Yes, I am Elio Ross, I am a medical doctor and I am part of this process since 20 years in the region of Tuscany. We are trying to make an integration of the complementary medicine in healthcare, public healthcare of our region. We are involved, I am also Director of the Center of Reference for Homeopathy in the Hospital of Lucca, and we are working since five years in integrative oncology. With the agreement and in collaboration with the oncological department of our hospital, we have build up a clinic. The name is Complementary Medicine and Diet in Oncology, in which we see patient, 90 percent sent by the oncologist that want to use also complementary medicine to reduce the effect of chemotherapy, radiotherapy, and hormonal therapy, and to ameliorate the quality of life. This is a work that we have done complete in collaboration, patient meet me as expert of complementary medicine and meet also one oncologist because I am not a specialist in oncology, and we are both engaged to give the best treatment according to the different kind of symptoms the people list common. Symptoms are, well, we are working, of course, with the general symptoms of chemotherapy, nausea, vomit, diarrhea, and the fatigue. But, the most important request from the patient is connected to reduce the secondary symptom of iatrogenic menopause in patient with hormonal cancer. Our hospital is important center for breast cancer, so we are insert also in the breast unit of the hospital and we are in contact with the surgeon, with the oncologist for every kind of adverse effect the patient has. For instance, not only for chemotherapy, but in radiotherapy and in this case, we have done some work. We have compared the effect of our preventive protocol and we have seen a reduction of the inflammation due to the radiotherapy. I want to ask you, you have expertise in integrative oncology regarding the radiation phase, which is quite unique. Can you tell me which symptoms can be improved by herbal remedies, or homeopathic remedies, or other? We use a protocol in which we use both. I mean, we use homeopathic remedy before the radiation and after the radiation. One other maybe or other remedies like belladonna according to the symptoms. Then, we use Calendula locally and also Aloe gel. Ointment of Calendula. Yes. On the breast, for example. On the breast, or where the radiation is made. Then sometimes for head and neck cancer, there is a problem of mucositism, and in this case we use ratanya, and also we use a sort of alkaline-zinc treatment, which is a composition of citric acidum, and sodium bicarbonate, and this we say impartly. We put on the breast and after that we use Calendula and Aloe. We see severe effects of radiation reduced during the time and just the people, what is the consequence that the people can finish the 30, 28, 30 radiation without be obliged to interrupt and because of the burn effect of the radiation. So, it makes the oncologist actually. Happy. [inaudible] yeah, can provide the treatment better, I mean, there's adherence to the oncologic treatment. Yes, as I told you before, this integration is not against conventional oncology, but with conventional oncology. It means that we can optimize the effects of the conventional treatment, so they can reach the maximum level without not so many adverse effect. Of course, is not for every patient, but the majority of the patient, a significant number of the patient has benefited from this. So, where actually this consultation, this integrated consultation is taking place, inside the oncology department? No. But, then, in our hospital, we have two hospitals in our city. One is the acute hospital, so it means that there is the treatment for acute disease, not only for chronic, but acutization of chronic, and the surgical operation, etc. Then, the other one is for the, we say, territorial. I mean, it's for outpatient. So, all the clinics are outpatient clinics, are insert in these which is Campo di Marte Hospital, which was the first one hospital, then is transformed in a sort of multi-clinics division. Then we are there, but with the oncologist with me. So, actually, from the patient's perspective, you're providing the Integrative treatment or the herbal treatment as part of the oncology treatment? Yes. In particular, we are part of the so-called the Breast Unit. There is a Breast Unit, now is in Lucca, but tomorrow will be also an integrated Breast Unit with other hospital near by Lucca, which is Versilia and Massa. Then we will be insert, the same happen in other hospitals. In Tuscany, there are six center, at least the six center of the Integrative Oncology. These centers start from their specific discipline, in our case is homeopathy, but there is also herbal therapy, phytotherapy in Careggi. There is acupuncture which is in Florence, in Firenze. Then we have both these discipline in the same town but everybody use a different kind of complimentary medicine according to the symptoms of the patients. In our case, for instance, we start with homeopathy, then we had the mini case phythotherapy. Then if it's not enough, for instance, for flashes of heat of the patient with iatrogenic menopause, we send them to the acupuncturist. Generally, we don't use all together in the same time just to see what is useful or not, but sometimes we use also together. Depends of the case. [inaudible] I wanted to ask you, I mean, there are three domains were each is related to herbs. One you described phytotherapy or what we call herbal medicine. Yes. The other one is nutrition, the kitchen. The Italian cuisine is well-known. I know that many patients use herbs as part of the daily nutrition. And the third arena is homeopathy, where a lot of remedies come from herbal resources. Yes. Yeah. Can you explain, from the Italian perspective, what's the difference between phytotherapy, herbs, as part of the cuisine and homeopathy? Yes. I mean, clinical homeopathy as you use. Well, the clinical homeopathy is easier to explain. These herbs are treated as a drug, and so homeopathic drugs means that there is a solution. It can be in a scale of one to 10, one to 100, and this solution has been reapplied for many times. So, whoever, not the herb but the global with the solution that is characterized by this scale, which is C for 100, or D for decimal for one to 10. The number of time in which the solution is made, which mean five, six, 30, or 200 if you want. This is possible to distinguish easily from the herbal, which is in Italy has two channel. One, is the use of herb. It means to go in what we call herboristeria, and you take 100 grams of a chamomile, or melissa, or what you want. In general, you see a herborist which is not a doctor but is a qualified health practitioner, who give some advice, what is useful in your case, or you go to the doctor. For instance, in Tuscany, we have a center of reference for a phytotherapy in Careggi, in the University Hospital of Florence of Firenze. You take a drug which is with a title and standardized drug, so you can give to the patient the herb, but knowing which is the active principle, how much of active principle is insert. Because we have the problem, of course, with normal herb, that if the season is dry and the principle is high. If the season is wet, the principle is diluted. So you give the herb, but you don't know exactly what is inside the herb. May I ask you? If we take it to the clinical realm, clinical practice. Si. Let's consider a woman that has breast cancer, she received chemotherapy, radiation, and now she's receiving hormonal therapy,- Yes. -and suffers hot flashes and climacteric symptoms, and so on. Can you describe in practice what you would prescribe in terms of herbs, maybe homeopathy, maybe nutrition, maybe acupuncture. How would you tailor a treatment to such a patient? Yes. Generally, we use this strategy. If the patient is coming for chemotherapy with some symptoms, generally the patient can come before chemotherapy. So, we use a very simple protocol to give to the patient and before the chemotherapy and the day after to reduce, but in general way, the symptoms. Generally, we use homeopathic remedies and nux vomica, for instance. Sometimes, cadmium sulfuricum, and we use also curcuma, in the way that can be absorbed by the patient, otherwise is not very much useful. This is the minimum level. After the first cycle of chemotherapy, start to appear the symptoms that are specific of this patient, can be the ache, diarrhea, or maybe the nausea or vomit, more important than not to reduce that. On this case, the next cycle of therapy, we advise the patient to take other kinds of homeopathic remedy or other things. Be careful not to make interference, because we all know that there are herbs that can interfere with chemotherapy or some kind of [inaudible]. Then, when the major effects of chemotherapy are disappeared after a few days, then if the patient has a climacteric symptom, we start again or we start, if the first visit, with a general treatment that is to use the homeopathic remedy, more adapted to these kind of flushes. It can be during the night with the perspiration or not, the high part of the body or not. These kinds of symptoms that give indication for one or other remedy. So you match specific remedy to specific- Yes. But this is- -sort of symptom. The specific is within a group of remedy, which are indicated indices. So, it's in the middle, what they call constitutional remedy and the specific remedy. Then, from the- For example, if you can specify a few examples of these remedies? One is laccases and one is sepia are there for more acute symptoms Sanguinaria, other can be glonoinum, belladona, or may be other symptoms can be sulphur or pulsatilla. All remedies who has a connection with hormonal pattern of the patient. In this case, suppressed hormonal pattern in general. Then we use and it became more or less the standard care for these pollens, which is a specific pharmaceutical name pollens, which are [inaudible]. Without the allergens for people was and is able to reduce the level of, so the combination. What kind of pollens? Any kind of pollens. What is in spring are making sneezing. They are like pollens that we use also for bees that these kind of, and this is able to reduce the level of symptoms and then with the combination of the two, the specific remedy and homeopathic remedy in this treatment, and sometimes also Cimicifuga as an herbal remedy. We don't use soya, isoflavone of soya because we think that at the moment, to stimulate also in negative sense, the receptors over estrogenic receptor. It can be dangerous. We must be very careful and so we don't want that. But you use Cimicifuga racemosa, black cohosh. Yes, sometimes. General, the standard care is pollen and then in some case, when the patient arrives to have more than 30 flashes per day or something like that, probably she needs also an acupuncture. So, we send that to the clinical acupuncture which is in our same place. I want to stress that one, we are in a public hospital. So, for oncological patient, all we did, what we are doing for the pa- means the visitor and also the acupuncture cycle is free of payment. That's unique to Tuscany? Yes. I mean so integrative treatment in your hospital is provided free of charge? Free of charge for oncological patient. As part of supportive palliative care? Yes, of course. Why? Because the oncological patient has the right to have free healthcare service. Because we are insured in the public health care, also the service of complementary medicine is free of charge. This is important because of you know, people if has a cancer, has a lot of problems. Also for money problem, economical problem, and we don't want to be another addictive expenses for them and the government Tuscany is very clever because since the very first beginning, if you non-tab this kind of pathology, you have to pay a ticket. That is like every kind of specialities, dermatology if you want to make a visit in there. If you are not, unemployed, old age, or there are what we exemption that included also complementary medicine. So, I understand your service, I mean, people that come to your service, patients with cancer come from all sorts of psychosocial economic status. Yes. People that have expert previous knowledge and experience in complementary medicine and people that never heard of complementary medicine, old people? Old people, yes. Generally in the hospital, coming older people has not known very well homeopathy or this complementary medicine. They are real people. I mean, if you are working in a private situation, generally, you see people that are convinced, the ecological people that want to make alternative treatment, etc. In the public hospital, people generally doesn't know exactly what is homeopathy, what is complementary medicine. They are sent by their doctor or general family doctor or in this case, from the oncologist or the surgeon or the breast cancer surgeon or different kinds of psychologists, psycho-oncologists. We are working a lot with psycho-oncology. For instance, every month, we make a meeting of the new women in the hospital who are the diagnosis of breast cancer and that there are about 30 new cases every month in the small city of Lucca. So it's a growing phenomenon and these women has the possibility to meet all day staff of the breast unit. The surgeon, the radiotherapist, etc. To ask a question to have clarified, and included in the staff, we are also me and I present our activity, what we do, and the diet. What kind of diet that they have to do. For instance, for a cancer of the breast, there is a lot of importance. We pay great importance not to exceed in the consume of milk and milk dairy products because there is a lot of problem with the milk. The presence of extrusion within the milk. So Elio, I would like to ask you, I mean you have an expertise if I understand correctly with approaching, talking to patients that have no previous experience with herbal medicine, homeopathy, integrative concepts that it's new for them. It's not only the rich, educated, and ecological-oriented people. No. You are right, but you have to take in account that in Tuscany, thanks to this process, they seen 20 years has done to integrate. We have a population in which there is the knowledge of what is complementary medicine is grown up during the years and there is about 20 percent of the Tuscany population using complementary medicine. If you take children for instance, one children for 25 percent is using especially homeopathy. So, people are coming from the counter, the mountain, etc. Okay, but in general, there's a much higher level of knowledge of complementary medicine. One consequence of this is that this is more acceptable complementary medicine from the medical convention and medical establishment. It mean that, for instance, 67 percent of oncological patient can speak freely with their oncologist that they are using complimentary medicine without any consequence. Including herbs? Including herbs, yes, which are used by patient in general cooking, but not with health, in general health purpose. They are using to give more of flavor to the dishes etc. But then- So, which medicinal plants you would say that are relevant in cancer cure, are really implemented in the Italian cuisine that people really can relate to that, it's not something weird like Salvia maybe or other that you think are relevant. Yes. We give [inaudible] , from general point of view, we advise the patient to use herbs cooking first of all. Herbs, also spices, for us is [inaudible]. Ginger. Ginger etc. And this is our advise. So you use the affinity of patients with cancer in Italy to the cuisine, to the Italian lifestyle. Yes. Generally, we use to advise the patient not to eat too much meat, to use fish and they use the poor fish, I mean the fish has more science, then to use every kind of of vegetables, especially cauliflower, [inaudible] Brassica which is what we know has the possibility to interfere positively with the evolution of the disease, and also the small fruits, the wood, the bush fruit like raspberry, cranberry, these kind of. Then pomegranate. The advise is they use fresh, I mean, but we don't. And also we had prepared, years ago, a course with a cooker for patient that we want to use, to learn how to use herbs and vegetables in their daily cooking. So, you actually worked with the chefs or people that are experts in cooking? We did, but now it is difficult because it's some too many things, so we have not a real program for integrative oncology. We just make this a clinical experience, but we can do much more of what we are doing if we have time, hour of service, if we have funds and in this moment in Italy, as all over the world, there is a lot of problem, But in any case, we can do something on this. We can give a book in which there is cooking advice. Recipes. Yes, recipes and how to cook with the health purpose I mean. Especially for menopause, for women not to gain weight, not to reduce, for instance, all the spicy food, I mean capsicum. peperoncino, and the chilly and the pepper, black pepper warm people. So, if you have the problem to be warm. Because you are in menopause, you have to reduce alcohol for instance, that you have to reduce or eliminate. All this kind of advice that in general the classical oncologist, conventional oncologist doesn't give to the patient. They says many times eat what you want. Yes. That is not the correct answer. Elio, finally, I mean, the last question may be. Can you open up in a more broadened perspective, a European perspective, I know that you're very active in integrative medicine all over Europe. So, can you just point out which areas in Europe are really relevant or active in integrative oncology where you think herbs are really implemented in supportive cancer care? Which are the countries which are really the pioneer in this areas all over Europe. I think definitley that here in Germany is the place in which there is a long tradition, starting 1930, in that time and this is the situation in which there is a recognition of complimentary medicine but it also is related to the kind of healthcare they have, which is based on insurance that can decide what they have to perform or not etc. What other countries are involved in terms of oncology and integrative oncology? Well, in Switzerland, which is not Europe, but because it's connected to. Not EU. No. Austria also and England for instance. We did a survey a few years ago and we catch about 40 places, centers, and cancer institute, and cancer hospital in Europe, and many of them were coming from German and Switzerland, few from France and England, and some of them also in east countries but not so much. I think that is very spread that they used to use complimentary medicine in cancer patients. We have the historical work of [inaudible]. It's about 18 to 73 percent of the patient. But is very different situation to different countries. For instance, in Spain, it is a country that they know quite well there is no places, except some private places but not possibility to insert in public health care. In other countries like, for instance, northern countries [inaudible] , then in Denmark etc, there is some experience. The oldest experience are related to anthroposophical medicine, but this is a very specific treatment like with [inaudible] so they are concentrated very much on this, not on this other treatment that are complimentary to the [inaudible] but this is very specific
