[MUSIC] My name is Thomas Breitkreuz. I'm working in internal medicine in an anthroposophic hospital. We're doing integrative oncology and palliative care, and currently, I work in two hospitals which is the Fielder Clinic in Stuttgart, which is one of the bigger anthroposophic hospitals, where I work as the medical director. And the other one is Paracelsus Hospital, which is more or less nearby, near Bad Liebensell in the Black Forest. And there I've been working over seven years now in the integrative oncology department. >> So I would like to ask you from your own perspective and experience, how do you integrate in practice herbal medicine and specifically anthroposophical herbal medicine in the care, the supportive care, of patients with cancer admitted to your hospital? How it looks like? What's the objectives of treatment? >> So, maybe first of all, we are in somehow lucky situation in the anthroposophic hospitals, because our concept of integrative medicine is that there is not the oncologist and the integrated practitioner, but that our staff is always double trained. So it's the oncologist who knows about herbs, mistletoe therapy, helloborus therapy, for example. And so we can deal with this in the manner that we can combine what we do most often, or sometimes we use just chemotherapy if the patient says don't give me herbs. Or we treat only with the anthroposophic medicines if the patient says I'm too weak to receive the chemotherapy. So the good situation, if you want, is that the integration is based on a double qualification of the doctors and the nurses and the other professions as well. So let's speak about the most often situation. The most often situation is that we combine chemotherapy and conventional oncologic treatment with herbal treatment within the field of anthroposophic medicine, because we feel that both somehow belongs together. We have to do something against the cancer, these are therapies who aim to destroy cancer cells, and we have to foster health processes. We have to strengthen healthy resources, which we do mostly with the herbal medicines which we use in anthroposophic medicine. And so in general, you will find integrative settings where both is combined. And the most important medicines we use are mistletoe preparations and Helleborus niger preparations, where we have a long history of experience of decades. And lot of studies as well, showing that the clinical experience, what we'd collect with the patients and what we find within studies is somehow showing us the same. So there are no contradictions between, so studies were somehow confirming experiences we made before it in clinical practice. >> So you're talking about basically European mistletoe, or Viscum album. >> Yeah. >> And how do you use that? I mean, what's the idea behind the use of Viscum album or mistletoe for which indications? >> Yeah, so first, Viscum album has a very long tradition now, for 100 years. And this year, 2017 we will celebrate the centenary of mistletoe treatment. The first one was done in Switzerland in Zurich just 100 years ago. And mistletoe is a very interesting plant because over the decades in research, we learned that there are lots of features of mistletoe, it's not just one mechanism, not only one interaction with pathology or with resources. But it's a panel, and very often it's the same when we use plants, that you find not only one biochemical pathway, but you find a pattern of certain effects. And we used mistletoe therapy first to treat patients with cancer fatigue. >> Mm-hm. >> But at the same time, we know that lots of other features and symptoms, like for example weight loss, anxiety. Immunologic competence concerning neutropenia or infections during the phase of neutropenia influence as well. So when you look at the modern mistletoe studies, you find that they are sometimes focusing on survival, and then they check a panel of core symptoms of advanced or less advanced cancer diseases. And so our use of the mistletoe treatment is first, fatigue, second, to foster healthy immunological responses of the organs to fight better against cancer. And third, it can be used in quite a lot of additional symptoms as well. >> And I understand that you use other herbal remedies- >> Yeah. >> I mean, as oils or in other routes of administration? >> Yes, mistletoe and a little bit less, Helleborus niger. These both two plants are famous in anthroposophic medicine because there are strong studies and we know that we may better control symptoms. And there are some studies indicating that overall survival may be better like in pancreatic cancer, where we have some strong studies. There's a big study now on going in Sweden, where the oncologist of Southern Sweden Collaborate, and to do a revival of mistletoe study in pancreatic cancer to see if it does not only help for advanced cancer symptoms, but for overall survival as well. So these two, and I could say Helleborus is the second important drug which is given like the mistletoe, not orally, in general, but subcutaneously or even intravenously. And Helleborus is used in conditions where you have, so to say, B symptoms, like in lymphoma patients. So weight loss, severe sweating, more inflammatory Clinical picture the patient presents with. And then of course, there are lots of other more specifically administered herbs. It can be external by sorts of massage or compresses or ointments, or given internally. But this always has to do with more specific symptoms, it's so general concerning the indication, it's more specific. For example, like in homeopathy, we use [INAUDIBLE] for nausea and vomiting or we use [INAUDIBLE] in polyneuropathy situations. We use [INAUDIBLE] compresses from externally, so-called liver compresses to foster metabolism. When we see that the patient has a severe fatigue and weight loss, and we want to stimulate the healthy capacities of the liver to help the patient in the situation. So one could say the two flagships are the mistletoe and the Helleborus, and then there are lots of differentiated indications for certain herbs. And quite a lot of these herbs, we share that with phototherapy or sometimes with homeopathy. The herbs are not different herbs than those which are used in other medical traditions. >> So can you describe a typical day in a patient that has come to receive chemotherapy in a day care clinic in your hospital? >> Yes. >> Which herbs will be introduced in which phase, by who? I understand that it's not only the physicians that are involved, that the nurses and other healthcare practitioners. So please describe it from the perspective of the patient. What this patient will receive during that treatment. >> So most patients with solid tumors might be in metastatic conditions or in [INAUDIBLE] therapeutic settings. They will have, at the same time, an ongoing [INAUDIBLE]. That means first that they learn to do on their own, subcutaneous injections mostly three times a week during the whole phase of the chemotherapy. Because we learned by lots of studies and lots of experience that fatigue is less, infections are less, people have less loss of appetite and so on. And in patients who come to us and who experience a strong chemotherapy-induced fatigue, we will give intravenous [INAUDIBLE] applications just before the chemotherapy starts. So for example, when we wait for the actual blood count And we start with the normal preparatory infusions concerning anti-emetic agents and so on. We add a mistletoe infusion and we see the studies and when we ask the patients that if we do so and combine it the same day, the post chemotherapy fatigue will be much less. But we do this not in every patient, but we try to identify the best patients who have a strong chemotherapy associated fatigue. Then of course, we use medicines to prevent nausea and vomiting, this could be [INAUDIBLE], this could be [INAUDIBLE]. Sometimes subcutaneously, sometimes just orally. Then we use, this is not planned sometimes but other [INAUDIBLE] medicines like [INAUDIBLE] in a potentized way to prevent neuropathy. If we do chemotherapy with platines or taxons it's a very, very well used modality and there is a big study ongoing in Munich which will show us how strong the effects are. Then of course the nurses, very often, will do some external applications to the patients. For example, if the patient has a strong anxiety during chemotherapy. Everybody knows these patients who come, who get the IV line, or the port And in this moment, sweating starts, sympathetic tone gets up, patients are really, really anxious. Then we do IV administrations of bryophyllum, which is a very, very good calming plant, if you want. And they will have an external application of the so called Alvin-Vac Lavinia Pancreas centers you very much of the lavender smell. You'll have the [INAUDIBLE] on your chest. Gold and stibium. >> Gold, stubium, and avendelet, it's a combination. It's an on-critical use. And we use is justly the situation, which makes the patient come back to himself or herself to feel a bit closer within the body and be a bit more centered. Maybe the patient's who are somehow very excited and difficult to central. They will have a foot off at the same day or even during the chemotherapy because it brings them down rosemary or lavender for example. And there are other modalities from the field of anthroposophic medicine like a special movement therapy which we call youth therapy. Which we can use to center the patients, and sometimes patients even will do a therapy, immediately before or after the chemotherapy. Is basically there is there is strong impulse of mult-professional team. You just mention physicians, nurses and manure practitioners and other based all together, how much is it to valuable all over Germany. Do patients in Germany receive this kind of philosophical, herbal, systems of health as part of the German health? Yeah, [INAUDIBLE] or? >> Okay, so these needs adifference here to answer, so first the medicines themselves, they are available in every pharmacy. They are licensed as medicine you can, they can prescribed or if they are OTC medicines. You can buy them in every pharmacy so this is somehow favorable situation you have here. That is due to our pluralistic regulatory system. Second question, are the medicines reimbursed by the health insurances. Answers sometimes yes and sometimes no. So medicines like Lipitor are going to borrow those. They are regularly reimbursed if you have an advanced cancer stage. It's limited stage, so an adjuvant situation, in some time, some cases the health insurance is paying, and in some times they pay not. It's a bit A diversity depends on the insurance policy in this field. And then concerning the availability of the therapies. You know of course there is a restricted number of anti-persophic hospitals or outpatient oncologic departments are oncologists specialized in medicine. So this is a minority of patients who receive that, but we learned that the demand of the public is great. And that's why there is more and more good cooperation between anthroposophic hospitals and other hospitals. To try to build up an integrative setting integrative oncologies and we try best to distribute what has shown to be helpful for the patients in the experience of the anthro hospitals. That it may be part of a more general, the setting in oncology in Germany. >> So can you elaborate a little bit more on the situation all over Europe concerning integrative care and [INAUDIBLE] medicine in regards to patient-centered care and during cancer treatment? >> Yeah. First, if we just start with the medicines, you may know that in Germany, we had a very specific situation. In 1975, we had a drug lull, which constituted that there should be a so-called therapeutic pluralism in Germany. That was an answer to the Nazi times, interestingly. Because at that time, the Bundestag stated that the politicians cannot decide what is a good medicine, and what is not a real medicine. And if homeopathy or fighter therapy or anthroposofic medicine is wrong or right, they said the state has to offer pluralistic decisions for the patient. And that's why we became specific regulations for these therapy systems which were called. Which means specific therapeutic systems and they are export from the assistance and the Drugship Regulation Authority. They formed bodies to do a good regulation for the drugs of these different traditions and this unique in Europe. It is not representative of Europe, in the European Union. We have a much weaker tradition concerning fighter therapy or homeopathy or anthroposotic medicine. And therefore, the regulation of herbals first there are only some, not even 200 herbals, which are regulated on the repeat level. So it's only a minority. And for example, there does not exist any indication or any regulation for herbs with oncologic indications. Because most of the EU countries who have no tradition in the field of complementary medicine who have no strong traditions in this field. Their regulators are somehow frightened, anxious. They don't want to risk anything for the patients and for themselves. And so the European regulation is much more restrictive and much more safety oriented. And that's why you have lot of use of herbs in the European Union but you have no specific regulation for the use of those medicines in oncologic diseases. And concerning reimbursement and the accreditation as medical systems. There are, of course, some countries in Europe are very strong with some complementary and traditional systems like homeopathy, or naturopathy, or anthroposophic medicine. For example, Germany, France, Great Britain, Switzerland, Austria, are somehow have good regulations. And there are countries like the northern countries or the countries in the south girdle like Spain or Portugal or Greece where traditions have not been very strong. And there, you don't have a general acceptance or you do not have a specific regulation for these medical systems. So in fact, Europe is very diverse concerning that. And because all these 27 members of the European UNICEF have to find compromise, the compromise is mostly safety oriented. The level of regulation is somehow low, and the member states with strong traditions they have their own regulations which is highly above the general European level. >> Now you're now challenged by the stream of refugees that come from areas like the Middle East, Africa, North Africa. And you have a bigger and bigger increased community of patients, from these countries which basically or more, have high affinity with traditional medicine, and herbal medicine in particular. And I understand that this health belief model, which is quite different from the European one may challenge doctor patient communication. So what would be your advice to oncologists, health care practitioners in Germany? That first, that need patients with cancer that come from these countries, and which really are more attached to traditional herbal medicine, which may be non-relevant in terms of evidence-based medicine. I mean, well, luckily, we have some studies in herbal medicine that is effective. But these herbs that they use, maybe not research, at all. So what are the key concepts that you would recommend to physicians, to nurses, who deal with these patients and their health belief model? >> Yeah, so I think the step would be that we understand better the concepts that people bring with them and the ideas they are living with concerning cancer and what could be helpful for cancer. So we face a situation where we need learnings concerning that. And it's great that we have this conference here in Berlin where we did a workshop specifically on this topic of refugees. And where we somehow felt together with our colleagues from the Middle East and from Israel that it is really worth to share ideas, to share knowledge, to share understanding. That we are able to better understand the health beliefs and the traditions. What do people do when they face when they face cancer? So the first thing is, of course, that we have to learn more about that. And of course, I'm convinced that lots of the practices in the Middle East are effective concerning symptoms, concerning palliative care symptoms in oncology. And they may have to have better cause concerning life quality during chemotherapy. And of course, the first thing what we need, I feel, is not that we need lots of randomized control trials. We have to understand what the people use and why they use it. We have to identify if there are risks concerning interactions between conventional therapies and certain plants or certain teas or certain, Food supplements, or certain plants people eat. And first, we have to learn what we can foster, what we can do to offer some integrative oncology for these people who bring different traditions with them. [MUSIC]
