World Congress Integrative Medicine & Health 2017: Part one

Introduction

I1 World Congress for Integrative Medicine & Health 2017 - A global forum for exploring the future of comprehensive patient care

Benno Brinkhaus¹, Torkel Falkenberg^2,3, Aviad Haramati^4,5, and Stefan N. Willich¹

¹Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany; ²Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Karolinska Institutet, Stockholm, Sweden; ³I C – The Integrative Care Science Center, Järna, Sweden; ⁴Department of Biochemistry, Molecular and Cellular Biology, Georgetown University, Medical Center, Washington, DC, USA; ⁵Department of Medicine, Georgetown University Medical Center, Washington, DC, USA

We are excited to present the abstracts of the keynote speakers, parallel sessions and oral and poster presentations of the World Congress on Integrative Medicine & Health (WCIMH 2017; http://www.ecim-iccmr.org/2017/) to be held in Berlin on May 3-5, 2017, which will be jointly convened by the European Society of Integrative Medicine (ESIM) and the International Society for Complementary Medicine Research (ISCMR). The Congress will take place in association with a number of national and international organizations from North America and other continents. Consequently, the congress will provide the most comprehensive global forum and perspective in the field of Complementary and Integrative Medicine in 2017.

The congress goal is reflected in its tag line: The Future of Comprehensive Patient Care - Strengthening the Alliance of Researchers, Educators and Providers. We believe that by bringing together researchers, educators and providers, who are addressing various aspects of Integrative Medicine and health, we can build on the evidence obtained through research to inform clinical education and practice and thereby create a better platform for comprehensive patient care.

The main themes of the Congress are:

• 1. Clinical care: The practice of Integrative Medicine should be based on distinct definitions, should be informed by evidence and evolve from guidelines that are developed by experts from conventional and complementary medicine.

• 2. Education: Academic leaders and health officials have called for future clinicians to possess the knowledge and skills to understand how Integrative Medicine can be incorporated into conventional care to improve the health of the public. Therefore, it is essential to share best practices in how to create robust curricular opportunities for medical students to experience systematic teaching of the principles, strengths and limitations of Integrative Medicine.

• 3. Research: Within this Congress scientists will showcase the highest quality research worldwide in this field and will provide the state-of-the-science evidence base through plenary lectures, symposia and abstract presentations.

• 4. Traditional healing systems (THS): Traditional healing practices and practitioners are an important and often underestimated part of health care. THS is found in almost every country in the world and the demand for its services is increasing. Research contributing to evidence informed decision making is imperative to develop a cohesive and integrative approach to health care that allows governments, health care practitioners and, most importantly, those who use health care services, to access THS in a safe, respectful, cost-efficient and effective manner.

• 5. Arts and medicine: For the first time at a research congress, this theme will explore the important contributions of the arts (music, visual arts, dancing, etc,) for integrative therapeutic interventions to achieve optimal health and healing.

Given the ambitious scope of this worldwide international congress, the four authors of the present editorial serve as co-presidents and they are guided by the International Organizing Committee consisting of many experts from around the world including Myeong S. Lee, Jianping Liu, Kenji Watanabe (from Far East Asia), Renee Street (Africa), Amie. Steel (Australia), Paulo Arturo Caceres Guido, Chin An Lin (South America), Heather Boon, Josephine Briggs, John Weeks (North America) and Abdullah Al-Bedah, Mohamed Khalil, Elad Schiff (Middle East and Israel).

The programming for each of the five themes is directed by WCIMH 2017 theme subcommittees involving some of the most highly regarded clinicians, educators and researchers in the world in this field (in alphabetic order): Linda Balneaves, Lesley Braun, Eva Bojner Horwitz, Gustav Dobos, Jeffery Dusik, David Eisenberg, Iva Fattorini, Eckhart G. Hahn, Suzanne B. Hanser, Frederick Hecht, George Lewith, Harald Matthes, Andreas Michalsen, Judy Rollins, Volker Scheid, Michael Teut, Robert Saper, Claudia M. Witt, Merlin Wilcox and Darong Wu. The Local Organizing Board is coordinated by M. Cree. We are very grateful to all organisations and individuals working diligently to making this first World Congress for Integrative Medicine & Health in 2017 a great success.

We are also pleased to announce that the opening welcome will include the Director General for the World Health Organization, Dr Margaret Chan (on video). All plenary speakers are internationally recognized experts in the field of Complementary and Integrative Medicine such as Josephine B Briggs (US) and Merlin Willcox (UK) as keynote speakers for the theme traditional healing systems; Klaus Linde (Ger) and Michael Moore (UK) for the research theme; Lisa M Wong (US) and Töres Theorell (Sweden) will address the theme of arts and medicine; Darong Wu (China) and Jeffery A Dusek (US) are presenting on the theme of clinical care; and Aviad Haramati and David Eisenberg (both US) will close the Congress with presentations on education.

In addition, more than 100 oral presentations in over 40 parallel sessions will be in the program to provide newly emerging data from recent research projects, experiences from new treatment aspects in clinical care, descriptions of new models of education in medicine, information about integration of traditional healing systems in health care systems and new aspects on the integration of arts in medicine. In addition, more than 400 posters will be presented in guided poster sessions during the three days of the Congress.

To translate the congress goals and objectives into a tangible action for the field, a Berlin Agreement is being developed. With the title ‘Social and Self-responsibility in practicing and fostering Integrate Health and Medicine Globally,’ this document is meant to help shape the future of comprehensive patient care in Integrative Medicine, and addresses the responsibilities of all participants, including patients and citizens, physicians and all colleagues working in the healthcare system. The Berlin Agreement has been developed by the WCIMH 2017 congress presidents and the International Organizing Committee to create a document for further distribution to the scientific and clinical community and to health care stakeholders, decision makers, and politicians. We anticipate having the final version of the Berlin Agreement endorsed by a number of organizations prior to the Congress and also soliciting the support of congress at the WCIMH 2017 in Berlin. Our hope is that this document will provide an important impetus for further engagement world-wide after the Congress has concluded.

Immediately before the start of WCIMH 2017 on Wednesday May 3rd 2017 there will be several high-quality pre-conference workshops covering all congress topics. Reflecting the political situation in recent years, especially in Europe, we have arranged for a unique half-day workshop on the topic: “Refugees with Chronic Diseases between the Middle-East and Europe: The Role of Traditional and Integrative Medicine in Bridging Gaps”, The speakers are all from the Middle East and Europe and will address how Integrative Medicine may serve as an important element to overcome the problematic health situation of refugees around the world.

We are convinced that the field of Complementary and Integrative Medicine, including traditional healing systems and medicine and the arts, will benefit from The 2017 World Congress on Integrative Medicine & Health—a preeminent scientific international forum that is focused on highlighting advances in these thematic areas. We invite all practitioners, educators and researchers in the field of Integrative Medicine to come together, participate and engage together to make this Congress an exciting meeting for the successful advancement of Integrative Medicine across the globe.

I2 The Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally

April 5, 2017

Introduction

Faced by multiple challenges, including the rise of chronic, lifestyle related diseases, and grossly inequitable access to healthcare, we are committed to achieving the Sustainable Development Goals 2030 to foster healthy lives and promote well-being for all ages. We are part of a global movement to orient care, and the education, research and policy that support it, toward a model that draws on biomedical, complementary and traditional medicine practices and respects multiple philosophies. This approach to medicine and healthcare:

“ … reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing.”¹

Our work stands on that advanced in 1978 at the Alma-Ata Conference that mobilized a movement for primary healthcare for all and officially declared the importance of integration of effective traditional practices to promote global health. Today, the World Health Organization (WHO) advocates universal health coverage and integration of safe and effective traditional providers and complementary services into health service delivery, as well as self- care practices. These are key objectives of the WHO’s traditional medicine strategy 2014-2023. We also affirm our alignment with the declarations from Beijing in 2008 and Stuttgart in 2016 and fully support calls on governments and non-governmental agencies to adopt, support, fund, research and promote activities that advance evidence informed integrative care models.

With this Berlin Agreement we call on ourselves as individuals to engage, to the best of our abilities, in the following:

Model Health

Recognizing that our ability to impart and enhance health and well-being is not only performed by a social and professional health practice, but is also informed by our own self-care and resilience, we strive to model personal engagement in health-creating practices.

Engage Patients

Knowing that the most important strategy for fostering health is to engage patients in better lifestyle choices, we seek to develop our skills to activate patients to be self-responsible, to strengthen their resilience, and become captains of their own healing processes.

In respect for the importance of natural processes as guides for enhancing well-being, we educate and stimulate patient understanding of, and participation in, efforts to protect and sustain the natural environment.

Promote Interprofessionalism and Team Care

Knowing that no single type of practitioner has all the answers that can be useful to a given patient, we individually seek to develop quality relationships with members of other disciplines and professions to guarantee that we can quickly connect patients to the right services from the right practitioners and right professions at the right time;

Aware that such care may be provided via knowledge or practitioners from multiple global healing traditions, we personally commit to continuously broadening our understanding, awareness and engagement with other fields and resources.

Recognise the importance of traditional medicine in global healthcare

Given that traditional medical products, practices and practitioners are the main access to healthcare in most regions of the world, we highlight the importance of global investment to systematically develop best practices in these diverse systems that supports their safe and effective use and integration with biomedical practices.

Commit to Evidence-Informed Dialogue and Practice

Aware that a substantial portion of what is done in medicine and healthcare lacks a quality evidence base, we personally seek ever more effective ways to end polarizing dialogue and to stimulate collaboration in our collective ability to research, create and operationalize optimal evidence informed integrative care.

Foster Whole Systems Research

Committed to practices that respect the whole human being through use of diverse modalities and often through teams of practitioners, we personally champion development of methods, funding, and dissemination of research that address chronic diseases from multiple etiologies and treatments that often are best resolved through whole person and whole systems approaches.

Aware that questions related to cost are often an obstacle to the system-wide implementation of these models and thus access to these services, we will personally endeavor to support heightened focus on research that includes the economic dimensions of integrative models of care.

Stimulate Collaboration

Given the limitations and harm that can emanate for professions and stakeholders operating in isolation, we challenge ourselves individually, and within our own professional organizations and institutions, to commit to programs and projects that stimulate increased respect, collaboration and understanding across disciplines, traditions, professions, and stakeholders.

Bridge Clinical Care with Prevention, Community and Public Health

Knowing that clinical medical interventions represent but 10%–20% of the factors that shape the health of a community, we actively engage in creative methods to deepen the preventive and lifestyle dimensions of our individual practices while also connecting our practices and patients to community and public health resources.

Engage as Change Agents

Recognizing that imbalances in social, environmental, economic and political structures are major influences in the health of citizens, we seek to foster more equitable communities and societies.

To better empower our own work, we seek to expand our abilities to work closer and more constructively with other professions, government agencies, non-governmental organizations, private and not for profit businesses, patients and other stakeholders in advancing integrative health and medicine.

Through engaging these personal and social responsibilities, we will improve individual patient care and positively influence the preconditions of healthcare systems, locally and globally, to achieve optimal health and healing in the individuals, communities and planet we serve.

¹Definition of Integrative Medicine and Health. Academic Consortium for Integrative Medicine and Health (www.imconsortium.org)

This agreement was developed by the Congress Presidents (B. Brinkhaus (Germany), A. Haramati (USA), T. Falkenberg (Sweden) and S.N. Willich (Germany) with J. Weeks (USA) and the other members of the International Organizing Committee (A.M.N. Al-Bedah (Saudi Arabia), H. Boon (Canada), P.A. Caceres Guido (Argentina), M. Khalil (Saudi Arabia), M.S. Lee, (Korea), C.A. Lin (Brazil), J. Liu (China), E. Schiff (Israel), A. Steel (Australia), R. Street (South Africa) and K. Watanabe (Japan) of the World Congress on Integrative Medicine and Health 2017 in Berlin and is supported by several societies such as the e.g.

European Society of Integrative Medicine (EU)

Academic Collaborative for Integrative Health (USA)

Integrative Health Policy Consortium (USA)

Academy of Integrative Health and Medicine (USA)

Umbrella Association of Austrian Doctors for Holistic Medicine (AUT)

Association of Anthroposophic Physicians in Germany (Germany)

Interprofessional Organization for Anthroposophic Medicine (Germany)

German Physicians Society of Osteopathy (Germany)

International Society for Chinese Medicine (Germany)

German Physicians' Association for Ayurvedic Medicine (Germany)

The Society of Complementary Medicine in Israel (Israel)

German Association of Homeopathic Physicians (Germany)

Latin American Society of Phytomedicine (Latin America)

Argentine Council of Osteopaths - Registry of Osteopaths (Argentina)

First Ayurveda Health Foundation (Argentina)

Spanish Federation of Integrative Medicine (Spain)

as well as individual clinicians, researchers, educators and policy-makers.

Plenaries

Plenary session I

S1 The lessons from integrative medicine: sometimes less really is more

Josephine P Briggs

NCCIH, NIH, Bethesda, MD, USA

It is widely recognized that our health care system does too much of some things, and too little of others. Learning what actually works and for whom – finding the true balance between benefit and harm - is the charge to the biomedical research enterprise. Negative findings are as important a product of evidence-based medicine as the positives. Three examples will be explored: cancer screening, pain management, and end-of life care. Critical examination of common health care practices in these areas is yielding surprises; careful examination of data from observational studies and large scale randomized trials is frequently finding less benefit than expected (or even harm) of some drugs, widely used screening strategies, and other health interventions; and in some cases a more favorable benefit to harm ratio of gentle ‘old-fashioned’ approaches that come from outside the mainstream.

Nevertheless, translation of evidence into good care remains problematic. Increasingly it is understood that the answers will lie in part with greater patient engagement and shared decision making. Integrative medicine practitioners are defining an innovative style of practice that provides a model for greater openness to the patient’s voice. Health care decision making needs to more effectively marry the insights that come from evidence-based medicine with the individual values of each patient. Integrative practitioners tap into an interest of patients in greater involvement and often in less use of technology. While the input and expertise of the health care practitioner is essential for good care, so is an active, partnership with the patient and the flexibility to adapt to the patient’s concerns.

S2 Traditional medicine and primary healthcare in Africa

Merlin Willcox (Merlin.willcox@phc.ox.ac.uk)

Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Coxford Rd, Southampton 2016 5ST, UK

Background

It is often stated that 80% of the world’s population relies on traditional medicine for their primary health care [1]. However very few countries in Africa have attempted to integrate traditional and modern healing systems for the benefit of patients. On the contrary, traditional medicine has been widely discouraged and some practices even banned. We set out to investigate ways in which traditional and modern medical systems could better collaborate, for the benefit of patients.

Methods

Surveys were undertaken in Mali, Uganda and Ethiopia of treatments used by patients for febrile illnesses, and associated outcomes. In Mali, we selected the plant associated with the best outcomes for further clinical research using a “reverse pharmacology” approach [2], in order to develop an improved traditional medicine. In Mali and Uganda, the “confidential enquiry” methodology was used to investigate maternal, perinatal and child deaths in a total of 10 subdistricts over 3 years. Local panels analysed how deaths could have been avoided by improvements in both traditional and modern medical systems, and made recommendations to this effect.

Results

Prevalence of use of traditional medicine for febrile illnesses varied widely, from 0% in the Apac district of Uganda, to 60% in the Sikasso area of Mali [3]. Of 66 plants traditionally used in Mali, Argemone mexicana was the only one systematically associated with clinical recovery. This was further investigated in a dose-escalating trial [4], and then in a randomised controlled trial [5]. Its use has since increased. The confidential enquiry revealed that traditional healers and traditional birth attendants had been involved in the care of 15% of children who had died (ranging from 5% to 36% in different districts), whereas official health centres and hospitals had been involved in 58% of cases in Mali and 49% in Uganda. The majority of children who had consulted a traditional healer had not been referred in a timely manner. Training courses were organised to improve recognition and referral of severe illnesses.

Conclusions

In Africa, usage of traditional medicine in primary care is still prevalent, at least for febrile illness in children, including illnesses which are eventually fatal. The “reverse pharmacology” approach facilitated the development of an evidence-based improved traditional medicine in Mali, which became more widely used. The “confidential enquiry” approach engaged both traditional and modern practitioners together in a discussion of what could be done to reduce childhood deaths.

References

1. Bannerman R, Burton J, Wen-Chieh C. Traditional Medicine and Health Care Coverage. Geneva: World Health Organisation; 1983.

2. Willcox M, Graz B, Falquet J, Diakite C, Giani S, Diallo D. A "reverse pharmacology" approach for developing an anti-malarial phytomedicine. Malaria Journal. 2011;10(Suppl 1):S8.

3. Diallo D, Graz B, Falquet J, Traore AK, Giani S, Mounkoro PP, et al. Malaria treatment in remote areas of Mali: use of modern and traditional medicines, patient outcome. Trans R Soc Trop Med Hyg. 2006;100(6):515-20.

4. Willcox ML, Graz B, Falquet J, Sidibe O, Forster M, Diallo D. Argemone mexicana decoction for the treatment of uncomplicated falciparum malaria. Trans R Soc Trop Med Hyg. 2007;101(12):1190-8.

5. Graz B, Willcox ML, Diakite C, Falquet J, Dackuo F, Sidibe O, et al. Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy and public-health implications. Trans R Soc Trop Med Hyg. 2010;104(1):33-41.

Plenary session II

S3 Evidence of effectiveness but not efficacy - why many complementary therapies are so hard to accept for biomedicine

Klaus Linde (klaus.linde@tum.de)

Institute of General Practice, Technical University Munich, Munich, Germany

While the integration of complementary therapies into health care practice continues to progress in many countries, the scientific and academic debate on many of these therapies seems to heat up again in the last decade after a period of relative openness. Interestingly, both those attacking and defending complementary medicine claim that their view is evidence-based. In my presentation I will try to analyze important reasons why there is so much, often fierce debate.

Using acupuncture and homeopathy as examples I will show how the same evidence is sometimes interpreted completely different. The more controversial the topic, the more interpretation is shaped by the influence of prior beliefs, personal preference of different types of evidences, previous knowledge and experience. The main problem for the acceptance of many complementary therapies is not the lack of evidence that patients benefit but weak theoretical foundations (leading again to stronger demand of proof of specificity). I will explain why “specificity” is such a crucial tool for demarcation of the unacceptable, both for science and the medical profession. At the same time, many of these “intellectual” problems do not seem to be relevant in the pragmatic reality of everyday practice.

In my view there are two important consequences of these considerations: 1) a public debate is needed whether “scientific nonsense” could be effective in practice – and if so, whether it should be reimbursed by public health insurance; 2) there is a strong need for more research on how complementary therapies work, but this research should not take the often naïve and mechanistic theoretical concepts of these therapies as granted.

Plenary session III

S4 Arts in health promotion

Töres Theorell^1,2

¹Department of Neuroscience, Karolinska Institute, Stockholm, Sweden; ²Stress Research Institute, Stockholm University, Stockholm, Sweden

Arts (music, writing, dance, visual arts and theatre) have a strong potential in health promotion. Health can be defined in many ways, ranging from strict absence of medical conditions to well-being in a wide social sense [1]. When we discuss musical experiences, flow is potentially a central concept in health promotion. The flow concept is particularly applicable to music performance. When a subject has practiced a difficult music piece and is finally able to perform it well, a high level of arousal and at the same time a high degree of elation arises. Our own experiments indicate that this state is associated with a concomitant activation of the sympathetic and parasympathetic systems. A subject who is allowed to have these rare experiences repeatedly collects flow experiences which add to a high quality of life. This would correspond to life-long flow capital. Flow experiences can arise in several domains, in sports, while performing theatre, while giving a lecture etc. According to our theory flow experiences add importantly to quality of life.

Alexithymia, inability to differentiate, describe and communicate feelings, is a central concept in psychosomatic medicine. Our research has shown that competence in arts is associated with a good ability to handle emotions. Each one of the artistic skills (see above) adds statistically to emotional ability and there are also additive effects. Since alexithymia has an established role in early stages of hypertension, burnout syndrome and abuse of alcohol these relationships are of importance to health promotion. However, our twin research has shown that a large part of the relationship between musical practice and alexithymia is genetically determined [2,3]. Therefore relatively large controlled intervention studies are required in order to establish health effects of musical experiences. An RCT study, the Culture Palette study, performed on health care centres in Stockholm, showed that cultural activities organized for women with burnout syndrome for three months twice a week were followed by improved burnout and alexithymia scores which were not seen in the control group [4]. The alexithymia changes were even more pronounced three months after the cultural intervention than immediately after the end, findings which may indicate that health promotion processes have started. Efforts to stimulate cultural activities should start in childhood [5].

References

1. Theorell T: Psychological Health Effects of Musical Experiences: Theories, Studies, and Reflections in Music Health Science Dordrecht, Netherlands: Springer, 2014

2. Theorell TP, Lennartsson AK, Mosing MA, Ullén F. Musical activity and emotional competence - a twin study. Front Psychol. 2014 Jul 16;5:774. doi: 10.3389/fpsyg.2014.00774.

3. Lennartsson AK, Bojner Horwitz E, Theorell T and Ullén F (2017) Lack of creative artistic achievement (writing, music, dance, theatre, visual arts) is related to alexithymia. Creativity Research Journal. In press 2017

4. Grape Viding C, Osika W, Theorell T, Kowalski J, Hallqvist J and Bojner Horwitz E (2015) ”The Culture Palette” a randomized intervention study for women with burnout symptoms in Sweden. Brit J Med Practitioners 2015; 8(2):a813

5. Theorell T, Lennartsson AK, Madison G, Mosing MA, Ullén F. Predictors of continued playing or singing--from childhood and adolescence to adult years. Acta Paediatr. 2015 Mar;104(3):274-84. doi: 10.1111/apa.12870

S5 Healing the community through the arts: framing and reflections

Lisa M. Wong (lisamwong@gmail.com)

Arts and Humanities Initiative, Harvard Medical School, Boston, MA 02115, USA

The arts are an essential element of human life that foster health, wellness and balance. Through the arts, the relationship between practitioner and patient can be affirmed and deepened. The arts in medicine focus on the whole person, making use of several therapeutic approaches: through dance, individuals living with movement disorders enhance their flexibility with grace and confidence; through mask-making, wounded veterans find a voice as they struggle with PTSD.

Integrating the arts into the practice of medicine presents an exciting new intersection of fields. Important new questions emerge. What is the role of the physician musician? How can the experience and knowledge of music therapist, neuroscientist and physician best be utilized to institute a personalized care plan for the patient? What does evidence-based practice look like through the lens of the artist in healthcare settings?

Caregivers and healthcare providers in training also benefit from the integration of the arts into their practice. Narrative medicine encourages healthcare providers to understand their own story, as well as the patient’s story, beyond the diagnosis. Looking deeply at art in the museum enhances observation skills, critical thinking, and communication. Analyzing, playing and listening to music invites deeper reflection and analysis of complex diagnoses.

Join the growing number of physicians, musicians, therapists, neuroscientists, and patients who are embracing the arts as a critical aspect of integrative medicine. Together we will pave the way forward, discover new parallels, learn from each other, and ultimately improve the way we care for our patients and each other.

Plenary session IV

S6 Integrating complementary and integrative health therapies into US hospitals – the role of practice based research in guiding the field

Jeffrey Dusek

Psychosomatic medicine, Neuropsychology, Allina Health, Minneapolis, MN, USA

Consumer demand for complementary and integrative health (CIH) therapies continues to grow in the United States (US). As a result, about 15 years ago, several US health systems were early adopters in the inclusion of CIH therapies into hospital settings. Several randomized controlled trials provided initial evidence that specific CIH therapies (e.g., acupuncture) were efficacious for relief of symptoms (e.g., pain) in certain hospitalized patient populations (e.g., post-surgery). Additional studies suggested that the CIH therapies were safe for these patients. While results of the randomized trials were important, translation of these results into clinical practice has been challenging due to the fact that neither health care administrators, nor clinical providers are aware of which CIH therapy would be most effective for specific condition relief in specific patient populations. An important question being asked is: can the right patient be provided the right CIH therapy for the right symptom relief outcome? This presentation will include a description of the development and evolution of one early adopter model for the integration of CIH therapies services into a US hospital setting. The presentation will also include results from a large National Institutes of Health practice based research evaluation in the early adopter model to explore the effectiveness of different CIH therapies on pain in varied clinical populations. The presentation will detail lessons learned from these experiences that will provide health care system administrators and clinical providers with guidance for efficient delivery of CIH therapies in US hospital settings and perhaps across the world.

S7 Integrating CAM into hospital care: prospectives from China (Abstract ID 220)

Darong Wu

2nd Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China

Objective

The integration of traditional Chinese medicine(TCM)and western medicine in China was initiated more than a century ago. Since early 1950s, TCM as one of the important component of complementary and alternative medicine (CAM), has been integrated into hospital care, including inpatients"medical services, due to several practical reasons, e.g. China"s health policy, Chinese traditions, patient"s promises and claims, etc.

Methods

There are mainly two types of model in terms of integration TCM into inpatient/hospital settings in China, (1) Disease-based model, which has been adopted in most of the western medicine hospitals, especially in the departments of cardiovascular disease, tumor disease, or other rehabilitation related diseases, or virus infection diseases; (2) Pattern diagnose-based model, usually is applied in the hospitals of integrative medicine or TCM medicine. Despite the types of model, more and more physicians and other health care professionals realize that it is important to help the patients to make informed health care decision during the integration procedure. And it shall combine the management methods which have been successfully applied in hospital operation, including clinical pathways and lean management.

Results

Clinical pathways has been adopted to efficient the progress of integrating TCM into inpatient services since 2002 in China. Researches found that it might help to reduce the length of stay, to maintain the cost within a reasonable range, and would still keep the quality of medical services in the same or even higher levels. The ideas of evidence-based practice, patient-informed decision,etc, have been embodied, while we would not ignore any "unexpected" outcomes from clinical practiceswhichmight be "new" ideas for further researches orfuture evidences.

Discussion

ntegrating TCM into inpatient services has six-decade history in China, any further development in this area may face both opportunities and challenges ahead.

Keywords: Integration, Complementary and Alternative Medicine (CAM), Traditional Chinese Medicine (TCM), Hospital Care, China

Plenary session V

S8 Nutrition and lifestyle education in an era of obesity and diabetes – might “Teaching Kitchens” serve as catalysts of personal and societal transformation?

David Eisenberg

Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, MA 02115, USA

To address dramatic global increases in obesity, diabetes and other lifestyle-related diseases, the medical establishment must invent and experiment with novel approaches whereby patients – and caregivers as role models – learn to eat, cook, move and think differently.

As a result of this presentation, participants will:

• Review trends in obesity, diabetes and other lifestyle-related chronic diseases in the US and globally

• Be introduced to the conceptual construct of a “Teaching Kitchen”. This includes educational approaches which combine: (1) nutrition education, (2) hands-on culinary instruction, (3) mindfulness training, (4) enhanced movement and exercise, and (5) optimal behavior change strategies including health coaching

• Appreciate the unique role played by mindfulness in these curricula

• Learn about Teaching Kitchen prototypes being developed and evaluated at universities, medical schools, hospitals, corporate workplaces, colleges, K-12 schools and community settings across the US, Europe and Asia

• Envision future models of medical education and healthcare delivery which focus on both: (a) “salutogenesis”, the creation and maintenance of health and wellness, in combination with (b) “pathogenesis”, which typically focuses on disease diagnosis and treatment, in an effort to enhance public health and reduce total healthcare related expenditures

• Be introduced to the recently established “Teaching Kitchen Collaborative” which includes more than 30 institutions with Teaching Kitchens, all of whom are committed to (a) establishing best practices; (b) developing shared research strategies; and (c) participating in multi-site studies to assess the clinical and financial impact of these emerging models

S9 Addressing chronic stress and burnout in health professionals: the educational imperative for incorporating mindfulness for self-care

Aviad Haramati

School of Medicine, Georgetown University, Washington D.C., United States

Recent reports suggest that chronic stress and burnout among physicians are pervasive problems and cause for concern. More than half of all physicians in the United States experience some element of burnout, and this can lead to changes in the patient-provider relationship and adversely impact on the quality of care. In some specialties, the rates are even higher. This trend may begin earlier with the observed decline in empathy during medical student training and the alarming rates of burnout in medical and other students in the health professions. In response, various groups are developing interventions with medical students, residents and faculty to address the rise in burnout and the decline in professional resiliency. Keys to this work are themes of self-awareness, mindfulness and exploring domains of control and meaning in the clinical encounter. In this plenary presentation, Dr. Haramati will review published outcomes on interventions using mindfulness approaches to reduce stress and burnout and improve wellbeing. A physiologic framework will be provided to explain why mindfulness appears to be effective. He will also share his perspective on why it is essential to incorporate mind-body techniques into the training curriculum for all health professionals—something that will require both skill and courage.

Pre-workshops

Research

A1 Qualitative research methods in complementary and integrative medicine

Bettina Berger (bettina.berger@uni-wh.de)

Department of Health, University of Witten/Herdecke, Witten/Herdecke, Germany

This workshop will give an insight in qualitative research methods for complementary and integrative medicine, teach how to reflect quality criteria of qualitative research methodology and try different ways to interpret data to know more about the diversity of qualitative methodologies.

A2 Getting your work published – tips from editors

Kathi Kemper (kathi.kemper.md@gmail.com)

OSU, Blacklick, OH, United States

This will be an interactive session led by three editors from prominent CAM journals – BMC CAM, Complementary Therapies in Medicine, and Journal of Alternative and Complementary Medicine. The pros and cons of submitting to different journals, the availability and recommended use of writing guidelines from the EQUATOR network will be reviewed and the participants will be offered a simple, hands on approach to writing a journal article without getting bogged down in writer’s block.

A3 Horizon 2020 – networking and creating working groups

Beate Stock-Schröer¹, Hedda Sützl-Klein²

¹Carstens-Foundation and FORUM, D-45276 Essen, Germany; ²ESIHR (European Society for Integrative Health Care), A-1070 Vienna, Austria

Correspondence: Hedda Sützl-Klein (hedda.suetzl-klein@aon.at)

During the preconference of 12th WCIMH (World Congress Integrative Medicine & Health 2017)/10th ECIM (European Congress of Integrative Medicine) a Horizon 2020-Networking Workshop will offer researchers and potential participants of Horizon 2020-projects the opportunity to network, share information and create working groups for research proposals involving integrative medicine and multimodal approaches. The workshop was initiated by DDr. Hedda Suetzl-Klein and Dr. Beate Stock-Schröer with support from researchers of the FORUM research network (Forum universitärer Arbeitsgruppen für Naturheilverfahren und Komplementärmedizin: http://www.uniforum-naturheilkunde.de).

Background and goals

Complementary and integrative medicine is supposed to provide opportunities for highly personalised medicine and other challenges of the specific programme „Health,

Demographic Change and Well-being” of Horizon 2020, the “EU Framework Programme for Research and Innovation” from 2014 – 2020. The goals of this pre-conference workshop are to analyse the current (and upcoming) work programme, to discuss potential topics of research and to build working groups for Horizon 2020 proposals. As well as defining topics, networking is a major aim, in order to form appropriate teams to formulate research proposals and increase the number of promising EU-projects (Horizon 2020-research projects) involving integrative medicine issues and multimodal approaches.

Speakers and working group leaders

Dr. Wolfgang Weidenhammer (KOKONAT-TU Munich, CAMbrella project coordinator) will analyse work programmes and current developments, Dr. Pierre Madl (University of Salzburg, participant in 3 FP7 research projects: CATO, Bridge, NanoValid) will share experience and lessons learned from former applications and successful EU-research projects.

To build working groups for Horizon 2020 applications, the researchers are supported by Prof. Dr. Jost Langhorst (University of Duisburg-Essen, Department of Internal and Integrative Medicine, Kliniken Essen-Mitte), Dr. Wolfgang Weidenhammer (KOKONAT-TU Munich), Prof. Dr. Roman Huber (University of Freiburg, Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, focussing on: prevention and treatment of chronic diseases), PD Dr. Kristjan Plaetzer (University of Salzburg: AMR and antimicrobial strategies based on natural resources), Doz. Dr. Alexander Haslberger (University of Vienna: Epigenetically active nutrition in integrative medicine therapies and prevention) and Dr. Pierre Madl (University of Salzburg: Integrative medicine, health & biophysics).

Clinical care

A4 Integrated Cchronic Care Model and diabetes: the project as implemented within the Center of Integrated Medicine of the Hospital of Pitigliano

Rosaria Ferreri (tyvvf@tin.it)

Hospital Centre of Integrated Medicine, Hospital of Pitiglian,o ASL SudEst Toscana, Grosseto, Italy

The care of people with diabetes is, all over the developed world, and now, even in countries in the developing world, one of the main problems of organization of systems of health protection. This goes far beyond the meaning of the care of a single disease, but rather is almost a paradigm of the Chronic Care Model, which, in most companies in the world, it is epidemiologically prevalent today. The challenge of this project is to develop an integrated protocol including Homeopathy and Phytotherapy to evaluate how, where and when it is possible to introduce the integrated protocol in the course of the CCM Diabetes. Proposals has been accepted by the chief of Medicine Department of the Hospital of Pitigliano. We are going to study different categories of diabetic patients included in the project:

• 1) Patients that have high value of emoglobina glicata, despite their anti diabetic oral therapy;

• 2) Patients that suffer from comorbidities (that could have influenced their metabolic status and the course of their diabetes)

We have approached the patients, collecting their informed consent, and establishing the integrated protocol to be adopted in each of the two categories. The protocols include:

• an homeopathic remedy

• a phytotherapy compound, made of two plants extracts

A group of 20 diabetic patients have been enrolled, ten of them were affected by diabetes and other ten have comorbidities; for each of them, we have collected data related to: blood sugar level, glycated haemoglobin, renal and hepatic function, blood pressure, (other parameters that will be included in a second phase of the project). To each of them we have given: a Questionnary (as SF12) for the quality of life and ADL skills for daily ability; we have also used EDMONTON scales for the assessment of symptoms and a CARD for the consumption of conventional drugs, to monitoring the use of antidiabetic drugs.

Results and discussion

We describe:

• A new organisational model, which includes new roles and new functions.

• A new common pathway.

• How to identify proactive patient using risk stratification tools.

• How we have improved hospital infrastructure, which supports sharing information and patient monitoring.

A common set of shared objectives and indicators linked to health outcomes and process improvement have been adepte and we"ll show the results in terms of:

• Ameliorating QoL: from 68 to 85% of them declare improvements in the general health feelings

• Improving HB glycate value : in 12 weeks have been improved about - 10%-

• Reducing use of conventional drugs: preliminary data will be shown

A5 Phyto-nutrition and diabetes

Rosaria Ferreri (tyvvf@tin.it)

Hospital Centre of Integrated Medicine, Hospital of Pitigliano, ASL SudEst Toscana, Grosseto, Italy

Introduction

Managing blood glucose and preventing complications in diabetes care are important goals for anyone with this chronic disease. Nutrients present in various foods play an important role in maintaining the normal functions of the human body and some phytonutrients help to lower blood glucose. Others protect insulin-producing cells in the pancreas from oxidative damage. But where can we get these nutrients? The best challenge is to have them through a studied diet, not only based upon calories and nutrients, but also taking in account the so called phyto-nutrients. That also why, recently, vegeterian regimen has been proposed to be the best to cope with diabetes.

Materials and methods

Phytonutrients are the plant nutrients with specific biological activities that support human health. Due to the fact that some of these nutrients have a great and recognized role in the help of chronic conditions, as diabetes is, we have tried to include them in the composition of an ideal diet, not based upon the energetic values but on phytonutrients and their ORAC value.

Discussion

Well show the composition of an ideal diet for patients with diabetes, that could be more helpful in the control of hyper insulinism and also in the control of oxidation process. We propose our rationale for the choice of foods and their distribution during the day, based upon the best research in the field of plant-derived preparations, such as pomegranate seed oil[1], grape skin extract [2], blood orange extract [3] barley b-glucan [4], anthocyanins from cherries [5], and green tea (2)-epigallocatechin-3 [6]. We also show that this strategy is also comparatively cheap, easy to be used by aged people and could significantly reduce health care costs.

Bibliography

1. Vroegrijk, I.O et al. -2011- Pomegranate seed oil, a rich source of punicic acid, prevents dietinduced obesity and insulin resistance in mice. Food Chem. Toxicol. 49: 1426–1430

2. Hogan, S. et al - 2011-. Dietary supplementation of grape skin extract improves glycemia and inflammation in diet-induced obese mice fed a Western high fat diet. J. Agric. Food Chem. 59: 3035–3041

3. Titta, L., et al. -2010-. Blood orange juice inhibits fat accumulation in mice. Int. J. Obes. (Lond.) 34: 578–588

4. Choi, J.S et al – 2010- Consumption of barley beta-glucan ameliorates fatty liver and insulin resistance in mice fed a high-fat diet. Mol. Nutr. Food Res. 54: 1004–1013

5. Jayaprakasam, B. et al - 2006- Amelioration of obesity and glucose intolerance in highfat-fed C57BL/6 mice by anthocyanins and ursolic acid in Cornelian cherry (Cornus mas). J. Agric. Food Chem. 54: 243–248

6. Lee, M.S et al – 2009 - Green tea (-)-epigallocatechin- 3-gallate reduces body weight with regulation of multiple genes expression in adipose tissue of diet-induced obese mice. Ann. Nutr. Metab. 54: 151–157

A6 A comprehensive integrative approach to the management of chronic pain

Gary Kaplan

The Kaplan Center for Integrative Medicine, Georgetown University, McLean, VA, United States

“Chronic pain” and “depression” are not actionable diagnoses; they are, instead, symptoms of a neuroinflammatory disease of multiple and compounding aetiologies. Exploring the proposal that accepted medical practices often fail to help chronic pain sufferers because they have been based on a fundamental misunderstanding of the illness itself, the goal of this workshop is to understand the pathophysiology of chronic pain and depression according to a neuroinflammatory model as well as the multiple aetiologies of neuroinflammation.

The participants will learn how to take a comprehensive, chronic-pain history according to the neuroinflammatory model of chronic pain and, based on that, create an integrative treatment.

A7 Visit of Gemeinschaftskrankenhaus Havelhoehe: Anthroposophic medicine in workaday life for patient centred care in a capital town (8.30-12.00 a.m, half day)

Harald Matthes

Hospital Havelhöhe, Berlin, Germany

On this excursion the participants will experience the concept of the Anthroposophic Clinic “Havelhoehe” and get to know practical integrative concepts. The program includes a guided Visit in different (optional) fields: a) From the intracardiac catheter to the Heart school (life style modification) b) Integrative Oncology in a certified oncology centre (OnkoZert) c) Integrative Pain Unit d) Integrative Psychosomatic Medicine e) Integrative Concepts of functional diseases (IBS) f) The Self-Governing Concept of the Clinic.

Time: 8.30 am - 12.15 pm (including bus transfer)

A8 Introduction to osteopathic medicine – a hands-on workshop

Gabriele Rotter (gabriele.rotter@charite.de)

Institute for Social Medicine, Epidemiology and Health Economics, Charité University Hospital, Berlin, Germany

This workshop offers an introduction to osteopathic medicine and is intended for medical students and medical doctors with few or no knowledge in osteopathic medicine. The participants should learn basic osteopathic principles, their indication and contraindication as well as the integration of osteopathy into the overall treatment strategy of a patient. During the hands-on part of the workshop participants are given a practical demonstration of basic examination procedure with special emphasis on palpation, as well as selected treatment techniques.

Education

A9 Implementing skills from hypnosis and touch therapies to improve doctor-patient communication

Elad Schiff¹, Zahi Arnon^2,3

¹Internal medicine and Complementary medicine service, Bnai Zion Medical Center, Haifa, Israel; ²Complementary-Integrative Surgery Service, Bnai Zion Medical Center, Haifa, Israel; ³The Emek Yezreel Academic College, Yezreel Valley, Israel

Correspondence: Elad Schiff

Currently, education toward optimal physician-patient communication does not take into account the impact of positive and negative suggestions on health and disease. Moreover, there is vast evidence in the medical literature that such suggestions can trigger placebo, or nocebo effects respectively. As an example, saying to a patient "here are your pain pills" implies that the patient owns the pain (nocebo), whereas "here are medications that will help you reduce pain, and increase your comfort" activate patient empowerment and control over pain (placebo). Implementing fundamentals of hypnosis to suggestions embedded in communication with patients can tremendously improve the outcomes of such encounters.

Hypnosis is a mind-body technique aimed to activate innate healing forces by using words with positive suggestions as well as non-verbal communication such as touch. The effect of hypnosis is thought to occur best in a "trance state" where the sub-conscious mind is more receptive to suggestions, which are conveyed to the nervous & immune systems. In contrast to the common belief that hypnosis requires patients to be calm and relaxed, hypnotic trance due to stressful health conditions is very common. Actually, patients are in spontaneous trance state during most encounters with physicians. Hypnotic trance places patients in a state-of-mind where they are highly influenced by suggestions- for the good (placebo), and for the bad (nocebo). Consequently, physicians could learn how to activate patient's healing forces by using the correct suggestions in verbal and non-verbal communication (i.e. touch and body gestures), based on fundamentals of hypnosis. The workshop will introduce health-providers and medical students to hypnotic based communication that potentiates the healing capacity of patients. Videos of real patient-physician encounters as well and vivid demonstrations, and hands on techniques to improve physical exam skills, are built in the workshop.

A10 Developing pre-residency core entrustable professional activities in integrative medicine: a skills-based workshop for medical educators and students

Eckhard Hahn (eckhart.hahn@uk-erlangen.de)

Medicine I, University Hospital Erlangen, Erlangen, 90154, Germany

The goal of this workshop is to provide the participants with a hands-on opportunity to create core Entrustable Professional Activities (EPAs) in integrative medicine for trainees entering residency and post-graduate training. EPAs are becoming an important part of outcomes based education and are increasingly looked at being essential in preparing students for graduate medical training. This workshop will build on precourse assignments, start with an interactive summary of this knowledge and will then shift to experiential as we create the opportunity for participants to work in groups and develop team-based core EPAs in integrative medicine that include interprofessional practice.

Outline of Workshop

• 1. Participants introduce themselves 5 min.

• 2. Workshop Activity: 20 min. Q&A 5 min

How to develop a team-based EPA – interactive summary of precourse assigment.

• 3. Work in small groups with facilitator: Creating a blueprint for team-based EPAs in Integrative Medicine. 30 min.

• 4. First patient encounter

• 5. Self-care

• 6. Treatment plan (a patient with breast cancer)

Coffee break 15 min.

• 4. Experiential learning of IM-EPAs: team-based practice. 30 min.

• 5. A simulated IM patient encounter

• 6. A simulated self-care session (patient with breast cancer)

• 7. A simulated assessment session of IM-EPA (treatment plan for patient with breast cancer).

• 8. Debriefing – later letters. 15 min

Total time 120 minutes

Precourse assignment:

• 1. Integrative Medicine in the Continuum of Medical Education;

• 2. Entrustable Professional Activities (EPAs) - especially core EPAs for entering residency;

• 3. Interprofessional aspects of Integrative Medicine (the team-based approach).

A11 Differentiating the psychological and physiological mechanisms of relaxation versus mindfulness: an experiential workshop and clinical implications

Christina M. Luberto (cluberto@mgh.harvard.edu)

Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA

Mind-body therapies, used to treat a variety of stress and pain-related conditions, often include the use of both relaxation techniques and mindfulness exercises. Relaxation techniques are interventions such as progressive muscle relaxation and diaphragmatic breathing that are intended to alter physiological and emotional states by eliciting the relaxation response. Mindfulness techniques, which can be taught using stand-alone exercises (e.g., mindful breathing, mindful sitting) or formal mindfulness-based interventions (e.g., Mindfulness-Based Stress Reduction), are intended to promote present moment awareness and acceptance as a way of enhancing self-regulation. Thus, there is a distinct difference in both the intention and, ultimately, the psychological and physiological mechanisms associated with these two approaches - which have important implications for informing clinical practice. Unfortunately, over time, the term “mind-body therapies” has become synonymous with both the use of relaxation therapies and mindfulness techniques, thereby obscuring these critical differences.

Therefore, the primary purpose of this workshop is to provide participants with a deeper understanding of the differences in the psychological and physiological mechanisms associated with relaxation versus mindfulness techniques, using a combination of experiential exercises and brief didactics. Four relaxation and mindfulness exercises (20-30 minutes each) will be used throughout the workshop to allow participants to experientially learn the difference between these two approaches. Each exercise will be followed by paired and/or group discussions to provide opportunities for processing and reflection. Three didactics will be interspersed throughout the workshop in order to supplement the experiential exercises: (1) theoretical/conceptual similarities and differences between relaxation and mindfulness approaches; (2) extant research documenting differences in psychological and physiological mechanisms and outcomes between these approaches; and (3) implications for clinical practice and research settings. Case examples will be used to exemplify when relaxation versus mindfulness training would be most clinically indicated based on evidence-based recommendations. This session deserves to be included in the program because it provides a depth of theoretical and practical knowledge that can help clinicians and researchers alike more accurately differentiate between types of mind-body practices to select interventions best suited to their clients’ needs. This level of nuance, comparing and contrasting specific mind-body approaches, is also an important next step for moving the field of mind-body medicine forward.

A13 Meditation and medicine – investigating the underlying laws and forces

David Martin, Silke Schwarz

Children’s Hospital, University of Tübingen, Tübingen, 72076, Germany

Correspondence: David Martin (david.martin@med.uni-tuebingen.de)

Meditation is increasingly becoming a relevant health factor: What do students and physicians need to know? What are the underlying factors and „natural laws“? What actually happens during meditation? This experiential workshop focuses on the different types of meditation and what they can do for students, physicians, medical personnel and patients.

A14 Developing clinical clerkships in Integrative medicine

Diethard Tauschel

Integrated Curriculum for Anthroposophic Medicine, Faculty of Health, University of Witten/Herdecke, Herdecke, Germany

In this workshop the participants will discover possibilities and problems in establishing, conducting and sustainably developing clinical clerkships in Integrative Medicine (IM). This will include aspects of curriculum development like needs assessment, finding and setting adequate goals, learning objectives and the use of feedback and evaluation.

Participants will be given an overview about the opportunities and challenges of IM clerkships, examples from 12 years of experiences of establishing and conducting IM Clerkships within the Integrated Curriculum for Anthroposophic Medicine.

Traditional healing systems

A15 Herbal medicine research: from margins to mainstream

Andrew Flower

University of Southampton, Southampton, SO16 5ST, United Kingdom

This pre-congress-workshop allows the participant to explore different research methods used to investigate herbal medicines as done at the University of Southampton.

The key domains of herbal medicine research such as quality control, batch consistency, the importance of stabilising levels of known active compounds, interactions with pharmaceuticals, model validity, and herbal pharmacokinetics will be considered.

Besides, the idea is to develop a model for future research into herbal medicines that can incorporate a properly phased, iterative programme of research that will optimise both pragmatic rigour and the clinical relevance of these investigations.

A16 Cost and health benefits from integrating new age Ayurveda into European health systems

Harsha Gramminger^1,2

¹Euroved GmbH, Bell, Germany; ²European Ayurveda Association, Bell, Germany

General Health Costs are spiraling in all developed and developing nations of the world. In 2013, Germany spent almost € 315 billion on health. This was an increase of about € 12,1 billion compared to 2012 : 3910,00 € in 2013 vs. 3770,00 € in 2012 per inhabitant.

Type 2 Diabetes, Obesity, Hyperlipidemia, Hypertension & Other “civilization” diseases are the main factors for these costs. With over 8 million sufferers (in 2009 and growing), Diabetes Mellitus is one of the most widespread diseases in Germany. Serious “secondary complications” and “associated diseases”/co-morbidities include heart attack, stroke, athlete’s foot etc. Total costs € 3.817.00 includes three components: Direct - disease (), Indirect () & associated complication () Obesity is another new global epidemic and set to become the “number one health problem globally” by the year 2025. In 2013 52% of all Germans were overweight, which is about 42.02 Million people! The associated conditions include: Type 2 Diabetes, Hypertension, Vascular diseases, Stroke, Coronary heart disease, Gall stones, Cancer, Sleep Apnea Syndrome, Diseases of the joints and of the skin and more. Clinical and practical experience is proven, that Ayurveda is able to improve the condition of both Type 2 diabetes and Obesity. Furthermore it is able by its lifestyle guidance and preventive holistic approach, to reduce and avoid follow – up diseases and costs. The presentation will show with facts and figures how the wisdom of Ayurveda can be followed for the New Age to prevent, manage and cure such diseases. Figures for savings to the European Health care costs will be presented and discussed. The presentation will show with facts and figures how the wisdom of Ayurveda can be followed for the New Age to prevent, manage and cure such diseases. Figures for savings to the European Health care costs will be presented and discussed.

A17 Ayurvedic herbs in modern times

Hedwig H Gupta (info@dr-gupta.de)

Private Medical Practice, Ludwigsburg, 71638, Germany

Ayurveda is an Asian Medical System with a history of more than three thousand years.

Through the centuries, as documented by ayurvedic texts, the materia medica kept changing slightly as new plants were described and added. But all in all the system stayed stable as the population using ayurvedic herbs grew only slowly and the usage of ayurvedic plants was confined mainly to southern Asia.

With the globalization of medical systems and the development of modern life Ayurveda faces tremendous changes which give rise to many questions that will be discussed in this presentation as: How can Ayurveda be practiced if more and more people use its herbs? Many classically described herbs are grown in the Himalayans or other areas of a very specific climate. Is it feasable and sensible for the whole world to use these plants? What effects do environmental changes, industrial agriculture of herbs and pollution have on the quality of herbs? How can locally grown plants be understood and integrated in a modern and ecologically correct ayurvedic therapy?

A18 West meets east - differences in general attitudes between European and Indian Ayurveda-patients

SN Gupta^1,2 (guptayurveda@yahoo.com)

¹Kayacikitsa (PG) Department, J. S. Ayurveda college & P.D. Patel Ayurveda Hospital, Nadiad (Gujarat), India; ²Academic advisory board, European Academy of Ayurveda, Birstein, Germany

Human behavior is always influenced by sociocultural environments. This is applicable also for patients, particularly regarding their attitude towards their disease, its treatment, their health service providers and co-patients. With a growing popularity of Ayurveda, contacts of European patients with Ayurvedic doctors are also growing. Socio-cultural differences may cause bilateral difficulties, often in the form of a cultural shock. To develop a physician-patient rapport, it is essential for the physician to understand these aspects, in which European patients differ from their Indian counterparts.

The article is not based on a scientific research, but on a 20 years’ observation in treating a great number of European patients in India and in Germany.

Faith and evidence

For Indians faith in the system is prime. For them the tradition of thousands of years is not challengeable. While in the West, an evidence based rational approach is the dominant factor. Decisions and actions are less emotionally driven as in Indians. Religious and spiritual beliefs play important roles in the context of healing for Indian patients, while Europeans expect scientifically evaluated therapies.

Individuality and relationship

Familial and social bonds in India are very strong therefore family members or close friends of a patient take care of the basic needs even a decision about treatment. While In the West, since the individuality is dominating, usually patient has to look after himself together with a decision about the treatment.

Disclosing ability

Western patients are very good in disclosing and explaining their problems, which is helpful for the physician. While in India, certain aspects of life, though very important e.g. sex, are still taboos.

Privacy

If European patients tend to respect other patients’ privacy and not embarras them by intervening while Indians, when upset, generally value people showing concern.

Accuracy

Europeans expect accuracy in everything. These features are seldom seen in Indian patients.

The mentioned differences still can be observed in most parts of India. But a few westernized islands already exist in India, too, mainly in urban Indian centers, where the differences are not as obvious.

A19 Home remedies from all over the world – evaluation and education

Annette Kerckhoff

Naturopathy, Charité University Hospital, Berlin, Germany

This workshop focuses on the evaluation of traditional folk remedies from all over the world. The top ten ingredients for home remedies will be examined closer; relevant data from food pharmacology and clinical trials will be presented to understand the active principle. Reliable and safe simple interventions are presented and advice for education is given.

These evaluated interventions using easy-to-get, worldwide spread and cheap ingredients can support health and self-efficacy.

A20 Ayurveda in Europe– what’s needed when healing tradition travels abroad?

Christian S Kessler^1,2, Andreas Michalsen^1,2

¹Institute of Social Medicine, Epidemiology and Health Economics, Charité University, Berlin, Germany; ²Department for Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany

Correspondence: Christian S Kessler (c.kessler@immanuel.de)

Ayurveda is one of the oldest codified traditional systems of medicine worldwide. During the last decades an increasing usage and acceptance of Ayurveda in countries outside of its original context, particularly in European countries and North America, has been observed. Notably, Ayurveda has developed quite heterogeneously during this journey by interacting with other concepts of healing and philosophy. Depending on where and by whom it is being practiced and called upon, it has taken different shapes to different degrees depending on a significant number of cultural, political, economic, geographical and other factors. Due to this complexity, interdisciplinary Ayurveda research and networking is required in all related fields, e.g. medicine, anthropology, philosophy, Indology, religious sciences and health economics, in order to further clarify Ayurveda’s current statuses in Western countries and its health care potentials in countries outside of South Asia. This pre-conference workshop invites (1) leading scientists in the field to present their research work related to Ayurveda as practiced outside of South Asia, (2) senior clinicians with long standing expertise in treating patients with Ayurvedic medicine in Western contexts to share their experience, and (3) board members of the leading Western therapists’ associations for Ayurveda (DÄGAM,VEAT, AFGIM, EUAA, EURAMA, DGA and others) to highlight crucial aspects related to national/supranational health care economics and policy making. This session deserves to be included in the program because Ayurveda is one of the fastest growing traditional systems of medicine in Western countries, however, it is still lacking acceptance as a whole system of medicine in conventional mainstream medicine. This session aims to develop strategies for a long-term inclusion of evidence-based Ayurvedic therapies into reimbursable Western health care delivery and health education in countries outside of South Asia. 6 interconnected short presentations (10 + 3 min.) will be followed by a 40 min. round table discussion to conclude the 120 min. session.

A21 Clinical trials on Ayurveda in western countries: implications for future projects

Christian S Kessler^1,2 (c.kessler@immanuel.de)

¹Institute for Social Medicine, Epidemiology and Health Economics, Charité University, Berlin, Germany; ²Immanuel Hospital Berlin, Department for Complementary Medicine, Berlin, Germany

Clinical research on traditional systems of medicine like Ayurveda should not just be doing research on unconventional therapies by using conventional methodology. Several issues have to be taken into account in order to facilitate a successful implementation of clinical trials that should simultaneously fulfill quality criteria of modern research methodology and internal criteria of complex whole systems approaches like Ayurveda. Moreover, within international collaboration projects cultural-, context- and setting-aspects as well as clear research communication between partners have to be taken into account in order to guarantee fruitful research cooperation. Experiences from clinical trials on Ayurveda in Germany will be presented, outlining chances, challenges, obstacles and pitfalls.

A22 Integrative Korean medicine treatment for the management of pregnant women’s health: Korean medicine approach

Eun S. Kim¹, Eun H. Jang², Rana Kim³, Sae B. Jan¹

¹Gynecology in Korean Medicine, You and Green Korean Medical Clinic, Daejeon, 35262, South Korea; ²Acupuncture, You and Green Korean Medical Clinic, Daejeon, 35262, South Korea; ³Obstetrics and Gynecology, You and Green Korean Medical Clinic, Daejeon, 35262, South Korea

Correspondence: Eun S. Kim (greenmiz@naver.com)

During the process of treating diseases and enhancing the health of pregnant women, Korean Medical Treatment increases rate of success of other medical treatments, at the same time as reducing any complications to help maintain pregnancy and induce term delivery. Under the binary medical system, separated as western and Korean Medicine Systems, there are various treatment modules for the improvement of pregnant women and the management of diseases during pregnancy.

In this respect, we suggest Korean Medical Treatment including acupuncture, moxibustion, hip steam bath, and traditional medicine as an effective adjuvant tool, could help reduce any complication caused by other medical treatments and even help improve health of patients overall. As the title of this year’s conference means, for the comprehensive patient care, introduction of integrative Korean Medicine Treatment would give a safe and effective way to reduce complications and, later improve overall health of patients psychologically and physically.

On the whole, Korean gynecology, based on the theory of traditional Korean Medicine, encompasses the disciplines of physiology and pathology of pregnant women from conception till delivery. Emesis gravidarum or cold is a common complication that occurs during early pregnancy period. It is possible to treat common cold with proper management of symptom such as prevention of pathogenic factors. Abortions such as threatened abortion can be prevented with inducing hemostasis and speeding up the absorption of hematoma.

There might be preterm labor associated with development of the fetus during the mid-pregnancy because of plummeting bearing capacity of uterine lining. This can be improved by increasing blood flow to uttering lining. Even in case of placenta previa, increasing blood flow to placenta would prevent abruption of placenta and slow down placenta previa. Amniotic fluid is interrelated with nutrition supply to fetus, so oligohydramnios can be partially improved just by increasing blood flow to the fetus. Growth of the fetus gives strain on your waist and causes musculoskeletal pain. Once the blood flow to the fetus naturally increases, muscles and ligaments supporting musculoskeletal system weaken. Consequently, musculoskeletal pain occurs in spite of little movement. This can be improved by applying acupuncture, moxibustion, Korean physical therapy. Delivery can be completed by the contraction of uterus. In Korean medicine, natural delivery does not mean reducing the pain, but shortening the pain interval. Thus, maximizing blood flow to uterine lining would shorten pain interval to achieve natural delivery.

A23 Ayurveda and salutogenesis

Martin Mittwede (martin.mittwede@ayurveda-akademie.org)

Director, Faculty of Ayurvedic Medicine, European Academy of Ayurveda, Birstein, Germany

Since more than 2500 years Ayurveda is based on concepts that were developed from a combination of philosophy and clinical practice. From a modern perspective we have to ask whether Ayurveda is more than a philosophy of life or a knowledge system. Traditional systems of medicine have a strong focus on health, wellbeing and prevention.

Ayurveda does not only include medicine and therapy, but is also a teaching of balanced life. On the basis of knowing oneself and knowing what is really strengthening or weakening in life, right decisions can be made which are the basis of action in everyday life and lead to good habits.

In this sense, knowledge of life also includes profound self-knowledge and healthoriented action. Inner and outer reality are connected to one another and give an integrated feeling of life (sense of coherence in the sense of salutogenesis)

Through scientific research, not only the successes of Ayurvedic therapies can be examined, but also the beneficial effects of a balanced life. It is important that the research approaches reflect the complex nature of the ayurvedic system and the multifactorial genesis of health as well.

By comparing Ayurveda with concepts of Salutogenesis deeper insights in traditional medical systems can be reached; and these can inspire new lines of empirical research.

A24 Introducing Ayurveda in a GP practice

Wiebke Mohme (mohme@gmx.net)

Ayurveda and naturopathy, General Practice, Hamburg Eimsbüttel, Germany

A large percentage of patients asking for Ayurveda in my GP practice suffer from stress-related and psychosomatic diseases. Ayurvedic concepts of lifestyle changes, diet, physical therapies and phytotherapy tailored to the individual state and constitution offer a perspective towards healing. Due to limited resources in terms of time, finances and availability of remedies and therapies practical approaches have to be chosen to translate these concepts into practical steps that fit into patients’ everyday life. To talk with the patients and explaining everything in a way they can relate to becomes crucible. The inclusion of yoga practice, breathing techniques, relaxation and meditation have proven useful and effective. The focus is on supporting the patient's motivation to change their condition, and exploring the patient's resources, skills and potential. If a condition cannot be changed it is important to foster acceptance of what is. Since most of the success of a treatment depends on the patient's cooperation and homework, anything that is offered has to add a sense of joy and satisfaction to their life.

Various topics

A25 Refugees with chronic diseases between the Middle-East and Europe: the role of traditional and integrative medicine in bridging gaps

Eran Ben-Arye^1,2, Massimo Bonucci³, Bashar Saad⁴, Thomas Breitkreuz^5,6, Elio Rossi^7,8, Rejin Kebudi⁹, Michel Daher¹⁰, Samaher Razaq¹¹, Nahla Gafer¹², Omar Nimri¹³, Mohamed Hablas¹⁴, Gunver Sophia Kienle¹⁵, Noah Samuels¹⁶, Michael Silbermann¹⁷

¹Integrative Oncology Program, Lin Medical center, Clalit Health Services, Haifa, Israel; ²Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; ³The Association for Integrative Oncologic Therapies Research (A.R.T.O.I.), Rome, Italy; ⁴Al-Qasemi Academy, Baqa El-Gharbia, Israel; ⁵Die Filderklinik, Stuttgart, Germany; ⁶Paracelsus-Krankenhaus Unterlengenhardt, Bad Liebenzell, Germany; ⁷ASL Tuscany North West, Lucca, Italy; ⁸Tuscan Network for Integrative Oncology, Florence, Italy; ⁹Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey; ¹⁰St. George Hospital, Balamand University, Beirut, Lebanon; ¹¹Children’s Welfare Teaching Hospital, Baghdad, Iraq; ¹²Radiation & Isotope Centre, Khartoum, Sudan; ¹³Ministry of Health, Amman, Jordan; ¹⁴Palliative Care Services, Gharbiya Cancer Society, Al Gharbiya, Egypt; ¹⁵University of Witten/Herdecke, Freiburg, Germany; ¹⁶Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel; ¹⁷Middle East Cancer Consortium, Haifa, Israel

Correspondence: Eran Ben-Arye (eranben@netvision.net.il)

The recent wave of immigration from the Middle-East to Europe has intensified the need to find a model for supportive care which is tailored to the dominant paradigm of health belief among refugees, with its high affinity for complementary and traditional (CTM) medicine. The Middle-Eastern context of health care contrasts significantly from that of integrative medicine research and clinical practice which is prevalent in Europe and other developed nations, where complementary medicine is typically used by patients from the upper socio-economic and educational level of society. The goal of the workshop will be to address the cross-cultural health conflicts experienced by refugees from the Middle East who have fled to Europe. The workshop will be comprised of integrative physicians from Middle Eastern countries invited by the Middle-East Cancer Consortium, as well as leading European figures from the field of integrative medicine. This workshop reflects the commitment of clinicians and researchers from Europe and the Middle East to bridge cross-cultural gaps experienced by refugees and health care providers by the use of an integrative bio-psycho-social-spiritual approach.

Young people in integrative healthcare – workshops

Y1 Open dialogue with experts - Integrative Medicine: A Conversation with Experts

Lena Bandelin, Anna-Lena Lang

Institute for Social Medicine, Epidemiology and Health Economics, Charité University Hospital, Berlin, Germany

This workshop will provide a space for conversation between students, young doctors, practitioners, and experts in the field of integrative medicine. This meeting will be casual in nature, where general questions that represent the diverse perspective may be asked to explore issues related to pursuing a career in integrative medicine. This session is for people who may ponder: What does integrative medicine mean to me? What does a holistic approach to patient care mean? Where do I see myself in the medical health system of the future? How will I get there? What integrative medicine resources are available to me to inform and improve medical practice? Hearing perspective from experts in various fields of integrative medicine whose work ranges from research to patient care, inpatient to outpatient practice, and public to private practice will help the attendee of this session have a better understanding of how to navigate their journey in integrative medicine. Possible experts that may serve on this panel include: Michalsen (Naturopathic medicine), Stange (Naturopathic medicine), Kessler (Ayurveda), Chris von Scheid (MBM), Haramati (Mindfulness), Brinkhaus (TCM), Girke (Anthroposophic Medicine)

Y2 Integrative medicine hands on workshop

Eva Wartner

Naturopathy, Immanuel Hospital Berlin-Wannsee, Berlin, Germany

90 minutes of Integrative Medicine/CAM practice! Discover elements of different IM disciplines through hands-on experience. Join us for cupping massage, sound therapy, phytotherapy, wet packs, yoga, dietary and mind body medicine. Leave with new knowledge and skills that you can immediately incorporate into your practice.

Y3 Integrative medicine online

Christoph Holtermann

Pediatrics, Filderklinik, Filderstadt, Germany

How does integrative medicine relate to the Internet? How do people interested in integrated medicine network and access information? This workshop will explore these questions using online networking and information tools like Facebook, mailing lists, and Wikipedia as case studies. The focus will be on how we are both affecting the medium and being shaped by the medium. How can we best utilize these resources to effectively communicate with one another? How can we further utilize these tools to address the questions and tasks necessary for integrative medicine’s development and success in the future?

Y4 Comparing medical student integrative medicine curricula from around the world

Maxwell Binstock

University of California, Berkeley, CA 94720-4206, USA

This event will explore the various integrative medicine curricula available to undergraduate medical students in different countries. Our panel will have medical student representatives from a diverse array of countries. They will share the student experience of integrative medicine education, including, but not limited to accessibility, topics, and curriculum design. We will compare and contrast programs from different countries and explore facilitators and barriers to undergraduate medical student learning and practice of integrative medicine. Ample time will be left for additional perspectives from other students in the audience as well as questions. The purpose of this session is to give students and educators additional insight, inspiration, and ideas of how to improve integrative medicine education for their country's undergraduate medical student. This workshop is meant for students, educators, practitioners, and researchers.

Y5 Composing the moment

Robert Riebau, Edin Mujkanovic

Institute for Music Scieneces and Music Pedagogy, University of Osnabrück, 49074 Osnabrück, Germany

Music may give one access to inspiring experiences of the moment. In our workshop we will explore unconventional techniques to get in touch with our creative energy. It is not about being "right" or "wrong," but rather learning how to have an open mind. We will have fun communicating and improvising through various instruments and sound making objects. Come on out and play!

Symposia

Research

X1 Yoga in therapy and prevention: the current state of the science on utilization, efficacy and safety

Holger Cramer¹, Romy Lauche², Andres Michalsen³, Lesley Ward⁴

¹University of Duisburg-Essen, Essen, Germany; ²University of Technology Sydney, Sydney, Australia; ³Charité – University Medical Centre, Berlin, Germany; ⁴Oxford University, Oxford, UK

Correspondence: Holger Cramer (h.cramer@kliniken-essen-mitte.de)

As yoga is gaining increased popularity as a therapeutic practice, it has become one of the therapies with the most rapid increase in prevalence. Accordingly, yoga’s potential as a preventive or therapeutic means has been explored in a growing number of clinical trials to date. The purpose of this symposium is to present a comprehensive overview on the state of the science on the application of yoga in therapy and prevention. Presenters will review scientific research on utilization, efficacy, and safety of yoga for the general population as well as for selected patient samples with specific mental or physical conditions. Dr. Lauche will present data on the association between yoga and weight control from clinical trials, systematic reviews and current cross-sectional analyses. Dr. Michalsen’s presentation will cover the current state of knowledge on yoga for stress reduction and include results of a new study on yoga for stress reduction in schools. Dr. Ward will present data on yoga for pregnancy, and for neurological conditions; and discuss the content of yoga interventions which have been developed for these conditions. Dr. Cramer’s presentation will cover the current state of knowledge on the safety of yoga both in clinical care and in everyday use. Presenters will also describe highlights of their own ongoing yoga research initiatives to further illustrate these concepts and approaches; and recent trends, developments and future directions for this field of research.

Given its relatively low costs, yoga could easily be implemented worldwide as a preventive or therapeutic means for a variety of important health conditions. As such, health-care providers are increasingly presented with patients using, or interested in trying, yoga for the management of their medical conditions. This increased use of yoga raises the issue of the efficacy and safety of yoga as a prevention strategy and therapy. The symposium will present up-to-date scientific evidence on the prevalence and patterns of yoga use as well as on the efficacy and safety of yoga for health conditions of global medical and socioeconomic importance. This information will promote evidence-based decision making on the clinical application of preventive or therapeutic yoga interventions. Gaps and open question in current research and implications for further studies will also be highlighted. The symposium thus aims to improve both clinical decision making and research quality on one of the most prevalent complementary therapies used for the prevention and therapy of chronic health conditions.

X2 The safety of yoga – a comprehensive review of clinical and epidemiological data

Holger Cramer

Department of Internal and Integrative Medicine, University of Duisburg-Essen, Essen, 45276, Germany

While yoga has long been viewed as a cure without harm, this view has been challenged in recent years. Mainly based on anecdotal evidence, the safety of yoga has been questioned in a number of lay-press articles. These publications seem to have led to a general uncertainty among yoga practitioners and those interested in starting practice.

To address this issue from a scientific perspective, the results of a systematic review of case reports on yoga-associated injuries and other adverse events are presented. Systematic reviews as well as own studies on epidemiological data will also be reported, assessing data from more than 10,000 yoga practitioners. Large population-based surveys on associations of yoga practice with falls, injuries, and joint problems will be covered. Further, clinical data will be presented in a meta-analysis on all available randomized trials on yoga reporting on safety-related data. In total, 94 trials with more than 8,400 participants were analyzed.

The available evidence shows that just as any other mental or physical practice, yoga is indeed associated with certain risks of injuries and other adverse events. However, yoga appears just as safe as other forms of exercise. Between one in four and one third of yoga practitioners have been injured or suffered another adverse event due to their yoga practice; however most were mild and transient. Given that yoga has been shown effective for a number of conditions and risk constellations, there no need to discourage yoga practice for healthy people or those with underlying physical or mental ailments.

X3 Effects of integrative medicine on purinergic signalling and on the autonomous nervous system - implications for the treatment of anxiety and pain

Dominik Irnich¹, Wolfram Stör², Geoffrey Burnstock³, Hans-Georg Schaible⁴, Thomas Ots⁵

¹Department of Anesthesiology, Multidisciplinary Pain Centre, University of Munich, Munich, Germany; ²German Medical Association for Acupuncture (DÄGfA), Munich, Germany; ³Autonomic Neuroscience Centre, University College Medical School, London, NW3 2PF, United Kingdom; ⁴Institute of Physiology, University of Jena, Jena, Germany; ⁵Private practice, Graz, Austria

Correspondence: Dominik Irnich (dominik.irnich@med.uni-muenchen.de)

This session presents the scientific underpinnings of the mind–body connection documenting the numerous interactions of the peripheral, autonomous and central nervous system. First, this session will provide important background information about how these systems profoundly impact human functioning, and how this can be modulated on different levels by techniques like acupuncture, neuraltherapy, meditation, relaxation techniques and movement therapies.

Second, it will be assessed how this knowledge can be translated into daily practice to achieve long term effects in chronic pain and anxiety disorders.

Strategies using a patient-centered approach will be presented for group treatment as well as in an individualized setting. Speakers will demonstrate that desensitization, somatic awareness, understanding, respect, discipline, empathy and patience are the basic principles of a successful treatment.

X4 Integrative gastroenterology

Jost Langhorst (j.langhorst@kliniken-essen-mitte.de)

Kliniken Essen-Mitte, University of Duisburg-Essen, Duisburg, Germany

Expertise

I have serious experiences regarding conference’ and session’ organizing and have chaired and held sessions at several conferences, in the field of complementary medicine as well as in gastroenterology and internal medicine. I have published numerous articles in the field of gastroenterology, conventional and complementary. Integrative gastroenterology can be considered my field of expertise, witnessed by several trials and publications. I am the director of the department for integrative gastroenterology with special focus on patient care and clinical as well as basic research. I am the expert in the field for complementary and alternative medicine (CAM) and psychosomatic medicine in Inflammatory bowel diseases for the German Society of Gastroenterology (DGVS). I am capable of organizing this session in an intelligent and forward fashion. The invited speakers demonstrate outstanding experience in high quality research in integrative gastroenterology on an international level. They have all been attending or organizing conferences in the past and are well recognized and leading experts in the field of integrative gastroenterology. We expect this session to be a success.