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Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine.

Abstract

Background

Whole medicine and health systems like traditional and complementary medicine systems (T&CM) are part of healthcare around the world. One key feature of T&CM is its focus on patient-centered and multimodal care and the integration of intercultural perspectives in a wide range of settings. It may contribute to good health and well being for people as part of the Sustainable Development Goals of the United Nations. The authentic, rigorous, and fair evaluation of such a medical system, with its inherent complexity and individualization, imposes methodological challenges. Hence, we propose a broad research strategy to test and characterize its possible contribution to health.

Methods

To develop a research strategy for a specific T&CM system, Anthroposophic Medicine (AM), applying multimodal integrative healthcare based on a four-level concept of man, we used a three-phase consensus process with experts and key stakeholders, consisting of (1) premeeting methodological literature and AM research review and interviews to supplement or revise items of the research strategy and tailor them to AM research, (2) face-to-face consensus meetings further developing and tailoring the strategy, and (3) postmeeting feedback and review, followed by finalization.

Results

Currently, AM covers many fields of medical specialties in varied levels of healthcare settings, such as outpatient and inpatient; primary, secondary, and tertiary care; and health education and pedagogy. It is by definition integrated with conventional medicine in the public healthcare system. It applies specific medicines, nursing techniques, arts therapies, eurythmy therapy, rhythmical massage, counseling, and psychotherapy, and it is provided by medical doctors, nurses, therapists, midwives, and nutritionists. A research strategy authentic to this level of complexity should comprise items with a focus on (I) efficacy and effectiveness, divided into (a) evaluation of the multimodal and multidisciplinary medical system as a whole, or of complex multimodal therapy concept, (b) a reasonable amount of methodologically rigorous, confirmatory randomized controlled trials on exemplary pharmacological and nonpharmacological therapies and indications, (c) a wide range of interventions and patient-centered care strategies with less extensive formats like well-conducted small trails, observational studies, and high-quality case reports and series, or subgroup analyses from whole-system studies, or health service research; (II) safety; (III) economics; (IV) evidence synthesis; (V) methodologic issues; (VI) biomedical, physiological, pharmacological, pharmaceutical, psychological, anthropological, and nosological issues as well as innovation and development; (VI) patient perspective and involvement, public needs, and ethics; (VII) educational matters and professionalism; and (IX) disease prevention, health promotion, and public health.

Conclusion

The research strategy extends to and complements the prevailing hierarchical system by introducing a broad "evidence house" approach to evaluation, something many health technology assessment boards today support. It may provide transparent and comprehensive insight into potential benefits or risks of AM. It can serve as a framework for an evidence-informed approach to AM for a variety of stakeholders and collaborating networks with the aim of improving global health.

Authors+Show Affiliations

Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany. Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Rappaport Faculty of Medicine, Technion, Haifa, Israel.Institute for Integrative Medicine, Witten/Herdecke University, Freiburg, Germany.Program of Health Policy, Systems and Management, School of Public Health, University of Chile, Santiago, Chile.Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Karolinska Institutet, Stockholm, Sweden.Department of Psychiatry and Psychiatric Rehabilitation, Saint John Hospital, Budapest, Hungary.Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.Integrative and Anthroposophic Medicine, Institute for Integrative Medicine, Witten/Herdecke University, Freiburg, Germany.University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland.Department of CAM, Faculty of Health Sciences, University of Pecs, Pilisszentkereszt, Hungary.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31781267

Citation

Kienle, G S., et al. "Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine." Evidence-based Complementary and Alternative Medicine : ECAM, vol. 2019, 2019, p. 3706143.
Kienle GS, Ben-Arye E, Berger B, et al. Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine. Evid Based Complement Alternat Med. 2019;2019:3706143.
Kienle, G. S., Ben-Arye, E., Berger, B., Cuadrado Nahum, C., Falkenberg, T., Kapócs, G., ... Szöke, H. (2019). Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine. Evidence-based Complementary and Alternative Medicine : ECAM, 2019, p. 3706143. doi:10.1155/2019/3706143.
Kienle GS, et al. Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine. Evid Based Complement Alternat Med. 2019;2019:3706143. PubMed PMID: 31781267.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine. AU - Kienle,G S, AU - Ben-Arye,E, AU - Berger,B, AU - Cuadrado Nahum,C, AU - Falkenberg,T, AU - Kapócs,G, AU - Kiene,H, AU - Martin,D, AU - Wolf,U, AU - Szöke,H, Y1 - 2019/11/12/ PY - 2019/04/28/received PY - 2019/08/22/revised PY - 2019/09/24/accepted PY - 2019/11/30/entrez PY - 2019/11/30/pubmed PY - 2019/11/30/medline SP - 3706143 EP - 3706143 JF - Evidence-based complementary and alternative medicine : eCAM JO - Evid Based Complement Alternat Med VL - 2019 N2 - Background: Whole medicine and health systems like traditional and complementary medicine systems (T&CM) are part of healthcare around the world. One key feature of T&CM is its focus on patient-centered and multimodal care and the integration of intercultural perspectives in a wide range of settings. It may contribute to good health and well being for people as part of the Sustainable Development Goals of the United Nations. The authentic, rigorous, and fair evaluation of such a medical system, with its inherent complexity and individualization, imposes methodological challenges. Hence, we propose a broad research strategy to test and characterize its possible contribution to health. Methods: To develop a research strategy for a specific T&CM system, Anthroposophic Medicine (AM), applying multimodal integrative healthcare based on a four-level concept of man, we used a three-phase consensus process with experts and key stakeholders, consisting of (1) premeeting methodological literature and AM research review and interviews to supplement or revise items of the research strategy and tailor them to AM research, (2) face-to-face consensus meetings further developing and tailoring the strategy, and (3) postmeeting feedback and review, followed by finalization. Results: Currently, AM covers many fields of medical specialties in varied levels of healthcare settings, such as outpatient and inpatient; primary, secondary, and tertiary care; and health education and pedagogy. It is by definition integrated with conventional medicine in the public healthcare system. It applies specific medicines, nursing techniques, arts therapies, eurythmy therapy, rhythmical massage, counseling, and psychotherapy, and it is provided by medical doctors, nurses, therapists, midwives, and nutritionists. A research strategy authentic to this level of complexity should comprise items with a focus on (I) efficacy and effectiveness, divided into (a) evaluation of the multimodal and multidisciplinary medical system as a whole, or of complex multimodal therapy concept, (b) a reasonable amount of methodologically rigorous, confirmatory randomized controlled trials on exemplary pharmacological and nonpharmacological therapies and indications, (c) a wide range of interventions and patient-centered care strategies with less extensive formats like well-conducted small trails, observational studies, and high-quality case reports and series, or subgroup analyses from whole-system studies, or health service research; (II) safety; (III) economics; (IV) evidence synthesis; (V) methodologic issues; (VI) biomedical, physiological, pharmacological, pharmaceutical, psychological, anthropological, and nosological issues as well as innovation and development; (VI) patient perspective and involvement, public needs, and ethics; (VII) educational matters and professionalism; and (IX) disease prevention, health promotion, and public health. Conclusion: The research strategy extends to and complements the prevailing hierarchical system by introducing a broad "evidence house" approach to evaluation, something many health technology assessment boards today support. It may provide transparent and comprehensive insight into potential benefits or risks of AM. It can serve as a framework for an evidence-informed approach to AM for a variety of stakeholders and collaborating networks with the aim of improving global health. SN - 1741-427X UR - https://www.unboundmedicine.com/medline/citation/31781267/Contributing_to_Global_Health:_Development_of_a_Consensus-Based_Whole_Systems_Research_Strategy_for_Anthroposophic_Medicine L2 - https://dx.doi.org/10.1155/2019/3706143 DB - PRIME DP - Unbound Medicine ER -