Complementary therapies

Helmut Roniger

Dr Helmut Roniger

Patient day

2016

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

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

Conventional vs CIM

Conventional Medicine CIM

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”

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”

Old Tumour Based Model

Radiation

Physician

Tumour

Patient

Tumour

Chemotherapy

Surgery

New Person Based Model

Immune Enhancement

Prayer

Surgery

Chemotherapy

Radiation

Vitamins &

Supplements

Exercise

Stress Reduction

Avoidance of Toxins

Emotional Support

Healthful Diet

SELF

Meditation

T

Participant

Physician & other

Practitioners

Foundations of Healing

Joy and Laughter

Will to Live

Hope

Spiritual Connection

Personal Autonomy

Conventional Medical Therapies

Complementary Therapies

Body-Mind Awareness

Emotional Connection

Stress Reduction

Avoidance of Physical Toxins

Healthful Diet

Healthful Water

Sleep, Rest and Relaxation

Vitamins and Supplements

Exercise

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

Placebo/Nocebo research Well researched Significant effect Can be stimulated and enhanced Size is disease and context driven Underutilized Hierarchy: 1. Surgical interventions: 50-100% 2. Infusions: 30-40% 3. Active placebo pills: with side effects 4. Colored pills: silver most effective 5. White inert sugar pills: 10%

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

0%

10%

20%

30%

40%

50%

60%

70%

80%

Stage 3B & 4 Lung Stage 4 Colorectal Stage 4 Breast

53%

60%

75%

20%

46%

67%

1 Year Survivor Rates

InspireHealth

BC

0%

10%

20%

30%

40%

50%

60%

Stage 3B & 4 Lung Stage 4 Colorectal Stage 4 Breast

25%

35%

55%

7%

20%

44%

2 Year Survival Rates

InspireHealth

BC

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.

117-124

Emotional Support

Optimism vs Pessimism

Optimists live 10 years longer than pessimists

BBC: The truth about personality: https://www.youtube.com/watch?v=TJtL1Owa2fw

RASMUSSEN, H., SCHEIER, M., GREENHOUSE, J. (2009) Optimism and Physical Health: A Meta-analytic Review. Ann Behav Med. 37(3). p. 239-256

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. 12-18. doi:10.1089/acm.2012.0533.

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

Complementary Cancer Therapy RLHIM

Iscador (a mistletoe preparation)

Acupuncture

Autogenic training, meditation

Dietetics

Physiotherapy

Art therapy

Homeopathy

Aromatherapy/ massage

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

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

Acupuncture Very safe and effective for symptom palliation

Chronic pain

Stress reduction/ relaxation

Nausea

Meditation Mindfulness or Mantra/ TM

Relaxation response

Insight into subconscious: Inner transformation of subconscious conflicts and negative emotions towards positive or acceptance

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