De bijdrage van
Antroposofische Gezondheidszorg
aan de ontwikkeling van
Integrative Medicine
26 juni 2014
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Congres informatie
Programma Info workshops
Locatie workshops
Sprekers Workshopleiders 2
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Achtergrondinformatie Antroposofische Gezondheids­zorg
& Integrative Medicine
Introductie
Integrative Medicine &
Antroposofische Gezondheidszorg
"Anthroposophic Medicine: An Integrative Medical
System Originating in Europe"
Enkele belangrijke publicaties
Enkele belangrijke organisaties en links
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Meer over het Lectoraat Antroposofische Gezondheidszorg
Medewerkers lectoraat 35
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Sponsors43
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Congres informatie
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Programma 26 juni 2014
De bijdrage van Antroposofische Gezondheidszorg
aan de ontwikkeling van Integrative Medicine
09.00 - 10.00 Ontvangst en inschrijving
10.00 - 10.05 Welkom door drs. Paul van Maanen, Hogeschool Leiden
10.05 - 10.15 Opening door de dagvoorzitter
10.15 - 11.00 Deel 1: Integrative Medicine (IM) en Antroposofische Gezondheidszorg (AG) binnen de gezondheidszorg:
kennisontwikkeling, kenmerken en positionering
• Henk Smid, directeur ZonMW
De ontwikkeling van kennis over IM in Nederland
• Prof. Dr. Peter Heusser, Universiteit Witten/Herdecke
Characteristics of AM and the position of AM in relation to IM
11.00 - 11.20 Pauze
11.20 - 12.30 Deel 2: Professionele integratie van “the best of both worlds”
• Dr. Hans Kerkkamp, Atrium Ziekenhuis
Ervaringen met en de voorwaarden voor de uitvoering van IM in de klinische praktijk
• Prof. Dr. Claudia Witt, Universiteit Zürich
The merging of conventional and complementary healthcare cultures
• Dr. Erik Baars, Hogeschool Leiden
Integratieve trends in de samenleving en wetenschap en de positie van AG hierin
12.30 - 13.15 Lunch
13.15 - 14.00 Werkgroepen ronde 1
14.05 - 14.50 Werkgroepen ronde 2
14.50 - 15.10 Pauze
15.10 - 16.20 Deel 3: Evidence van veiligheid en (kosten)effecten van therapieën
• Prof. Dr. Yvo Smulders, VUMC
Wetenschappelijke voorwaarden voor het toepassen van IM in de klinische praktijk
• Prof. Dr. Benno Brinkhaus, University Medical Center Berlin
Cambrella - The roadmap for European CAM research
• Dr. Gunver Kienle, Universiteit Witten/Herdecke
An overview of the scientific evidence on (cost)effects of AM
16.25 - 17:00 Forumdiscussie over de toekomst van IM en de bijdrage van AG
17.00 - 17.15 Concert
17.15 - 18.00 Borrel
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Info workshops
1ste ronde
2de ronde
1.
1.
F0.015
2.
Using the merger integration model and its checklist to develop an integrative medicine service
(Claudia Witt)
F0.015
What is the mind (‘Geist’)?
(Peter Heusser)
2.
G2.126
3.
G2.017
4.
G2.046
Whole medical systems: scientific and
regulatory issues
(Harald Hamre)
3.
G2.048
Psychiatrie vanuit integraal en antroposofisch
perspectief (Marko van Gerven & Rogier Hoenders)
4.
G2.046
5.
G2.048
7.
G2.110
How can we overcome our differences? An interdisciplinary method towards personalized treatment
(Loes van den Heuvel & Kore Luske)
Case-study methodology
(Gunver Kienle)
AG en IM Kindergeneeskunde
(Edmond Schoorel & Ines von Rosenstiel)
G2.017
AG en IM Huisartsenzorg
(Peter Staal & Elkana Waarsenburg)
5.
G2.042
6.
Cambrella - The roadmap for
European CAM research (Benno Brinkhaus)
Patiëntervaringen met AG en IM
(Evi Koster & Miek Jong)
G2.042
De relatie van Evidence Based Medicine en ervaringswetenschap in de reguliere geneeskunde
(Guus van der Bie)
6.
G2.110
Zorgprogramma en behandelmodule
muziektherapie bij gehechtheidsproblematiek
(Odulf Damen & Martin Niemeijer)
7.
G2.126
6
Antroposofische behandeling
voor de patiënt met kanker
(Anja de Bruin, Marco Ephraïm)
Onderwijs in AG en IM
(Guus van der Bie & Frans Kusse)
Locatie workshops
Begane grond
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F0042
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F0054
F0034
Servicedesk
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Begane grond
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F0051a
F0024
Studentzaken
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F0058
B0.013: Kolf-/E.H.B.O-ruimte
B0.038, B0.039: Kleed-/Doucheruimten
B0.023: Studentenraad
F0.054: Decanaat
F0.015: Auditorium
F0.057: Stilteruimte
G0.002: Gymzaal
G0.023: Kolfruimte
G0.038: Auditorium
F0018
Auditorium
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Entree hoofdgebouw
Bookshop
Receptie
Naar H & J gebouw
Entree hoofdgebouw
Naar Z gebouw
Grand Café
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Gymzaal
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Toiletten
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Auditorium
Liften
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Restaurant
Binnentuin
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Goederenontvangst
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Sprekers
Dr. Erik Baars
Lectoraat Antroposofische Gezondheidszorg (Hogeschool Leiden)
Arts-epidemioloog Dr. Erik Baars
werkte meer dan vijftien jaar in de
antroposofische gezondheidszorg en is
senior-onderzoeker Gezondheidszorg
van het Louis Bolk Instituut. Sinds
2007 is hij als lector Antroposofische
Gezondheidszorg verbonden aan hogeschool Leiden.
Prof. Dr. Benno Brinkhaus
Institute for Social Medicine,
Epidemiology and Health Economics,
Charité - University Medical Center,
Berlin, Germany
Prof. Dr. Benno Brinkhaus, MD. Doctor
of internal medicine, acupuncture,
naturopathy and trained in epidemiology. Head of the Division for Complementary Medicine and acting director
of the Institute for Social Medicine,
Epidemiology and Health Economics,
Charité - University Medical Center,
Berlin, Germany. Coordinator of
students education of the Institute between 2005-2012. Worked from 1994
to 2001 as a physician and a research
associate in the Medical Department
I, Friedrich-Alexander-University
Erlangen-Nuremberg, Germany and
was between 1995-2001 head of the
department of complementary medicine. He is the principal investigator
of several projects in the field of Complimentary and Alternative Medicine
(CAM) and member of different medical
and acupuncture societies, reviewer
of national and international medical
journals.
Prof. Dr. Peter Heusser
University Witten/Herdecke,
Germany
Peter Heusser: Swiss; Medical School,
University of Bern; training in general
medicine (internal medicine, surgery,
paediatrics) in Swiss hospitals; training in anthroposophic medicine (AM),
Ita Wegman Klinik and Lukas Klinik
Arlesheim; practicing AM physician
for general and oncological patients.
Co-Chair in Swiss National Foundation
Research Project on quality of life in
advanced cancer patients treated with
AM. Research associate, evaluation
of complementary medicine, Swiss
Ministries for Health and Health Insu-
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rance.1995-2008 lecturer and head,
Department of Anthroposophic Medicine at the Institute of Complementary
Medicine (KIKOM), University of Bern.
Since 2009 professor and chair holder
for Theory of Medicine, Integrative and
Anthroposophic Medicine, head, Institute for Integrative Medicine, Witten/
Herdecke University, Germany.
Dr. Hans Kerkkamp
Atrium Medisch Centrum Parkstad
Hans Kerkkamp (1956) is sinds 2007
lid van de Raad van Bestuur van Atrium
MC te Heerlen. In Atrium MC is hij
onder andere verantwoordelijk voor
zowel de poliklinische als klinische
zorg, kwaliteit, veiligheid, innovatie
en het leerhuis. Daarvoor heeft hij
meer dan 25 jaar als anesthesioloog
gewerkt in diverse ziekenhuizen. De
laatste periode als medisch specialist
was hij verbonden aan het UMC Utrecht
als professor in de anesthesiologie
en was hij tevens medisch manager
van de Divisie Peri-operatieve zorg en
Spoedeisende hulp. Hij studeerde geneeskunde aan de Erasmus Universiteit
te Rotterdam.
Dr. Gunver Kienle
Institute for Applied Epistemology
and Medical Methodology, University
Witten/Herdecke, Freiburg, Germany
Gunver Kienle is a physician-researcher
at the Institute for Applied Knowledge
Theory and Medical Methodology
(IFAEMM) in Freiburg, Germany. She
has worked as a physician in oncology
and has many years of experience with
clinical research and the systemic
analysis of clinical studies. She has
published numerous scientific articles
and books (including on mistletoe
therapy, clinical trials, case-based
research methods and the placebo
effect). www.ifaemm.de
Henk Smid
ZonMW
Henk J. Smid (1956) is directeur van
ZonMw, de Nederlandse organisatie
voor gezondheidsonderzoek en zorgin-
novatie (www.zonmw.nl). Hij studeerde in 1983 af aan de International
University Lugano in de menswetenschappen en in 1984 Gezondheidswetenschappen Rijksuniversiteit Limburg,
met specialisatie beleid en beheer. Hij
vervulde diverse leidinggevende functies bij het toenmalige ministerie van
Welzijn, Volksgezondheid en Cultuur,
waar onder waarnemend directeur
Preventie, Epidemiologie en Patiëntenbeleid ( 1992) en plv. directeur Preventie, Algemene Gezondheidszorg en
Opleidingen (1993-1995). Henk Smid
was voorzitter Eurogroup for Animal
Welfare, een Europese lobby-organisatie die contacten onderhoudt met
de Europese Commissie en samenwerkt
met het Europees Parlement.
Prof. Dr. Yvo Smulders
VUMC
Yvo Smulders is hoogleraar Interne
Geneeskunde aan het VU Medisch Centrum te Amsterdam. Zijn dagelijks werk
bestaat uit het opleiden van artsen in
het specialisme Interne Geneeskunde.
Daarnaast heeft hij diverse onderzoekslijnen lopen. Een van zijn speciale interessegebieden is het gebruik (en
misbruik) van de aan- of afwezigheid
van epidemiologisch bewijs in de geneeskunde. Daaraan gerelateerd is de
interesse voor de betrouwbaarheid van
medisch-wetenschappelijk onderzoek.
9
Hij is een fervent aanhanger van de
reguliere westerse geneeskunde, maar
is wel kritisch ten aanzien van haar
valkuilen en beperkingen.
Prof. Dr. Claudia Witt
University Zürich, Switzerland
Dr. Claudia Witt, MD, MBA is a medical
doctor, epidemiologist and research
methodologist. Since 2014 she is
Professor for Medicine and Director of
the Institute for Complementary and
Integrative Medicine at the University
Zürich and the University Hospital
Zürich. Before she served as Acting
Director of the Institute for Social Medicine, Epidemiology and Health Economics at the University Medical Center
Charité in Berlin, Germany. 2011-2013
she served as the President of the International Society for Complementary
Medicine Research (ISCMR). Dr. Witt
has dedicated her career to evaluating
the efficacy, effectiveness, cost-effectiveness and safety of Complementary
and Integrative Medicine.
Workshopleiders
Guus van der Bie
Lectoraat Antroposofische Gezondheidszorg (Hogeschool Leiden)
Guus van der Bie was jarenlang docent
anatomie en embryologie aan de Universiteit Utrecht voordat hij huisarts
werd. Het huisartsenberoep oefende
hij 35 jaar uit in een multidisciplinair
antroposofisch Therapeuticum. Al die
jaren is hij betrokken gebleven bij de
opleiding van medische studenten
met betrekking tot de huisartsgeneeskunde. Sinds tien jaar is hij docent
“Complementaire zienswijzen in de
zorg” aan de Universiteit Utrecht en
was medeontwerper van het nieuwe
vak “Medical Humanities” (sinds 2008)
in het curriculum in Utrecht. Daarnaast is hij docent antroposofische
geneeskunde aan de Universiteit van
Witten-Herdecke (Dl) en internationaal
coördinator van antroposofische artsenopleidingen voor de Medizinische
Sektion van de Freie Hochschule für
Geisteswissenschaft te Dornach (Zw).
Benno Brinkhaus
Institute for Social Medicine, Epidemiology and Health Economics,
Charité - University Medical Center,
Berlin, Germany
Prof. Dr. Benno Brinkhaus, MD. Doctor
of internal medicine, acupuncture,
naturopathy and trained in epidemiology. Head of the Division for Complementary Medicine and acting director
of the Institute for Social Medicine,
Epidemiology and Health Economics,
Charité - University Medical Center,
Berlin, Germany. Coordinator of
students education of the Institute between 2005-2012. Worked from 1994
to 2001 as a physician and a research
associate in the Medical Department
I, Friedrich-Alexander-University
Erlangen-Nuremberg, Germany and
was between 1995-2001 head of the
department of complementary medicine. He is the principal investigator
of several projects in the field of Complimentary and Alternative Medicine
(CAM) and member of different medical
and acupuncture societies, reviewer
of national and international medical
journals.
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Anja de Bruin
Lectoraat Antroposofische Gezondheidszorg (Hogeschool Leiden)
Anja de Bruin is sinds september
2011 aangesteld als onderzoeker
bij het Lectoraat Antroposofische
Gezondheidszorg. Zij is projectleider
van het Zorgprogramma Kanker en is
verantwoordelijk voor het monitoren
van de zorgprogramma’s. Zij studeerde biomedische wetenschappen aan
de universiteit Maastricht en heeft
onderzoekservaring op het gebied van
het immuunsysteem en de neurowetenschappen. In het verleden heeft zij
haar bijdrage geleverd aan de registratie van de antroposofische geneesmiddelen van WALA en WELEDA.
instellingen en de laatste 11 jaar
in ‘reguliere’ ziekenhuizen. Na een
vroege pensionering wijdt hij zich de
laatste 5 jaren aan het opzetten van
een Academy for Integrative Medicine
in Nederland, nascholingsactiviteiten
van de Academie voor AG, publicaties
op het gebied van Integrative Psychiatry (Bolk’s Companions) en het mee
ontwikkelen van vernieuwing van de
zorgmethodiek binnen de AG.
Odulf Damen
Lectoraat Antroposofische Gezondheidszorg (Hogeschool Leiden)
Odulf Damen is muziektherapeut in
de verstandelijk gehandicaptenzorg/
kinder- en jeugdpsychiatrie en docent
muziektherapie aan Hogeschool
Leiden. Zijn bijzondere interesse gaat
uit naar de fenomenologie van Goethe.
Daarin ziet hij de mogelijkheid om een
verbinding te leggen tussen reguliere
onderzoeksmethoden en antroposofische gezichtspunten voor de therapiepraktijk. In de jaren 2008-2011 heeft
hij samen met collega’s een methode
uitgewerkt om de fenomenologie te
kunnen inzetten in de therapie, met
name bij vakspecifieke diagnostiek en
het opstellen van behandelplannen.
Daarmee is een wetenschappelijke
aanzet gegeven voor een individugeoriënteerde muziektherapie.
Marko van Gerven
Iona Stichting, Lievegoed Fonds/Antroposofische Vereniging In Nederland (AVIN)
Marko van Gerven, psychiater np
werkte 31 jaar als psychiater, waarvan
de eerste 20 jaren in antroposofische
Harald Hamre
Institute for Applied Epistemology
and Medical Methodology, University
Witten/Herdecke, Freiburg, Germany
Dr Harald Johan Hamre was born in
1958 in Bergen, Norway. He worked
for 2,5 years in anthroposophic clinics
in Germany and Spain and for eight
years as a community-affiliated general
practitioner in Norway. Since 1997 he is
a research scientist at the Institute for
Applied Epistemology and Medical Methodology at the University of Witten/
Herdecke, Freiburg, Germany. His main
research field has been clinical studies
into the effectiveness, costs and safety
of anthroposophic treatment in outpatient settings, where he has conducted
two large multicentre studies: the
AMOS study of chronic disease and the
IIPCOS-Anthroposophy study of acute
respiratory and ear infections. Other
research interests include the methodology of observational cohort studies
and single-case studies, bias in clinical
research, and the safety of dental
amalgam. Dr Hamre has published two
books and ca. 100 articles, papers, book
chapters and monographs.
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Peter Heusser
University Witten/Herdecke,
Germany
Peter Heusser: Swiss; Medical School,
University of Bern; training in general
medicine (internal medicine, surgery,
paediatrics) in Swiss hospitals; training in anthroposophic medicine (AM),
Ita Wegman Klinik and Lukas Klinik
Arlesheim; practicing AM physician
for general and oncological patients.
Co-Chair in Swiss National Foundation
Research Project on quality of life in
advanced cancer patients treated with
AM. Research associate, evaluation
of complementary medicine, Swiss
Ministries for Health and Health Insurance.1995-2008 lecturer and head,
Department of Anthroposophic Medicine at the Institute of Complementary
Medicine (KIKOM), University of Bern.
Since 2009 professor and chair holder
for Theory of Medicine, Integrative and
Anthroposophic Medicine, head, Institute for Integrative Medicine, Witten/
Herdecke University, Germany.
and has many years of experience with
clinical research and the systemic
analysis of clinical studies. She has
published numerous scientific articles
and books (including on mistletoe
therapy, clinical trials, case-based
research methods and the placebo
effect). www.ifaemm.de
Loes van den Heuvel
King Fisher Foundation
Loes van den Heuvel is huisarts (te
Utrecht) en werkzaam als onderzoeker
bij de Kingfisher Foundation, foundation for Phenomenology and Goethean
Science in het kader van het Bolk’s
Companions Project.
Miek Jong
Louis Bolk Instituut
Dr. Miek Jong heeft na haar promotieonderzoek op het gebied van hart- en
vaatziekten, in verschillende functies
gewerkt bij VSM geneesmiddelen. Zij
was daarbij verantwoordelijk voor
de registratie en klinisch onderzoek
met geneesmiddelen. Zij werkt nu als
afdelingshoofd Voeding & Gezondheid
bij het Louis Bolk Instituut, een onderzoeks- en adviesorganisatie op het
gebied van duurzame landbouw, voeding en gezondheidszorg. Daarnaast
werkt zij als associate professor Health
Sciences aan de Mid-Sweden Universiteit in Sundsvall, Zweden.
Aandachtsgebieden: integrative medicine, mind-body medicine, pragmatische klinische studies, voeding.
Rogier Hoenders
Lentis
Dr. H.J.R. (Rogier) Hoenders is docent
psychotherapie en deelopleider
volwassenenpsychiatrie bij Lentis. Ook
is hij psychiater, onderzoeker en leidinggevende bij het Centrum Integrale
Psychiatrie van Lentis.
Gunver Kienle
Institute for Applied Epistemology
and Medical Methodology, University
Witten/Herdecke, Freiburg, Germany
Gunver Kienle is a physician-researcher
at the Institute for Applied Knowledge
Theory and Medical Methodology
(IFAEMM) in Freiburg, Germany. She
has worked as a physician in oncology
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Evi Koster
Lectoraat Antroposofische Gezondheidszorg (Hogeschool Leiden)
Evi Koster is afgestudeerd als Sociaal
Geograaf en Kunstzinnig Therapeut
en sinds 2007 onderzoeker bij het
lectoraat AG. Tussen 2008 en 2012
is zij nauw betrokken geweest bij de
ontwikkeling van de CQ-Index AG.
Zij doet promotieonderzoek naar
clientervaringen in de Antroposofische Gezondheidszorg. Belangrijke
thema’s daarbij zijn kwaliteit van zorg,
zelfmanagement, eigen regie, health
promotion, kwaliteit van leven en
arts-patiëntrelatie.
Frans Kusse
Artsencentrum Integrale Geneeskunde
Frans Kusse is arts voor integrale
geneeskunde in het Artsencentrum
Integrale Geneeskunde in Amsterdam
(www.aiga.nl) en heeft zich gespecialiseerd in homeopathie. Naast redactiecoördinator van het Tijdschrift voor
Integrale Geneeskunde (TIG) is hij een
van de initiatiefnemers van de Academy for Integrative Medicine (AIM) i.o.
Kore Luske
King Fisher Foundation
Kore Luske is huisarts (te Arnhem)
en werkzaam als onderzoeker bij de
Kingfisher Foundation, foundation for
Phenomenology and Goethean Science
in het kader van het Bolk’s Companions
Project.
Martin Niemeijer
Lectoraat Antroposofische Gezondheidszorg (Hogeschool Leiden)
Martin Niemeijer werkt als onderzoeker bij het Lectoraat Antroposofische
Gezondheidszorg. Hij doet een promotieonderzoek naar een diagnostisch
instrument (IKC), ontwikkeld op basis
van de (heilpedagogische) constitutiebeelden. Als auteur en redacteur is hij
betrokken bij het boek Ontwikkelingsstoornissen bij kinderen (Van Gorcum,
5e druk, 2009). Tot midden 2013 was
hij als arts verbonden aan de Zonnehuizen Kind en Jeugd, een landelijk
werkende instelling voor Kinder- en
jeugdpsychiatrie en Verstandelijk
Gehandicaptenzorg.
Ines van Rosenstiel
Slotervaart Ziekenhuis/NIKIM/ECIM
Ines von Rosenstiel werkte gedurende
10 jaar als kinderarts/intensivist in
het AMC, waarvan 2 jaar als hoofd
van de Kinder Intensive Care. Sinds
2003 is zij werkzaam als algemeen
kinderarts in het Slotervaartziekenhuis
in Amsterdam. Als Hoofd Vakgroep
Kindergeneeskunde gaf zij in de jaren
2005 tot 2010 vorm in en inhoud aan
13
integratieve kindergeneeskunde in het
Slotervaartziekenhuis. De kinderadviespolikliniek voor integratieve
geneeskunde voorziet veel ouders
van kennis rondom vragen aangaande
aanvullende behandelwijzen.
Zij is medeoprichter van het NIKIM.
Daarnaast is zij ambassadeur van de
Stichting Medical Checks for Children.
Zij is actief lid van het IPIM-netwerk
(International Pediatric Integrative
Medicine) en de Holistic Pediatric
Association. Zij is spreker op diverse
nationale en internationale congressen met betrekking tot Integrative
Medicine. Zij is bestuurslid van de European Congres of Integrative Medicine
(ECIM).
Edmond Schoorel
Kindertherapeuticum Utrecht
Edmond Schoorel heeft als kinderarts
tot 2012 in het Diakonessenhuis in
Utrecht gewerkt. Het grootste deel van
zijn loopbaan heeft hij het reguliere
werk gecombineerd met de antroposofische aanpak. Van 1996 werkt hij in
een multidisciplinaire setting in het
Kindertherapeuticum in Zeist. Zijn
interesse is onder meer de rol van de
lichamelijke constitutie bij ziekte en
ontwikkelingsproblemen.
organiserend comité van het 2-jaarlijkse congres ‘Integrale Psychiatrie’ in
Groningen.
Peter Staal
Therapeuticum De Linde
Peter Staal is huisarts en antroposofisch arts in Tilburg. Hij studeerde in
Amsterdam en Gent (België) en was
vanaf de vestiging in Tilburg jarenlang betrokken bij het bestuur en de
certificatencommissie van de NVAA.
Tegenwoordig is hij bestuurslid van de
NVAZ (Ned. Ver. Antroposofische Zorgaanbieders). Hij schrijft columns in
meerdere bladen over antroposofische
geneeskunde en aanverwante zaken
zoals de opvoedkunst. Als huisarts
ligt zijn interesse bij de kindergeneeskunde en in de samenwerking
met collega’s hoe een gezonde sociale
verhouding (artsen , therapeuten ,
patiënten) tot een gezondere samenwerking en dus betere geneeskunde
kan leiden.
Claudia Witt
University Zürich, Switzerland
Dr. Claudia Witt, MD, MBA is a medical
doctor, epidemiologist and research
methodologist. Since 2014 she is
Professor for Medicine and Director of
the Institute for Complementary and
Integrative Medicine at the University
Zürich and the University Hospital
Zürich. Before she served as Acting
Director of the Institute for Social Medicine, Epidemiology and Health Economics at the University Medical Center
Charité in Berlin Germany. 2011-2013
she served as the President of the International Society for Complementary
Medicine Research (ISCMR). Dr. Witt
has dedicated her career to evaluating
the efficacy, effectiveness, cost-effectiveness and safety of Complementary
and Integrative Medicine.
Elkana Waarsenburg
Waarnemend huisarts
Elkana Waarsenburg werkt sinds 2009
als (waarnemend) huisarts in Groningen en Drenthe. Haar interesse gebieden zijn psycho-somatiek, Integrative
Medicine, palliatieve en terminale
zorg en Boeddhisme. Zij is lid van het
14
Achtergrondinformatie
Antroposofische Gezondheidszorg
& Integrative Medicine
15
Introductie
Tijdens dit congres staat de stand van zaken van de ontwikkeling van Integrative Medicine en de bijdrage van
de Antroposofische Gezondheidszorg hieraan centraal.
steeds meer interesse in IM bij beleidsmakers, wetenschappers,
zorgprofessionals en patiënten. Zo verschenen in 2011 en 2014
respectievelijk de signalementen ‘Effectiviteit van complementaire zorginterventies’ en ‘Signalement Ontwikkeling en
implementatie van evidence-based complementaire zorg’ van
ZonMW waarin tot meer onderzoek naar en implementatie van
complementaire zorginterventies wordt opgeroepen.
Integrative Medicine ontwikkelt zich wereldwijd
Integrative Medicine (IM) is een wereldwijd groeiende beweging, die zich langzaam maar zeker ook in Nederland uitbreidt
en waaraan de Antroposofische Gezondheidszorg (AG) nadrukkelijk wil en kan bijdragen. IM is in essentie gebaseerd op vier
pilaren:
• De gelijkwaardige arts/ therapeut-patiëntrelatie,
• De actieve rol van de patiënt in het voorkomen van ziekte,
zijn welbevinden en in het eigen genezingsproces,
• Het inzetten van ‘evidence-based’ veilige en effectieve
complementaire zorginterventies in combinatie met reguliere therapieën, en
• Het werken in een zogenaamde healing environment.
Sinds 2000 bestaat er in de Verenigde Staten het Consortium
of Academic Health Centers for Integrative Medicine (IM) die
werken aan de ontwikkeling, wetenschappelijke verantwoording
en implementatie van IM in de gezondheidszorg. Inmiddels
omvat het consortium 57 ‘academic medical centers’ waaronder
bv. de Harvard Medical School en de John Hopkins University.
Ook in andere delen van de wereld, Europa en Nederland is er
Antroposofische Gezondheidszorg
De Antroposofische Gezondheidszorg (AG) geeft al meer dan 90
jaar praktische invulling aan IM. AG heeft zich in deze periode
zowel kwantitatief als kwalitatief goed en snel ontwikkeld. Binnen de AG wordt de kennis van de reguliere geneeskunde en de
kennis van de antroposofische geesteswetenschap geïntegreerd
t.b.v. de gezondheidszorg praktijk. De AG behandeling, het gebruik en de selectie van geneesmiddelen en andere therapieën,
is sterk geïndividualiseerd en is gericht op het op gang brengen
van een ‘proces van ontwikkeling’ in en het versterken van het
natuurlijke zelfhelende vermogen van de patiënt. Ontstaan in
Centraal-Europa, wordt AG momenteel beoefend, onderzocht en
onderwezen in de meeste landen in Europa en in meer dan 80
landen in de wereld.
16
Integrative Medicine &
Antroposofische Gezondheidszorg
Om tot een verdere verheldering van de positionering
en de bijdrage van de AG aan de ontwikkeling van IM te
komen, volgen hier achtereenvolgens:
•
Enkele definities van IM
•
Een definitie van AG
•
De hoofd kenmerken van IM
•
De positie en bijdrage van AG aan IM:
een aanzet tot transparantie
•
IM is in essence based on four pillars (NIKIM, 2014):
∙∙ The horizontal doctor/therapist - patient relationship
or partnership
∙∙ The active role of the individual (patient) in preventing
disease, wellbeing and their own healing process
∙∙ The use of evidence-based safe and effective complementary and alternative therapies in combination with
conventional therapies
∙∙ Working in a ‘healing environment’.
•
IM (NCCAM):
Enkele definities van Integrative Medicine
• Integrative Medicine is the practice of medicine that
reaffirms the importance of the relationship between
practitioner and patient, focuses on the whole person, is
informed by evidence, and makes use of all appropriate
therapeutic approaches, healthcare professionals and
disciplines to achieve optimal health and healing (“The
Integrative Medicine Consortium”, 2004, edited May 2009).
•
•
BiologicallyBased Practices
Energy
Medicine
Wh
The Center defines integrative medicine (IM) as healing-oriented medicine that takes account of the whole
person, including all aspects of lifestyle. It emphasizes
the therapeutic relationship between practitioner and
patient, is informed by evidence, and makes use of all
appropriate therapies.
ole M ed
Mind-Body
Medicine
Manipulative&
& Body-Based
Practices
i c a l Sy s t e
ms
∙∙ Differentiates four main domains:
˚˚ Biologically-based practices
˚˚ Mind-body medicine
˚˚ Energy medicine
˚˚ Manipulative and body-based practices
∙∙ Is based on knowledge and practice from whole medical
systems
The defining principles of Integrative Medicine are:
∙∙ Patient and practitioner are partners in the healing
process.
∙∙ All factors that influence health, wellness, and disease
are taken into consideration, including mind, spirit,
and community, as well as the body.
∙∙ Appropriate use of both conventional and alternative
methods facilitates the body’s innate healing response.
∙∙ Effective interventions that are natural and less invasive should be used whenever possible.
∙∙ Integrative medicine neither rejects conventional medicine nor accepts alternative therapies uncritically.
∙∙ Good medicine is based in good science. It is inquiry-driven and open to new paradigms.
∙∙ Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness
are paramount.
∙∙ Practitioners of integrative medicine should exemplify
its principles and commit themselves to self-exploration and self-development. http://integrativemedicine.
arizona.edu/about/definition.html)
•
17
Strategic aims in the development of CAM research are:
∙∙ Mind-body: Advance research on mind and body interventions, practices, and disciplines.
∙∙ Natural products: Advance research on CAM natural
products.
∙∙ Real world patterns/ outcomes: Increase understanding of “real world” patterns and outcomes of CAM
use and its integration into health care and health
promotion.
∙∙ Research capacity: Improve the capacity of the field to
carry out rigorous research.
∙∙ Information: Develop and disseminate objective,
evidence-based information on CAM interventions.
(http://nccam.nih.gov/about/plans/2011/introduction.htm#objectives)
Een definitie van Antroposofische Gezondheidszorg
Anthroposophic medicine is an integrative multimodal
treatment system based on a holistic understanding of man
and nature and of disease and treatment. It builds on a concept of four levels of formative forces and on the model of
a three-fold human constitution. Anthroposophic medicine
is integrated with conventional medicine in large hospitals
and medical practices. It applies medicines derived from
plants, minerals, and animals; art therapy, eurythmy therapy, and rhythmical massage; counseling; psychotherapy;
and specific nursing techniques such as external embrocation. Anthroposophic healthcare is provided by medical doctors, therapists, and nurses. A Health-Technology Assessment Report and its recent update identified 265 clinical
studies on the efficacy and effectiveness of anthroposophic
medicine. The outcomes were described as predominantly
positive. These studies as well as a variety of specific safety
studies found no major risk but good tolerability. Economic
analyses found a favorable cost structure. Patients report
high satisfaction with anthroposophic healthcare. (Kienle,
G.S., Albonico, H.U., Baars, E., Hamre, H.J., Zimmermann, P.,
et al. (2013). Anthroposophic Medicine: An Integrative Medical System Originating in Europe. Global Advances in Health
and Medicine, 2(6):20-31)
medische en (b) een of meer ‘whole medical system(s)’
in de gezondheidszorgpraktijk. (Baars, 2014)
Op weg naar transparantie over de bijdrage van Antroposofische Gezondheidszorg aan de ontwikkeling van Integrative
Medicine
• De AG heeft een meer dan 90 jaar oude Europese traditie.
• De AG heeft zich wereldwijd in de klinische praktijk verder
ontwikkeld, in sommige gevallen zelfs tot ‘mainstream’
gezondheidszorg praktijk (bv. ziekenhuizen in Duitsland
(Filderklinik, Herdecke, Berlijn), Zwitserland en Zweden).
• De wereldbeschouwing van AG is gebaseerd op zowel de
natuurwetenschappen als de spirituele geesteswetenschap (antroposofie), met een degelijk filosofisch en
methodologisch fundament.
• De antroposofie leert ons dat:
∙∙ Er een gezamenlijke ontwikkeling van mensheid en
wereld is > essentie van de horizontale relatie.
∙∙ De mens meer is dan materie alleen (leven/ vitaliteit,
ziel en individualiteit) en vanuit deze visie kan men
ziekte en gezondheid begrijpen en individugeoriënteerd behandelen > focus op wholeness en het
individu (inclusief multilevel diagnostiek en multidisciplinaire, individugeoriënteerde zorginterventies).
• De AG concepten en zorgpraktijk geven een professionele
oriëntatie op gezondheid bevordering in aanvulling op en
geïntegreerd met een ziektebestrijdende benadering in
de gezondheidszorg.
• Vanaf haar ontstaan wordt de AG gekenmerkt door een
integratie van regulier medische/ gezondheidszorg
kennis en praktijk met antroposofische kennis en praktijk
> fuseren van culturen.
• Vanaf haar ontstaan is de AG wetenschappelijk georiënteerd:
∙∙ Reguliere wetenschap
∙∙ Antroposofische geesteswetenschap
∙∙ De integratie van beide benaderingen >
˚˚ Toenemend aantal empirisch studies, waaronder
enkele excellente studies
˚˚ Nieuwe concepten
˚˚ Nieuwe methoden voor een ‘science of wholeness’
(whole system benadering) en voor de klinische
praktijk (diagnostiek, zorginterventies, ...)
˚˚ Nieuwe therapieën
˚˚ Nieuwe farmaceutische procedures
> AG, als een vorm van Integrative Medicine, is toenemend evidence-based.
• Naar verwachting is de verdere integratie van AG met
zowel de reguliere gezondheidszorg als andere ‘whole
medical systems’ erg vruchtbaar voor beide partijen.
(Baars, 2014)
De belangrijkste kenmerken van Integrative Medicine als
gezondheidszorgpraktijk
• De ‘whole medical system’ wereldbeschouwing geeft het
fundament aan:
∙∙ De horizontale relatie: Het belang van partnerschap
tussen patiënt/ cliënt en zorgprofessional in het diagnostisch en therapeutisch proces.
∙∙ De focus op ‘wholeness’ en het individu: De focus op de
‘wholeness’/ complexiteit (geest, ziel, lichaam, leefstijl,
omgeving) en de individualiteit van de patiënt/ cliënt.
∙∙ Gezondheid bevorderen: De oriëntatie op het aanspreken van het zelfhelend vermogen, de activiteit van
het individu en de helende omgeving om te komen tot
optimale gezondheid en heling.
• De integratie van reguliere gezondheidszorg en ‘whole
medical systems’ drukt zich uit in het:
∙∙ Inzetten van evidence-based veilige en effectieve
reguliere en complementaire zorginterventies: Het
gebruik van reguliere en complementaire zorginterventies, waarvoor enig hoge kwaliteit wetenschappelijk
bewijs van veiligheid en effectiviteit is.
∙∙ Fuseren van culturen: De integratie van wereldbeschouwingen, attitudes, concepten (gezondheid,
ziekte, therapie, helingsproces, etc.) en methoden (diagnostiek, therapieën, farmaceutische processen, etc.)
van de (a) op de natuurwetenschappen gebaseerde bio-
18
19
GLOBAL ADVANCES IN HEALTH AND MEDICINE
ORIGINAL ARTICLE
Anthroposophic Medicine: An Integrative Medical System
Originating in Europe
人智医学：一种起源于欧洲的综合医学体系
Medicina antroposófica: un sistema de medicina integradora que tiene su
origen en Europa
Gunver S. Kienle, Dr med, Germany; Hans-Ulrich Albonico, Dr med, PhD, Switzerland; Erik Baars, Dr med, MSc, PhD,
The Netherlands; Harald J. Hamre, Dr med, Germany, Norway; Peter Zimmermann, Dr med, PhD, Finland; Helmut
Kiene, Dr med, Germany
Author Affiliations
Institute for Applied
Epistemology and
Medical Methodology at
the University of Witten/
Herdecke, Germany (Drs
Kienle, Kiene, and
Hamre); European
Scientific Cooperative on
Anthroposophic
Medicinal Products
(ESCAMP), Freiburg,
Germany (Drs Kienle,
Baars, and Hamre); Clinic
for Family and
Complementary
Medicine, Langnau im
Emmental, Switzerland
(Dr Albonico); University
of Applied Sciences
Leiden, The Netherlands;
Louis Bolk Institute,
Driebergen, The
Netherlands (Dr Baars);
Department of
Gynecology, Plusterveys,
Nastola Medical
Center, Finland
(Dr Zimmermann).
Correspondence
Gunver Kienle, Dr med
gunver.kienle@ifaemm.de
Citation
Global Adv Health Med.
2013;2(6):20-31. DOI:
10.7453/gahmj.2012.087
Key Words
Anthroposophic
medicine, integrative,
patient-centered, holistic
Disclosures
The authors completed
the ICMJE Disclosure
Form for Potential
Conflicts of Interest and
had no conflicts related
to this work to disclose.
20
ABSTRACT
Anthroposophic medicine is an integrative multimodal treatment system based on a holistic understanding of man and nature and of disease
and treatment. It builds on a concept
of four levels of formative forces and
on the model of a three-fold human
constitution. Anthroposophic medicine is integrated with conventional
medicine in large hospitals and medical practices. It applies medicines
derived from plants, minerals, and
animals; art therapy, eurythmy therapy, and rhythmical massage; counseling; psychotherapy; and specific
nursing techniques such as external
embrocation.
Anthroposophic
healthcare is provided by medical
doctors, therapists, and nurses. A
Health-Technology Assessment
Report and its recent update identified 265 clinical studies on the efficacy and effectiveness of anthroposophic medicine. The outcomes
were described as predominantly
positive. These studies as well as a
variety of specific safety studies
found no major risk but good tolerability. Economic analyses found a
favorable cost structure. Patients
report high satisfaction with anthroposophic healthcare.
摘要
人智医学是一种综合性的多模式
治疗体系，它建立在对人类与大
自然，以及对病症和治疗的整体
理解之上。其基础为四层构成力
概念和三重人体体质模型。在大
型医院以及实际的医疗实践中，
人智医学与传统医学是结合在一
起使用的。它采用从植物、矿物
和动物中提取的药物；采用艺术
疗法、精神疗法和节律性按摩；
采用咨询、心理治疗和特种护理
技术，比如外用搽剂等。人智医
疗由医生、治疗师和护士提供。
一项卫生技术评估报告及其最近
的更新文档列举了 265 项针对人
智医学效用和效益的临床研究。
其研究结果被阐述为这种疗法具
有压倒性的正面优势。这些研究
以及其他各种特定的安全性研究
并没有发现其重大的风险，而是
提示具有很好的耐受性。经济分
析也发现它具有有利的成本构
成。人智医疗在患者报告中获得
了很高的满意度。
SINOPSIS
La medicina antroposófica es un
sistema de tratamiento multimodal
integrador que se basa en un entendimiento holístico del hombre y la
naturaleza, así como de la enferme-
A
nthroposophic medicine is an integrative
medical system, an extension of conventional
medicine incorporating a holistic approach to
man and nature and to illness and healing. It was
founded in the early 1920s by Rudolf Steiner and Ita
Wegman. It is established in 80 countries worldwide,
most significantly in Central Europe. It is practiced
by physicians, therapists, and nurses and provides
Volume 2, Number 6 • November 2013 • www.gahmj.com
dad y del tratamiento. Se desarrolla
sobre un concepto de cuatro niveles
de fuerzas formativas y sobre el
modelo de una constitución humana en tres partes. La medicina antroposófica se integra con la medicina
convencional en grandes hospitales
y en consultorios médicos. Aplica
medicamentos de origen vegetal,
mineral y animal; terapias artísticas, euritmia curativa y masaje rítmico; orientación, psicoterapia y
técnicas de enfermería específicas,
tales como la frotación externa. La
atención sanitaria antroposófica es
realizada por médicos, terapeutas y
personal de enfermería. En un
informe de evaluación de la tecnología sanitaria y en su reciente
actualización se identificaron 265
estudios clínicos sobre la eficacia y
la efectividad de la medicina antroposófica. Los resultados se describieron como predominantemente
positivos. Estos estudios, así como
diversos estudios de seguridad específicos, no encontraron ningún riesgo importante y sí una buena tolerabilidad. Los análisis económicos
revelaron una estructura de costes
favorable. Los pacientes indican
una alta satisfacción con la atención sanitaria antroposófica.
specific treatments and therapies including medication, art, movement, and massage therapies and specific nursing techniques. The entire range of all acute
and chronic diseases is being treated, with a focus on
children’s diseases, family medicine, and particularly
chronic diseases necessitating long-time complex
treatments. Patients are highly satisfied with this
holistic form of healthcare.
Original Article
ANTHROPOSOPHIC MEDICINE
ANTHROPOSOPHY AS A SPIRITUAL SCIENCE
Anthroposophic medicine is based on the cognitive
methods and cognitive results of anthroposophy.1
Anthroposophy was established by Rudolf Steiner (18611925).2 After studying empirical sciences, mathematics,
and philosophy in Vienna, Steiner was commissioned at
the age of 22 to publish Johann Wolfgang Goethe’s scientific writings in Kürschners Deutscher Nationalliteratur
(German National Literature) and collaborated on the
Sophie Edition of Goethe’s works in Weimar.3,4 Steiner
began developing anthroposophy in 1901.5
Anthroposophy is a view on humanity and nature that is
spiritual and that at the same time regards itself to be
profoundly scientific.6 Steiner considered anthroposophy a consequential evolutionary step in the development of Western thought.7 In anthroposophy, three traditions are integrated and enhanced: the empirical tradition of modern science as started by Copernicus, Kepler,
and Galileo; the cognitional tradition of philosophy as
initiated by Plato and Aristotle and as brought to a culmination in so-called German idealism by Hegel, Fichte,
Schelling, Schiller and Goethe; and finally the esoteric
tradition of Christian spirituality. The stability of this
integration was reflected in Steiner’s critique and rejection of the philosophy of Kant8 and of materialistic
reductionism.3 Kant had propagated the idea that there
were definite limitations to scientific knowledge,9 and
the materialistic reductionism movement had declared
the interactions of material particles to be the basic principle of all scientific explanation.10-12 In contrast, Steiner
proposed and described how human beings could
expand their cognitive capacities and how these expanded capacities6 could be implied to investigate a variety of
formative forces that are, beyond particle interactions,
effective in organisms (Sidebar 1).13
The concept of a multilevel organism with diverse
subsystems is compatible with modern system approaches in developmental biology and with holistic models of
cancer.16-18 In anthroposophy, the concept of the formative forces is rather elaborate and is also accompanied by
a corresponding concept of material matter. The physical structures of matter are considered only one level,
and when a substance is absorbed into the context of an
organism, the substance becomes “enlivened” or even
“ensouled.”1 The investigation of the formative forces
and their material correspondences and of the diverse
interrelations among these forces provides the basis for
the anthroposophic worldview. This view brings spiritual dimensions to the natural sciences.6
Steiner provided anthroposophy with a deeply
reflected epistemology.3-5,7,8,19-21 On the other hand,
anthroposophy has proven to be not only a philosophy
or a new orientation in science but also to be practically
applicable. It induced a large variety of developments in
different fields: a School of Spiritual Science with various
specialized sections, founded in 1924 in Dornach,
Switzerland; a new method of education (Waldorf
schools, also known as Rudolf Steiner schools), currently
with more than 1000 schools and approximately 2000
Original Article
Sidebar 1 Anthroposophic Concept of the
Human Organism and Pathogenesis
The Four-level Concept of Formative Forces13
The anthroposophic concept of the human being claims that
the human organism is not only formed by physical (cellular,
molecular) forces but by a total of four levels of formative
forces: (1) formative physical forces; (2) formative growth
forces that interact with physical forces and bring about and
maintain the living form, as in plants; (3) a further class of
formative forces (anima, soul) that interact with the growth
forces and physical forces, creating the duality of internalexternal and the sensory, motor, nervous and circulatory
systems as seen in animals; (4) an additional class of formative forces (Geist, spirit) that interacts with the three others
and supports the expression of the individual mind and the
capacity for reflective thinking, which is unique for humans.
The Three-fold Model of the Human Constitution14,15
When the four levels of formative forces are integrated
with the human polarity of active motor movement and
passive sensory perception, the three-fold constitution of
the human being comes into being. It embraces three
major systems: two being polar to each other (nerve-sense
system and motor-metabolic system), and one being intermediate (rhythmic system). These subsystems are spread
over the entire organism but predominate in certain
regions: the nerve-sense system in the head region, the
motor-metabolic system in the limb region, the rhythmic
system in the respiratory and circulatory organs and thus
in the “middle” region.
In these three subsystems, the four levels of formative
forces are considered to interrelate differently. In the nervesense system, the upper two levels of forces (spirit, soul) are
relatively separate from the lower two levels, thus providing
the conditions for the origination of self-consciousness, conscious perceptions, and conscious thought processes. In the
motor-metabolic system, the interpenetration is closer, thus
providing the conditions for the execution of personally
intended bodily movements. In the rhythmic system, the
interrelations of the upper and lower levels fluctuate
between increasing and decreasing connection and are associated with the origination of emotion; the interpenetration
increases during the rhythmical lung process of inspiration
and decreases during expiration.
The model of the three-fold human constitution
leads to distinct re-interpretations of the conventional
teachings of physiology.
kindergartens, home programs, child care centers, and
preschools worldwide; the curative education movement, which currently has more than 600 centers for
curative education and social therapy worldwide for
children, young people, and adults with disabilities and
developmental problems; a new direction in agriculture,
biodynamic farming; the creation of an art of movement,
eurythmy; a renewal of various artistic practices such as
recitation, dramatic art, painting, sculpture, and architecture; and attempts to reshape social life (three-fold
social order22,23). One anthroposophic enterprise, Sekem,
in Egypt,24 has been honored with the alternative Nobel
Prize and with the Schwab Foundation Prize.
Anthroposophic insights have been integrated into mod-
www.gahmj.com • November 2013 • Volume 2, Number 6
21
GLOBAL ADVANCES IN HEALTH AND MEDICINE
ern culture; numerous people in public life, commerce,
banking, politics, culture, theatre and film, literature, the
fine arts, music, fashion, and medicine have emerged
from the anthroposophic scene.
BASIC PERSPECTIVES OF ANTHROPOSOPHIC MEDICINE
The etiologies and pathogeneses of diseases are concretely understood as abnormal interactions among the
different levels of the human organism and its three
subsystems (Sidebar 1).25,26 Reflecting upon these interactions is the basis for specific anthroposophic medical
and treatment schedules. An example of such a diagnostic and therapeutic procedure has recently been outlined
in a case report on anxiety and eurythmy therapy.27
Another basic aspect comes from the following:
Once the existence and effectiveness of formative forces
are taken into account, another view on the evolution of
humanity and nature emerges, with specific relationships between the generating processes of the forms and
substances in external nature and in the human body.
Pathological deviations in the human organism can thus
be seen in correspondence with formative processes and
substances in nature. These correspondences are like
those between keys and keyholes. Such or similar relations have been recognized in all cultures, even in humanity’s earliest times. Assessing these relationships can
enable rational medicinal therapies.1
Guiding principles of anthroposophic healthcare are
recognizing the autonomy and dignity of the patient and
helping people to help themselves. Self-responsibility is
addressed, and therapeutic goals are to stimulate different
forms of self-healing—to stimulate hygiogenesis,28
which means to create a coherent autonomic regulation
of the organism; and salutogenesis,29 which means to create a coherent psycho-emotional and spiritual self-regulation.30 The treatments do not merely intend to restore a
former healthy condition, a “restitution ad integrum,” but
to provoke a new level of the organism’s and the individual’s inner strength.13
Anthroposophic medicine thus pursues a holistic
approach. Rather than focusing on a singular pathological datum, the aim is to strengthen the whole constitution of the sick patient, taking into account all dimensions: physical, emotional, mental, spiritual, and social.
Treatments therefore often are multimodal. They are
individually tailored in an attempt to synergize the
effects of the different therapeutic components and so to
enhance the chances for health improvement. Such treatment is conceived as a therapeutic system.31-33
PRACTICE AND FACILITIES OF ANTHROPOSOPHIC
MEDICINE
Anthroposophic medicine is practiced in both
inpatient and outpatient settings by trained medical
doctors. Currently there are approximately 24 anthroposophic medical institutions, which include hospitals,
departments in hospitals, rehabilitation centers, and
other inpatient healthcare centers in Germany,
Switzerland, Sweden, Italy, The Netherlands, and the
22
Volume 2, Number 6 • November 2013 • www.gahmj.com
Sidebar 2 Anthroposophic Hospitals, Hospital
Departments, Rehabilitation Centers
Acute Hospitals
• Gemeinschaftskrankenhaus Havelhöhe, D-Berlin (Sidebar 3)
• Gemeinschaftskrankenhaus Herdecke, D-Herdecke (Sidebar 3)
• Filderklinic, D-Filderstadt: Internal medicine, oncology,
cardiology, gastroenterology, emergency and intensive
care medicine, gynecology and obstetrics, pediatric
medicine, pediatric psychiatry, neonatology, surgery,
anesthesia, radiology, psychosomatic medicine
• Ita Wegman Klinik, CH-Arlesheim: Internal medicine (with
oncology, cardiology, neurology, respiratory
medicine, geriatrics), psychiatry, psychosomatic medicine
• Paracelsus-Spital, CH-Richterswil: Surgery, urology,
internal medicine, oncology, gastroenterology, respiratory
medicine, cardiology, gynecology and obstetrics, radiology, anesthesia, emergency department, palliative care
• Vidarkliniken, S-Järna: Rehabilitation (cancer, stressrelated diseases, chronic pain), palliative care (cancer)
Specialty Hospitals and Departments
• Asklepios – West Hospital Hamburg, Center for Holistic
Medicine, D-Hamburg: Internal medicine, psychosomatic
medicine
• Lahnhöhe Hospital, D-Lahnstein: Psychosomatic medicine
• Öschelbronn Hospital, D-Öschelbronn: Internal medicine, oncology
• Paracelsus Hospital, D-Bad Liebenzell-Unterlengenhardt:
Internal medicine
• Klinikum (Hospital) Heidenheim, D-Heidenheim: General
medicine
• Friedrich-Husemann-Klinik, D-Buchenbach: Psychiatry
• Lukas Clinic, CH-Arlesheim: Integrative tumor therapy
and supportive care
• Hospital Emmental – Department of Complementary
Medicine, CH-Langnau i.E.: General, oncology, palliative,
and psychosomatic medicine.
• Hospital Scuol – Department of Complementary
Medicine, CH-Scuol: General, oncology, palliative and
psychosomatic medicine, perioperative care
• Lievegoed Klinik, NL-Bilthoven: Psychiatry
Rehabilitation and Other Inpatient Healthcare Centers
• Alexander von Humboldt Klinik, D-Bad Steben:
Geriatric rehabilitation center
• Sanatorium Sonneneck, D-Badenweiler
• Reha-Klinik Schloss Hamborn, D-Borchen über
Paderborn
• Haus am Stalten, D-Steinen
• Höfe am Belchen, D-Kleines Wiesental – Neuenweg:
Therapeutic Community for Children and Young
Persons’ Psychiatry
• Heilstätte Sieben Zwerge, D-Salem-Oberstenweiler:
Drug-related diseases,
• Mutter und Kind Kurheim Alpenhof, D-Rettenberg
• Casa di Cura Andrea Cristoforo, CH-Ascona
• Casa die Salute Rapael, I-Roncegno (Trento)
• Rudolf Steiner Health Center, Ann Arbor, Michigan,
United States: Therapy and training center for chronic
illnesses
Abbreviations: CH, Switzerland (Confoederatio Helvetica); D, Germany
(Deutschland); I: Italy; NL, Netherlands; S, Sweden.
Original Article
ANTHROPOSOPHIC MEDICINE
Sidebar 3 Examples of Integrated Healthcare in
Two Anthroposophic Hospitals
Gemeinschaftskrankenhaus Herdecke, a tertiary care center
and academic teaching hospital founded in 1969, is responsible for providing acute inpatient services for the town of
Herdecke and its immediate and more distant surrounding
areas, including emergency medical services (level II and level
III care). Anthroposophic medical care—medication, nursing
care, physiotherapy, therapeutic baths, rhythmical massage,
therapeutic riding, ergotherapy, speech therapy, psychotherapy, eurythmy therapy, art therapies (using music, painting, sculpture, speech therapy)—is integrated into the following specialty departments:
Figure 1 Filderklinik, an anthroposophic hospital in Filderstadt,
Germany. Source: Filderklinik; reprinted with permission.
United States (Sidebars 2 and 3 and Figure 1). In
Germany, three large anthroposophic hospitals provide
accident and emergency services within the requirement plans of the German Federal States (Bundesländer);
two of them are academic teaching hospitals linked to
neighboring universities (Sidebar 3). They provide specialty training for physicians. In 1983, the first private,
nonstate university in Germany was founded out of one
of these hospitals (University of Witten/Herdecke). In
addition to the anthroposophic hospitals, there are
more than 180 anthroposophic outpatient clinics worldwide in which anthroposophic physicians and therapists work together. Anthroposophic physicians also
work in their own practices. Additionally, a variety of
outpatient departments at large hospitals provide
anthroposophic healthcare and consultation service (eg,
Center for Integrative Medicine, Cantonal Hospital St
Gallen, Switzerland; Institute of Complementary
Medicine, University of Berne, Switzerland; Center for
Complementary Medicine, University of Freiburg,
Germany). Practitioners of anthroposophic medicine
were decisively involved in the implementation of the
liberal and pluralistic healthcare in Germany and in the
relevant formulation of the German Medicines Act in
1976. Since 1976, anthroposophic medicine in Germany
has been defined, alongside homeopathy and phytotherapy, as a distinct “special therapy system” (besondere
Therapierichtung) in the Medicines Act34 and is represented in Germany by its own committee at the Federal
Institute for Drugs and Medical Devices. Also,
Switzerland and Latvia have recognized anthroposophic medicine as a distinct therapy system. In some countries, legal recognition is restricted to pharmaceutical
regulation. The authorization, registration, and supervision of the profession of anthroposophic doctors are
delegated to national medical associations.
Physicians
Anthroposophic medicine is practiced by physicians with specialized training in anthroposophic as
well as conventional medicine, and anthroposophic
therapies are also prescribed by many other physicians
Original Article
• Anesthesia, including pain therapy.
• Surgery: general, abdominal, trauma surgery including
endoprosthesis, plastic, vascular and thoracic, oncological
surgery, minor pediatric surgical procedures.
• Gynecology and obstetrics: approximately 900 births/year.
• Interdisciplinary early rehabilitation.
• Internal medicine: cardiology, gastroenterology,
respiratory medicine, psychosomatic medicine.
• Interdisciplinary oncology: ward, day clinic, outpatient
department, patient counseling, psychooncology.
• Pediatrics: pediatric diabetes and endocrinology, diabetes
training, therapy center; neuropediatrics with a special
focus on epilepsy with digital electroencephalogram
(EEG), EEG monitoring, video EEG; developmental
retardation services; pediatric oncology and hematology,
collaboration with the Society for Pediatric Oncology and
Hematology; neonatology, pediatric intensive care
medicine; pediatric and adolescent psychiatry, day hospital
and secure ward with compulsory care, psychotraumatology (eg, posttraumatic stress disorder), eye movement
desensitization and reprocessing, attention deficit/hyperactivity disorder, family therapy, psychosomatic medicine.
• Neurology, including a department for spinal cord
injuries, stroke, paraplegia.
• Neurosurgery.
• Emergency admission/intensive care medicine/
intermediate care unit.
• Adult psychiatry: acute and intensive care ward, secure
ward with compulsory care, day hospital.
• Radiology: x-ray, ultrasound, computer tomography, digital subtraction angiography, magnetic resonance imaging.
Various departments provide outpatient consultations and
treatment.
Gemeinschaftskrankenhaus Havelhöhe, taken over in 1995
and reorganized as a hospital for anthroposophic medicine,
is an acute hospital with 304 beds providing acute inpatient
services for the surrounding area.
Anthroposophic medical care—including medication,
nursing care, eurythmy therapy, art therapies (using music,
painting, sculpting), rhythmical massage, massage using the
Dr Pressel method, psychotherapy, physiotherapy, exercises,
and manual lymph drainage—is integrated into the following specialty departments, with further interdisciplinary
competence centers and interdisciplinary cooperation in
the treatment of tumors:
• Internal medicine: General, oncology, diabetes (with a
diabetes education center, type I and II), gastroenterology
www.gahmj.com • November 2013 • Volume 2, Number 6
23
GLOBAL ADVANCES IN HEALTH AND MEDICINE
with varying levels of training. Anthroposophic physicians often work in primary care, but anthroposophic
medicine is not limited to general practice. It also is practiced in more specialized realms (Figure 2; Sidebar 3).
Sidebar 3 Examples of Integrated Healthcare
in Two Anthroposophic Hospitals (cont.)
•
•
Figure 2 Anthroposophic physician performing surgery at an
anthroposophic hospital. Source: Gemeinschaftskrankenhaus
Havelhöhe; reprinted with permission.
The certification requirements to become an
anthroposophic physician are defined and regulated on
national levels, which share similar curriculum. In
Germany, for instance, the curricula requires 3 years of
postgraduate medical practice, 1 year’s study of anthroposophic medicine according to a predefined program,
and 2 years of medical practice under the guidance of a
mentor. In addition, specific training courses are available in certain specialties. A further International
Postgraduate Medical Training (IPMT) in anthroposophical medicine consists of a series of yearly weeklong training and enables registered medical doctors to
acquire a certificate of anthroposophic doctor after 3
years. Full curriculum training is available in several
countries including Argentina, Australia, Austria, Brazil,
Chile, Cuba, Denmark, Estonia, Finland, France, Georgia,
Germany, Hungary, India, Israel, Italy, Japan, Latvia, The
Netherlands, New Zealand, Norway, Peru, The
Philippines, Poland, Romania, Russia, Spain, Switzerland,
Taiwan, Ukraine, United Kingdom, and the United
States. Several professorships for anthroposophic medicine exist, and postgraduate training is offered at a variety of universities/medical schools.
Guidelines for good professional practice set standards for anthroposophic physicians regarding ethical
principles, training, certification, continuous medical education, professional conduct, relationship with colleagues
and therapists, and social commitments. Internationally,
anthroposophic physicians are represented by the
International Federation of Anthroposophical Medical
Associations (IVAA), which functions as an umbrella
organization with regard to political and legal affairs.
ANTHROPOSOPHIC THERAPIES
Anthroposophic medicine employs, in addition to
conventional treatments, special medications and special therapeutic procedures, including eurythmy thera-
24
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•
•
•
•
•
•
•
•
•
(endoscopy: gastroscopy, colonoscopy, endoscopic
retrograde cholangiopancreatography, ballonenteroscopy, endosonography, all interventional
therapeutic procedures—such as polypectomy, mucosectomy, sclerotherapy, banding, stenting, ultrasound-guided drainage, endoscopic ultrasound-guided fine-needle
aspiration, pH determination in esophagus and stomach,
manometry, multipolare radiofrequency—cardiology
(invasive and noninvasive investigations including
cardiac catheter laboratory, percutaneous transluminal
coronary angioplasty, stent implantation, pacemakers,
Havelhöhe Heart School).
Palliative ward and pain ward including port insertion,
feeding catheters, stents, epidural catheters, pumps,
neurolytic blocks.
Respiratory medicine, including whole body
plethysmography, sleep apnea investigations,
flexible video-bronchoscopy, thoracoscopy,
endobronchial ultrasound, filling of pneumonectomy
cavities, allergen provocation and challenge testing
and hyposensitization, determining the indications
for long-term and domestic oxygen therapy).
Surgery: general and oncological, visceral, hand,
orthopedics, trauma, center for minimally invasive
surgery including natural orifice transluminal endoscopic
surgery, vascular surgery, colorectal cancer center,
outpatient and inpatient operations.
Gynecology and obstetrics (approximately 1200 births/year).
Breast center.
Drug withdrawal therapy (multiple drug users, heroin,
alcohol).
Psychotherapeutic medicine, psychosomatic medicine.
Developmental pediatrics.
Anesthesia, including pain therapy.
Interdisciplinary intensive care ward, including
hemodialysis.
Radiology, myelography, angiography, and computed
tomography, nuclear medicine (single-photon emission
computed tomography camera, myocardial scintigraphy,
brain perfusion scintigraphy).
Various departments provide outpatient consultations. Fifty
percent of the patients are from outside the region, which
is regarded as a manifestation of high acceptance by
patients. Havelhöhe Hospital is an academic teaching hospital of the Charité.
py, rhythmical massage, anthroposophic art therapy,
and counseling. In addition, there are special anthroposophic nursing techniques. The therapies can be used
as monotherapy or combined with other anthroposophic therapies.
Medications
Plant, mineral, and animal substances are used in
anthroposophic medications. Anthroposophic medications are conceived, developed, and produced in accordance with the anthroposophic knowledge of the
human being, nature, and substance and are sometimes
potentized. The method of production is specified in the
German homeopathic pharmacopoeia, in the Swiss
Original Article
ANTHROPOSOPHIC MEDICINE
Pharmacopoeia, and in the Anthroposophic Pharmaceutical
Codex and follows good manufacturing practice. The
medications are administered orally, rectally, vaginally,
parenterally (intracutaneously, subcutaneously, or
intravenously), or topically (applied to the skin, conjunctival sac, or nasal cavity). Several pharmaceutical
companies produce anthroposophic medicines (eg,
Weleda, Arlesheim, Switzerland; Wala Heilmittel,
Eckwälden, Germany; Abnoba Heilmittel, Pforzheim,
Germany). In anthroposophic medical practice, homeopathic and herbal medicine preparations are also used,
in addition to conventional pharmaceuticals if appropriate. The nonprofit, independent European Scientific
Cooperative on Anthroposophic Medicinal Products
(ESCAMP) investigates issues of system evaluation of
anthroposophic medicine for regulatory purposes.
External Applications
External applications—such as embrocation, compresses (Figure 3), hydrotherapy, and medicinal baths—
are used as elements of nursing care and therapy to
stimulate, strengthen, or regulate hygiogenic processes.
For this purpose, etheric or fatty oils, essences, tinctures, and ointments are used, as well as carbon dioxide
in baths. Of particular importance is rhythmical massage (described below).
Figure 3 Nursing packs. Source: Jürg Buess, Hiscia; reprinted with
permission.
Nursing
In nursing care, the intention is to become
acquainted with the whole patient and perceive the
patient in his or her physical, psychological, and spiritual being. A caring bond is developed, which aims at
developing a personal, accompanying, and mediating
relationship with the patient. In affiliation with two
anthroposophic hospitals (Gemeinschaftskrankenhaus
Herdecke and Filderklinik, Filderstadt; Sidebar 2) staterecognized training institutes provide 3-year courses in
anthroposophically extended nursing. In addition, several institutions provide further training opportunities.
Art Therapy
Anthroposophic art therapy was developed main-
Original Article
ly by Margarethe Hauschka,35 who also founded the
first training institution for this form of therapy in
1962.36 Anthroposophic art therapy employs the following techniques:
• Sculptural forming: Stone, soapstone, wood, clay,
beeswax, plasticine, and sand are all used as
sculpting materials.
• Therapeutic drawing and painting: The materials
used include paints and brushes, chalk, crayons,
and paper.
• Music therapy: Instruments used include percussion instruments such as the glockenspiel, xylophone, cymbals, resonant wooden blocks, drums
and kettledrums; various wind instruments such
as flute, crumhorn, shawm, trumpet, and alpenhorn; string instruments such as the chrotta (a
simplified cello), violin, viola, and double-bass;
and plucked instruments such as the harp, lyre
and kantele. Melodies, sounds, and rhythms are
improvised with the therapist or simply listened
to. The choice of instrument depends on the individual circumstances of the patient, according to
the severity and stage of the illness.
• Anthroposophic speech therapy: This involves using
articulation, consonants, vowels, text rhythms, and
hexameters. Breathing plays a particular role in
speaking (speech is formed exhalation). The indications for anthroposophic speech therapy are not
only disorders of the voice but also general medical
diseases, psychosomatic and psychiatric diseases,
and learning and developmental difficulties.
Art therapy is provided as individual therapy, as
individual therapy in small groups, or as group therapy.
The patients learn to work specifically with the particular medium (such as painting or sculpture). Before the
first treatment, there is a special session for obtaining
an art-therapeutic anamnesis and diagnosis. Each succeeding therapy session usually lasts for 50 minutes
and takes place once a week. Qualification as an anthroposophic art therapist requires 4 years’ college training
and a 2-year period of professional experience under a
mentor. In Germany and The Netherlands, master of
arts degrees are possible.
EURYTHMY THERAPY
Eurythmy therapy (In Greek, eurythmy means “harmonious rhythm”; Figure 4) is an exercise therapy
involving cognitive, emotional, and volitional elements.
It is provided by eurythmy therapists in individual or
small group sessions during which patients are instructed to perform specific movements with the hands, the
feet, or the whole body. Eurythmy therapy movements
are related to the sounds of the vowels and consonants,
to music intervals, or to soul gestures (eg sympathyantipathy). For each patient, one movement is or several
movements are selected depending on the patient’s disease, his constitution, and on the therapist’s observation
www.gahmj.com • November 2013 • Volume 2, Number 6
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GLOBAL ADVANCES IN HEALTH AND MEDICINE
Anthroposophic Psychotherapy and Counseling
Psychotherapy has been extended by anthroposophic perspectives to anthroposophic psychotherapy.
Full training is available in different countries, and a
master’s/bachelor’s degree in anthroposophic psychotherapy is available in Germany, The Netherlands,
Italy, and the United Kingdom. Counseling on biographical-existential, lifestyle, nutritional, social, mental, and spiritual issues is a central element of anthroposophic medical care.
RESEARCH ON ANTHROPOSOPHIC MEDICINE
Figure 4 Eurythmy therapy. Source: Professional Association for
Eurythmy Therapy; reprinted with permission.
of the patient’s movement pattern.27 This selection is
based on a core set of principles, prescribing specific
movements for specific diseases, constitutional types,
and movement patterns.37,38 A therapy cycle usually
consists of 12 to 15 sessions, each usually lasting 30 to
45 minutes; between sessions, patients practice the
exercises daily. Qualification as an eurythmy therapist
requires 5 and a half years of training according to an
international standardized curriculum. Eurythmy therapy is believed to have both general effects (eg, improving breathing patterns and posture, strengthening muscle tone, enhancing physical vitality39) and diseasespecific effects.38
Since its development in the 1920s and early
1930s, anthroposophic medicine has been associated
with extensive research activities. After World War II,
when anthroposophic medicine was re-established in
Europe, the focus was on founding practices, clinics,
and hospitals rather than on research. In the 1970s and
1980s, research was again performed but also restrained
by the predominant paradigm of the double-blind randomized trial, which is difficult to implement for nonpharmacological treatments, counseling, and whole
system treatment. Randomization and blinding often
have been rejected by anthroposophic physicians and
their patients due to strong therapy preferences and the
focus on the physician-patient relationship and highly
individualized treatment approaches.40,41 During the
past 30 years, research activities have grown steadily,
including laboratory work, preclinical studies, clinical
trials and observational studies, epidemiological
research, safety assessments, economic analyses,
patient’s perspective assessments, systematic reviews,
meta-analyses, and Health-Technology Assessment
(HTA) reports. Intense work has been done on methodological issues, with a major focus on individualized
therapy assessment, including systematic improvements of case report assessments.13 Research centers
were set up at anthroposophic hospitals and universities. At present, research is particularly focused on the
evaluation of the total system of anthroposophic medicine and, on the other hand, on individualized, personalized therapeutic approaches.
Clinical Efficacy and Effectiveness
Rhythmical Massage
Rhythmical massage was developed from Swedish
massage by Wegman, who was a physician and physiotherapist. Traditional massage techniques are augmented by lifting movements, rhythmically undulating or
gliding movements, and complex movement patterns
such as lemniscates and by using special loosening
techniques from the deeper areas out to the periphery.
In addition to effects on the skin, subcutaneous tissues,
and muscles, rhythmical massage is believed to have
both general effects (eg, enhancing physical vitality)
and disease-specific effects. Rhythmical massage is
practiced by physiotherapists with additional 1.5 to 3
years of rhythmical massage training according to a
standardized curriculum.
26
Volume 2, Number 6 • November 2013 • www.gahmj.com
The most comprehensive review of clinical efficacy and effectiveness of anthroposophic treatments—an
HTA report and its update13,42—identified 265 studies.
Thirty-eight of these studies were randomized controlled trials, 36 were prospective studies, and 49 were
retrospective nonrandomized controlled studies. The
remaining 142 studies were observational, without a
comparison group.
The studies investigated a wide spectrum of anthroposophic treatments in a multitude of diseases: 38 evaluated the whole system of anthroposophic healthcare,
10 examined nonpharmacological therapies, 133 were
devoted to anthroposophic mistletoe extracts in cancer,
and 84 to other anthroposophic medication treatments.
Methodological quality differed substantially; some
Original Article
ANTHROPOSOPHIC MEDICINE
studies showed major limitations and hardly allow
valid conclusions regarding efficacy/effectiveness,
while others were reasonably well-conducted.
Two-hundred fifty-three of the 265 studies (including 32 of the 38 randomized trials) described a positive
outcome for anthroposophic treatments—meaning a
comparable or a better result than with conventional
treatment or a clinically relevant improvement of the
condition, often in chronic disease and after unsuccessful
conventional treatments. Twelve studies found no benefit, one of them with a negative trend. In one of these 12
studies,43 the standard treatment in the comparison
group—intravesical instillation of Bacillus CalmetteGuerin in superficial bladder cancer—was superior.
Mistletoe in Cancer. Mistletoe treatment for cancer originated within anthroposophic medicine. It is
one of the most commonly prescribed complementary
cancer therapies in Central Europe44,45 and has been
investigated intensely.46,47 Mistletoe (Viscum album L,
not to be confused with Phoradendron, the American
mistletoe) is a shrub that grows on different host trees.
Extracts are made from specific parts of the plant (eg,
fresh leafy shoots and berries). Anthroposophic mistletoe preparations (Abnobaviscum, Helixor, Iscador
[labeled as “Iscar” in the United States], and Iscucin) are
available from different host trees such as oak, apple,
and pine. The harvesting procedure is standardized, and
the juices from both summer and winter harvests are
mixed together.
Mistletoe extract (ME) contains a variety of biologically active compounds,46,47 such as lectins, viscotoxins, other low molecular weight proteins, VisalbCBA
(Viscum album chitin-binding agglutinin), oligo- and
polysaccharides, flavonoids,48 vesicles,49 triterpene
acids,50 and others. ME and several of its compounds
are cytotoxic, and the lectins in particular have strong
apoptosis-inducing effects.51-53 They also have an effect
on multidrug-resistant cancer cells54 and enhance the
cytotoxicity of anticancer drugs.55,56 In mononuclear
cells, ME possesses DNA-stabilizing properties. ME and
its compounds stimulate the immune system (in vivo
and in vitro activation of monocytes/macrophages,
granulocytes, natural killer cells, T-cells, dendritic cells)
and induce a variety of cytokines.46,47 The cytotoxicity
of killer cells can also be markedly enhanced by a bridging effect through rhamnogalacturonans.57,58 Injected
into tumor-bearing animals, ME and several of its compounds inhibit and reduce tumor growth.46,47 ME also
enhances endorphins in vivo.46,47
Clinical studies on mistletoe in cancer describe
rather consistently positive effects on quality of life:
improved coping, sleep, appetite, energy, ability to
work, and emotional and functional well-being, as well
as reduced fatigue, exhaustion, nausea, vomiting,
depression, and anxiety. Less consistently, the studies
describe reduced pain and diarrhea.59 Regarding survival, study results were inconclusive until recently,60,61 and best evidence had rested mainly on epidemiological studies. A well conducted, large, random-
Original Article
ized controlled trial has just been concluded; it investigated mistletoe therapy in patients with advanced
pancreatic cancer who were not eligible for chemotherapy. The first interim analysis with 220 patients
found a statistically significant benefit for survival
(primary outcome parameter), with a median survival
of 4.8 months in mistletoe-treated patients vs 2.7
months in control patients. Also, quality of life measured as a secondary outcome was superior regarding
the functional scales and the symptoms of fatigue,
sleep, pain, nausea, vomiting, and appetite. As expected, body weight decreased in control patients but
increased in mistletoe-treated patients.62
Tumor remissions are rare in the common lowdose subcutaneous mistletoe therapy.60,61,63 However,
they have repeatedly been described following local and
high-dose applications of mistletoe extracts, eg, in liver
cancer,64 pancreatic cancer,65 Merkel cell carcinoma,66
breast cancer,66 primary cutaneous B-cell lymphoma,67
cutaneous squamous cell carcinoma,68 and others.46,61
Local inflammatory response and fever often are
observed at the beginning of treatment, and the tumor
then regresses during the next couple of months.
Frequent side effects are dose-dependent local skin
reactions and flu-like symptoms. Allergic reactions
have been reported. Overall, mistletoe treatment is considered to be safe.13,46,69
System Evaluations. The largest clinical studies
on anthroposophic medicine were two system evaluations, together consisting of more than 2700 patients.
The Anthroposophic Medicine Outcomes Study
(AMOS) is an observational cohort study of German
outpatients treated for mental, musculoskeletal, respiratory, and other chronic conditions.70 One hundred
fifty-one qualified anthroposophic physicians, 275
therapists, and 1631 patients aged 1 to 75 years participated. At study entry, patients had been ill for 3 years
(median) or 6.5 years (mean). Following anthroposophic treatment (art therapy, rhythmical massage, eurythmy therapy, physician-provided counseling, anthroposophic medications), substantial and sustained
improvements of disease symptoms and quality of life
were observed. The improvements were found in
adults70 and children71 in all therapy modality
groups72-76 and in all evaluable diagnosis groups (anxiety disorders, asthma, attention deficit/hyperactivity
disorder, depression, low back pain, migraine77-83), and
the effects were retained after 4 years. The improvements in quality of life were at least of the same order of
magnitude as improvements following other (nonanthroposophic) treatments.84 In sensitivity analyses
(combined bias suppression), maximally 37% of the
improvement could be explained by natural recovery,
regression to the mean, adjunctive therapies, and nonresponse bias.85 In a nested prospective nonrandomized comparative study, AMOS patients with low back
pain had comparable or significantly more improvements than patients receiving conventional care.81
The International Integrative Primary Care
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GLOBAL ADVANCES IN HEALTH AND MEDICINE
Outcomes Study on anthroposophic medicine was conducted in four European countries and the United States
and compared primary care patients who were treated
by anthroposophic or conventional physicians for acute
respiratory and ear infections. Compared to conventional therapy, anthroposophic treatment was associated with much lower use of antibiotics and antipyretics
as well as quicker recovery, fewer adverse reactions, and
greater therapy satisfaction. These differences remained
after adjustment for country, age, gender, and four
markers of baseline severity. Only 3% of the anthroposophic patients would have agreed to randomization.40
A complex project on anthroposophic healthcare
in advanced cancer funded by the Swiss National
Science Foundation demonstrated the difficulties of
recruiting patients for randomized system comparison
even in a university hospital patient population.
Although anthroposophic medicine was well integrated into the University Hospital setting and patient
compliance with anthroposophic therapy was good,
the randomized controlled trial component of the project ultimately had to be abandoned. Still, in the observational part of the study, anthroposophic treatment
showed an improvement in physical, psychic, cognitive-spiritual, and social dimensions of quality of life
and was perceived by patients as having beneficial
effects on physical recovery and well-being, emotional
and cognitive-spiritual quality of life, and the quality of
human relations and care, while conventional therapy
was perceived as beneficial mainly through effects on
tumors with alleviation of symptoms and pain.86-89
A system comparison of anthroposophic and conventional healthcare in cancer patients was performed
at the University of Uppsala in Sweden. Randomization
could not be financed with public funds; therefore, a
prospective matched-pair design was implemented.
Prior to treatment, quality of life was more compromised in the anthroposophic patients. During and after
the anthroposophic treatment, the quality of life
improved, whereas the control group treated with conventional medicine showed no change.90,91
Another observational study investigated patients
with chronic inflammatory rheumatic conditions
receiving anthroposophic healthcare over a 12-month
period. They achieved a relevant reduction in the local
and systemic inflammatory activity, relief of disease
symptoms, and an improvement in functional capacity
including the psychosocial dimension. Patient satisfaction was high and conventional therapy could largely
be avoided or reduced.92 This study gave rise to a large
comparative effectiveness study, comparing anthroposophic with conventional healthcare for patients with
rheumatoid arthritis. The study was funded by the
German Federal Ministry of Education and Research; it
has concluded but has not yet been published.
Another study investigated chronic facial pain
(mostly trigeminal neuralgia, present for more than 10
years in half of patients) that had been conventionally
treated to no avail. Anthroposophic treatment was fol-
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Volume 2, Number 6 • November 2013 • www.gahmj.com
lowed by clinical improvement (one-fifth of patients
became pain-free and almost two-thirds experienced a
clear improvement), and conventional therapeutic
agents were reduced.93 A retrospective study showed a
favorable cure rate of anorexia nervosa following inpatient anthroposophic therapy.94
Clinical Studies on Single or a Fixed Set of
Interventions. A variety of studies has investigated
monotherapies or fixed combination therapies, for
instance mistletoe treatment in cancer (see above) and in
hepatitis,95-97 betulin-based oleogel in actinic keratosis,98,99 rhythmic embrocation (with Solum oil) in
chronic pain,100 hepar magnesium in seasonal fatigue
symptoms,101 arnica/echinacea in care of umbilical
cords of newborns,102,103 eurythmy therapy in attention
deficit/hyperactivity disorder104, body-temperature enemas in febrile children,105 mistletoe combined with
Articulatio coxae or genus D30 in osteoarthritis of the
hip and knee,106 Gelsemium comp. in acute occipital
muscular pain,107 and many others. Most studies, except
one on migraine,108 one on postoperative wound care,109
and one on actinic keratosis,99 showed positive results.
Four recent new randomized controlled trials—on Disci/
Rhus toxicodendron comp. in chronic low back pain,110
on Articulatio genus D5 in ostheoarthritis of the knee,111
on calendula cream in skin care during radiation,112 and
on Ovaria comp. in menopausal symptoms113—found
no benefit compared to placebo treatment.
Patient’s Perspective. Patient satisfaction was generally high, and therapeutic expectations were fulfilled.13,42,114 For instance, in a recently completed Dutch
survey (Consumer Quality Index, a national standard to
measure healthcare quality from the perspective of healthcare users), 2.099 patients reported very high satisfaction
with anthroposophic primary care practices (8.4 and 8.3
on a scale of 0 to 10, 10 being the best possible score).115
Safety
A variety of investigations specifically assessed the
safety of anthroposophic treatments.13,69,72-74,116-119 In
general, the tolerability is good. Adverse reactions are
infrequent and mostly mild to moderate in severity.
Three types of adverse reactions to anthroposophic medications are commonly described: local reactions from
topical application, systemic hypersensitivity including
very rare cases of anaphylactic reactions, and aggravation
of preexisting symptoms in sensitive patients. In a
detailed safety analysis from the AMOS study, the incidence of confirmed adverse reactions to anthroposophic
medications was 3% of users and 2% of the medications
used116; adverse reactions in eurythmy therapy, art therapy, and rhythmical massage were reported in 3%, 1%,
and 5% of the patients, respectively72-74; and no serious
adverse reactions were found.116 Theoretically, avoidance
of necessary conventional treatment in anthroposophic
healthcare settings might pose a risk, but no evidence has
been found for this.13,42 Comparative studies found similar81 or lower40,114,120 rates of side effects in anthroposophic than in conventional healthcare.
Original Article
ANTHROPOSOPHIC MEDICINE
Cost
Several economic analyses assessed costs of anthroposophic medicine. They point to a favorable cost
structure and found cost savings partly due to lower
drug costs, fewer specialist referrals, and fewer hospital
days and admissions. This cannot be explained by a
reduced disease burden—on the contrary, in most studies, anthroposophically treated patients are more
severely affected or have been ill for a longer period
before starting therapy.13,121-125
Case Reports
Case report methodology has been developed to
provide validated and transparent information from
the point of care with special focus on individualized
healthcare.126-130 Case reports describe the specific
anthroposophic treatment approach in detail (eg, see
references 27, 67, 68, 131, and 132). Methods for systematic and critical appraisal still have to be worked out.
CONCLUSION
Anthroposophic medicine is an example of a multimodal treatment system—based on a holistic paradigm of the organism, disease, and treatment—that can
be fully integrated with conventional medicine in
medical practices and hospitals. Great emphasis is put
on individualized healthcare. Assessing this healthcare
system, an integrative evaluation strategy has been
applied, including system approaches as well as studies
in isolated treatment components with regard to efficacy, effectiveness, safety, and costs, as well as qualitative methods and high-quality case reports on individual treatment.
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complementary and conventional medicine. Forsch Komplementmed.
2011;18(6):315-20.
Studer HP, Busato A. Development of costs for complementary medicine
after provisional inclusion into the Swiss basic health insurance. Forsch
Komplementmed. 2011;18(1):15-23.
Kooreman P, Baars EW. Patients whose GP knows complementary medicine
tend to have lower costs and live longer. Eur J Health Econ. 2012
Dec;13(6):769-76.
Kienle GS. Why medical case reports? Global Adv Health Med. 2012;1(1):8-9.
Kienle GS, Kiene H. Clinical judgement and the medical profession. J Eval
Clin Pract. 2011;17(4):621-7.
Kiene H, Schön-Angerer T. Single-case causality assessment as a basis for
clinical judgment. Altern Ther Health Med. 1998;4(1):41-47.
Kiene H. Komplementäre Methodenlehre der klinischen Forschung.
Cognition-based Medicine. Berlin, Heidelberg, NY: Springer-Verlag; 2001.
Kiene H, Hamre HJ, Kienle GS. In support of clinical case reports: a system of
causality assessment. Global Adv Health Med. 2013;2(2):28-39.
Wode K, Schneider T, Lundberg I, Kienle GS. Mistletoe treatment in cancerrelated fatigue: a case report. Cases J. 2009 Jan 22;2(1):77.
Kienle GS, Meusers M, Quecke B, Hilgard D. Patient-centered diabetes care in
children: an integrated, individualized, systems-oriented, and
Multidisciplinary Approach. Global Adv Health Med 2013;2(2):12-19.
G U I D E L I N E S
A Little Structure Goes a Long Way
Introducing a new website that supports the need for completeness and transparency in case reports.
Please visit www.CARE-statement.org to learn more about the CARE checklist and CARE guidelines.
Global Advances in Health and Medicine endorses the CARE Guidelines and offers tools that support the
publication of high-quality case reports.
www.CARE-statement.org
Original Article
www.gahmj.com • November 2013 • Volume 2, Number 6
31
Enkele belangrijke publicaties
Introductie
Heusser, P. (2010). Anthroposophische Medizin und Wissenschaft: Beiträge zu einer ganzheitlichen medizinischen Anthropologie. Stuttgart, New York: Schattauer Verlag.
IVAA (2012). Facts and Figures on Anthroposophic Medicine
(AM) Worldwide. Brussels: IVAA.
IVAA (2012). The system of Anthroposophic Medicine. Brussels:
IVAA.
Kienle, G.S., Albonico, H.U., Baars, E., Hamre, H.J., Zimmermann, P., et al. (2013). Anthroposophic Medicine: An
Integrative Medical System Originating in Europe. Global
Advances in Health and Medicine, 2(6):20-31.
ZonMW (2014). Signalement Ontwikkeling en implementatie van
evidence-based complementaire zorg. Den Haag: ZonMW.
Kosteneffectiviteit
Herman, P.M., Poindexter, B.L., Witt, C.M., Eisenberg, D.M.
(2012). Are complementary therapies and integrative care
cost-effective? A systematic review of economic evaluations.
BMJ open, 2(5).
Kooreman, P., Baars, E.W. (2012). Patients whose GP knows
complementary medicine tend to have lower costs and
live longer. The European Journal of Health Economics,
13(6):769-776.
Kooreman, P., Baars, E.W. (2014). Complementair werkende
huisartsen en de kosten van zorg. Gezondheidszorg ESB,
99(4678):90-92.
Integrative oncologie
Ben-Arye, E., Schiff, E., Zollman, C., Heusser, P., Mountford,
P., et al. (2013). Integrating complementary medicine in
supportive cancer care models across four continents. Med
Oncol, 30:511. DOI 10.1007/s12032-013-0511-1.
Heusser, P., Kienle, G. (2009). Anthroposophic Medicine, Inte­
grative Oncology, and Mistletoe Therapy of Cancer. In: Abrams
D, Weil A (eds): Integrative Oncology, pp. 322-40. New York:
Oxford University Press.
Heusser, P., Berger Braun, S., Ziegler, R., Bertschy, M., Helwig,
S., et al. (2006). Palliative In-Patient Cancer in an Anthroposophic Hospital: Treatment Patterns and Compliance
with Anthroposophic Medicine. Forsch Komplementärmed,
13:94-100.
Tröger, W., Galun, D., Reif, M., Schumann, A., Stanković, N.,
et al. (2013). Viscum album [L.] extract therapy in patients
with locally advanced or metastatic pancreatic cancer: A
randomised clinical trial on overall survival. European Journal of Cancer, 49(18):3788-3797.
Von Rohr, E., Pampallona, S., van Wegberg, B., Cerny, T.,
Hürny, C., et al. (2000). Attitudes and beliefs towards disease and treatment in patients with advanced cancer using
anthroposophical medicine. Onkologie, 23(6):558-63.
Veiligheid
Jeschke, E., Ostermann, T., Lüke, C., Tabali, M., Kröz, et al.
(2009). Remedies Containing Asteraceae Extracts. Drug
safety, 32(8):691-706.
Jong, M.C. , Jong, M., Baars, E.W. (2012). Adverse drug
reactions to anthroposophic and homeopathic solutions for
injection: a systematic evaluation of German pharmacovigilance databases. Pharmacoepidemiology and Drug Safety.
DOI: 10.1002/pds.3298.
Effecten
Baars, E.W., Jong, M. C., Boers, I., Nierop, A. F. M., Savelkoul,
H. F. J. (2012). A Comparative In Vitro Study of the Effects
of Separate and Combined Products of Citrus e fructibus and
Cydonia e fructibus on Immunological Parameters of Seasonal Allergic Rhinitis. Mediators of Inflammation. Article ID
109829, 10 pages. doi:10.1155/2012/109829 (10 p)
Hamre, H. J., Kiene, H., Ziegler, R., Tröger, W., Meinecke, et al.
(2014). Overview of the Publications From the Anthroposophic
Medicine Outcomes Study (AMOS): A Whole System Evaluation
Study. Global Advances in Health and Medicine, 3(1): 54-70.
Kienle, G.S., Kiene, H., Albonico, H.U. (2006). Anthroposophic
Medicine: Effectiveness, Utility, Costs, Safety. Stuttgart, New
York: Schattauer Verlag.
Kienle, G.S., Glockmann, A., Grugel, R., Hamre, H.J., Kiene, H.
(2011). Klinische Forschung zur Anthroposophischen Medizin – Update eines „Health Technology Assessment“-Berichts und Status Quo. Forsch Komplementmed, 18:269-82.
Integrative psychiatrie
Hoenders, R. (2013). Integrative psychiatry; conceptual
foundation, implementation and effectiveness. PhD thesis,
Groningen: Rijksuniversiteit Groningen.
32
Klantervaringen
Baars, E.W., Koster, E.B., Schoorel, E.P. (2011). Klantervaringen met een geïntegreerde reguliere en antroposofische
benadering in het Kindertherapeuticum in Zeist. Nederlands
Tijdschrift voor Kindergeneeskunde 79(6):174-178.
Esch, B., Marian, F., Busato, A., Heusser, P. (2008). Patient satisfaction with primary care: an observational study comparing
anthroposophic and conventional care. Health and Quality of
Life Outcomes 6(74). DOI:10.1186/1477-7525-6-74.
Jong, M.C., Busch, M., Fritsma, J., Seldenrijk, R. (2012).
Integration of complementary and alternative medicine in
primary care: what do patients want? Patient Educ Couns,
89(3):417-22.
Koster, E.B., Ong, R.R., Heybroek, R., Delnoij, D.M., Baars,
E.W. (2014). The consumer quality index anthroposophic
healthcare: a construction and validation study. BMC health
services research, 14(1):148.
Curriculum for Anthroposophic Medicine (ICURAM). Patient
Educ Couns. DOI.org/10.1016/j.pec.2012.04.006.
Fuseren van culturen
Mittring, N., Perard, M., Witt, C.M. (2013). Corporate culture
assessments in integrative oncology: a qualitative case study of two integrative oncology centers. Evid Based Complement Alternat Med. 2013:316950.
Capita Selecta Integrative Medicine
Cassileth, B.R., Gubili, J., Simon Yeung K. (2009). Integrative
medicine: complementary therapies and supplements. Nat
Rev Urol 6(4):228-33.
Crawford, C., Lee, C., Buckenmaier, C., Schoomaker, E., Petri,
R., et al. (2014). The current state of the science for active
self-care complementary and integrative medicine therapies
in the management of chronic pain symptoms: lessons learned, directions for the future. Pain Med 15(1):104-113.
Delgado, R., York, A., Lee, C., Crawford, C., Buckenmaier, et al.
(2014). Assessing the quality, efficacy, and effectiveness of
the current evidence base of active self-care complementary
and integrative medicine therapies for the management of
chronic pain: a rapid evidence assessment of the literature.
Pain Med 15(1):9-20.
Eisenberg, D. (2012). Integrative medicine in 2021: an imagined retrospective. Explore (NY) 8(2):81-84.
Horrigan, B., Lewis, S., Abrams, D., Pechura, C. (2012).
Integrative medicine in America: How integrative medicine is
being practiced in clinical centers across the United States.
Minneapolis, MN: The Bravewell Collaborative. http://
bravewell.org/content/Downlaods/IMinAm.pdf
Maizes, V., Rakel, D., Niemiec, C. (2009). Integrative medicine
and patient-centered care. Explore (NY) 5(5):277-289.
Witt, C.M., Chesney, M., Gliklich, R., Green, L., Lewith, G.,
et al. (2012). Building a strategic framework for comparative effectiveness research in complementary and
integrative medicine. Evid Based Complement Alternat Med
2012:531096.
Witt, C.M., Holmberg, C. (2012). Changing academic medicine:
strategies used by academic leaders of integrative medicine-a qualitative study. Evid Based Complement Alternat Med
2012:652546.
Wolever, R.Q., Abrams, D.I., Kligler, B., Dusek, J.A., Roberts, R.,
et al. (2012). Patients seek integrative medicine for preventive approach to optimize health. Explore (NY) 8(6):348-352.
Methodologie
Fischer, H. F., Junne, F., Witt, C., von Ammon, K., Cardini, F.
et al. (2012). Key issues in clinical and epidemiological
research in complementary and alternative medicine–a systematic literature review. Forschende Komplementärmedizin/
Research in Complementary Medicine, 19(2):51-60.
Gagnier, J.J., Kienle, G., Altman, D.G., Moher, D., Sox, H., et al.
(2013). The CARE guidelines: consensus-based clinical case
reporting guideline development. Global Adv Health Med.
2(5):38-43.
Kiene, H. (2001). Komplementäre Methodenlehre der klinischen
Forschung. Cognition-based Medicine. Berlin - Heidelberg New York: Springer.
Kienle, G.S., Albonico. H.-U., Fischer, L., Frei-Erb, M., Hamre,
H.J., et al. (2011). Complementary therapy systems and
their integrative evaluation. Explore: The Journal of Science
and Healing, 7(3):175-87.
Onderwijs
Heusser, P., Scheffer, C., Neumann, M., Tauschel, D., Edelhäuser, F. (2012). Towards non-reductionistic medical anthropology, medical education and practitioner–patient-interaction: The example of Anthroposophic Medicine. Patient
education and counseling, 89(3):455-460.
Scheffer, C., Tauschel, D., Neumann, M., Lutz, G., Cysarz, D.,
et al. (2012). Integrative medical education: Educational
strategies and preliminary evaluation of the Integrated
33
Enkele belangrijke organisaties en links
Antroposofische gezondheidszorg
• Antroposana (patiëntenvereniging): www.antroposana.nl
• International Federation of Anthroposophic Medical
Associations (IVAA): http://www.ivaa.info/home/
• Medizinische Sektion, Goetheanum, Zwitserland:
∙∙ Algemeen: http://www.medsektion-goetheanum.org/
∙∙ Onderzoek: http://www.medsektion-goetheanum.org/
en/research/
• Nederlandse Vereniging van Antroposofische Zorgaanbieders (NVAZ):
∙∙ Algemeen: www.nvaz.nl
∙∙ Beroepsverenigingen: http://nvaz.nl/leden/leden-beroepsverenigingen
∙∙ Institutionele zorgaanbieders: http://nvaz.nl/leden/
leden-institutionele-zorgaanbieders
∙∙ Therapeutica/ gezondheidscentra: http://nvaz.nl/
leden/leden-therapeutica-en-gezondheidscentra
• Academie Antroposofusche Gezondheidszorg: http://
www.academie-antroposofische-gezondheidszorg.nl/
• Edith Maryon College: http://www.maryoncollege.nl/
Wetenschappelijke tijdschriften
• Advances in Integrative Medicine: http://www.sciencedirect.com/science/journal/22129626
• African Journal of Traditional, Complementary and
Alternative medicines (AJTCAM): http://journals.sfu.ca/
africanem/index.php/ajtcam
• Alternative & Integrative Medicine: http://esciencecentral.org/journals/alternative-integrative-medicine.php
• Alternative Therapies in Health and Medicine: http://
www.alternative-therapies.com/index.cfm
• Asian Journal of Complementary and Alternative Medicine: http://www.literatipublishers.com/Journals/index.
php?journal=A-CAM
• BMC Complementary and Alternative Medicine: http://
www.biomedcentral.com/bmccomplementalternmed/
• Chinese Journal of Integrative Medicine: http://www.
springer.com/medicine/journal/11655
• Complementary Therapies in Medicine: http://www.
journals.elsevier.com/complementary-therapies-in-medicine/
• European Journal of Integrative Medicine: http://www.
europeanintegrativemedicinejrnl.com/
• Evidence-Based Complementary and Alternative Medicine
(eCAM): http://www.hindawi.com/journals/ecam/
• Focus on Alternative and Complementary Therapies:
http://onlinelibrary.wiley.com/journal/10.1111/%28IS
SN%292042-7166
• Forschende Komplementärmedizin: http://www.karger.
com/Journal/Home/224242
• International Journal of Alternative Medicine: http://
recentscience.org/ijam-international-journal-of-alternative-medicine/
• Integrative Medicine Research (IMR): http://www.
imr-journal.com/
• Journal of Alternative and Complementary Medicine:
http://www.liebertpub.com/overview/journal-of-alternative-and-complementary-medicine-the/26/
• Journal of Ayurveda and Integrative Medicine (J-AIM):
http://www.jaim.in/
• Journal of Evidence-Based Complementary & Alternative
Medicine (JEBCAM): http://chp.sagepub.com/
• Journal of Integrative Medicine: http://www.jcimjournal.
com/jim/
• Merkurstab: www.merkurstab.de
Integrative Medicine
• Consortium of Academic Health Centers for Integrative
Medicine: http://www.imconsortium.org/members/
home.html
• International Society for Complementary Medicine Research: http://www.iscmr.org/
• National Center for Complementary and Alternative Medicine (NCCAM): http://nccam.nih.gov/
• NIKIM:
∙∙ Algemeen: www.nikim.nl
∙∙ Links: http://www.nikim.nl/integrative-medicine/
im-links/
• World Health Organization (WHO traditional medicine
strategy: 2014-2023): (http://www.who.int/medicines/
publications/traditional/trm_strategy14_23/en/
• ZonMW (Signalement 2014): http://www.zonmw.nl/nl/
publicaties/detail/signalement-ontwikkeling-en-implementatie-van-evidence-based-complementaire-zorg/?no_cache=1&cHash=a640da3ea1d8ab09849637c2d6f9cdbe
34
Meer over het
Lectoraat Antroposofische Gezondheidszorg
35
Lectoraat Antroposofische Gezondheidszorg
Hogeschool Leiden
beroepspraktijk ook daadwerkelijk kunnen worden ingepast.
De lectoraten en kennisnetwerk(en) van Hogeschool Leiden
hebben dan ook tot doel om een optimale interactie tussen
onderzoek, onderwijs en de beroepspraktijk tot stand te brengen door het verzamelen, ontwikkelen, verspreiden en (leren)
toepassen van kennis.
In de praktijk betekent dit, dat door de lector en de leden
van de kennisnetwerken zelf onderzoeksprojecten worden
uitgevoerd. De hiermee opgedane kennis en ervaring worden
verwerkt in de verschillende initiële en post-initiële opleidingen en komt terecht in het werkveld bij de beroepsbeoefenaren
en bij het werkveld betrokken organisaties.
Hogeschool Leiden bouwt aan centra en netwerken waarmee
zij zorgt voor focus, massa en onderscheidende kwaliteit.
Hogeschool Leiden profileert zich in het bijzonder op Life
Sciences, Jeugd en Zorg.
Hogeschool Leiden heeft lectoraten en netwerken als volgt
ingedeeld:
Hogeschool Leiden is een hogeschool van gemiddelde
grootte, met ongeveer 9.000 studenten en 800 werknemers. Hogeschool Leiden werkt met passie, talent en
menselijke maat. Ze biedt een activerende leer- en werkomgeving en draagt bij aan innovatie van de beroepspraktijk en aan de ontwikkeling van professionals.
De student centraal
Werken met passie, talent en menselijke maat vereist een
kritsch-reflectieve houding, zelfbewustzijn, de drang om continu te leren, eigenwijsheid en een zoektocht naar verbetering
en innovatie. Hogeschool Leiden kiest met de menselijk maat
vooral voor contact, authenticiteit en integriteit.
Hogeschool Leiden leidt studenten op tot die beginnende
beroepsbeoefenaren, waar partners in de regio en daarbuiten
behoefte aan hebben. Het werkveld is dan ook leidend voor het
onderwijs en het onderwijs kan alleen maar worden vormgegeven en uitgevoerd in samenwerking met het werkveld.
In een goed gestructureerde en veilige omgeving prikkelt en
stimuleert de hogeschool studenten met als doel een kritische, onderzoekende en reflecterende (beroeps)houding te
ontwikkelen en ernaar te handelen.
Life Sciences:
• Biodiversiteit
• Innovatieve Moleculaire Diagnostiek
• Expertisecentrum Jeugd:
• Jeugdzorg en Jeugdbeleid
∙∙ Licht Verstandelijke Beperking en Jeugdcriminaliteit
∙∙ Natuur en Ontwikkeling Kind
∙∙ Ouderschap en Ouderbegeleiding
∙∙ Passend Onderwijs/Inclusive Education
∙∙ Residentiële Jeugdzorg
∙∙ Talentmanagement
Opleidingen en clusters
Hogeschool Leiden biedt bacheloropleidingen aan op het
gebied van Educatie, Management en Bedrijf, Techniek, Zorg
en Social Work en Toegepaste Psychologie. Daarnaast biedt de
hogeschool ook masteropleidingen, post-HBO opleidingen, en
nascholing en opleidingen voor professionals.
Zorg:
• Antroposofische Gezondheidszorg
• Eigen Regie
• Geestelijke Gezondheidszorg
Overige lectoraten en kennisnetwerken:
• Onderzoeksmethoden en Technieken
• PR en Social Media
• Virtuality Driven Learning
• Management & Bedrijf
Praktijkgericht onderzoek
De aanleiding voor het instellen van de lectoraten en kennisnetwerken was de veranderende behoefte aan kennis in de
beroepsopleiding en in het werkveld.
Om het handelen van (toekomstige) beroepsbeoefenaren goed
te kunnen onderbouwen zijn in toenemende mate actuele en
voor de praktijk relevante gegevens nodig. Maar niet alleen
is er meer kennis nodig, de verzamelde gegevens moeten ook
op een zodanige manier worden aangereikt, dat deze in de
36
Lectoraat Antroposofische Gezondheidszorg
Het lectoraat Antroposofische Gezondheidszorg (AG) is, na een
voorbereidend en verkennend jaar, aan Hogeschool Leiden van
start gegaan voor een periode van drie jaar (2008 –2010) en
bevindt zich momenteel in het laatste jaar van haar tweede
termijn (2011-2014).
In de afgelopen jaren heeft het werk van het lectoraat zich met
name gefocust op: (1) het leveren en ontwikkelen van optimale kwaliteit van de AG zorg (het ontwikkelen van Practice Based
Evidence), (2) het aantonen van effectiviteit en veiligheid (het
ontwikkelen van Evidence Based Practice), en (3) het bijdragen aan verantwoorde communicatie over AG.
kent vele therapieën waarmee de patiënt actief de eigen
gezondheidstoestand kan beïnvloeden. Naast de klassieke,
maar tegelijkertijd antroposofisch verruimde therapieën, zoals
psychotherapie en fysiotherapie, zijn dat onder meer kunstzinnige therapie (muziek en beeldend), spraak- en euritmietherapie, ritmische massage, verpleegkundige begeleiding,
en begeleiding en behandeling op gebied van voeding. Deze
therapieën worden zowel in de eerste- als in de tweedelijnszorg toegepast.
Voor vrijwel alle beroepsgroepen geldt dat de zorgverleners in
eerste instantie regulier opgeleid zijn en daarnaast een aanvullende antroposofische, erkende beroepsopleiding hebben
gevolgd.
De AG bestaat uit meerdere sectoren: de eerstelijn, bestaande
uit huisartsgeneeskunde, consultatiebureaus, bedrijfsgeneeskunde, schoolartsendiensten, en een rijkgeschakeerde tweedelijnszorg. De huisartsen werken in zelfstandige praktijken,
of in zogeheten therapeutica (multidisciplinaire gezondheidscentra), samen met verschillende andere disciplines.
Er zijn zo’n 150 praktiserende antroposofische (huis)artsen
en specialisten in Nederland. Daarnaast zijn er 15 consultatiebureaus voor zuigelingen en kleine kinderen tot 4 jaar,
deels ingebed in regionale instituties. Naar schatting maken
ongeveer 200.000 cliënten gebruik van deze diensten. De antroposofische tweedelijnszorg in Nederland strekt zich uit van
geestelijke gezondheidszorg (GGZ) en verslavingszorg (VZ) tot
aan ouderenzorg en zorg aan cliënten met een ontwikkelings-,
verstandelijke en/of lichamelijke stoornis (VGZ).
Kenmerken en waarden van de AG
Kenmerken van de AG
De antroposofische gezondheidszorg (AG) is aan het begin
van de twintigste eeuw ontstaan als een verruiming van de
bestaande reguliere geneeskunde en heeft zich in de ruim
90 jaar van haar bestaan, zowel kwantitatief als kwalitatief,
goed en snel ontwikkeld. Het fundament van de AG werd door
de filosoof Dr. Rudolf Steiner en de arts Ita Wegman gelegd.
Ze werkten samen om de theoretische kennis en de praktijk van de reguliere gezondheidszorg te integreren met de
kennis van de antroposofische geesteswetenschap. Ontstaan
in Centraal-Europa, wordt AG momenteel gepraktiseerd en
onderwezen in de meeste landen in Europa en in meer dan 80
landen in de wereld. AG kan worden beschouwd als een vorm
van Integrative Medicine ‘avant la lettre’, waarbij er naast en
geïntegreerd met de reguliere behandelmogelijkheden gebruik
gemaakt wordt van aanvullende antroposofische diagnostiek,
geneesmiddelen en niet-medicamenteuze therapieën.
Binnen de AG wordt aandacht geschonken aan de samenhang
tussen lichaam, ziel en individualiteit in relatie tot ziekte en
gezondheid. Ook is er veel aandacht voor leefstijl, de relatie
tussen aandoening en persoonlijk functioneren, omgevingsfactoren en betekenisgeving. Veelgenoemde en gewaardeerde
kenmerken van de antroposofische gezondheidszorg zijn de
sterk individugerichte aanpak, het ondersteunen en stimuleren van het zelfgenezend vermogen van de mens, een gelijkwaardige relatie tussen zorgvrager en zorgverlener, meer tijd
en aandacht voor de zorgvrager en een verantwoorde voorkeur
voor natuurlijke medicatie. De antroposofische zorgverlening
Praktijkmethoden van de AG
Vanuit de antroposofisch geesteswetenschappelijke kennis:
• hanteert de AG aanvullende specifieke, de reguliere
gezondheidszorg aanvullende, preventieve praktijkmethoden;
• hanteert AG aanvullende diagnostische methoden en
categorieën;
• zet de AG aanvullende nieuwe therapieën (medicamenteus en niet-medicamenteus) in;
• is zij primair georiënteerd op het versterken van de
zelfherstellende krachten van de mens (gezondheid
bevorderen) van het organisme (lichaam en vitaliteit), de
ziel en de individualiteit;
• is zowel diagnostisch, therapeutisch als qua houding
sterk individugeoriënteerd.
37
AG integreert de verworvenheden van de gangbare wetenschap en geneeskunde/gezondheidszorg en de antroposofische geesteswetenschap, zich onder meer uitdrukkend in de
integratie van:
• reguliere en antroposofische preventie
• reguliere en antroposofische diagnostiek
• gezondheid bevorderende en ziektebestrijdende therapeutische benaderingen
• groepsgeoriënteerde protocollen/ richtlijnen en individu
georiënteerde benaderingen
•
•
•
•
AG als whole medical system
De AG kan beschouwd worden als een whole medical system
benadering in aanvulling op de reguliere gezondheidszorg. De
kenmerken van whole medical systems zijn, onder meer:
• Ontologische positie:
∙∙ Gebaseerd op en uitgaande van een holistische ontologie (‘er is meer dan materie alleen’)
• Diagnostiek:
∙∙ Dubbele diagnose (regulier + bv. antroposofisch)
∙∙ Zowel individu- als systeem-/ contextgeoriënteerd
• Behandeling:
∙∙ Complex
∙∙ Uniek voor de individuele patiënt
∙∙ Georiënteerd op het versterken van het herstelvermogen, gezondheid (salutogenese)
• Sturing van therapieprocessen:
∙∙ Veelal gebaseerd op het geschoolde oordeelsvermogen
∙∙ Naast gebruik van gevalideerde meetinstrumenten
• Evaluatie:
∙∙ Primair: op het niveau van de individuele patiënt
∙∙ Secundair: op groepsniveau (bv. in Comparative Effectiveness Research)
• Geheel van diagnostiek, processturing, behandelingskeuzes en evaluatie van effecten:
∙∙ Ontwikkeling van inspirerende zorgprogramma’s/
zorgpaden als (whole medical system) aanvulling op
richtlijnen en protocollen
• Kwaliteitscontrole:
∙∙ Primair: door het objectiveren van het subjectieve
oordeel
∙∙ Secundair: door het gebruik van objectiverende meetinstrumenten
•
eigen gezondheidstoestand).
Individugericht:
∙∙ Professionele, persoonlijke aandacht voor de patiënt
als uniek mens in zijn of haar eigen situatie en omgeving.
Gelijkwaardigheid:
∙∙ Gelijkwaardigheid tussen de patiënt en de behandelaar(s).
Totaalbeeld:
∙∙ De AG kijkt naar lichaam, vitaliteit, ziel en individualiteit in hun relatie tot ziekte en gezondheid.
Kwaliteit:
∙∙ De AG biedt duurzame behandeling (veilig, niet of
nauwelijks bijwerkingen, effectief, kosteneffectief,
verbetering van de kwaliteit van leven). De zorgprofessionals zijn dienstbaar aan de behandeldoelen en
behoeften van de patiënt.
Persoonlijke ontwikkeling:
∙∙ Ziekte en gezondheid worden binnen de AG in verband
gebracht met ontwikkeling (herstel, er beter van
(kunnen) worden, zingeving, het een plek geven in je
leven en meer verbinding met jezelf, de wereld en het
spirituele krijgen).
Missie, visie, kengetallen en positionering van het lectoraat
AG
Missie
Het lectoraat Antroposofische Gezondheidszorg (AG) verzamelt kennis, verricht praktijkonderzoek en communiceert
over onderzoeksresultaten binnen het domein van de AG,
om daarmee de AG zorgpraktijk (a) verder te ontwikkelen,
(b) wetenschappelijk te verantwoorden, (c) verantwoorde
communicatie over AG mogelijk te maken, (d) de integratie
met de reguliere gezondheidszorg optimaal mogelijk te maken,
en (e) de AG opleidingen inhoudelijk te ondersteunen. Het
lectoraat werkt hierbij samen met (inter)nationale partners en
financiers binnen en buiten de AG.
Visie
Het lectoraat AG wil op termijn zowel binnen de reguliere
gezondheidszorg, de universitaire/ hogeschool wereld en
binnen de AG een van de belangrijke onderzoeksgroepen in
Nederland en Europa zijn, gericht op het domein van AG (op
zich en als onderdeel van Integrative Medicine (IM)). De onderzoeksgroep wil hierbij erkend en gewaardeerd worden door
de hoogwaardige en innovatieve kwaliteit van het onderzoeks-
Waarden van de AG
Enkele van de belangrijke waarden van de AG zijn:
• Eigen regie:
∙∙ De AG stimuleert de eigen regie/ empowerment van
patiënten (beter omgaan met en verbeteren van de
38
en ontwikkelwerk, de goede, professionele samenwerking met
het AG veld/ het gezondheidszorg veld i.h.a., en de goede,
professionele samenwerking met partners binnen projecten.
De onderzoeksgroep wil dat de stakeholders van het lectoraat
voortdurend tevreden zijn over ‘geproduceerde producten en
resultaten’.
•
Kengetallen
De kengetallen over de afgelopen periode van zes jaar (2008 –
2013) zijn:
• Aantal medewerkers:
∙∙ start: 1 medewerker met 0.4 FTE
∙∙ eind 2013: 14 medewerkers met een totale omvang qua
aanstelling van 4.8 FTE.
• Aantal studenten dat meewerkte in projecten: 63
• Aantal projecten: 56; zie hiervoor http://www.hsleiden.
nl/lectoraten/antroposofische-gezondheidszorg/Onderzoeksprojecten
• Aantal publicaties: totaal 120, waarvan:
∙∙ Boeken/rapporten: 26
∙∙ Boekbijdragen: 42
∙∙ Artikelen: 45
∙∙ Overige publicaties: 7
∙∙ http://www.hsleiden.nl/lectoraten/antroposofische-gezondheidszorg/Publicaties
• Aantal presentaties: 86
•
Positionering van het lectoraat t.o.v. de diverse stakeholders
Het netwerk van het lectoraat bestaat uit:
• AG werkveld:
∙∙ AG-instellingen
∙∙ Beroepsverenigingen
∙∙ Farmaceutische bedrijven: Weleda, Wala
∙∙ NVAZ
∙∙ Patiëntenvereniging: Antroposana
∙∙ Therapeutica
∙∙ Zorgprofessionals
• AG opleidingen:
∙∙ Academie Antroposofische Gezondheidszorg
∙∙ Edith Maryon College
∙∙ Opleiding Kunstzinnige Therapie, Hogeschool Leiden
• Overig AG-gerelateerd:
∙∙ IMO
∙∙ Lectoraat Leiderschap, Hanze Hogeschool
∙∙ Medische sectieraad AViN
• Onderzoeksgroepen NL:
∙∙ Bernard Lievegoed Leerstoel
∙∙ GGD Haaglanden
•
39
∙∙ Lectoraat Biodiversiteit, HL
∙∙ Lectoraat Innovatieve moleculaire diagnostiek, HL
∙∙ Lectoraat Eigen Regie, HL
∙∙ Lectoraat GGZ, HL
∙∙ Louis Bolk Instituut
∙∙ RIVM
∙∙ TNO Systems Biology
∙∙ Universiteit Tilburg, Health Economics
Onderzoeksgroepen internationaal:
∙∙ Alanus Hochschule, Alfter, Duitsland
∙∙ ESCAMP, Freiburg Duitsland
∙∙ FIH Netzwork Onkologie, Berlijn, Duitsland
∙∙ Health Promotion Team. Folkhälsan Research Centre
∙∙ IFAEMM, Freiburg Duitsland
∙∙ Institut für Kunsttherapie und Forschung
∙∙ Research Council Medical Section Goetheanum
∙∙ Universiteit Witten/Herdecke, Witten, Duitsland
Fondsen:
∙∙ AViN
∙∙ Bernard Lievegoed Fonds
∙∙ Crowdfunding
∙∙ Ekhaga Stiftelse
∙∙ Gyllenberg Stiftelse
∙∙ Iona Stichting
∙∙ Naturalis
∙∙ Raphaëlstichting
∙∙ Stichting Innovatie Alliantie: RAAK-Publiek
∙∙ Stichting ‘t Boshuis
∙∙ Stichting Triodos Fonds
∙∙ Stichting Antroposofische Gezondheidszorg Phoenix
∙∙ ZonMW
∙∙ Het AG-werkveld is ook co-financier
Overige stakeholders:
∙∙ NIKIM, kenniscentrum voor integrative medicine
Medewerkers lectoraat
Lector
Naam: Erik Baars
Functie: Lector Antroposofische
Gezondheidszorg
Aandachtsgebied: Antroposofische Gezondheidszorg
Naam: Esther Kok
Functie: Epidemioloog
Kenniskring
Naam: Annemarie Abbing
Functie: Projectontwikkelaar,
fondswerver, onderzoeker (PhD
student)
Naam: Evi Koster
Functie: Onderzoeker (PhD
student)
Naam: Guus van der Bie
Functie: Huisarts, docent
Naam: Martin Niemeijer
Functie: Arts, onderzoeker
(PhD student)
Naam: Anja de Bruin
Functie: Onderzoeker
Naam: Anne Ponstein
Functie: Onderzoeker, docent
opleiding Kunstzinnige
Therapie, projectleider werkveldteams
Naam: Odulf Damen
Functie: Onderzoeker, docent
opleiding Kunstzinnige Therapie, muziektherapeut
Naam: Lisanne Visser
Functie: Onderzoeksassistent
40
Naam: Wil Uitgeest
Functie: Onderzoeker (PhD
student), docent opleiding
Kunstzinnige Therapie
Naam: Egbert van Wijk
Functie: Projectleider lectoraat
AG, antroposofisch en homeopatisch huisarts
Overige medewerkers
Naam: Rachel HeybroekBellwinkel
Functie: Managementondersteuner
41
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Stress,
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Met hartritme-biofeedback wordt de disbalans bij
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een nieuw perspectief geboden, waarmee de cliënt
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op het lichaam en andersom. Maar vooral hoe ze de
balans in het autonome zenuwstelsel nu zelf kunnen
gaan beïnvloeden.
Deze opleiding gaat in op de wetenschappelijke
achtergrond en biedt een basis voor het klinisch
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Doelgroep: Artsen,
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psychiaters
en
werken met HRV-biofeedback apparatuur:
StressEraser, Cardio SenseTrainer en
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werken met resonantiefrequentie en
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begrip Neuroceptie (prof Stephen Porges)
en affectregulatie bij autisme spectrum
stoornissen
emotielandschap en coherent luisteren
oefeningen affectregulatie en affect
exposure
HartFocus-bewegingsoefeningen
keuzemomentoefening
stressprotocol , driefasen protocol HeartQ
HRV bij depressie paniekstoornissen,
trauma, ADHD en autisme,
Informatie, filmpjes, boeken en spelmateriaal
http://www.hartfocus.nl
Hier staan ook filmpjes hoe kinderen blij zijn met
hun hartmobieltje, hoe muziek en het hartritme
samenhangen, wat de werking van het hartritme is
bij meditatie, en nog veel meer.
HartFocus heeft ook een webwinkel met het boek
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Opleidingsdata
HartFocus (Loosdrecht): 4,18 september en 9 okt
of 14, 28 nov en 12 dec 2014
RINO-NH (Amsterdam): 28 okt, 11 nov, 2 dec 2014
klinisch
Docent: Drs Kees Blase, medisch fysicus en
andragoloog. Als directeur Landelijk Centrum
Stressmanagement is hij in staat een brug te slaan
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van hartritme-biofeedback in Nederland en verzorgt
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Evaluatie Wat het de 300 reeds opgeleide
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“Inspiratie, nieuwe behandelmethode kunnen
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(jeugdpsychiater). “Enthousiasme, dat ik van mijn
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aan hun stressmomenten” (klinisch psycholoog).
Inhoud
wetenschappelijke achtergrond van
hartritme-biofeedback/ hartcoherentie
42
Met dank aan de sponsors van dit congres
43
Lectoraat Antroposofische Gezondheidszorg
Hogeschool Leiden
Zernikedreef 11
2333 CK Leiden
Postbus 382
2300 AJ Leiden
071 – 51 88 715
lectoraat.ag@hsleiden.nl
hsleiden.nl/lectoraten/antroposofische-gezondheidszorg/
facebook.com/people/Erik-Baars/100008296023288 twitter.com/Lectoraat_AG
linkedin.com/pub/erik-baars/4/668/b13
Aanmelden voor de digitale nieuwsbrief van het lectoraat
(elke 2-3 maanden): stuur een e-mail naar:
lectoraat.ag@hsleiden.nl