By Mieke Linders
Physician-scientist Erik Baars obtains his PhD degree in Wageningen.
Stroom attends the PhD ceremony of the professor of Anthroposophic Healthcare at the University of Applied Sciences Leiden. His PhD thesis deals with a highly explosive subject: the scientific foundations of anthroposophic remedies.
On Friday 18 November 2011, Erik W. Baars defended his dissertation, Evidence-based curative health promotion: a systems biology-orientated treatment of seasonal allergic rhinitis with Citrus/Cydonia comp. The PhD candidate emphasized the importance of the development of a health-promoting approach in medicine, in addition to the common disease-fighting measures. To do so, among other things, he studied the effectiveness, the working mechanism and the safety of the remedy Citrus/Cydonia (lemon/quince) in the treatment of hay fever.
Erik Baars wrote a courageous and valuable thesis that hopes to open up established medical practice to other approaches in medicine, such as CAM (complementary and alternative medicine). CAM intends to be supplementary to conventional medicine. Making some reservations, CAM includes anthroposophic medicine, which by nature assumes a completely integrated position. Although CAM methods have been used for a long time, and their effectiveness and safety have been 'proven' in practice over the years, they are often not accepted by regular medical practice. The evidence for their effectiveness is considered insufficient, unscientific or pseudo-scientific.
The time seems right for conventional medicine to broaden its perspective. On the basis of an impressive amount of research and literature, Erik Baars outlines developments in health care. In research methods, particularly in molecular medicine and systems biology, the gap between the view that an organism can be reduced to its tiniest parts (reductionism) and the view that the whole is more than the sum of its parts (holism) is getting narrower.
The prognosis of an increasing life expectancy for Dutch men and women will lead to larger numbers of chronically ill people and rising health care costs. Patients have become more articulate and independent. And worldwide, patients have been showing increased interest in alternative supplementary health care options.
These developments emphasize the importance of 'health-promoting medicine', in addition to curative medicine - providing patients with remedies and practical methods to make a preventative and curative contribution to their own health, and as such, to contribute to a reduction of health care costs.
Health by self-regulation
In 1948, the World Health Organization (WHO) defined health as a state of complete physical, mental and social well-being. As opposed to this definition, Erik Baars describes 'health by self-regulation'. Common definitions of health are based on a final stage, paying no heed to the mechanisms that cause and maintain health. In anthroposophic medicine in particular, the human organism is considered as a whole, a single being made up of body, soul and mind (individual). The organism wants to use the body's self-healing properties to maintain or restore the wholeness and balance of the bodily functions, rather than fight the symptoms of a disease. An example of self-regulation is the wholesome effect of fever in infectious diseases, especially in children. The chrono-biological rhythmical system, all of the life rhythms in an organism, can also be seen as a self-regulating activity which makes the organism healthy. Some self-regulating mechanisms, like the immune system, are (partly) in place from birth. Others can be (further) developed during the course of one's life, such as psychological self-regulation. A healthy body regulates itself through continuous interaction with its surroundings, physically, mentally and socially. According to this model, health and disease can be defined by the presence or absence of sufficiently self-regulating mechanisms or processes.
Citrus/Cydonia and hay fever
Erik Baars' thesis not only contributes to the development of a definition of health by self-regulation, it also develops and tests methods for measuring this self-regulation. For example, by monitoring patterns (using biomarkers), it was possible to measure effects on hay fever sufferers' immune systems after administration of Citrus/Cydonia comp. The condition of 22 patients before and after treatment was monitored. The remedy was administered as a nasal spray and by means of subcutaneous injection (into the tissue layer between the skin and the muscles). The results encourage further studies with larger numbers of participants and a comparison with healthy people's data.
The next goal was to study the effects and the safety of treating hay fever with Citrus/Cydonia comp. as an example of a health-promoting treatment. A study of the experiences of 39 General Practitioners who prescribed Citrus/Cydonia comp. to treat hay fever, has provided the first practice-based evidence of the positive results of the treatment. Two in vitro studies (carried out in a laboratory) studied the effects on cells and the safety of Citrus/Cydonia by means of blood tests. The study results indicate that Citrus/Cydonia may be able to restore the disrupted immune system, in such a way that all symptoms disappear.
Another study has looked into the effectiveness of Citrus/Cydonia combined, compared to Citrus and Cydonia administered separately. The activity of the immune cells of five healthy patients and five patients who suffer from grass pollen allergy were analysed in vitro after administration of the three extracts, and compared. The study found that the effects of the combined remedy (Citrus/Cydonia) were no better than the effects of the separate remedies. The study did find a difference between the effect of the lemon and quince remedies. Further study was recommended.
Grass pollen allergy
The study contained thirteen patients who had suffered from grass pollen allergy for an average of nine years, and who had been taking commonly prescribed medication due to the severity of their symptoms. Twelve patients were given Gencydo-injections (a preparation of lemon and quince by Weleda) before and during the hay fever season. One patient was only given injections during the season. The outcome measures that were used were: nasal and non-nasal hay fever symptoms, use of backup medication (antihistamines and corticosteroids) and subjective experience. A clear indication was found that Gencydo was effective in a large part of the subpopulation.
Further, the study focused on the effectiveness and safety of two ways of administration: subcutaneous injection and nasal spray. Two parallel groups (national, randomized) were compared. Twenty-three patients were treated for six weeks after a one- or twee-week period in which they received no treatment. The measures of effect were: hay fever-related immunological changes, the severity of the symptoms, and safety. Blood samples were taken before and after treatment. Both manners of administration were proven to be safe and to result in clinical effect.
The safety of anthroposophic and homeopathic injection fluids was also studied by means of systematic evaluation of side effects. The data was taken from the pharmacoviligance files of eight German manufacturers of homeopathic and anthroposophic remedies, from the period 2000-2009. This resulted in an excellent safety profile, with very rare side effects overall and no reported side effects for Citrus/Cydonia medication.
Finally, a study is mentioned which compared the data of 1913 regular GPs to that of 79 GPs with CAM-training (acupuncture (25), homeopathy (28), anthroposophy (26)). This study showed a 0-30% reduction of health care costs and lower death rates in the practices of GPs with CAM-training, depending on age and type of CAM. The study found fewer hospitalizations and less use of medication.
These studies provide Erik Baars with evidence to prove the quality, safety, effectiveness and cost-effectiveness of an evidence-based health-promoting approach. He describes the Goetean phenomenological method as a qualitative method of research, which studies both the 'lower' levels of an organism (atoms, subatoms, etc.) as well as the 'higher' levels (the organism's immediate surroundings, the society, the non-material powers in living organisms, etc.). The search for pattern recognition in this type of research is in tune with the increased interest in systems research which has been noticeable in biology, pharmacology and medical science over the past decades.
The previously prevailing approach of 'one gene, one remedy, one disease' has, in general, fallen short, as a result of the complexity of disease as well as the complexity of the human organism. This has resulted in an increased interest in supplementary alternative preventative and curative health promotion, both in society and in health care circles. In 1925, Rudolf Steiner and Ita Wegman first recognized the qualities of Citrus and Cydonia, based on their observations of a qualitative pattern in the plants' organizational level. This shows that research based on subjective, qualitative pattern recognition is possible.
A shortcoming of the Goetean research model, according to Baars, is that until now, it has been exclusively used in scientific and medical practice, but it does not meet the current scientific requirements. The studies he mentions are based on small groups of patients. They lack data on healthy research subjects and on hay fever patients whose symptoms vary in severity. Therefore, Erik Baars hopes to continue his research efforts. As someone remarked during his PhD defence, the word 'towards' occurred with notable frequency in his text. Baars emphasized that his thesis represented the first step in a direction that is waiting to be explored.
Finally, the PhD Examining Committee, through professor Savelkoul, immunologist at Wageningen University and Research, praised the pioneering work Erik Baars has done with regard to health promotion, the many research areas he included, his perseverance and his focused defence. The Committee then qualified the dissertation as 'good' and the defence as 'very good'.
Towards integrated anthroposophic health care
Citrus/Cydonia is an anthroposophic remedy. Anthroposophic medicine is based on a non-material organization in nature alongside the material organization, and on the 'higher' complex organization of organisms in time, space and function. These higher complex organizational levels of organisms can be studied in a subjective-qualitative manner, using statistics to uncover patterns. Both the higher and lower levels can be regarded in order to reach a diagnosis. Treatment is systems-orientated, which may be expressed in the fact that several substances or therapies are used at the same time. Aspects can be influenced on different levels, either simultaneously or in phases. Higher levels can be encouraged to regulate lower levels, so that the wholeness and balance may be restored.
Treatment of this kind requires both the organism and the patient to actively contribute. As such, it promotes health. This treatment is relatively new and forms an addition to other shifts in medical science. Erik Baars assumes it will take some time for this type of medical care to become sufficiently evidence-based and sufficiently known, and as such to be considered relevant. However, once integrated in health care as an addition to disease-fighting methods, this will mean a merger of the best of two worlds.