
Active therapies:
Eurythmy: movement therapy. Helps to activate healing forces, helps to overcome fatigue, find new active relation to own own physical vitality
Art therapy (painting): express inner psychological dynamics, helps to find individual ways of coping with the disease
IVAA, European Parliament, Strasbourg,

30. Multimodal approach IV: Art therapy / Eurythmy therapy
Art therapy: Painting / design
Speech therapy
Sculpture
Music therapy
Eurythmy therapy: movement therapy
Patient is active in the healing process
based on psycho-somatic interaction:
creativity  impression and expression  physiological functions
available in bedside setting

31. Mrs A. J., 54 years, relapse of breast cancer
Case history
Mrs A. J., 54 years, relapse of breast cancer
Hospital discharge after 12 days:
Strengthened vitality, good appetite, regained 2 kg
No shortness of breath, effective pleurodesis
New ideas for every day life
Learned mistletoe injection technique
Course after 2 months:
Rapidly growing lymph node metastasis
Liver / lungs: stable
Decision to start short course of chemotherapy in combination with whole-body-hyperthermia
IVAA, European Parliament, Strasbourg,

32. Chemotherapy: outpatients department
Combination with anthroposophic medicines
Warm surrounding is helpful
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33. Case
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34. Whole body hyperthermia: 38 – 40° - artificial fever
Infrared lamps and isolation beds
Betters the outcome:
Fever and immune stimulation effective in itself, part of AM therapies
Combination with chemotherapy: antitumoral effect (tumour cells die, amplifies effects of Cx)
IVAA, European Parliament, Strasbourg,

35. Warm feet, teas, cooling of head Duration: 3 hours
Monitoring
Warm feet, teas, cooling of head
Duration: 3 hours
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36. Network oncology: own research and documentation; no funding by producers

37. IVAA, European Parliament, Strasbourg, 10.5.11

38. Mrs A. J., 54 years, relapse of breast cancer
Case history
Mrs A. J., 54 years, relapse of breast cancer
Chemotherapy / hyperthermia / mistletoe therapy:
3 months of treatment with 4 courses of epirubicin (3 week interval)
Reduction of metastases (complete: liver; partial: lymph nodes)
No side effects during therapy
Continues AM therapy (mistletoe, constitutional, eurythmy therapy:
Completely regained weight and vitality
Active at work, changed every day life, positive attitude towards life
Clinically stable since 3 years
IVAA, European Parliament, Strasbourg,

39. Doctor´s team of my department
Postgraduate training centres for specialization in internal medicine / cardiology / oncology
IVAA, European Parliament, Strasbourg,

40. Gliederung
AM training in some universities; the best known is Witten / Herdecke
Centre for new approaches in medical education
Reforms of medical studies adapted by 8 other Universities / Medical Schools in Germany

41.
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