Complementary Therapies in Medicine, 2018-10-01, Volume 40, Pages 145-150
An assessment of the scientific status of anthroposophic medicine, applying criteria from the philosophy of scienceErik W. Baars (a,b,c), Helmut Kiene (d), Gunver S. Kienle (a,d,e), Peter Heusser (a,f), Harald J. Hamre (a,d)
a ESCAMP, Zechenweg 6, D-79111 Freiburg, Germany
b Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, The Netherlands
c University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK Leiden, The Netherlands
d Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Zechenweg 6, D-79111 Freiburg, Germany
e Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
f Witten/Herdecke University, Gerhard-Kienle-Weg 4, D-58313 Herdecke, Germany
Abstract
Objectives: The objective was to evaluate the scientific status of anthroposophic medicine (AM) according to demarcation criteria proposed in contemporary philosophy of science.
Design: Criteria for what is science were retrieved from eight publications in the philosophy of science, focusing either on science in medicine or on the demarcation between science and pseudoscience or non-science. Criteria were combined, redundancies were excluded, and the final set of criteria was ordered in a logical sequence. The analysis yielded 11 demarcation criteria (community, domain, problems, goals, axiomatic basis, conceptual basis, quality of concepts, methodology, deontic basis, research products, tradition).
Results: Assessing the scientific status of AM according to the 11 criteria, all criteria were fulfilled by AM.
Discussion: AM is grounded on the notion that specific non-atomistic holistic formative forces exist and can be empirically and rationally assessed. From a position claiming that such holistic forces cannot possibly exist or cannot be empirically and rationally assessed, the axiomatic and conceptual basis of AM can be contested. However, such an a priori rejection is problematic in the presence of empirical evidence supporting the validity of holistic concepts, as discussed in the paper. Future research should therefore focus on the tenability of the ontological reductionist position in science and on the further validation of AM non-atomistic holistic concepts, methods and practices.
Conclusion: In this analysis, using criteria from philosophy of science, AM fulfilled all 11 criteria for what is science.
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https://www.sciencedirect.com/science/article/pii/S0965229917308804Excerpts:
"Anthroposophic medicine (AM) is an integrative medical system, founded in Central Europe in the early 1920s. AM is provided by physicians, therapists and nurses and integrates conventional medicine with the concepts, methods and therapies derived from anthroposophy. The anthroposophic concept of man claims the human organism to be not only formed by physical (cellular, molecular) forces but by altogether four classes of formative forces: (1) formative physical forces; (2) formative vegetative forces which interact with physical forces and bring about and maintain the living form, as in plants; (3) a further class of formative forces (anima , soul) which interact with the vegetative and physical forces, creating the duality of internal-external and the sensory, motor, nervous and circulatory systems, as in animals; (4) and an additional class of formative forces (Geist , spirit) which interact with the three others and enables the manifestation of individual mind with the capacity for reflective thinking, as in humans. The interactions of these forces are understood to vary between different regions and organs in the human body, resulting in a complex equilibrium. This equilibrium can be distorted in various forms of human disease, and is sought to be regulated by anthroposophic therapies.
"Specific AM therapies include medicinal products, physical therapies such as rhythmical massage therapy, art therapies and movement therapies such as eurythmy therapy. Since its initiation by Rudolf Steiner (1861–1925) and Ita Wegman (1876–1943), AM has developed worldwide, its scientific status however has been repeatedly questioned.
"In this paper we assess the scientific status of AM, checking its concepts, methods and practice against criteria from the philosophy of science...Theoretical and practical criteria in order to demarcate science from pseudoscience or non-science have been developed with a focus on methods rather than on contents or doctrine, assuming that adequate methods will result in valid knowledge."
"The final set of criteria ( Table 1 ) was then applied to AM.
"Table 1
Criteria for the demarcation of science and non-science, based on contemporary philosophy of science.
[ list of 11 criteria, none of which refer to natural as opposed to supernatural]
"In the following we describe the results of our criteria-based analysis of the scientific status of AM. For each criterion ( Table 1 ) the corresponding AM features are outlined, in order to assess the degree of criterion fulfillment."
"3.1. Community"
"Today, university chairs for AM (three in Germany, one each in The Netherlands and Switzerland) and research institutes around the world examine AM. Scientists are trained in natural sciences and evidence-based medicine as well as in AM concepts and methodologies...they publish in peer reviewed journals of conventional medicine, CAM or AM and participate in research conferences on conventional medicine, CAM and AM worldwide."
"3.2. Domain
"AM regards itself as an extension of modern medicine. AM physicians, therapists, and nurses are fully trained in conventional medicine, and additionally go through structured AM training...Specific issues of the AM domain include the epistemological foundation, development, description and validation of the concepts of AM, its working principles and medical and non-pharmacological treatments, and its diagnostic procedures; the evaluation of safety, quality, efficacy, effectiveness, and costs of AM; the integration of AM with conventional medicine; and the development, description and validation of specific AM healthcare practice-oriented evaluation methodologies."
"3.5 Axiomatic basis
"For AM, main axiomatic positions include...
"AM is founded in an epistemology that refers to an empirical and rational cognition of holistic formative forces."
"AM acknowledges the level of causative factors that are investigated by conventional physics, chemistry, physiology, etcetera, as well as the causative levels of formative forces, and integrates both."
"AM intends to understand salutogenetic and pathogenetic effects on specific organs, organ systems and the whole organism by exploring the abovementioned levels of formative forces, hereby differing from the conventional biomedical paradigm that ultimately attempts to explain health and disease by physico-chemical interactions of molecules."
"3.6 Conceptual basis
"AM concepts and treatments are derived from general anthroposophic concepts, and have led to new forms of therapy (e.g., eurythmy therapy) and new modalities of existing therapies."
"The conceptual systems used by the AM scientific community in dealing with the AM research domains include: the non-atomistic holistic concepts of life, soul, and spirit; the relationship between the realms of nature and man; the origins of health and disease; possible spiritual-existential aspects of disease in the patient’s biography; diagnosing and treating the different levels of organization in organisms with regard to health and disease..."
"3.7 Quality of concepts
"Since the inception of AM 90 years ago, its concepts have been consistently and transparently used across different fields of medicine (anatomy, biochemistry, cardiology, dermatology, embryology, gynecology, internal medicine, neurological rehabilitation, obstetrics, oncology, pediatrics, primary care, psychiatry, pulmonary medicine, rheumatology) , and among AM researchers, pharmacists, physicians, and therapists. Although the concepts are relatively stable, they have been further elaborated and diversified through research. Like in other scientific areas, the concepts are not always easily accessible when specific AM training is lacking.
"The concepts have been operationalized and tested in a broad array of preclinical research, for example on mistletoe extracts, and in more than 300 clinical studies ranging from case series and qualitative studies to double-blind randomized trials. Due to limited resources, however, only a part of the full range of concepts has been validated empirically while others await their investigation or are subject to ongoing work."
"The AM concepts are in line with a general epistemological trend in the life sciences: from a mechanistic, reductionist worldview towards a more holistic approach in developing theories of living organisms."
"Nevertheless we acknowledge that for many scientists who accept and are interested in the fields of systems biology, epigenetics and emergence, the concept of non-atomistic holistic formative forces might be a step to far, and will be regarded as ‘overloaded ontology’ (=demarcation criterion 7i)...we refer to the references in Section 8, where methods have been described that lead to observations of these higher order, non-atomistic holistic formative forces."
"3.8 Methodological basis"
"Double-blind randomized controlled trials (RCTs) often cannot be applied, since only a small number of AM treatments (e.g., Citrus/Cydonia for hay fever) fit the ‘one-indication one-treatment’ approach, and treatments often are difficult to blind because of specific physiological reactions to medication treatment and due to therapist-patient interactions during art or movement therapy sessions. AM physicians and their patients often reject randomization because it can disturb the physician-patient relationship and because of strong therapy preferences."
"Specific methods for the assessment of the organism’s higher organization levels and their relationship to the lower physical and physiological levels have been and are being developed and investigated."
"3.9 Deontic basis
"Since AM is a system of medicine that integrates diagnostics and therapies from conventional medicine with anthroposophic insights, diagnostics and therapies, the deontic rules in conventional medical research largely also apply for AM research. Due to the holistic ontological and epistemological position of AM, additional rules are used, guiding some of the research for the holistic approach to diagnostic, preventive and treatment procedures.
"3.10 Research products
"Different types of research products come from AM: study results, healthcare programs, methods for healthcare practice, measurement instruments and research methodologies.
"A Health-Technology Assessment (HTA) report identified 265 clinical studies on the efficacy and effectiveness of AM, covering a broad spectrum of disorders and showing predominantly good results, with few, mostly mild to moderate side effects, a high measure of client satisfaction and favorable cost-effectiveness compared to conventional treatment."
"3.11 Tradition"
"The tradition of the natural sciences and of conventional medicine is a general basis for AM practice and research. AM is compatible with the scientific facts of this tradition line, except for positions that categorically exclude the possibility of formative forces and their accessibility through observation and cognition."
"The epistemological foundation of AM , can be described as an objective and empirical ontological idealism, which has also been called universalism and, in the sense of Goethe, phenomenalism."
"Phenomenalism in the sense of Goethe and Steiner stands in a tradition of holistic thinking in science , which is important in contemporary research fields such as ecology and quantum mechanics, in methodologies such as phenomenology and in the evaluation of whole medical systems, and complex interventions.
"AM also stands in a historical tradition of preventive and curative health promotion."
"Health promotion of holistic forms of healthcare are presently studied and taught in 73 academic centers for integrative medicine in the US and in academic centers in the fields of the social sciences and public health.
"Finally, AM stands in a tradition of diagnostic and therapeutic orientation on the individual. This approach was common medical practice until the arrival of epidemiology in the 20th century...However, both in conventional medicine and in CAM there is renewed interest in the development of methodologically sound approaches to the individual patient."
"4 Discussion"
"Withstanding such potential criticism, our application of the criteria reveals the very crucial point of the whole issue which could eventually outweigh all other issues: Do formative forces, as assumed in AM, exist and if so, can they be empirically and rationally assessed - or not? Ultimate clarification of this question is beyond the scope of this paper. It may be fair, however, to point out that the holism-reductionism debate has provided strong arguments pro holism and current conceptualizations of the organization of living organisms are shifting towards holistic views, e.g. in epigenetics and emergence. In several research fields, emergent phenomena are characterized as irreducible and in need of new holistic conceptualizations. Furthermore, some holistic conceptions of AM have been validated to a considerable extent. A first example is mistletoe. From the anthroposophic view, it had been predicted as effective in cancer treatment. Meanwhile, a considerable number of mistletoe ingredients have been shown to have anti-cancer effects, covering a broad array of oncological working principles; and clinical mistletoe studies demonstrated effectiveness, for example in advanced pancreatic cancer. Another example are recent experiment series on ultra-high dilutions providing replicable effects far beyond Avogadro’s number. These examples clearly support the validity of the respective AM concepts."
"5 Summary and conclusion
"We have assessed the scientific status of AM according to 11 demarcation criteria proposed in contemporary philosophy of science (community, domain, problems, goals, axiomatic basis, conceptual basis, quality of concepts, methodology, deontic basis, research products, tradition). AM fulfilled all 11 criteria - but their application reveals a controversial topic: AM is grounded on the notion that specific holistic formative forces exist and can be empirically and rationally assessed. From a position claiming that such holistic forces cannot possibly exist or cannot be empirically and rationally assessed, the axiomatic and conceptual basis of AM can be contested. However, such an a priori rejection is problematic in the presence of empirical evidence supporting the validity of holistic concepts, as discussed above."
"To date ESCAMP [hEuropean Scientific Cooperative on Anthroposophic Medicinal Products] as received financial support from the following non-profit organizations:
"Software AG - Stiftung (Germany), Mahle-Stiftung (Germany), Christophorus Stiftung (Germany), Ekhagastiftelsen (Sweden), Vidarstiftelsen (Sweden), Iona Stichting (The Netherlands); and from the following industrial sponsors: European Association of Manufacturers of Medicines for Anthroposophic Therapy (AEFMUTA, France), WALA-Heilmittel GmbH (Germany), Weleda AG (Switzerland)."
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Here are some critiques of anthroposophic medicie:
https://sciencebasedmedicine.org/a-university-of-michigan-medical-school-alumnus-confronts-anthroposophic-medicine-at-his-alma-mater/https://www.quackwatch.org/11Ind/steiner.html
