Ogni antibiotico è efficace in relazione a un determinato gruppo di microrganismi comprare doxycycline senza ricettain caso di infezioni oculari vengono scelte gocce ed unguenti.

Komplementärmedizin – warum wir couchepin überleben


Warum wir Couchepin überleben
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen


Geburtsdatum 31.10.1955
Staatsexamen 1981
FMH Innere Medizin 1989
Praxis: Im Noll 38, 4148 Pfeffingen seit 1989
ASA-TCM 1999
Vize-Präsident SGIM 2001-2002
FACP 2002
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen


Zur Zeit gehaltene Ämter und Aufgaben
Präsident der UNION der komplementär-
Vizepräsident der Assoziation der schweizerischen
Ärztegesellschaften für Akupunktur und TCM (ASA)
Vorstandsmitglied AG TCM
Mitglied des Lenkungsausschusses der Initiative „Ja
Experte für TCM beim Schweizerischen
Vorstandsmitglied der Schweizerischen Gesellschaft
für Innere Medizin SGIM
CEO China Medical GmbH
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen


Ärztliche Methoden der UNION
Anthroposophische Medizin
Akupunktur und TCM
Neuraltherapie
Phytotherapie
SAGEM mit 11 Gesellschaften: AKS, GAMM,
SABIT, SSDM,AEAP, SAGLÜ, SAGOS, SAHUM, SANTH, • Weitere, nicht – ärztliche Therapeuten:
EMR mit ca. 200 Methoden
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen


UNION: 1700 Mitglieder, 120-200 Millionen
Umsatz pro Jahr – innerhalb der
Ca. 6500 Grundversorger Praxen: 2/5 mit
EMR: ca. 12'000 angemeldete
TherapeutInnen; geschätzter Umsatz 1
Milliarde CHF (1/50 der gesamten
Gesundheitsausgaben, 150 Franken /P/a)
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen


PEK: Bausteine der Evidence
HTA (Health Technology Assessment)
Feldstudie in allg. und CAM Praxen
Oekonomiedaten der Santesuisse
Literaturstudien
• vom BAG zitierte weitere Daten (nicht
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen


HTA: alle 5 positiv
Feldstudie und Oekonomiedaten: max.
gleiche Kosten, bessere Patienten- • Literaturstudien: 3 von 5 positiv
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen


Prov. Abschlussbericht 15.3.05: 3 von 5
positiv : Homöopathie, Anthroposophie, • Def. Abschlussbericht 23.4.05: 0 von 5
Beschlussfassung nicht auf wissenschaftlicher, sondern politischer Basis.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Levels of Evidence and .
I. Evidence is obtained from meta-analysis of multiple, well-
designed, controlled sutides. Randomized trials with low false-
positive and low false-negative errors (high power).
II. Evidence is obtained from at least one well-designed
experimental study. Randomized trials with high false-positive
and/or negative errors (low power).
III. Evidence is obtained from well-designed, quasi-experimental
studies such as non-randomized, controlled single-group, pre-
post, cohort, time, or matched case-control series
IV. Evidence is from well-designed, nonexperimental studies such
as comparative and correlational descriptive and case
V. Evidence from case reports and clinical examples
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Grades of Recommendation
A There is evidence of type I or consistent findings from
multiple studies of types II, III, or IV
B There is evidence of type II, III, or IV and findings are generally
C. There is evidence of types II, III, or IV but findings are
D. There is little or no systematic empirical evidence
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen gemäss American Heart Association (AHA)
Level 1 bis 8 mit feinerer Differenzierung
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Level of Evidence gemäss Scottish Intercollege
High quality meta analysis, systemic review of RCTs or RCTs with a very low
risk of bias
Well conducted meta analysis, systemic review of RCTs, or RCTs with a low
risk of bias
Meta analysis, systemic reviews of RCTs, or RCTs with a high risk of bias
2++ High quality systemic reviews of case-control or cohort studies.
High quality case-control or cohort studies with a very low risk of
confounding bias, or chance and a high probability that the relationship
is casual.

Well conducted case control or cohort study with a low risk of
bias, or chance and a moderate probability that the relationship is casual.
Case control or cohort studies with a high risk of confounding, bias, or
chance and a significant risk that the relationship is not casual.
Non-analytical studies, e.g. case report, case series
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen What is EBM?
Evidence-Based Medicine (EBM) is the
integration of best research evidence with
clinical expertise and patient values.
David L. Sackett, Evidence-Based Medicine Page 1, 2nd Edition,

Churchill Livingstone 2000
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen How do we actually practice EBM?
Step 1 – converting the need for information (about prevention,
diagnosis, prognosis, therapy, causation, etc.) into an
answerable question
Step 2 – tracking down the best evidence with which to answer

that question
Step 3 – critically appraising that evidence for its validity

(closeness to the truth), impact (size of the effect) and
applicability (usefulnuess in our clinical practice)
Step 4 – integrating the critical appraisal with our clinical

expertise and with our patient‘s unique biology, values and
circumstances
Step 5 – evaluating our effectiveness and efficiency in executing

steps 1-4 and seeking ways to improve them both for next time
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Cervical Radiculopathy (Simon Carette, M.D.)
A 37-year-old woman presents with a two-week
history of severe neck pain radiating to her left
shoulder girdle and extending to the arm, forearm,
and dorsum of the hand. She reports having had no
fever, weight loss, leg weakness, or urinary or bowel
dysfunction. Physical examination reveals weakness of
her left triceps, finger extensors, and wrist flexors, as
well as hypoesthesia of the third digit and a diminished
triceps reflex.
How should her case be managed?

Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Cervical Radiculopathy (Simon Carette, M.D.)
TREATMENT
Nonsurgical Management
The main objectives of treatment are to relieve pain,
improve neurologic function, and prevent recurrences.
None of the commonly recommended nonsurgical
therapies for cervical radiculopathy has been tested in
Thus, recommendations derive largely from case series
and anecdotal experience. The preferences of
patients should be taken into account in decision
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Cervical Radiculopathy (Simon Carette, M.D.)
SURGICAL VS. NONSURGICAL MANAGEMENT
As summarized in a recent Cochrane review, there
are few good-quality studies comparing surgical and
nonsurgical treatments for cervical radiculopathy…
However, at one year, there was no difference among
the treatment groups in any of the outcomes
measured, including pain, function, and mood.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Evidenz In der Praxis
In der allgemeinärztlichen Praxis sind nur ca.
20% - 30% aller Interventionen evidenz-
Die Methodologie für Praxis und für CAM
wird differenzierter und flexibler
Evidenz isolierter Interventionen als
alleiniges Kriterium für die Praxis zunehmend
umstritten (komplexe Syteme)
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Verzerrung (Interpretation) der Datenlage durch.
die Schulmedizin
Medizinische Fakultäten: Bewahrung des Status Quo
Pharmazeutische Industrie: Wirtschaftsinteressen
. und bei der CAM
Dogmatik: Einseitigkeit der Betrachtungsweise,
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Synopsis: eine mögliche Sicht
Entzündliche Erkrankungen des BewegungsapparatesBehandlung während der Infekte (bakteriell) Funktionelle Störungen Psychiatrie (gravierend) Psychiatrie (ambulant) Allgemeine Innere Medizin Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen PEK: Arztkosten der CAM
Durchschnittlicher Umsatz eines CAM
Arztes/a 400'000.- , COM Arzt/a 800'000.-
Zu beachten ist, dass CAM-Ärzte ein Drittel
weniger Patienten pro Jahr behandeln, mehr
Frauen, Jüngere Patienten
Insgesamt besteht eine Kostendifferenz von
24% zu Gunsten der CAM-Ärzte (944 : 701
CHF /P/a); nach statistischer Korrektur im
extremsten Fall gleiche
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen PEK: weitere Parameter der CAM
Höhere Patientenzufriedenheit beim CAM-
Im Durchschnitt mehr chronisch erkrankte
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen PEK: Gesamtkosten der CAM
200 Millionen zu ca. 53 Milliarden = ca. 0,5%
der gesamten Gesundheitskosten CH
200 Millionen zu 23 Milliarden Gesamtkosten in
der Sozialversicherung= ca. 0,9%
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Kosten der CAM
Wie viel kosten bei gleicher langfristiger
Qualität inkl. dem Management allfälliger
unerwünschter Wirkungen und Integration aller
Kosten (stationär, ambulant, AUF, Invalidität.)
und mindestens gleicher
Patientenzufriedenheit eine schulmedizinische
und eine CAM Behandlung?
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen PEK Kosten: Summary
Ö CAM ist patientenbezogen günstiger, nach
Korrektur maximal gleich teuer wie
konventionelle Medizin.
Ö Innerhalb der Grundversicherung ist ein
additives Verhalten der Ärzte und Patienten
nicht zu belegen und unwahrscheinlich.
Ö Die Frage nach der freien Wahl ins-
besondere durch den Patienten ist aufgrund
ökonomischer Daten i.S. einer liberalen und
marktöffnenden Haltung zu bejahen.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Das Gesundheitswesen wird teurer werden –
so oder so.
Die Frage ist
und
zu wessen Nutzen?
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Randomized multicenter trial of natalizumab in acute MS
relapses: clinical and MRI effects (O'Connor PW et al.)
Natalizumab (TYSABRI® ) is a monoclonal antibody that inhibits
the trafficking of leukocytes across the endothelium from the
bloodstream to the central nervous system in relapsing-remitting
multiple sclerosis (MS).
Natalizumab is being evaluated in two ongoing randomized,
double-blind, placebo-controlled trials. Study 1 enrolled patients
who had not received other disease-modifying agents in the prior
6 months. Study 2 enrolled patients on interferon beta-1a
(AVONEX). Natalizumab was administered intravenously 300 mg
every 4 weeks for up to 28 months.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Randomized multicenter trial of natalizumab in acute MS
relapses: clinical and MRI effects (O'Connor PW et al.)
Natalizumab Placebo Natalizumab
Placebo plus
plus AVONEX
Clinical Endpoints
Annualized relapse rate 0.25

MRI Endpoints
Patients with 0 new or

newly enlarging MRI
lesions, %
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Randomized multicenter trial of natalizumab in acute MS
relapses: clinical and MRI effects (O'Connor PW et al.)
Based on the above clinical trial data, natalizumab
was approved by the FDA on November 23, 2004 for
the treatment of patients with relapsing forms of MS.
IMPACT ON INTERNAL MEDICINE
Approximately 350,000 individuals have been
diagnosed with MS in the US, with 10,000 new cases
annually. Most patients with relapsing MS will be
eligible for treatment. The annual cost of the drug will
likely be in the range of $ 10,000.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Cost-effectiveness of cardiac resynchronization therapy in
patients with symptomatic heart failure (Nichol G et al.)
Heart failure is a common, costly, and debilitating illness.
Resynchronization of ventricular contraction in patients with heart
failure improves ejection fraction.
OBJECTIVE

To assess the incremental cost-effectiveness of cardiac
Cardiac resynchronization therapy versus medical therapy.
OUTCOME MEASURES

Quality-adjusted life-years (QALIs), costs, and incremental cost-
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Cost-effectiveness of cardiac resynchronization therapy in
patients with symptomatic heart failure (Nichol G et al.)
RESULTS OF BASE-CASE ANALYSIS
Medical therapy yielded a median of 2.64
(interquartile range, 2.47 to 2.82) discounted QALYs
and a median discounted lifetime cost of $ 34,400
(interquartile range, $ 79,800 to $ 156,500) per
The incremental cost per QALY for cardiac
resynchronization is similar to that of other commonly
used interventions but is sensitive to changes in
several key variable. Resynchronization therapy
should not be considered in patients with comorbid
illness that shortens life expectancy.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Fecal DNA versus fecal occult blood for colorectal-cancer
screening in an average-risk population (Imperial TF, et al.)
If stool testing is to be done for purposes of colon cancer
screening, we already know that hemoccult is both insensitive
and not specific (since not all cancers bleed, but other lesions
do). Recently it has become possible to test stool for cancer DNA.
This study was designed to compare hemoccult to fecal DNA
testing as a screening modality for colon cancer.
5486 subjects were enrolled, but only 4404 had data available for
both stool tests. 31 had colon cancer; 16 (51.6%) were positive for
fecal DNA but only 4 (12.9%) for hemoccult.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Fecal DNA versus fecal occult blood for colorectal-cancer
screening in an average-risk population (Imperial TF, et al.)
IMPACT ON INTERNAL MEDICINE
This is the largest study to date assessing the utility of fecal DNA
testing. It was less sensitive than earlier and smaller reports had
claimed, but it does appear to be a more sensitive test than
hemoccult.
Furthermore, the cost of the test ($400-800) may limit its
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Der akademisch-pharmazeutische Komplex
steuert im Wesentlichen den Fluss der
Geldmittel im Gesundheitswesen. Diese
Steuerung optimiert dabei ihre eigene
Rentabilität, ohne Rücksicht auf den
Gesamtnutzen, die soziale Verträglichkeit und
nicht selten den individuellen Nutzen.
Die ungehinderte Fortführung dieses
Verhaltens ist auch durch die entsprechende
Stützung der verantwortlichen Behörden
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Trends in antimicrobial drug development: Implications for the
future (Spielberg B, et al.)
AIM
To review the paucity of new antibacterial agents: is

there actually a paucity, and, if so, why?
RESULTS
1.FDA approvals for new antibacterials

1983-92: 30
1993-97: 10
1998-03: 9
2.Analysis of 15 largest pharmaceutical companies
which account for 53 of last 57 new molecular
entities: 5/315 (1.6%) are antibacterials.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Trends in antimicrobial drug development: Implications for the
future (Spielberg B, et al.)
3.Finances: 3 total withdrawals; most of the rest were
- Cost of new drug: $400-800 million and 8 years.
- Antibiotics are taken 7-14 days; statin is lifetime
(hence rash of new HIV, HBV and HCV drugs).
- Public health: We (ACP, CDC, IDSA) urge
physicians to reduce abx use, especially new
- Financial reality: Potential recovery on new
antibiotic for resistant GPC is $100,000/yr
compared to $1,100,00/yr for a good
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Trends in antimicrobial drug development: Implications for the
future (Spielberg B, et al.)
Resistant GPC including MRSA and VRE; not
Respiratory pathogens – all S. pneumoniae
2004 (None)
Proposed solutions include:
1. Economic incentives such as patent extensions and tax
2. Reduction in regulatory demands (FDA issues).
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dementia: Long-term donepezil treatment in 565 patients with
Alzheimer's disease (AD2000): randomised double-blind trial
(AD2000 Collaborative Group) AIM
To determine whether donepezil produces worthwhile

improvements in disability, dependency, behavioural and
psychological symptoms, caregivers' psychological wellbeing,
or delay in institutionalization.
RESULTS
Over 2 years of follow-up, cognition averaged 0.8 MMSE points

better (P‹0.0001) and functionality 1.0 BADLS points better
(P‹0.0001) with donepezil. Donepezil had no effect on
institutionalization, progression of disability, behavioural or
psychological symptoms, caregiver psychological status, care
costs, adverse events, or deaths. Donepezil 5 mg and 10 mg
were equivalent.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dementia: Long-term donepezil treatment in 565 patients with
Alzhiemr's disease (AD2000): randomised double-blind trial
(AD2000 Collaborative Group) IMPACT ON INTERNAL MEDICINE
Anticholinesterase inhibitors may produce

modest symptomatic improvements but
probably do not alter the disease course. The
decision to begin treatment with a
cholinesterase inhibitor should be
individualized with careful attention paid to
clinical response and tolerability.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Survival after Initial Diagnosis of Alzheimer Disease
(Larson E et al.) Examine correlates of survival after initial diagnosis of
Alzheimer's disease (AD).
Patients with AD had significantly decreased survival
compared with life expectancy of US population.
Median survival for men was 4.2 years; 5.7 years for
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Review: High-dose vitamin E supplementation is associated
with increased all-cause mortality (Miller ER III et al.)
Does vitamin E supplementation increase all-cause
mortality? Does a dose-response relation exist
between vitamin E and all-cause mortality?
METHODS

Data sources: MEDLINE (1966 to August 2004),
Cochrane Central Register of Controlled Trials,
bibliographies of relevant studies and reviews, and
personal files of the investigators.
CONCLUSIONS

High-dose (≥ 400 IU/d) vitamin E supplementation is
associated with increased risk for all-cause mortality.
A dose-response relation exists between mortality and
vitamin E doses › 150 IU/d.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Review: Somatostatin and its analogues do not reduce mortality
in acute bleeding oesophageal varices (Gotzsche PC et al.)
In patients with suspected acute bleeding from oesophageal
varices, are somatostatin or its analogues more effective than
placebo or no treatment?
METHODS

Data sources: MEDLINE (1966 to February 2004), the Cochrane
Library, abstracts from conference proceedings, reference lists of
trials, and contact with authors.
CONCLUSIONS

In patients with suspected acute bleeding from oesophageal
varices, somatostatin or its analogues do not reduce mortality.
Patients who receive somatostatin require fewer units of blood
products and have a lower failure rate of haemostasis.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Mediterranean diet, lifestyle factors and 10-year mortality in
elderly European men and women: the HALE project
(Knoops KT et al.) CONTEXT
Dietary patterns and lifestyle factors are associated with mortality

from all causes, coronary hear disease, cardiovascular diseases,
and cancer, but few studies have investigated these factors in
OBJECTIVE
To investigate the single and combined effect of Mediterranean

diet, being physically active, moderate alcohol use, and non-
smoking on all-cause and cause-specific mortality in European
elderly individuals.
MAIN OUTCOME MEASURES
Ten-year mortality from all causes, coronary heart disease,

cardiovascular diseases, and cancer.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Mediterranean diet, lifestyle factors and 10-year mortality in
elderly European men and women: the HALE project
(Knoops KT et al.) RESULTS
The combination of 4 low-risk factors lowered the all-cause

mortality rate to 0.35 (95% CI, 0.28-0.44). In total, lack of
adherence to this low-risk pattern was associated with a
population-attributable risk of 60% of all deaths, 64% of deaths
from coronary heart disease, 61% from cardiovascular diseases,
and 60% from cancer.
CONCLUSION
Among individuals aged 70 to 90 years, adherence to a

Mediterranean diet and healthful lifestyle is associated with a
more than 50% lower rate of all-cause and cause-specific
mortality.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen zeichnen sich durch eine kritische Distanz zum
pharmazeutisch-akademischen Komplex aus;
sie sind in der Grundversorgung aber gut
Zusammen mit geringen Nebenwirkungen und
dem eigenverantwortlichen Umgang kann die
Komplementärmedizin bereits heute zu
geringerem und gleichzeitig sinnvollem
Wachstum der Gesundheitskosten führen.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Is there evidence to suggest that glucosamine and chondroitin
should be part of the standard treatment for osteoarthritis?
(McAlindon TE et al.) Glucosamine sulphate and chondroitin sulphate are
two of a number of supplements and medications
referred to as "SYSADOA", "slow-acting drugs for OA",
or "DMOADs".
Chondroitin-treated subjects had a slower onset of

action and symptomatic response, which lasted for up
to 3 months after end of the study; another RCT found
a similar increased duration of response (2). Two RCTs
comparing glucosamine sulphate with ibuprofen
found over an 8-week period that ibuprofen was faster
in reducing pain by 2 weeks but that at 8 weeks
glucosamine sulphate was better. Similar results were
found in a 4-week study.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Is there evidence to suggest that glucosamine and chondroitin
should be part of the standard treatment for osteoarthritis?
(McAlindon TE et al.) At the time of this writing, it appears that
glucosamine and chondroitin are effective in
reducing knee joint pain and in improving
joint function; show symptomatic efficacy in
individuals with mild to moderate knee OA;
and are probably equivalent in efficacy to
standard NSAIDs and other analgesics.
However, individuals with more severe knee
OA do not appear to benefit from these
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Treatment of irritable bowel syndrome with herbal preparations:
results of a double-blind, randomized, placebo-controlled,
multicentre trial (Madisch A et al.)
BACKGROUND/AIM
This study was undertaken to assess the utility

of a commercially available herbal
preparation (STW 5), a related preparation
(STW 5-II), and a bitter candytuft monoextract
in treating irritable bowel syndrome.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Treatment of irritable bowel syndrome with herbal preparations:
results of a double-blind, randomized, placebo-controlled,
multicentre trial (Madisch A et al.)
METHODS
208 patients with irritable bowel syndrome (≥3 months of

abdominal discomfort associated with disturbed bowel habits)
were randomized into one of four groups. Twenty drops of the
medication was taken three times/day for 4 weeks. The primary
outcomes were 2 symptom scores (irritable bowel and pain).

RESULTS
Patients receiving either STW 5 or STW 5-II had significantly better

scores on both scales than did those receiving the monoextract
or placebo. All of the agents were well tolerated and no serious
side effects were observed.
AUTHORS' CONCLUSION
STW 5 and STW 5-II were both effective in alleviating the

symptoms of irritable bowel syndrome.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Treatment of irritable bowel syndrome with herbal preparations:
results of a double-blind, randomized, placebo-controlled,
multicentre trial (Madisch A et al.)
IMPACT ON INTERNAL MEDICINE
This was a high quality study; there was an adequate

randomization scheme employed and concealment of
allocation did occur. A power calculation was performed. Care
was taken to blind the study to both patients and investigators. It
should be noted that both STW 5 and STW 5-II contain peppermint
leaves and caraway fruit. These agents have appeared to be
useful in RCTs of patients with non-ulcer dyspepsia. Furthermore,
the commercial preparation costs about $15-20 for a month's
supply. It would seem reasonable for practitioners to consider
adding it to their therapeutic armamentarium.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Effectiveness of Acupuncture as Adjunctive Therapy in
Osteoarthritis of the Knee. A Randomized Controlled Trial
(Berman B et al.) AIM
Examine the efficacy of acupuncture as a complementary

therapy to pharmacologic therapy for osteoarthritis (OA) of the
METHODS
Two TCTs comparing true to sham acupuncture in patients with

knee osteoarthritis. Berman study also included an education
control. Major methodological points.
CONCLUSION
Acupuncture appears to be a useful adjuctive therapy in

improving pain and function in patients with knee osteoarthritis.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Effectiveness of Acupuncture as Adjunctive Therapy in
Osteoarthritis of the Knee. A Randomized Controlled Trial
(Berman B et al.) Vas et al (BMJ)
Berman et al (Annals)
Study Design
97 (mean age 67;40% female); Spain
570 (mean age 65.5, 64% female, 69% white) in US
All NSAID stopped for one wk before trial
11% simple analgesics, 31% nonselective NSAIDS, 28%
COX-2 inhibitors; 6% were receiving an opioid.
Diclofenac 50 mg tid prn for all
Continued meds and permitted to seek usual care
True acupuncture (N=48); Sham (N=49) to 9
True acupuncture (N=190); Sham (N=191) or control
acupuncture points with electrostimulation to all
education (N=189). 9 points used. Tapered schedule
local points in pairs. One treatment/wk x 12.
for 26 weeks (2 treatments/wk x8; 1 treatment/wk x2;
Treatment averaged 29.4 min.
treatment every other week x4wk, 1 treatment/month
x12wk). Electrical stimulation to 1 local/sham point.
Treatment averaged 20 min. Education group: 6 2-hr
group sessions over 12 wks
VAS Pain intensity, WOMAC pain, stiffness, and
Changes in the WOMAC pain and function scores at 8
function subscales; diclofenac dosage; QOL
and 26wks.
scale at baseline and 1wk after 12wks
Fol ow-up
Education group:57%; Intervention /sham: 75% each
ITT and per protocol
Intention to treat
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Effectiveness of Acupuncture as Adjunctive Therapy in
Osteoarthritis of the Knee. A Randomized Controlled Trial
(Berman B et al.)
RESULTS
Both studies found that acupuncture is an effective adjunctive

therapy to pain medication when treating OA of the knee.
- Pain decreased and function improved in both groups of patients.
- Effects on physical capability differed between studies, probably due to

the use of different measures.
- In the Vas trial, where diclofenac tablet use was measured at the end of
the study, a mean of 85 had been taken by the true acupuncture group
compared with 139 in the sham group.
IMPACT ON INTERNAL MEDICINE
Acupuncture represents a relatively low risk intervention with

potentially high benefits.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Acupuncture cuts medical expenses
(Journal of Chinese Medicine – No. 77 – Feb 05) In this innovative Japanese study, the health expenses of two
companies whose employees engaged in similar physical labour
were compared. In one company around half the employees
received a total of eight acupuncture treatments, once a week,
for neck/shoulder, knee and lumbar pain. In the second
company, used as a control, none of the employees received
acupuncture. After acupuncture, the pain in 83% of
neck/shoulder cases, 88% of knee cases and 77% of lumbar
cases was reduced by more than 50%, there was a significant
decrease in tension, depression, anger, fatigue and mental
confusion scores, the number of visits to conventional hospitals
decreased by around 50% and average medical expenses were
reduced by about 30%. (11th Annual Symposium on
Complementary Health Care 2004).
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Acupuncture for chronic headache in primary care: large,
pragmatic, randomised trial (Vickers AJ et al.)
OBJECTIVE
To determine the effects of a policy of "use acupuncture" on

headache, health status, days off sick, and use of resources in
patients with chronic headache compared with a policy of
"avoid acupuncture".
METHODS
401 patients with chronic headache, predominantly migraine,

from general practices in England and Wales were studies in a
randomised, controlled trial. Patients were randomly allocated to
receive up to 12 acupuncture treatments over three months or to
a control intervention offering usual care. Headache score, SF-36
health status, and use of medication were assessed at baseline,
3, and 12 months.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Acupuncture for chronic headache in primary care: large,
pragmatic, randomised trial (Vickers AJ et al.)
RESULTS
Headache score at 12 months, the primary end point, was lower in the

acupuncture group (16.2, SD 13.7, n=161, 34% reduction from baseline)
than in controls 22.3, SD 17.0,n=140, 16% reduction from baseline). The
adjusted difference between means is 4.6 (95% confidence interval 2.2
to 7.0;P=0.0002). This result is robust to sensitivity analysis incorporation
imputation for missing data. Patients in the acupuncture group
experienced the equivalent of 22 fewer days of headache per year (8 to
38).SF-36 data favoured acupuncture, although differences reached
significance only for physical role functioning, energy, and change in
health. Compared with controls, patients randomised to acupuncture
used 15% less medication (P=0.02), made 25% fewer visits to general
practitioners (P=0.10), and took 15% fewer days off sick (P=0.2).
CONCLUSIONS
Acupuncture leads to persisting, clinically relevant benefits for primary

care patients with chronic headache, particularly migraine.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Marginalisierung der CAM.
Relegation in die Zusatzversicherung
Erratische Anerkennungspraxis von
Therapeuten (Bund, Kantone)
De facto Ausschluss aus Lehre und
Forschung (NFP etc.)
CAM -Zulassungsbedingungen bei
Swissmedic sind schwierig
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen . und Integration der CAM
Durch politischen Druck
Natürlicher Generationenwechsel mit
Umdenken ist im Gang
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Gründe für den Erfolg der CAM
Kulturphilosophische Öffnung und
Überwindung der reinen Aufklärung
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen „Disentchantment" mit der Schulmedizin
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Zunehmende Qualität der
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Eine Führungsposition der Schweiz
in der integrativen Medizin ?
Prädestination der Schweiz aus historischen
Gründen mit langer Tradition u.a. der
Naturheilkunst, Anthroposophie,
Homöopathie und vieler weiterer CAM
Methoden.
Hohe Akzeptanz bei der Ärzteschaft und bei
Bestehende weit gefächerte komplementär-
medizinische KMU
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen Aufgrund dieser starken Kräfte im Bereiche
der Philosophie, der demographischen
Entwicklung und der Medizin selbst wird die
komplementäre Medizin in den nächsten
Jahren an Bedeutung gewinnen.
Und dies trotz Couchepin.
Mit diesen Worten möchte ich mich bei Ihnen für Ihre
Aufmerksamkeit ganz herzlich bedanken.
Dr. med. Joerg Fritschi, CH-4148 Pfeffingen

Source: http://www.ngsh.ch/ngsh_downloads/KomplementaermedizinUeberleben.pdf

i-deal.am

Instituto IDEAL Conferencia abierta El modelo económico de Macri y sus consecuencias sociales Está muy claro lo que pasaArnaldo Bocco Buenas noches, les agradezco realmente la invitación. Estuve hace poco enuna reunión muy interesante, donde analizamos en aquel a ocasión la visita delpresidente Obama y qué había dejado en su paso por la Argentina.

journal.hep.com.cn

Protein Cell 2014, 5(2):113–123DOI 10.1007/s13238-013-0013-0 Signaling control of the constitutiveandrostane receptor (CAR) Hui Yang, Hongbing Wang& Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn Street, Baltimore, MD 21201,USA& Correspondence: hwang@rx.umaryland.edu (H. Wang)Received November 24, 2013 Accepted December 7, 2013