Search

ZusammenfassungZur Prävention einer SARS-CoV-2-Infektion existieren seit Dezember 2020 vorläufig zugelassene Injektionspräparate auf mRNA- oder Vektorbasis, die unerwartete Impfwirkungen haben können, welche die Patient*innen in unsere Praxis führen. Homöopathie in der Bandbreite ihrer Möglichkeiten von Analyseverfahren und Arzneien (Urtinktur bis Q-Potenzen) bietet ein überraschend erfolgreiches, spezifisches und günstiges Angebot zur Therapie unerwarteter Wirkungen von Anti-SARS-CoV-2-Impfpräparaten.

Background and objective Since 1997 several meta-analyses (MA) of placebo-controlled randomised efficacy trials of homoeopathy for any indication (PRETHAI) have been published, with different methods, results, and conclusions. To date, a formal assessment of these MA has not been undertaken. Main research objective for this systematic review was efficacy of homoeopathic treatment in MA of PRETHAI. Methods Inclusion criteria: MA of PRETHAI in humans; all ages, countries, settings, publication languages; published 1.1.1990-31.10.2020. Exclusion criteria: systematic reviews without MA; MA restricted to age or gender groups, specific indications, or specific homoeopathic treatments; MA not including efficacy. We searched 8 online databases (completed 14.12.2020). Primary outcome was the effect estimate for all included trials in each MA and after sample restriction to trials of higher methodological quality, according to predefined criteria. Risk of bias of MA was assessed by ROBIS. Quality of evidence was assessed by GRADE. Data synthesis was the proportion of MA showing a significant positive effect of homoeopathy vs. no significant difference. Results Six MA were included, covering individualised homoeopathy (I-HOM, n = 2), non-individualised homoeopathy (NI-HOM, n = 1) and all homoeopathy types (ALL-HOM = I-HOM + NI-HOM, n = 3), respectively. The MA comprised between 16 and 110 trials, published 1943-2014, with a median trial sample size of 45 to 97 patients. Risk of bias (low/unclear/high) was rated as low for three MA and high for three. Effect estimates for all trials in each MA showed a significant positive effect of homoeopathy, compared to placebo (5 of 5 MA, no data in 1 MA). Sample restriction to high-quality trials was available from 4 trials, the effect remained significant in 3 MA (thereof 2x ALL-HOM, 1x I-HOM) and was no longer significant in 1 MA of NI-HOM. Discussion The quality of evidence for positive effects of homoeopathy beyond placebo (high / moderate / low / very low) was high for I-HOM and moderate for ALL-HOM as well as for NI-HOM. There was no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo. The available MA of PRETHAI show significant positive effects of homoeopathy beyond placebo. This is in accordance with laboratory experiments showing effects, in part reproducible, of homoeopathically potentised preparations in physico-chemical, in-vitro, plant-based and animal-based test systems. Other Primary funding sources: Christophorus-Stiftung, Stuttgart, DE; Stiftung Marion Meyenburg, Hamburg, DE; Dr. Hauschka-Stiftung, Bad Boll/Eckwälden, DE. Registration: PROSPERO, CRD42020209661

Objectives: Homeopathy (HOM) is a therapeutic method, which is widely used by patients and medical professionals. The medical conditions as well as the homeopathic medical products investigated vary strongly. There is an extensive amount of research, and this necessitates a bibliography that comprehensively presents the entire body of clinical evidence grouped according to medical conditions. Design: Thirty-seven online sources as well as print libraries were searched for HOM and related terms in eight languages (1980 to March 2021). We included studies that compared a homeopathic medicine or intervention with a control regarding the therapeutic or preventive outcome of a disease (classified according to International Classification of Diseases-10). The data were extracted independently by two reviewers and analyzed descriptively. Results: A total of 636 investigations met the inclusion criteria, of which 541 had a therapeutic and 95 a preventive purpose. Seventy-three percent were randomized controlled trials (n = 463), whereas the rest were non-randomized studies (n = 173). The leading comparator was placebo (n = 400). The type of homeopathic intervention was classified as multi-constituent or complex (n = 272), classical or individualized (n = 176), routine or clinical (n = 161) and isopathic (n = 19), or various (n = 8). The potencies ranged from 1X (dilution of -10,000) to 10 M (100-10.000). The included studies explored the effect of HOM in 223 medical indications. We present the evidence in an online database. Conclusions: This bibliography maps the status quo of clinical research in HOM. The data will serve for future targeted reviews, which may focus on the most studied conditions and/or homeopathic medicines, clinical impact, and the risk of bias of the included studies.

De nombreux medecins generalistes et pediatres sont regulierement confrontes aux questions de leurs patients quant aux mesures qu’ils recommanderaient, en plus de la vaccination contre la grippe saisonniere, pour la prevention et le traitement des maladies grippales, y compris la grippe et desormais la COVID-19. En medecine complementaire notamment, il existe un grand nombre de methodes eprouvees a cet effet, que nous souhaitons presenter dans cet article.

The Department of Haematology/Oncology at the University Children's Hospital Bern (HONK), has adopted an integrative approach in addition to state of the art oncological care and implemented a collaboration with the Institute of Complementary Medicine IKOM, University of Bern, over the past 10 years. Stakeholder satisfaction with this service was high. We present descriptive data and report on 4 exemplary patients treated with additional individualized homeopathy (iHOM). Data concerning frequency of consultations, pathologies, follow-ups and clinical results were reviewed and summarized using descriptive statistics. 94 paediatric oncologic patients consulted for iHOM. Indications for the complementary treatment was wide-ranging. No interactions with conventional treatment and no adverse side-effects of iHOM were detected. We present four characteristic patient histories, in which iHOM was used in addition to standard treatment for mucositis, permissive tissue infection, insomnia and affective dysfunctions. All four patients clinically improved in an immediate temporal relationship to the additional treatment. CONCLUSION: The collaboration between HONK and IKOM established iHOM in paediatric oncology in Bern. In this setting, iHOM was a safe and supportive additional treatment for various indications during the conventional cancer care. However, no generalizable results can be deducted from these data. We emphasize future research on this topic.

Background: Recurrent urinary tract infections are of importance for public health as most clinicians are faced with repeated and long-term administration of broad-spectrum antimicrobial agents leading to an increased risk of resistant bacteria. One encouraging treatment approach may be individualized homeopathy. Case Reports: Here, four female cases with recurrent urinary tract infections are reported. They were treated successfully with the homeopathic strategy after several conventional approaches revealed no improvement. The follow-up period was a minimum of 3 years and the frequency of episodes with urinary tract infection as well as of antibiotic treatment was documented. Additionally, the patients were asked to assess the treatment outcome retrospectively in a validated questionnaire. Results: The treatment resulted in a reduction of urinary tract infections and the need for antibiotics from monthly to less than 3 times a year. Three of the four women had no cystitis and related intake of antibiotics for more than 1.5 years. A relapse of symptoms could be treated efficiently with a repetition of the homeopathic remedy. All subjective outcome assessments resulted positive. Conclusion: This case series suggests a possible benefit of individualized homeopathic treatment for female patients with recurrent urinary tract infections. Larger observational studies and controlled investigations are warranted.

Aim. The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use. Methods. We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence. Conclusions. CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.

An increasing number of parents turn to homeopathy for treatment of their hyperactive child. Two publications, a randomised, partially blinded trial and a clinical observation study, conclude that homeopathy has positive effects in patients with attention deficit hyperactivity disorder (ADHD). The aim of this study was to obtain scientific evidence of the effectiveness of homeopathy in ADHD. A total of 83 children aged 6–16 years, with ADHD diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria, were recruited. Prior to the randomised, double blind, placebo controlled crossover study, they were treated with individually prescribed homeopathic medications. 62 patients, who achieved an improvement of 50% in the Conners’ Global Index (CGI), participated in the trial. Thirteen patients did not fulfill this eligibility criterion (CGI). The responders were split into two groups and received either verum for 6 weeks followed by placebo for 6 weeks (arm A), or vice-versa (arm B). At the beginning of the trial and after each crossover period, parents reported the CGI and patients underwent neuropsychological testing. The CGI rating was evaluated again at the end of each crossover period and twice in long-term follow-up. At entry to the crossover trial, cognitive performance such as visual global perception , impulsivity and divided attention, had improved significantly under open label treatment ( P

Studies suggest that complementary and alternative medicine (CAM) is widely used in the European Union (EU). We systematically reviewed data, reporting research quality and the prevalence of CAM use by citizens in Europe; what it is used for, and why.We searched for general population surveys of CAM use by using Ovid MEDLINE (1948 to September 2010), Cochrane Library (1989 to September 2010), CINAHL (1989 to September 2010), EMBASE (1980 to September 2010), PsychINFO including PsychARTICLES (1989 to September 2010), Web of Science (1989 to September 2010), AMED (1985 to September 2010), and CISCOM (1989 to September 2010). Additional studies were identified through experts and grey literature. Cross-sectional, population-based or cohort studies reporting CAM use in any EU language were included. Data were extracted and reviewed by 2 authors using a pre-designed extraction protocol with quality assessment instrument.87 studies were included. Inter-rater reliability was good (kappa = 0.8). Study methodology and quality of reporting were poor. The prevalence of CAM use varied widely within and across EU countries (0.3-86%). Prevalence data demonstrated substantial heterogeneity unrelated to report quality; therefore, we were unable to pool data for meta-analysis; our report is narrative and based on descriptive statistics. Herbal medicine was most commonly reported. CAM users were mainly women. The most common reason for use was dissatisfaction with conventional care; CAM was widely used for musculoskeletal problems.CAM prevalence across the EU is problematic to estimate because studies are generally poor and heterogeneous. A consistent definition of CAM, a core set of CAMs with country-specific variations and a standardised reporting strategy to enhance the accuracy of data pooling would improve reporting quality.

Background: The terms used for defining complementary and alternative medicine (CAM) including the methods, procedures and therapies vary greatly. The task of the CAMbrella working group on terminology was to explore the existing CAM terminologies and to develop a pragmatic definition of CAM that is acceptable Europewide. This can then be used to systematically research, e.g., its prevalence and legal status and to investigate the citizens’ demands on CAM and the perspectives of providers of CAM in Europe. Methods: Terms and definitions were collected from both scientific and non-scientific sources. The terms and definitions identified were analysed and discussed among the CAMbrella working group participants on several occasions with the aim of arriving at a consensus. Results: We developed a proposal for a pragmatic European definition of CAM: ‘Complementary and alternative medicine (CAM) utilised by European citizens represents a variety of different medical systems and therapies based on the knowledge, skills and practices derived from theories, philosophies and experiences used to maintain and improve health, as well as to prevent, diagnose, relieve or treat physical and mental illnesses. CAM has been mainly used outside conventional health care, but in some countries certain treatments are being adopted or adapted by conventional health care.’ Conclusion: Developing a uniform, pragmatic pan-European definition of CAM was complicated by a number of factors. These included the vast diversity of existing definitions, systems, disciplines, procedures, methods and therapies available within the EU.

Introduction: Job satisfaction and therefore wellbeing of physicians is an important issue in high quality and safety of health care provision. The role of additional qualification in complementary medicine (CM) for job satisfaction of general practitioners (GPs), however, has not been explored. This study compared job satisfaction of conventional and homeopathic Swiss GPs. Methods: Participants of the Swiss Family Doctors Conference 2013 and members of the Swiss Association of Homeopathic Physicians participated in the survey. They indicated the extent of job satisfaction on 17 questions covering patient care, work-related burden, income-prestige, personal rewards, and professional relations. Results: Data of n = 125 GPs with homeopathic proficiency certificate and data of n = 143 GPs without any proficiency certificate in CM were analyzed. Overall job satisfaction was high and did not differ between the groups. However, due to lower number of patients per day, homeopathic GPs reported higher satisfaction in relations with patients and with workload, and lower satisfaction with income and in relations with peers compared to conventional GPs. Controlling for further confounding variables (e.g. working hours per week, practice setting), homeopathic GPs reported less satisfaction with their income than their conventional colleagues. Conclusions: Longer consultation time and lower number of patients homeopathic GPs see per day, may allowthem to unfold a deeper and more satisfying relationship with their patients and to lessen the workload. However, this comes along with financial discontent compared to conventional GPs. Certification in homeopathy and increased consultation time, respectively, may represent a way to enhance GPs’ job satisfaction.

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

This report describes clinical, neuropathological and molecular genetic findings in a Swiss family with four brain tumours in only two generations. The neoplasms observed covered a wide range of biologic behaviour, from a slowly growing lesion already apparent at birth, to anaplastic astrocytoma in a young adult and glioblastomas at the age of less than 10 years. The only non-neural neoplasms in this family were a case of leukemia and an adrenocortical carcinoma. A germline deletion of codon 236 of the p53 tumour suppressor gene was identified as an underlying cause and detected in all affected family members. This mutation has not previously been reported as germline transmission or in sporadic tumours. The unusual accumulation of CNS tumours may be due to a certain organ-specific effect of this particular p53 mutation or it may reflect the specific genetic back-ground of this family.

S POSTER PRESENTATIONS Use of homeopathy in patients with organ transplant in Switzerland: first results and further steps Martin Frei-Erb*, Klaus von Ammon and Loredana Torchetti Institute of Complementary Medicine IKOM, University of Bern, Bern, Switzerland Correspondence: Dr Martin Frei-Erb, Institute of Complementary Medicine IKOM, University of Bern, Bern, Switzerland. E-mail: martin.frei@ikom.unibe.ch (M. Frei-Erb) Objective: To investigate retrospectively use of Complementary and Alternativemedicine (CAM), in particular homeopathy, in the treatment of patients with organ transplantation in Switzerland and to present a roadmap to follow-up. Methods: Members of the Swiss transplant association were asked to complete a questionnaire about CAM use retrospectively. Results: Of the 267 patients contacted, 124 (46%) completed the questionnaire, and data of 118 (44%) participants could be analyzed: 55 were women (47%), mean age was 56 years, and 64 (54%) indicated CAM use. Different CAM methods were most common, with classical homeopathy being the most popular during the underlying disease leading to transplant (15% of all participants), but loosing importance before, during and after the transplantation itself. About 25% CAM users had informed their treating physicians about CAM use. Family doctors were mostly supportive, while specialists were more cautious about CAM use. Among the 54 non-CAM users, the most frequent reasons for not choosing CAM were insecurity about interactions with conventional treatment (46%), and lack of information about this option (28%). Conclusion: The results point to the need of more information on possibilities and limits of CAM as add-on in the treatment of patients with transplantations for both, treating doctors and concerned patients. This could be achieved with mixed methods research: qualitative studies to gain knowledge about the attitude and needs of patients and physicians; clinical studies on the effectiveness and safety of CAM for transplant patients based on the present results. The effect of disclosing information about prescribed homeopathic medicine to patients on their clinical outcomes: a comparative study Mahsa Asasi* and Nazila Assasi Classical Homeopath Clinic, Ontario, Canada Correspondence: Mahsa Asasi, Pharm.D., DHMHS, Canada. E-mail: Info@classicalhomeopath.ca (M. Asasi) Background: Dispensing homeopathic medicines in a homeopathic office setting is very common among homeopaths. However, some homoeopaths feel uncertain about how and what to disclose to patients about the prescription. Based on findings of our previous study most of the homeopaths do not openly communicate the prescription details because they are concerned about possible negative impact of patient’s knowledge of homeopathic medicine on the treatment outcomes. Objectives: Our study aims at finding evidence about negative or positive effects of the current dispensing methods among homeopaths in Canada. Methods: A comparative study was performed. The study groups consisted of the patients who had received basic information about their medicines and those who had not. Information on actual practice of prescription, dispensing methods and related patient’s reactions, and the treatment outcomes was recorded during the course of treatment, and compared between the two study groups. Results: Based on the results of our study, there was no statistically significant difference between the patients who received a labeled homeopathic medicine and those who did not in terms of expected treatment effects. Our findings showed that a high proportion of patients receiving a nonlabeled remedy who asked about their medicine’s name became more anxious and concerned about taking the prescribed medicine when the homeopath refused to provide the requested information. Conclusion: In our study the negative effects of not labeling homeopathic medicines on treatment outcomes dominated its positive effects. It seems to be essential to develop regulations and standards for prescriptions or office-based dispensing of homeopathic medicines, and to include these standards in training of homeopaths.

Background: The demand for complementary and alternative medicine (CAM) treatment in the European Union (EU) has led to an increase in the various CAM interventions available to the public. Our aim was to describe the CAM services available from both registered medical practitioners and registered non-medical practitioners. Methods: Our literature search comprised a PubMed search of any scientific publications, secondary references and so-called grey literature, a search of government websites and websites of CAM organisations to collect data in a systematic manner, and personal communications, e.g., via e-mail contact. Due to the different reliability of data sources, a classification was developed and implemented. This weighted database was condensed into tables and maps to display the provision of CAM disciplines by country, showing the distribution of CAM providers across countries. Results: Approximately 305,000 registered CAM providers can be identified in the EU (∼160,000 non-medical and ∼145,000 medical practitioners). Acupuncture (n = 96,380) is the most available therapeutic method for both medical (80,000) and non-medical (16,380) practitioners, followed by homeopathy (45,000 medical and 5,800 non-medical practitioners). Herbal medicine (29,000 practitioners) and reflexology (24,600 practitioners) are mainly provided by non-medical practitioners. Naturopathy (22,300) is dominated by 15,000 (mostly German) doctors. Anthroposophic medicine (4,500) and neural therapy (1,500) are practised by doctors only. Conclusion: CAM provision in the EU is maintained by approximately 305,000 registered medical doctors and non-medical practitioners, with a huge variability in its national regulatory management, which makes any direct comparison across the EU almost impossible. Harmonisation of legal status, teaching and certification of expertise for therapists would be of enormous value and should be developed.

Background: In the last 2 decades there has been a large increase in publications on complementary and alternative medicine (CAM). However, CAM research methodology was heterogeneous and often of low quality. The aim of this systematic review was to investigate scientific publications with regards to general issues, concepts and strategies. We also looked at research priorities and methods employed to evaluate the clinical and epidemiological research of CAM in the past to identify the basis for consensus-based research strategies. Methods: We performed a systematic literature search for papers published between 1990 and 2010 in 7 electronic databases (Medline, Web of Science, PsychArticles, PsycInfo, CINAHL, EMBASE and Cochrane Library) on December 16 and 17, 2010. In addition, experts were asked to nominate relevant papers. Inclusion criteria were publications dealing with research methodology, priorities or complexities in the scientific evaluation of CAM. All references were assessed in a multistage process to identify relevant papers. Results: From the 3,279 references derived from the search and 98 references contributed by CAM experts, 170 papers fulfilled the criteria and were included in the analysis. The following key issues were identified: difficulties in past CAM research (e.g., randomisation, blinding), utility of quantitative and qualitative research methods in CAM, priority setting in CAM research and specific issues regarding various CAM modalities. Conclusions: Most authors vote for the use of commonly accepted research methods to evaluate CAM. There was broad consensus that a mixed methods approach is the most suitable for gathering conclusive knowledge about CAM.

The discussion of the problems and value of homeopathy presupposes a thorough knowledge of its scientific foundations. The fundamental difference between conventional medicine and homeopathy requires the employment of different research tools. While both systems rely on exact empirical observation, their methodologies and pharmacologies differ in the way their medicines are manufactured, in their modes of observation and treatment and in their therapeutic objectives.

With regard to unexpected side effects (adverse drug effects) it is necessary to distinguish between the ones which are characteristic to homeopathy and even intended and the known pharmacological-toxic effects of (otherwise appropriate) medicines.

The characteristic features of homeopathy are its particular drug therapy and application, its drug provings on the healthy subject, the development of its pharmacology, the case-taking and exact observation of the individual patient’s symptoms and idiosyncrasies, the conclusions drawn from numerous individual healing processes and its extended treatment target. All these aspects result in an approach that is fundamentally different, in theory and practice, from mainstream medicine. While both systems are based on exact empirical observation, their methods of observation and interpretation differ. In mainstream medicine, treatment is based on the clinical diagnosis while the symptoms displayed by the individual patient play a lesser role. In homeopathy, on the other hand, the choice of medication depends on the totality of symptoms and signs displayed by the individual patient. The clinical diagnosis is important for assessing the medical situation but has little bearing on the choice of remedy. Administering homeopathic remedies and mixtures merely on the basis of a clinical diagnosis goes against the principles of homeopathy.

Systematic reviews are used to filter conclusive, reproducible information – usually concerning the effectiveness of medical interventions – from the overwhelming quantity of individual study results. For this purpose research results are systematically collected, evaluated and summarized. They differ from traditional reviews and expert commentaries in that they have a scientific, transparent and reproducible approach which tries to minimize the risk of bias. Systematic reviews are not so much about reflecting expert opinions; rather, they seek to establish a balanced and neutral reproduction and analysis of the evidence available.

The generally high acceptance of complementary medicine (VSAO Berne 1988, Jenny et al. 2002) and the particular demand for five complementary medical specialities led to the appointment of a university chair for natural medicine in Zurich in 1994/1995 and, due to a people’s initiative, to the installation of a chair with a partial professorship for homeopathy at Bern University (KIKOM).

What kinds of individuals or groups are using CAM (complementary alternative medicine) for which reasons, and how often? These questions are of much interest to health authorities, service providers, service guarantors, the economy and the public in general. This chapter describes studies published on these topics in Europe and beyond. Studies from Switzerland are examined in more detail in Chapter 8.

Surveys conducted in the Western world all show that health-care costs tend to rise faster than general living costs. In the USA they rose from US$ 141 per person per year in 1960 through US$ 341 in 1970, US$ 1052 in 1980, and US$ 2689 in 1990 to US$ 4094 in 1998. For Switzerland the per person health-care costs were US$ 2412 in 1998 (see ◘ Fig. 12.2) and for Germany US$ 2222. All in all, the USA spent US$ 1100 billion on health care in 1998, Switzerland US$ 37 billion (see ◘ Fig. 12.1). In 2003, these costs rose to US$ 40 billion in Switzerland (CHF SFR 50 billion). They make up 11% (Swiztzerland) to 14% (USA) of the gross domestic product (cf. ◘ Fig. 12.3).

Pilocytic astrocytomas are the most common astrocytic tumors of childhood and differ clinically and histopathologically from those astrocytomas that affect adults. Studies of adult astrocytic tumors have revealed allelic losses on chromosomes 10, 17p, 19q and alterations in the epidermal growth factor receptor (EGFR) gene. We have previously examined pilocytic astrocytomas for allelic losses on chromosomes 10 and 19q and for amplification of the EGFR gene, but did not detect genomic alterations at these loci. In the present study we assayed 20 pilocytic astrocytomas for loss of allelic heterozygosity of chromosome 17p, including one locus in the p53 tumor suppressor gene. In addition, because pilocytic astrocytomas frequently affect patients with neurofibromatosis type 1 (NF1) and the NF1 gene has been mapped to 17q11.2, we also examined multiple loci on the long arm of chromosome 17. Allelic loss was observed on chromosome 17 in four cases (three sporadic, one NF1); all lost portions of the long arm in chromosome 17, and one tumor lost the short arm as well. One tumor showed an interstitial delection on the long arm that included the region of the NF1 gene. These data suggest the presence of a tumor suppressor gene on 17q that is associated with pilocytic astrocytomas. A potentiel candidate for this gene is the NF1 tumor suppressor gene.

Glioblastoma multiforme is a clinically and histologically heterogeneous lesion; however, to date, it has not been possible to subdivide glioblastomas on a clinical, histopathological or biological basis. Previous studies have demonstrated that loss of portions of chromosomes 10 and 17 and amplification of the epidermal growth factor receptor (EGFR) gene are the most frequent genetic alterations in glioblastoma. We therefore examined 74 glioblastomas from 67 patients for loss of heterozygosity on chromosomes 10 and 17, and for amplification of the epidermal growth factor receptor gene, to determine whether glioblastomas can be subtyped on a genetic basis. Using Southern blot analysis we were able to detect different patterns of genomic alterations. Eighteen of 67 informative patients were characterized by a loss of heterozygosity on the short arm of chromosome 17 in the tumor tissue. Forty-five of 64 informative patients showed a loss of heterozygosity on chromosome 10. Amplification of the epidermal growth factor receptor gene was noted in 25 of 67 patients and was restricted to those glioblastomas that had lost portions of chromosome 10. Epidermal growth factor receptor gene amplification occurred significantly more often in patients without chromosome 17p loss than in patients with chromosome 17p loss (p = 0.01). In addition, those glioblastomas with a loss of chromosome 17p occurred in patients significantly younger than those with glioblastomas characterized by EGFR gene amplification (p = 0.001). These data emphasize the genetic heterogeneity of glioblastoma and suggest the division of glioblastoma into genetic subsets.

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

✓ Although the loss of tumor suppressor genes and the activation of oncogenes have been established as two of the fundamental mechanisms of tumorigenesis in human cancer, little is known about the possible interactions between these two mechanisms. Loss of genetic material on chromosome 10 and amplification of the epidermal growth factor receptor (EGFR) gene are the most frequently reported genetic abnormalities in glioblastoma multiforme. In order to examine a possible correlation between these two genetic aberrations, the authors studied 106 gliomas (58 glioblastomas, 14 anaplastic astrocytomas, five astrocytomas, nine pilocytic astrocytomas, seven mixed gliomas, six oligodendrogliomas, two ependymomas, one subependymoma, one subependymal giant-cell astrocytoma, and three gangliogliomas) with Southern blot analysis for loss of heterozygosity on both arms of chromosome 10 and for amplification of the EGFR gene. Both the loss of genetic material on chromosome 10 and EGFR gene amplification were restricted to the glioblastomas. Of the 58 glioblastoma patients, 72% showed loss of chromosome 10 and 38% showed EGFR gene amplification. The remaining 28% had neither loss of chromosome 10 nor EGFR gene amplification. Without exception, the glioblastomas that exhibited EGFR gene amplification had also lost genetic material on chromosome 10 (p < 0.001). This invariable association suggests a relationship between the two genetic events. Moreover, the presence of 15 cases of glioblastoma with loss of chromosome 10 but without EGFR gene amplification may further imply that the loss of a tumor suppressor gene (or genes) on chromosome 10 precedes EGFR gene amplification in glioblastoma tumorigenesis.

Introduction: The aim was to investigate retrospectively use of Complementary and Alternative Medicine (CAM) in the treatment of patients with organ transplantation in Switzerland. Methods: Members of the Swiss transplant association completed a questionnaire about CAM use retrospectively. Five different stages were differentiated: CAM usage (1) during underlying disease, (2) before transplant, (3) during hospitalisation/ rehabilitation from transplant, (4) for transplant complications and (5) after transplant for other diseases. Results: Of the 267 patients contacted, 124 (46%) completed the questionnaire, and data of 118 (44%) participants could be analyzed: 55 women (47%), mean age 56 years. Overall, 64 (54%) indicated CAM use, with about 30% usage at every stage (except during hospitalization with only 10%). Different methods were most common: during underlying disease classical homeopathy (15% of all participants), before transplant dietary supplements (13%), during hospitalization meditation (3%), for transplantation complications dietary supplements (10%), and after transplant for other diseases massage (11%). Among the 64 CAM-users, the most important reasons for the usage were improvement of general condition (36%) and abatement of adverse effects of conventional treatment (25%). Among the 54 non-CAM-users, most frequent reasons for not choosing CAM were insecurity about interactions with conventional treatment (46%), and ignorance of this option (28%). About 35% of the CAM-users reported an improved general condition, while 30% noticed an abatement of side effects of conventional treatment. Conclusions: To prevent dangerous interactions with conventional treatment, more information on possibilities of CAM in the treatment of patients with transplantations is needed for doctors and patients.

c Medical Practice, Zurich, d PanMedion Foundation, Zurich, Switzerland Summary Introduction: The Health Technology Assessment report on ef- fectiveness, cost-effectiveness and appropriateness of home- opathy was compiled on behalf of the Swiss Federal Office for Public Health (BAG) within the framework of the 'Program of Evaluation of Complementary Medicine (PEK)'. Materials and Methods: Databases accessible by Internet were systematically searched, complemented by manual search and contacts with experts, and evaluated according to internal and external valid- ity criteria. Results: Many high-quality investigations of pre-clin- ical basic research proved homeopathic high-potencies induc- ing regulative and specific changes in cells or living organisms. 20 of 22 systematic reviews detected at least a trend in favor of homeopathy. In our estimation 5 studies yielded results indicat- ing clear evidence for homeopathic therapy. The evaluation of 29 studies in the domain 'Upper Respiratory Tract Infections/Al- lergic Reactions' showed a positive overall result in favor of homeopathy. 6 out of 7 controlled studies were at least equiva- lent to conventional medical interventions. 8 out of 16 placebo- controlled studies were significant in favor of homeopathy. Swiss regulations grant a high degree of safety due to product and training requirements for homeopathic physicians. Applied properly, classical homeopathy has few side-effects and the use of high-potencies is free of toxic effects. A general health-eco- nomic statement about homeopathy cannot be made from the available data. Conclusion: Taking internal and external validity criteria into account, effectiveness of homeopathy can be sup- ported by clinical evidence and professional and adequate ap- plication be regarded as safe. Reliable statements of cost-effec- tiveness are not available at the moment. External and model validity will have to be taken more strongly into consideration in future studies.

Fortfuhrung der Serie zur Vorstellung der vier komplementarmedizinischen Fachgesellschaften der UNION: Das homoopathischen Therapie-Konzept wird vorgestellt.

Udgivelsesdato: 2000-Jun Brain tumors pose a particular challenge to molecular oncology. Many different tumor entities develop in the nervous system and some of them appear to follow distinct pathogenic routes. Molecular genetic alterations have increasingly been reported in nervous system neoplasms. However, a considerable number of affected genes remain to be identified. We present here a comprehensive allelotype analysis of 466 nervous system tumors based on loss of heterozygosity (LOH) studies with 129 microsatellite markers that span the genome. Specific alterations of the EGFR, CDK4, CDKN2A, TP53, DMBT1, NF2, and PTEN genes were analyzed in addition. Our data point to several novel genetic loci associated with brain tumor development, demonstrate relationships between molecular changes and histopathological features, and further expand the concept of molecular tumor variants in neuro-oncology. This catalogue may provide a valuable framework for future studies to delineate molecular pathways in many types of human central nervous system tumors.

Background: The CAMbrella coordination action was funded within the Framework Programme 7. Its aim is to provide a research roadmap for clinical and epidemiological research for complementary and alternative medicine (CAM) that is appropriate for the health needs of European citizens and acceptable to their national research institutes and healthcare providers in both public and private sectors. One major issue in the European research agenda is the demographic change and its impact on health care. Our vision for 2020 is that there is an evidence base that enables European citizens to make informed decisions about CAM, both positive and negative. This roadmap proposes a strategic research agenda for the field of CAM designed to address future European health care challenges. This roadmap is based on the results of CAMbrella's several work packages, literature reviews and expert discussions including a consensus meeting. Methods: We first conducted a systematic literature review on key issues in clinical and epidemiological research in CAM to identify the general concepts, methods and the strengths and weaknesses of current CAM research. These findings were discussed in a workshop (Castellaro, Italy, September 7-9th 2011) with international CAM experts and strategic and methodological recommendations were defined in order to improve the rigor and relevance of CAM research. These recommendations provide the basis for the research roadmap, which was subsequently discussed in a consensus conference (Jarna, Sweden, May 9-11th 2012) with all CAMbrella members and the CAMbrella advisory board. The roadmap was revised after this discussion in CAMbrella Work Package (WP) 7 and finally approved by CAMbrella's scientific steering committee on September 26th 2012. Results: Our main findings show that CAM is very heterogenous in terms of definitions and legal regulations between the European countries. In addition, citizens' needs and attitudes towards CAM as well as the use and provision of CAM differ significantly between countries. In terms of research methodology, there was consensus that CAM researchers should make use of all the commonly accepted scientific research methods and employ those with utmost diligence combined in a mixed methods framework. Conclusions: We propose 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions. These are: Research into the prevalence of CAM in Europe: Reviews show that we do not know enough about the circumstances in which CAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance. Research into differences regarding citizens' attitudes and needs towards CAM: Citizens are the driver for CAM utilization. Their needs and views on CAM are a key priority, and their interests must be investigated and addressed in future CAM research. Research into safety of CAM: Safety is a key issue for European citizens. CAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of CAM. Research into the comparative effectiveness of CAM: Everybody needs to know in what situation CAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of CAM as an additional or alternative treatment strategy in real-world settings. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of CAM treatments must be investigated; it is likely that they are significant. Research into different models of CAM health care integration: There are different models of CAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of CAM provision in health care systems should be one focus for CAM research. We also propose a methodological framework for CAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research. Furthermore, structural and sufficient financial support for research into CAM is needed to strengthen CAM research capacity if we wish to understand why it remains so popular within the EU. In order to consider employing CAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of CAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of CAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data. Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using CAM in apparently increasing numbers. We propose that the EU actively supports an EU-wide strategic approach that facilitates the development of CAM research. This could be achieved in the first instance through funding a European CAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field. With the aim to develop sustainability as second step, a European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration. We wish to establish a solid funding for CAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe's reality. We are confident that our recommendations will serve these essential goals for EU citizens. BACKGROUND: The CAMbrella coordination action was funded within the Framework Programme 7. Its aim is to provide a research roadmap for clinical and epidemiological research for complementary and alternative medicine (CAM) that is appropriate for the health needs of European citizens and acceptable to their national research institutes and healthcare providers in both public and private sectors. One major issue in the European research agenda is the demographic change and its impact on health care. Our vision for 2020 is that there is an evidence base that enables European citizens to make informed decisions about CAM, both positive and negative. This roadmap proposes a strategic research agenda for the field of CAM designed to address future European health care challenges. This roadmap is based on the results of CAMbrella’s several work packages, literature reviews and expert discussions including a consensus meeting.METHODS: We first conducted a systematic literature review on key issues in clinical and epidemiological research in CAM to identify the general concepts, methods and the strengths and weaknesses of current CAM research. These findings were discussed in a workshop (Castellaro, Italy, September 7–9th 2011) with international CAM experts and strategic and methodological recommendations were defined in order to improve the rigor and relevance of CAM research. These recommendations provide the basis for the research roadmap, which was subsequently discussed in a consensus conference (Järna, Sweden, May 9–11th 2012) with all CAMbrella members and the CAMbrella advisory board. The roadmap was revised after this discussion in CAMbrella Work Package (WP) 7 and finally approved by CAMbrella’s scientific steering committee on September 26th 2012.RESULTS: Our main findings show that CAM is very heterogenous in terms of definitions and legal regulations between the European countries. In addition, citizens’ needs and attitudes towards CAM as well as the use and provision of CAM differ significantly between countries. In terms of research methodology, there was consensus that CAM researchers should make use of all the commonly accepted scientific research methods and employ those with utmost diligence combined in a mixed methods framework.CONCLUSIONS: We propose 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions. These are: Research into the prevalence of CAM in Europe: Reviews show that we do not know enough about the circumstances in which CAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance. Research into differences regarding citizens’ attitudes and needs towards CAM: Citizens are the driver for CAM utilization. Their needs and views on CAM are a key priority, and their interests must be investigated and addressed in future CAM research. Research into safety of CAM: Safety is a key issue for European citizens. CAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of CAM. Research into the comparative effectiveness of CAM: Everybody needs to know in what situation CAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of CAM as an additional or alternative treatment strategy in real-world settings. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of CAM treatments must be investigated; it is likely that they are significant. Research into different models of CAM health care integration: There are different models of CAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of CAM provision in health care systems should be one focus for CAM research. We also propose a methodological framework for CAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research. Furthermore, structural and sufficient financial support for research into CAM is needed to strengthen CAM research capacity if we wish to understand why it remains so popular within the EU. In order to consider employing CAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of CAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of CAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data. Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using CAM in apparently increasing numbers. We propose that the EU actively supports an EU-wide strategic approach that facilitates the development of CAM research. This could be achieved in the first instance through funding a European CAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field. With the aim to develop sustainability as second step, a European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration. We wish to establish a solid funding for CAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe’s reality. We are confident that our recommendations will serve these essential goals for EU citizens.

The anatomical and surgical approach to the sella region is of special interest for microsurgeons involved in ear, nose, and throat surgery, neurosurgery, ophthalmology, maxillofacial surgery, and skull base surgery. We investigated the surface morphology of the cavernous sinus and the sella turcica in 48 adult and 2 neonate specimens. To simplify the morphometric recording, distances between anatomical landmarks were defined. In addition, three triangles-the preinfundibular, the parasellar, and the internal carotid artery triangle-are introduced. These triangles are defined in order to determine the location where cranial nerves III, IV, V, and VI penetrate the dura with respect to the anterior and posterior clinoid processes and the tuberculum and dorsum sellae. The triangles were found to be symmetrical, with identical bilateral measurements, and the entry points of the cranial nerves were found to be constant. In 17 cases (34%), we found a dehiscence of the sellar diaphragm, and in 15 cases (30%), rope-like adhesions at the pituitary stalk.

P53 protein accumulation and growth fraction were assessed immunohistochemically in primary and recurrent astrocytoma with malignant progression. The tumors analyzed were diffusely infiltrating astrocytomas of the cerebral hemispheres and they were graded according to the World Health Organization (WHO) criteria into low grade astrocytoma (grade II), anaplastic astrocytoma (grade III), and glioblastoma (grade IV). The fraction of P53-positive cases, i.e., biopsies containing P53 immunoreactive cells, significantly increased during progression, in group II–III from 65% to 90%, in group II→IV from 68% to 95%, and in group III→IV from 69% to 100%. None of the initially P53-positive cases became P53 negative after progression. During progression, the P53 labeling index (LI)increased significantly in groups II→III (3.5%→9.8%) and II→ IV (3.3%→13%), suggesting that P53 immunoreactive glioma cells may have a growth advantage. The mean proliferating cell index (PI), analyzed by monoclonal antibody MIB-1, increased significantly in groups II→III (2.5%→11%), II→IV (2.9%→19%), and III→IV (8.7%→16%). Gemistocytes showed a significantly lower PI than the average of all tumor cells.