Bettina Reiter

High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research

The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens’ needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public’s health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on CAM research should be established to investigate the identified gaps of knowledge and to address upcoming health care challenges.

EU FP7 Project ‘CAMbrella’ to Build European Research Network for Complementary and Alternative Medicine

Background: The status of complementary and alternative medicine (CAM) within the EU needs clarification. The definition and terminology of CAM is heterogeneous. The therapies, legal status, regulations and approaches used vary from country to country but there is widespread use by EU citizens. A coordination project funded by the EU has been launched to improve the knowledge about CAM in Europe. Objectives and Methods: The project aims to evaluate the conditions surrounding CAM use and provision in Europe and to develop a roadmap for European CAM research. Specific objectives are to establish an EU network involving centres of research excellence for collaborative projects, to develop consensus-based terminology to describe CAM interventions, to create a knowledge base that facilitates the understanding of patient demand for CAM and its prevalence, to review the current legal status and policies governing CAM provision, and to explore the needs and attitudes of EU citizens with respect to CAM. Based on this information a roadmap will be created that will enable sustainable and prioritised future European research in CAM. CAMbrella encompasses 16 academic research groups from 12 European countries and will run for 36 months starting from January 2010. The project will be delivered in 9 work packages coordinated by a Management Board and directed by a Scientific Steering Committee with support of an Advisory Board. Output: The outcomes generated will be disseminated through the project’s website, peer review open access publications and a final conference, with emphasis on current and future EU policies, addressing different target audiences.

Building a Sustainable Complementary and Alternative Medicine Research Network in Europe

Background: Since CAMbrella is a networking project funded by the European Commission explicitly to build and sustain a complementary and alternative medicine (CAM) research network in Europe, communication and dissemination play a large role and form a work package of their own. The present article gives an outline of the communication and dissemination work in the CAMbrella consortium. The intensive building of sound internal communication is an essential part in establishing a functioning structure for collaboration in a diverse group of 16 partner institutions from 12 countries, as exists in the CAMbrella project. Methods: The means and tools for dissemination of results to the scientific community and the European public at large, as well as to the European policy makers, are presented. The development of the corporate design and a dissemination strategy are described in detail. In addition, some basic information regarding previous CAM research efforts, which might be interesting for future consortium building in the field of CAM research, is given. Results: Internal communication within a heterogeneous research group, the maintenance of a work-oriented style of communication and a consensus oriented effort in establishing dissemination tools and products will be essential for any future consortium in the CAM field. Conclusion: The outlook shows the necessity for active political encouragement of CAM research and the desideratum of a Pan-European institution analogous to the NIH (National Institutes of Health) in the USA.

CAM in Europe - Ideas and Notions

The present editorial wants to draw your attention, once again, to the current European CAM research situation which has been stirred and – for some people maybe even – shaken by the start of CAMbrella, the pan-European research network for complementary and alternative medicine (CAM), in Munich, in January 2010 [1]. Dieter Melchart already dedicated his editorial of the last issue of Forschende Komplementarmedizin / research in complementary medicine [2] to some of the controversial questions that seem to mushroom in the CAM field as soon as anything gets the go: envy-driven and so-called skeptical positions (as if, by definition, a CAM researcher was not a skeptic, i.e. a rational and scrutiny-driven person ...) say that first, you should not have started the thing at all, and second, it would have been better if the money had been granted to the skeptics. But this is of no big interest, or: as Karlsson-on-the-Roof, the famous little flying man in Astrid Lindgren’s children’s story used to say, when he was caught with a prank: ‘This does not make odds to a great mind!’ The much more interesting question is: What is going on in CAMbrella? For a general overview, you can consult the CAMbrella website (www.cambrella.eu) which gives detailed information on the entire working process and the different questions that will have to be answered by the end of 2012, when the final CAMbrella conference will be held in Brussels. In order to be informed on a regular basis, just subscribe to the quarterly newsletter; the first two issues are already available (www.cambrella.eu/newsletter). A major goal of the project is to deliver an informed proposal to the European public of how a definition of the various medicines could work that encompasses the whole of Europe (in its difference to North America or Asia) and at the same time does not eliminate the oddities and peculiarities of different regional traditions. Given the 27 member states and the 3 candidate countries (Croatia, Macedonia, Turkey), this is not a small task. For instance, is the term ‘Integrative Medicine’ suitable for the European patchwork situation? This notion is heavily doubted by the editor in chief of this journal, Harald Walach [3], for instance. Should we use a term that takes into account the European aspect, e.g. ‘Traditional European Medicine,’ a term which was coined to counterbalance the traditional Asiatic medicines like TCM or TTM, or should we stick to the NCCAM definition, for the sake of interrelatedness? How about the classical term of ‘Naturheilkunde’ in the German context or ‘Non-Conventional Medicine’ which seems to be more prevalent in the northern countries? One of CAMbrella’s tasks – in fact a fairly fundamental one – is the establishment of a glossary of CAM in Europe that includes a comprehensive definition of what CAM means in the European context. As one of the journals in the field – and the most relevant European one in that matter – Forschende Komplementarmedizin / research in complementary medicine wishes to offer particular input to that debate that was opened at the ISCMR [4] workshop ‘Complementary or Integrated? – Clarifying the Concepts’ at the ECIM congress in Berlin, in November 2009. At that workshop, Claudia Witt, Associate Editor, and Harald Walach, Editor in Chief of the present journal both gave topical statements regarding the definitional issues, and the ensuing discussion with the audience was a friendly and open, yet conceptionally sharp debate. ‘The targeted outcome’ of the Berlin workshop was to start ‘a series of, hopefully, clarifying discourses around the notion of integrative versus complementary medicine’ [5]. To continue this process for its own sake and the whole field as well as to give an informed input to the discussions that have to take place within the CAMbrella group, the Associate Editors of Forschende Komplementarmedizin / research in complementary medicine will share their ideas about that subject in one of the following issues of this journal.

Daniel Kaiser - † Juli 2014

Daniel Kaiser ist nicht mehr. Im Juli setzte er seinem Leben ein Ende. Seine ganze Leidenschaft galt der Homöopathie. Von Studienzeiten an bis zu seinem Tod setzte er sich unermüdlich für diese Heilweise ein: für ihre Verbreitung unter den Medizinstudierenden, für die Verbesserung ihrer Lehre und ihrer praktischen Ausbildung, für die Fortbildungsliteratur – für jeden Aspekt, der die Homöopathie voranbringen konnte. Die Carstens-Stiftung «Natur und Medizin» hat ihm Großartiges zu verdanken. 1991/92 entwickelte er zusammen mit Bernhard Luft und der Stiftung das Konzept einer Kommunikationsund Fortbildungsplattform für die studentischen Arbeitskreise für Homöopathie, seit Herbst 1992 «Wilseder StudentInnen-Forum für Homöopathie» genannt, das bis heute zweimal im Jahr Vertreter der jeweils bestehenden studentischen Arbeitskreise um die Homöopathie versammelt. Diese Einrichtung, die ohne Daniel Kaiser nicht entstanden wäre, ist medizingeschichtlich längst als weltweit einzigartig gewürdigt worden. Die ersten Treffen lebten von seinem Schwung, seiner Leidenschaft, seiner frohen Ausstrahlung, seinen immer wieder neuen Impulsen. Gleich mit dem ersten Treffen im März 1992 gründete er die «Homöopathischen Flugblätter», ebenso neu und einmalig wie das Forum. Erst nach etwa 10 Jahren fielen sie dem elektronischen Zeitalter zum Opfer. Er war bescheiden genug, sich nach wenigen Treffen aus dem Forum zurückzuziehen und anderen den Vortritt zu lassen. Nun war jedoch ein Netzwerk junger leidenschaftlicher Homöopathen im Übergang vom Studium zum Arzt sein entstanden, das nach Kontinuität verlangte. So entstand auf Drängen Kaisers das «Alt-Wilseder Forum für Homöopathie», in dem sich bis heute einmal im Jahr diejenigen treffen, die dem Studentenforum entwachsen sind. Auch dieses Forum sucht seinesgleichen und wäre ohne Kaiser nicht entstanden. Im vergangenen Winter war er beim 20. Treffen dabei, das wegen des Jubiläums in Wilsede – dem namensgebenden Ursprungsort der ganzen Bewegung – in der Lüneburger Heide stattfand. Vollkommen neuartige Strukturen der Nachwuchsförderung in der Homöopathie, vom Studierenden bis zum Facharzt, gehen damit auf Kaiser zurück. Der Geist von Wilsede – Offenheit jenseits aller Schulen der Homöopathie, Offenheit für Wissenschaft und Forschung und ein freundschaftliches Miteinander – ist wesentlich durch ihn geprägt. Nicht nur die Carstens-Stiftung «Natur und Medizin», sondern die ganze homöopathische Gemeinschaft, insbesondere die mittlerweile mehreren Hundert Teilnehmer der Wilseder Foren, verneigen sich in Dankbarkeit vor Kaiser. Dem Entschluss, seinem Leben ein Ende zu setzen, kann man – bei aller Trauer – nur mit größtem Respekt begegnen. Sein schweres psychisches Leiden hat ihn schlussendlich in tiefer Verzweiflung zu Boden gedrückt.

20 Years and No Wrinkles - a Reason to Be Proud

a Institut für Transkulturelle Gesundheitswissenschaften, Europa-Universität Viadrina, Frankfurt/O., b Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité Universitätsmedizin Berlin, c Fakultät für Gesundheit (Department für Humanmedizin), Universität Witten/Herdecke, d Zentrum für naturheilkundliche Forschung der II. Medizinischen Klinik und Poliklinik, Technische Universität München, e Abteilung für Naturheilkunde, Klinik für Innere Medizin, Immanuel Krankenhaus Berlin, Germany f National Research Centre in Complementary and Alternative Medicine, NAFKAM, Department of Community Medicine, Faculty of Health Science, University of Tromsø, Norway g Private Praxis, Wien, Austria h Institut für Naturheilkunde, Klinik für Innere Medizin, Universitätsspital Zürich, Switzerland

Meaning and context.

(1) Basic notions about sets (a) A set is a group of objects. Any group objects a, b, c can form a set. The basic way to represent a set is {a, b, c}. (b) If an object x is a member of a set A, it is denoted by x ∈ A. If b is not a member of A, it is denoted by x / ∈ A. (c) Sets can include other sets: {a, b, {c, d}, {e, f, g}}, {{a, b}, {a, b}}. Sets are determined only by their members, not their order. (d) Sets which contain only one member are called singletons: {a}, {{a, b}} are singletons. (e) A set which contains no members is called the empty set or the null set and is denoted by {}, ∅. (2) Relations between sets (a) If two sets A, B do not share any common members, they are called disjoint sets: {a, b} and {c, d} are disjoint. (b) If every member of a set A is a member of a set B than A is a subset of B and B is a superset of A. It is denoted by A ⊆ B and B ⊇ A respectively. Examples: {a, b, c} is a subset of {a, b, c, d, e}. Every set is a subset and a superset of itself : for every set A, A ⊆ A and A ⊇ A. Every set is a superset of the empty set: for every set A, ∅ ⊆ A. (3) Operations in sets

Phytotherapie in Europa: Neue Entwicklungen

ESCOP geht online mit dem erweiterten Aufbau einer wissenschaftlichen Dokumentation pflanzlicher Arzneimittel Die European Scientific Cooperative on Phytotherapy (ESCOP) ist die Dachorganisation der nationalen Phytotherapie-Gesellschaften in Europa, mit Delegierten aus Österreich, Belgien, Schweiz, Deutschland, Dänemark, Spanien, Frankreich, Irland, Italien, den Niederlanden, Polen, Türkei und Großbritannien. Sie verfolgt seit über 20 Jahren das Ziel, die wissenschaftliche und regulatorische Anerkennung von pflanzlichen Arzneimitteln in Europa zu fördern. Das Scientific Committee besteht aus Experten der Pharmazie, Medizin, Biologie und Chemie. Es verfasst Monografien mit einer Kontinuität, die ihresgleichen sucht. Die Monografien bieten eine übersichtliche Darstellung der wissenschaftlichen und traditionellen Informationen über die sichere und wirksame Anwendung pflanzlicher Arzneimittel, welche von Herstellern, Gesundheitsbehörden, Universitäten und Wissenschaftlern häufig nachgefragt wird. Das Komitee bearbeitet und wählt aus der zum Teil immensen Anzahl an Publikationen für jede Arzneipflanze die relevanten Arbeiten sorgfältig aus und verwendet gerne auch Vorschläge von spezialisierten externen Experten [1]. Mittlerweile sind von der ESCOP 107 Monografien zu Arzneipflanzen in 2 Bänden [2, 3] publiziert worden. Die Gruppe der Supervising Editors der ESCOP gewährleistet eine redaktionelle Überarbeitung der Monografien, welche die hohe Qualität maßgeblich mitbestimmt. Ganz neu werden Online-Veröffentlichungen von neuen und aktualisierten Monografien in Angriff genommen. Der Vorteil ist, dass die Monografien einzeln erhältlich sind und nicht mehr gesammelt in Buchform erscheinen müssen. Die Monografien werden aktueller sein, als es in Buchform möglich wäre. Die erste Monografie der neuen Online-Reihe (www.escop.com) ist Cimicifugae rhizoma (Traubensilberkerzen-Wurzel). Sie kann nach Bezahlung herunter geladen werden [4]. Weitere 18 Online-Versionen sind in Arbeit. Folgende werden aktualisiert: Uvae ursi folium, Symphytii radix, Plantaginis lanceolatae folium/herba und Hamamelidis aqua. Inhaltlich wird es sich um «State-of-the-art»-Monografien handeln, so wie wir das von der ESCOP gewohnt sind. Die frühen ESCOP-Monografien wurden formell bei der European Medicines Agency (EMA) eingereicht, als Basis für europäische Community Herbal Monographs für die Zulassung bzw. Registrierung von «traditionellen» und «regulären» pflanzlichen Arzneimitteln. Nach der Gründung des Herbal Medicinal Product Commitee (HMPC) sieht es die ESCOP als wichtige Aufgabe, die Entwürfe zu HMPC-Monografien zu prüfen und Kommentare abzugeben, die auf den ESCOP-Monografien basieren.