So, I'm Marc Schlaeppi. I'm a physician from Switzerland, trained in the western part of Switzerland, French-speaking. I'm trained in Internal Medicine, later on in anthroposophic medicine and I'm a medical oncologist. So, I regularly trained in the Kantonsspital in St. Gallen. There, I was responsible for melanomas, for brain tumors for those patients, and now since 2009-2012, we developed a Center for Integrative Medicine. We see many people with cancer diseases. Yeah, maybe, yeah. So, can you describe the model that you designed in St. Gallen. I understand that it's part of the oncology treatment on the oncology ward. So, yes. We have outpatients who are referred for integrative treatments. There are also wards, Acute Oncology and two Palliative Care wards where we consult as integrative physicians, but also the nurses there are trained for external applications, for rhythmic embrocations, et cetera. So, we have trained staff at those wards for Integrative Medicine. But, the physicians come from the center to see patient there. I see. So, it's completely integrated and it's part of the health system. I mean, the patients do not have to pay for this treatment? No, if they are inpatient, they do not have to pay. If they are outpatients, they have to pay, but it's covered by the health insurance when physicians do treat them or when nurses do treat them. When therapists, for example, eurythmy therapy, art therapy there, they have to have a special insurance. This is a two thirds of the population has this insurance. If they don't have the insurance, they have to pay by their own. Can you describe what happens in Switzerland in terms of integrative oncology activity, oncology centers, and you're not the only center, I understand. There's more centers throughout. You mean in St. Gallen or in Switzerland? No, in Switzerland. They are different. At the University Hospitals in Bern, for example, there is a Center for Complementary Medicine Institute. In Zurich, we have also an Institute for Complementary and Integrative Medicine, and there are a few private hospitals which have Complementary and Integrative Medicine. Lausanne as well. The University Hospital of Lausanne also starts now a program for Integrative Medicine. So, I wonder how it looks like practically from the patient's perspective and the oncologist's perspective. When a patient comes in to receive chemotherapy, for example. Yes. Where would you find the integrative treatments and in which point, which area you would prescribe integrative treatments, and what kind of treatment? If the patient, for example, first diagnosis of breast cancer, so curative setting. The patient asks if there is a possibility to have complementary medicine and then the physician oncologist is to refer to us. This is the mechanism. So, it's the initiative of the patient? Very often. But, if the oncologists see that there could be an indication for Integrative Medicine, they do refer, but it's very often the initiative comes from the patient himself. Then what happens? The patient is referred for consultation? For consultation, goes to a physician of the center and there, depends on what he has, problems, he receives a prescription or a therapy individualized. Yeah. The consultation is for how long with the integrative physician? The first consultation, we have one hour. So, really at one hour to see the patient, have a history examination, and to propose a therapy, and then we can start the therapy and see the patient again after, it depends, four weeks, two months, three months. What are the main indications for integrative treatment and we're mainly interested in herbal related treatments? With the example of woman with breast cancer, so you can give therapies before an operation, after an operation. You can give it during the chemotherapy because of side effects. You can give drugs, herbal medications, and when chemotherapy, radiotherapy is finished, if endocrine therapy starts, you also have side effects, and then you can treat those patients with drugs or other things, of course. For example, a patient that undergoes operation in the sense that you can offer perisurgical integrative intervention,. Can you just describe which kind of interventions you may offer? You can give. Now, with anthroposophical medicine, we give something for the heart and circulation, Aurum-Onopordon comp it is cardiodoron with Aurum, Stibium, there are different possibilities to give before, after with Arnica, for example, or we let nurses go to the ward and they make an external application [inaudible] or the heart compression. All the different external application for the liver, for example, or also when they are very tired postoperatively, a rhythmic embrocation with an ointment with oxalis oil, for example, for the vitality to become better. Yeah, things like that. So, the indications would be preoperation anxiety, I assume, indications for your treatment. Yes, anxiety can be a topic but not always. What are the clinical indications. I did it for the anesthesia for better operating time, to recover better, for example. This anxiety, of course, you can give therapies like [inaudible] , for example. Aurum is very good for that as well. So, how do conventional surgeons and oncologists perceive these interventions? I mean, it happens within the same field where they work. I understand that you use those interventions right in front of the surgery theater or in the department, or in the inpatient or outpatient clinics, and they see it. I mean it's part of what happens around. Yes, when we receive a written consilium, referral, and then we write, it's an electronical thing on the system, what is our proposition. Then we write down, Aurum-Onopordon comp or Stibium or mobile integrative nursing with external application and then they come and do that. But you don't find any hesitance from the conventional team or I mean, people don't say, "Well it's rubbish. It's only non-specific effect." I mean, don't you hear some antipathy, let's say, you don't find it? What it is important for the colleagues is that it's safe and if there is also a potentiation, let's say, at D6 then it's really no interaction risk and you can give that. I think safety is an important issue for those colleagues and if the patient is happy with that, I think it's also okay for them. So, if they sent the referral, they want also the things the therapy happens. So regarding safety, how would you personally as an oncologist, I mean what are the considerations you have regarding safety? For example, in situation of Viscum album mistletoe injections to patients with melanoma and supposedly brain tumors, I mean, how would you react? How would you deal or evaluate the magnitude of risk versus safety versus effectiveness, and how would you consider that? It's not so easy. I mean, it's not obvious. Yes, also there is a question of at what time of this illness the things happen and in which an indication I prescribe Viscum album, for example. There are data, for example, pancreas carcinoma or non-small cell lung cancer and I think there are many different publications we chose that mistletoe is basically safe. There you have other diseases as you said, for example, melanoma where there is controversy. I think the data don't show that there is a danger. The publication you cited, or it's a study there was nothing to find about brain metastasis, for example, but in an adjuvant setting if there is, for example, also an immune therapy I am careful. Okay. I don't combine automatically anti-PD-1 or Ipilimumab with mistletoe. I think we need more publication. There are publications coming and are in preparation, but this is really, you must be differentiated. You cannot say, "This is no problem. You give it." You must look at the situation and the potential interactions, and there are many interactions with herbs and conventional medicine. Of course, it is important. I would like to ask you about palliative care and the role of herbal medicine and anthroposopic medicine in palliative care. I mean, there are some areas in palliative care which are not optimally, I mean, the treatments that we can offer today are not optimum and that there's like a lagoon of areas where the treatment for fatigue, for example, is really not optimal, or in areas like anxiety where patients do not want to take anxiolytics. In which areas of palliative care would you say that would you consider herbal versus anthroposopic medicine as promising? Compared to conventional non-optimal treatment. What are the leading areas you think really anthroposophic medicine can help in places where other modalities fail to give complete answer? Yes. I think fatigue is really an important topic. Insomnia, so is sleep disturbances. This is a very important topic as well appetite, anorexia. Also just to me so this sort of like depression or anxiety. There you can really do treatments with so interesting anthroposophic medicine. Drugs you can take but also application you do is drugs. So, external application are in my opinion a very useful and interesting so in an inpatient wards when people cannot sleep, anxiety. Also very often they have cold feets. So, if a nurse mix [inaudible] rhythmic- Massage. -massage on the invocation. It gives a substance, it gives me a technique which gives peace and quiet. Makes them very quiet and very often the anxiety goes down, they have warm and can better sleep and it's a very effective tool for the patient but also for the nurse. She also has to become calm for this three to five minutes intervention. We made focus groups we asked them and they really described that before she goes to the patient and doing this rhythmic massage truly has to become mindful before doing that and not this patient is disturbing me and I'd given nervous benzodiazepine for example. So you're opening up another area which is very interesting. Not focusing alone on the patient's realm, but on the health care provider's perspective. So, do you think that integrative care can assist the burnout that we experience as medical professionals? I mean the nonexistence of mindfulness which is so, I mean in daily life and we really not very mindful with ourselves? Yes. So how would you relate to that, what sorts of horizons can integrative care anthroposophic care or herbal medicine can offer to the health care practitioners challenges. Yes, I think those techniques, the need to adapt the professional come into a state of mindfulness and so that can help them of course to have a better working place situation. This is what people said. They feel more mindful. Yes, yes. But it's always also a bitter fight you must take this time to really do it. Or to put it when you have done an external application then nobody has to come in this room because there must be silence. So, you put a message don't go in or silence and respect that. So it's also a cultural thing in the wards. So I would like to ask you or maybe it's too personal I don't know, what's the meaning of being anthroposophical oncologist in [inaudible] beyond the physical, beyond the anthroposophical remedies and technologies. What's the real impulse that brings you in, I mean as on one hand oncologist and the other hand anthroposophical doctor. I mean what is your real intention there? What are you trying to achieve through all these area of expertise that you own? Yes I think the chance to be anthroposophical physician is to have two dis-conventional, in oncology you have another point of view, another perspective on your patients. You have different possibilities to help this patient on areas where maybe in conventional medicine you wouldn't think about it. For example, you can work on the life area to help this yeah. With Mr. Toe for example, you can also work on the emotional part with arts therapy, you can speak to what we call the [inaudible] , and then to how they see life and what is the meaning. So, you can get this very, yes, holistic perspective which is very interesting and I think helpful.
