Anthroposophic Medicine in the Context of Evidence-Based Medicine

Diagnostic and therapeutic measures require evaluation and scientific evidence. Evidence-Based Medicine (EBM), established by David Sacket and others, rests on three pillars:

• The status of scientific clinical research (external evidence)
• Individual medical and therapeutic experience (internal evidence)
• The values and needs of patients (patient preference)

External evidence comes from many sources, ranging from expert opinion (designated as evidence level 5) to more formal study designs, including clinical case observations, randomized and controlled studies, and meta-analysis (evidence level 1). These studies document the results of treatments on carefully defined groups of patients. As such, they are a valuable basis for prospectively assessing the potential efficacy of a therapeutic measure in a given case. Whether the therapeutic change will occur, as expected, also depends on the medical assessment of the individual case. Evaluation of each individual course of treatment is necessary, especially considering the often large number of patients who are unfortunately treated without benefit (Number Needed to Treat) as well as keeping an eye toward possible undesirable side effects (Number Needed to Harm). No available study can predict with certainty that the hoped-for positive effect will occur in each individual case of treatment. Finally, patient preferences must be considered. At the start of treatment, many patients want a treatment approach that corresponds to their values and their life situation. While external evidence refers to past outcomes, and while assessment of individual cases (internal evidence) evaluates current treatment, patient preference should help set objectives for the future course of treatment.

All three pillars of evidence-based medicine are used in Anthroposophic Medicine. A growing number of studies document the currently available external evidence based on both experimental and clinical studies. In addition, there is broad research in the areas of prevention, health services research, whole-system evaluations, and overall analyses of the efficacy, cost-effectiveness, and safety of Anthroposophic Medicine (see also: https://medsektion-goetheanum.org/en/research/).

In the realm of internal evidence, researchers from anthroposophic medical institutions play a major role in the development of concepts such as cognition-based medicine (CBM) and they are developing methods for the systematic assessment of individual cases (see also: https://medsektion-goetheanum.org/forschung/system-assessment-reviews-research-methods/methodology-and-case-reporting/).

A “Vademecum process” is used to systematically evaluate medical reports from practical experience and make them available to colleagues based on the relevant indications. The respective evidence in individual cases can, in turn, lead to further clinical studies (see also: https://www.vademecum.org/?_locale=en).

For the pillar of patient preference anthroposophic researchers regularly conduct qualitative studies, mostly in the form of questionnaires and interviews, with the aim of strengthening the perspective and autonomy of patients.

Only when external and internal evidence is combined with the needs of the patients can the gap between scientific research and practical medicine be bridged. In addition to efficacy research and the development of qualitative research methods, anthroposophic scientists and physicians continually strive to relate their understanding of the human being, through its physical, functional, psychological, social, ecological and spiritual dimensions. (see also: https://medsektion-goetheanum.org/forschung/basic-concepts-and-anthropology-medical-history/medical-anthropology/).

Anthroposophic Medicine is currently practiced in more than 80 countries in both outpatient and inpatient settings. In addition to a large number of medical and therapeutic practices, there are 22 hospitals, sanatoriums, dedicated wards, day hospitals and medical centers in Germany, Great Britain, Switzerland, Sweden, the Netherlands, Italy, the USA and Brazil. Anthroposophic medicinal products are manufactured and distributed in most European countries, as well as in North and South America, Russia, South Africa, Egypt, Japan, Australia and New Zealand. In Switzerland and Germany, obligatory health insurance covers the costs for care in anthroposophic hospitals.

Anthroposophic physicians undergo standard general and specialist medical training. In most countries, further training to become an anthroposophic physician requires several years of additional, part-time coursework, or at least five years of participation in the International Postgraduate Medical Training (IPMT) program. At certain locations, such as Witten/Herdecke University in Germany, training opportunities are offered within the scope of standard medical school training.

In many countries, Anthroposophic Medicine actively participates in, and contributes to, the further development of a truly integrative health-care system. It works within a broad, interprofessional network towards medical recognition of the nature of the human being on the levels of body, soul and spirit. Anthroposophic Medicine develops health promotion and disease prevention programs, participates in expert committees on guidelines, contributes to citizens’ and patients’ initiatives and is active within the European Union (EUROCAM, ECHAMP, ELIANT). As part of that work, international interprofessional teams are developing special contributions to key areas in the provision of health care. The current areas of focus in the anthroposophic medical movement (CARE Areas, 2016–2023) are:

• CARE I: Pregnancy, birth and early childhood
• CARE II: Fever and infectious diseases
• CARE III: Psychosomatic diseases, with special consideration of sleep and anxiety disorders, depression and post-traumatic stress disorder
• CARE IV: Oncology
• CARE V: Palliative medicine, pain therapy and the care of dying patients

The current CARE Areas are aligned with human biography. They begin with pregnancy, childbirth and early childhood, lead via the frequently feverish diseases of childhood to the mental challenges that arise especially in the middle of life, and reach the end of life with oncological diseases and palliative medicine. In all these areas, proven approaches and concepts are developed across all professions and are made available to the public in the realms of clinical practice, teaching and research.

The worldwide collaborators of the anthroposophic medical movement work independently in research, development, teaching and the practical application of Anthroposophic Medicine, as well as in the coordination of activities relevant to specific countries and professions, along with organizing conferences, seminars, events and public relations work.

The international coordination of these diverse activities happens in the Medical Section of the School of Spiritual Science at the Goetheanum in Dornach, Switzerland, which is currently headed by Dr. med. Matthias Girke, specialist in internal medicine, and his deputy, Georg Soldner MD, pediatrician (see: https://medsektion-goetheanum.org/en/anthroposophic-medicine/). Together with the Section heads, an International Coordination for Anthroposophic Medicine (IKAM) forms an interdisciplinary body that currently comprises 30 representatives from the various fields of life and professional work. Alongside the doctors, nurses, midwives, therapists and educators for special needs who work together in IKAM, there are researchers, patient and clinic association representatives, pharmaceutical manufacturers, and coordinators of student work, training and continuing education, as well as public relations. The aim is to achieve a modern, non-hierarchical understanding of leadership corresponding to the human heart function that alternates between perception and activity, periphery and center (1).

The central task of the International Federation of Anthroposophic Medical Associations (IVAA) is to expand and secure the political and legal framework for the practice of Anthroposophic Medicine. Important decisions at the Section level are discussed and adopted each year with the IVAA executive boards (see: www.ivaa.info).

1. Glöckler M, Heine R. Die anthroposophisch-medizinische Bewegung. Verantwortungsstrukturen und Arbeitsweisen. 4. Aufl. Dornach: Verlag der Förderstiftung Anthroposophische Medizin im Verlag am Goetheanum; 2015.