PAAM Medical Newsletter, Vol. 1, Issue 7, November 14, 2014
Dear PAAM Members!
Greetings from the PAAM Board! May this time of Michael be a source of inspiration and strength of will to implement your deeper intentions as anthroposophic physicians! We in the PAAM Board appreciate your willingness to be a part of our organization and participants in the impulse to cultivate and bring anthroposophic medicine to an ever increasing number of people. We know that learning and practicing anthroposophic medicine can be difficult and strange to explain to others. We appreciate your perseverance! May the iron will of the Archangel Michael help you succeed in your endeavors. As things heat up, and our patients become more complex and there appear to be many demands and obstacles in our way to what we really want to do, it is good to remind ourselves of one of Rudolf Steiner’s many mantric verses:
To resolve our past requires knowledge (cognition-insight).
To forge our future we need courage.
To experience the present we must develop dedication.
Our thinking needs riddles to wake up,
Our feeling needs pain to mature,
Our willing needs resistance to become strong.
Please note: This Letter is for your thoughtful consideration and personal research and is not to be taken as something dogmatic to believe in nor promote as something official from PAAM or the international anthroposophic medical movement.
Attachments:
1. Cognition-based medicine and case reports. The attachments listed below are anthroposophic medicine’s answer to the rigid adherence to viewing the randomized control clinical trial as the only really valid way to gain medical knowledge. Helmut Kiene, M.D. , Gunver Kienle, M.D., and Herald Harme, M.D. have worked together for years in their Institute for Applied Epistemology and Medical Methodology now at the University of Witten in Herdecke, Germany. The second and third documents are short and to-the-point written introductions to the cognition-based medicine, as a complement to “evidence-based medicine” and indicate how we as practitioners in clinical practice can engage in meaningful investigation and documentation on a single clinical case. The first listed file is a formal journal article that provides a more in-depth, historical and philosophical analysis and justification for causality assessment in single case clinical reports. This journal article is, of course, more demanding and analytical, so beware.
Case Reports and Causality - Kiene, Harme, and Kienle, 2013 (open access)
Kiene Method of Assessing Efficacy with Small Patient Numbers
Kiene Cognition-based Medicine (open access)
2. CARE Guidelines for case reports answers the question how one goes about writing and presenting a convincing case report. This article has been published in, I think, 3 separate journals and is getting good reviews. Our recent PAAM General Newsletter had an interesting and wonderful case report from PAAM member Lyn Madsen, M.D., PhD. Over the years the PAAM General Newsletter has brought many informative and interesting case reports as well. The current CARE guidelines are designed to be more rigorous and transparent so that physicians and others inside and outside of anthroposophic medicine can see the documentation of how someone was specifically treated and what happened over time. This a higher standard we will be asked to implement, but Kiene, et.al., feel it is a way to advance the knowledge and practice base of medicine. We need one or more legitimate alternatives to expensive, complex, rigid RCTs that apply to a only limited, homogenous group of patients. Of course, there are also limits to a single case study, but an accumulation of several case studies, rigorously documented, can become powerful evidence for a real therapeutic effect. Please look over the table of reporting guidelines and keep them as a reference. Consider writing up some of your cases following these new guidelines. The journal, Global Advances in Health and Medicine, which published these guidelines and is sympathetic to anthroposophic medicine, would most surely be interested. May we all have the Michaelic will to see this through!
CARE Guidelines for case reports 2014
3. Two book reviews on PAAM member Branko Furst’s monograph, The Heart and Circulation- An Integrative Model. This is a major achievement for the history of medicine and for anthroposophic medicine in particular. In the April Newsletter, I made a short announcement about it. After reading the full monograph and talking to Branko about aspects of the book, I wanted to more fully call your attention to it. It is certainly a technical book, with many citations from the wide scientific literature that Branko consulted to bring home the point that science, when widely consulted with an open mind, can confirm and open up a vista for the anthroposophic medical viewpoint (originated by Rudolf Steiner) that the heart is not a mechanical pressure-propulsion pump, pumping blood throughout the circulation, but that is an impedance organ that briefly stops the flow of blood originating in the periphery and rhythmically provides it with increase pressure, vortex motion, redirection and a pulsatile motion (the heart as a “damming-up” organ, to use Steiner’s own words). A “hemocentric” view sees the blood as an autonomous, self-moving organ that responds to the metabolic demands of the peripheral tissues. These two reviews give a succinct idea of what the monograph is about. Consider buying and reading the book. If you like cardiovascular physiology, this book is for you! It will provide you the necessary arguments and scientific studies that point to the flaws of the traditional, mechanical and cardiocentric view of the heart as a pump. Many things seem to be adequately explained by this traditional view, but other things aren’t, and this monograph documents the disparities.. Steiner always insisted that the anthroposophical view of physiology and pathology is not all that strange and certainly not counter to true science. One must, however, consult science very widely and reinterpret the materialistic conclusions to arrive at a true view of the dynamic state of affairs. Thank you, Branko, for your years of hard work and service to advance the field of medicine so that it can begin to be more holistic and inclusive of all the phenomena that has been documented, but ignored or overlooked.
Book review In-Context (open access)
Kuemmell HC, Review
Contributions:
1. From PAAM member Ross Rentea, M.D. and the Lili Kolisko Institute’s website comes a wonderful mantric verse from Rudolf Steiner. September 29th is the Michaelmas festival when the Archangel Michael is recognized and honored for his activities that bring health, balance and wellbeing to human beings and to the earth. He is conceived and known as a loyal and mighty, cosmic being who, with his iron will and flaming sword, carries out the deep intentions of the creative and freedom-bestowing Power of the universe. This Power and Being is the real, ennobling impulse for our individuation. He courageously fights against the Dragon who opposes in many ways our progressive developement. With proper receptivity, stern countenance of Michael can be a source of awakening, strength and affirmation, and not of condemnation or fear. His name is pronounced Mic(h)a-el, in recognition for his close association with God, “El” in Hebrew.
Michael!
Lend me your sword
That I may be armed
To overcome the Dragon in me.
Fill me with your Strength
That I may vanquish
The Spirits that want to lame me.
Work in me in such a way
That Light may stream
To mine “I” and I may thus be led
To actions that are worthy of you.
Michael!
Looking over this newsletter, I fear you will be overwhelmed with all the content. May Michael steel your will to read and digest what is in this newsletter!
As always thank you for your interest and commitment to anthroposophic medicine!
For the PAAM Board,
Ricardo R. Bartelme, M.D.