Complementary therapies. Helmut Roniger

Transcription

1 Complementary therapies Helmut Roniger

2 Dr Helmut Roniger Patient day 2016

3 Overview 1. Conventional Medicine vs CIM 1. History 2. Broken machine vs self repairing organism 3. Evidence base = research funding: patentable vs not patentable 4. CAM or CIM 2. Spontaneous Remission 3. Placebo/Nocebo 4. Therapeutic communication 5. CIM therapies 1. Mistletoe 2. Hyperthermia 3. Meditation 4. Acupuncture

4 CAM or CIM Complementary and Alternative Medicine Fading appeal because of alternative Alternative medicine implies the avoidance of proven conventional treatments Evidence based conventional treatments should be part of the first line approach Complementary and Integrative Medicine New kid on the block Better describes the blending of the best of old and new medicine

5 Conventional vs CIM Conventional Medicine Usually patentable Research funding base secure Highly researched and evidence based Bottom up research Disease specific Technology driven Disease focused: interrupting pathology Broken machine model curing CIM Usually not patentable Research funding base minimal Small evidence base Reverse engineering Holistic Traditional empirism Health focused Unleashing natural healing ability Self repairing organism model healing

6 Old Tumour Based Model Surgery Tumour Tumour Radiation Physician Chemotherapy Patient

7 New Person Based Model Healthful Diet Immune Enhancement Prayer Participant Vitamins & Supplements Exercise SELF T Surgery Chemotherapy Radiation Physician & other Practitioners Stress Reduction Emotional Support Avoidance of Toxins Meditation

8 Foundations of Healing Conventional Medical Therapies Complementary Therapies Vitamins and Supplements Sleep, Rest and Relaxation Exercise Healthful Water Healthful Diet Avoidance of Physical Toxins Stress Reduction Emotional Connection Body-Mind Awareness Personal Autonomy Joy and Laughter Spiritual Connection Hope Will to Live

9 Spontaneous Remission Rare but severely underreported More than 3000 cases described Associated with sudden febrile disease often by infection and/or significant shift towards a congruent positive emotional outlook to life Cancer was the best thing that happened to me O REGAN,B., HIRSHBERG,C.(1993)Spontaneous Remission. Institute of Noetic Sciences

10 Placebo/Nocebo research Well researched Significant effect Can be stimulated and enhanced Size is disease and context driven Underutilized Hierarchy: 1. Surgical interventions: % 2. Infusions: 30-40% 3. Active placebo pills: with side effects 4. Colored pills: silver most effective 5. White inert sugar pills: 10%

11 Therapeutic Communication Therapeutic communication essential in cancer care: How to communicate complex and challenging information to new cancer patients truthfully, motivating to engage with toxic or invasive therapy while ideally inspiring an expectancy of the best possible outcome and the willingness for positive behavioral change? Potential for nocebo effect if poor communication

12 1 Year Survivor Rates 80% 70% 60% 75% 67% 60% 53% 50% 46% 40% InspireHealth BC 30% 20% 20% 10% 0% Stage 3B & 4 Lung Stage 4 Colorectal Stage 4 Breast

13 2 Year Survival Rates 60% 55% 50% 44% 40% 35% 30% 25% 20% InspireHealth BC 20% 10% 7% 0% Stage 3B & 4 Lung Stage 4 Colorectal Stage 4 Breast

14 Emotional Support Study with 90 breast cancer patients stage II and III * Conclusions: Two aspects of close relationships marital confiding and dependable, non-household supports were protective against breast cancer progression. Analysis of close relationships together with emotion processing variables suggested unique protective effects against mortality, but a larger study is necessary to determine whether this is the case. * WEIHS, K., ENRIGHT, T. and SIMMENS, S. (2008) Close relationships and emotional processing predict decreased mortality in women with breast cancer: preliminary evidence. Psychosomatic Medicine. 70(1). p

15 Optimism vs Pessimism Optimists live 10 years longer than pessimists BBC: The truth about personality: RASMUSSEN, H., SCHEIER, M., GREENHOUSE, J. (2009) Optimism and Physical Health: A Metaanalytic Review. Ann Behav Med. 37(3). p

16 Effects of CIM in cancer care Improved QoL 1) Better stress management, 2) Improved sleep quality, 3) Better pain control 4) Better side effect management of conventional therapy FRENKEL, M. and COHEN, L. (2012) Effective Communication About the Use of Complementary and Integrative Medicine in Cancer Care. Journal of Alternative and Complementary Medicine. 20 (1). Pp doi: /acm

17 Complementary Cancer Therapy RLHIM/ UCLH NHS service provided by statutory registered physicians and health workers Working in tandem with conventional cancer services Referral by GP or Oncologist

18 Complementary Cancer Therapy RLHIM Iscador (a mistletoe preparation) Acupuncture Autogenic training, meditation Dietetics Physiotherapy Art therapy Homeopathy Aromatherapy/ massage

19 Mistletoe Most prescribed herbal treatment for cancer in Europe Excellent tolerance and safety Good evidence base for improvement of QoL Emerging evidence for survival benefits Small costs compared to conventional drugs Oral, subcut, iv: subcut has best evidence base

20 Hyperthermia/ artificial fever Not available in UK on the NHS Gives significant survival benefits as extreme local hyperthermia in combination with chemotherapy and radiotherapy but expensive and dependent on highly trained teams

21 Acupuncture Very safe and effective for symptom palliation Chronic pain Stress reduction/ relaxation Nausea

22 Meditation Mindfulness or Mantra/ TM Relaxation response Insight into subconscious: Inner transformation of subconscious conflicts and negative emotions towards positive or acceptance

23 Conclusion CIM can significantly enhance QoL and possibly survival Difficulty with research funding because not patentable Focus on unleashing natural self healing: natural unspecific immune therapy Importance to use highly qualified ideally statutory registered practitioners Integrated into conventional treatment pathways Avoidance of clash of therapies Maximizing synergism Conventional and CIM practitioners communicate