The shortage of general practitioners (GPs) and the aging workforce of established GPs in Switzerland are persistent. Furthermore, data on GPs with additional training in complementary medicine (CM) are lacking. This study aimed to obtain information on GPs with training in CM. A nationwide cross-sectional study was conducted using an anonymous online survey to assess the demographics, practice structures, workloads, and future perspectives. The participants were members of four CM societies representing doctors with CM certificates (n = 1,067) in traditional Chinese medicine/acupuncture (TCM/A), homeopathy (HOM), anthroposophical medicine, and phytotherapy. Overall, 206 GPs were included and divided into three groups: TCM/A (n = 73), HOM (n = 76), and others (n = 57). Most participants were male, and approximately half worked in double or group practices. They worked an average of 36 h per week, which had decreased by 13 h over the past 5 years, with plans for further reduction in the future. Approximately 18% planned to continue working beyond the retirement age, and 4% wanted to retire before that age. The majority expressed optimism about the future of CM in Swiss healthcare but less for individual CM disciplines. Compared to the 2015 Swiss Workforce Study, more CM GPs were female, worked less often in group practices, made fewer house calls, and were more optimistic about the future. CM-GPs in Switzerland face the same challenges as conventional GPs. National action and collaboration are needed to improve working conditions and to address the trend towards part-time work and an ageing workforce to safeguard healthcare for the population.

BACKGROUND:Randomised controlled trials (RCTs) are an established research method to investigate the effects of an intervention. Several recent systematic reviews and meta-analyses of RCTs with homeopathic interventions have identified shortcomings in design, conduct, analysis, and reporting of trials. Guidelines for RCTs in homeopathic medicine are lacking.OBJECTIVES:This paper aims to fill this gap in order to enhance the quality of RCTs in the field of homeopathy.METHODS:Identification of the homeopathy-specific requirements for RCTs by reviewing literature and experts' communications. Systematization of the findings using a suitable checklist for planning, conducting, and reporting RCTs, namely the SPIRIT statement, and high-quality homeopathy RCTs as examples. Cross-checking of the created checklist with the RedHot-criteria, the PRECIS criteria, and a qualitative evaluation checklist. Consideration of the REFLECT statement and the ARRIVE Guidelines 2.0 for veterinary homeopathy.RESULTS:Recommendations for future implementation of RCTs in homeopathy are summarized in a checklist. Alongside, identified useful solutions to the issues encountered when designing and conducting homeopathy RCTs are presented.CONCLUSIONS:The formulated recommendations present guidelines additional to those in the SPIRIT checklist, on how to better plan, design, conduct, and report RCTs in homeopathy.

Objectives: Homeopathy (HOM) is a therapeutic method, which is widely used by patients and medical professionals. The medical conditions as well as the homeopathic medical products investigated vary strongly. There is an extensive amount of research, and this necessitates a bibliography that comprehensively presents the entire body of clinical evidence grouped according to medical conditions. Design: Thirty-seven online sources as well as print libraries were searched for HOM and related terms in eight languages (1980 to March 2021). We included studies that compared a homeopathic medicine or intervention with a control regarding the therapeutic or preventive outcome of a disease (classified according to International Classification of Diseases-10). The data were extracted independently by two reviewers and analyzed descriptively. Results: A total of 636 investigations met the inclusion criteria, of which 541 had a therapeutic and 95 a preventive purpose. Seventy-three percent were randomized controlled trials (n = 463), whereas the rest were non-randomized studies (n = 173). The leading comparator was placebo (n = 400). The type of homeopathic intervention was classified as multi-constituent or complex (n = 272), classical or individualized (n = 176), routine or clinical (n = 161) and isopathic (n = 19), or various (n = 8). The potencies ranged from 1X (dilution of -10,000) to 10 M (100-10.000). The included studies explored the effect of HOM in 223 medical indications. We present the evidence in an online database. Conclusions: This bibliography maps the status quo of clinical research in HOM. The data will serve for future targeted reviews, which may focus on the most studied conditions and/or homeopathic medicines, clinical impact, and the risk of bias of the included studies.

Viele Haus- und Kinderarztinnen und -arzte sind immer wieder mit Fragen ihrer Patient/-innen konfrontiert, welche Massnahmen sie uber die saisonale Grippeimpfung hinaus zur Vorbeugung und Behandlung von grippeahnlichen Erkrankungen, einschliesslich Influenza und neu auch COVID-19, empfehlen wurden. Gerade aus dem Bereich der Komplementarmedizin gibt es dafur eine Vielzahl in der Praxis bewahrter Verfahren, die wir in diesem Artikel vorstellen mochten.

De nombreux médecins généralistes et pédiatres sont régulièrement confrontés aux questions de leurs patients quant aux mesures qu'ils recommanderaient, en plus de la vaccination contre la grippe saisonnière, pour la prévention et le traitement des maladies grippales, y compris la grippe et désormais la COVID-19. En médecine complémentaire notamment, il existe un grand nombre de méthodes éprouvées à cet effet, que nous souhaitons présenter dans cet article.

Background:Recurrent urinary tract infections are of importance for public health as most clinicians are faced with repeated and long-term administration of broad-spectrum antimicrobial agents leading to an increased risk of resistant bacteria. One encouraging treatment approach may be individualized homeopathy.Case Reports:Here, four female cases with recurrent urinary tract infections are reported. They were treated successfully with the homeopathic strategy after several conventional approaches revealed no improvement. The follow-up period was a minimum of 3 years and the frequency of episodes with urinary tract infection as well as of antibiotic treatment was documented. Additionally, the patients were asked to assess the treatment outcome retrospectively in a validated questionnaire.Results:The treatment resulted in a reduction of urinary tract infections and the need for antibiotics from monthly to less than 3 times a year. Three of the four women had no cystitis and related intake of antibiotics for more than 1.5 years. A relapse of symptoms could be treated efficiently with a repetition of the homeopathic remedy. All subjective outcome assessments resulted positive.Conclusion:This case series suggests a possible benefit of individualized homeopathic treatment for female patients with recurrent urinary tract infections. Larger observational studies and controlled investigations are warranted.

INTRODUCTION:Burning mouth syndrome (BMS) is a rare disease of unknown origin. No efficient treatment is known, and integrative approaches are warranted. So far, individualised homeopathy (iHOM) has not been evaluated or reported in any peer-reviewed journal as a treatment option.METHODS:At the Centre of Complementary Medicine at a university institute in Switzerland, a 38-year-old patient with BMS and various co-morbidities was treated with iHOM between July 2014 and August 2018. The treatment involved prescription of individually selected homeopathic single remedies. During follow-up visits, outcome was assessed with two validated questionnaires concerning patient-reported outcomes. To assess whether the documented changes were likely to be associated with the homeopathic intervention, an assessment using the modified Naranjo criteria was performed.RESULTS:Over an observation period of 4 years, an increasingly beneficial result from iHOM was noted for oral dysaesthesia and pains as well as for the concomitant symptoms.CONCLUSION:Considering the multi-factorial aetiology of BMS, a therapeutic approach such as iHOM that integrates the totality of symptoms and complaints of a patient might be of value in cases where an association of psychological factors and the neuralgic complaints is likely.

evidence. Thus, it is not astonishing that ‘... three out of four prescribing physicians (who) use homeopathy as an opportunity to meet patients’ expectations without exposing them to unnecessary side-effects ...’, and it is remarkable that 42.4% of non-prescribers report the need for further research. In the questionnaires by Markun et al. [1] , the participants were asked about their agreement with explanatory models regarding the effectiveness of homeopathy (question 10). The authors mixed up several of these, in our opinion inappropriate, ‘models’: the law of similars relates to the prescribing of homeopathic remedies and is not an explanatory model. Water memory, quantum physics, chaos theory, etc. are explanatory models, but in large parts they are unproven hypotheses and not relevant for daily practice. From its very beginning, homeopathy has had an empirical base and has not been deduced from such theories as the authors assume. Also, items such as ‘satisfaction of patients’ expectations’ or ‘strengthening of the relationship between patient and physician’ are not explanatory models but can be positive and intended side-effects of a homeopathic consultation [4] . The authors concluded that prescribing homeopathic remedies on a placebo basis is an ethical dilemma. However, the results from clinical studies do not support the conclusion that the effect of homeopathic remedies is only a placebo effect. Results from both basic research and clinical studies on different evidence levels including meta-analyses [5–7] are in favor of at least a possible specific homeopathic effect (survey in [8] ). In particular, outcome and observational studies under real-practice conditions broadly show good or at least non-inferior results. On the contrary, we consider it an ethical problem if a safe and possibly helpful treatment is withheld from a patient because it is disliked or unknown by the treating physician. In their paper, the authors missed to discuss the impact on patients’ safety of withholding therapies, which are requested by patients and might be helpful. Denying complementary medicine can provoke self-treatment or treatment by not adeHomeopathy is a controversial subject, but the positions of Markun et al. [1] are clearly determined. They claim that ‘placebo effects seem the most obvious explanation’ for homoeopathic effects, because ‘explanation models for the effectiveness of homeopathy are not supported by natural sciences and the aggregated evidence from clinical trials is unconvincing’ to them. The authors lament that ‘still, many physicians continue to prescribe homeopathic treatments’ and view this as ethically problematic. Here, we argue that strong a priori standpoints may bear the risk of compromising the scientific discourse and may lead to imbalanced conclusions. The survey by Markun et al. [1] among ambulatory care doctors in the canton of Zurich showed 2 remarkable findings: not only certified homeopathic doctors (only 2.4% of the participants) expected specific results from homeopathic remedies, but as many as 50.4% of all homeopathy prescribing physicians did so, and only a small number (21.4%) intended to achieve only placebo effects. This means that most of the homeopathy prescribers were expecting specific effects of homeopathic remedies. Second, 53% of all participants even endorsed the use of homeopathy in certain indications, particularly where the possibilities of conventional medicine were exhausted or did not exist. Homeopathy, as many other medical therapies, cannot be explained in all aspects – however, ‘absence of evidence is not evidence of absence’ [2] . In conventional primary care, the majority of interventions, beyond doubt, has no proper evidence base. According to BMJ Clinical Evidence, a database collecting the best available evidence on common clinical interventions, there is evidence for beneficial effects for only 11% of the treatments, but for 50% of 3,000 treatments the effectiveness is unknown [3] . We assume that most general practitioners (GPs) are aware of this gap, cope with these uncertainties, and try to find the optimal and least harmful treatment for their patients by taking into account clinical expertise, patients’ expectations and preferences, and the best external Published online: November 28, 2018

The Department of Haematology/Oncology at the University Children's Hospital Bern (HONK), has adopted an integrative approach in addition to state of the art ontological care and implemented a collaboration with the Institute of Complementary Medicine IKOM, University of Bern, over the past 10 years. Stakeholder satisfaction with this service was high. We present descriptive data and report on 4 exemplary patients treated with additional individualized homeopathy (iHOM). Data concerning frequency of consultations, pathologies, follow-ups and clinical results were reviewed and summarized using descriptive statistics. 94 paediatric oncologic patients consulted for iHOM. Indications for the complementary treatment was wide-ranging. No interactions with conventional treatment and no adverse side-effects of iHOM were detected. We present four characteristic patient histories, in which iHOM was used in addition to standard treatment for mucositis, permissive tissue infection, insomnia and affective dysfunctions. All four patients clinically improved in an immediate temporal relationship to the additional treatment. Conclusion: The collaboration between HONK and IKOM established iHOM in paediatric oncology in Bern. In this setting, iHOM was a safe and supportive additional treatment for various indications during the conventional cancer care. However, no generalizable results can be deducted from these data. We emphasize future research on this topic.

Background/Aim: Though there exists a considerable amount of randomized controlled trials (RCTs) and several meta-analyses of clinical studies, the effects of homeopathy (HOM) in different indications and application modes remain unclear. The transferability of HOM into experimental conditions of RCTs and vice versa is questioned. We conducted a comprehensive systematic review focusing on both routine practice of potentized substances and applicability of the results for therapeutic use. Therefore, a pathology-based subgroup classification of diseases was developed that addresses the concept of homeopathic interventions interacting with the biophysical regulation systems of the target organism. The study protocol also foresees three meta-analyses: effects of HOM (1) compared with placebo in nine pathology-based subgroups, (2) compared with conventional treatment in nine pathology-based subgroups, and (3) in preventive use.

Fragestellung: Im Zusammenhang mit der Einführung ambulanter KM-Sprechstunden am Regionalspital Burgdorf wurde die ärztliche Einstellung zu Komplementärmedizin (KM) untersucht. Weiterhin wurden der Anteil der Ärzte mit KM-Angeboten im Versorgungsgebiet des Regionalspitals, deren KM-Erfahrungen sowie der Einfluss dieser Erfahrungen auf die Einstellung gegenüber KM untersucht. Material und Methoden: Alle Ärzte jeglicher Fachrichtung (n = 170) im Versorgungsgebiet wurden 2011 und 2012 schriftlich zu ihrer Einstellung gegenüber KM (Befürwortung/Ablehnung und Ambivalenz), ihrem KM-Angebot und ihren KM-Erfahrungen befragt (Rücklaufquote 45% bzw. 36%). Ergebnisse: Die Einstellung gegenüber KM war im Durchschnitt neutral (M = 2,47, Standardabweichung (SD) = 0,61; Befürwortung von KM von 1 = «stimme völlig zu» bis 4 = «stimme überhaupt nicht zu») und klar (M = 1,59, SD = 0,46; Einstellungsambivalenz von 1 = «habe klare Meinung» bis 4 = «bin mir sehr unsicher in meiner Meinung»). Die höchste Zustimmung erhielten die Forderungen nach wissenschaftlicher Untersuchung der KM (M = 2,10, SD = 0,95) und nach zertifizierter ärztlicher KM in der Grundversicherung (M = 2,53, SD = 1,15). Knapp ein Drittel der Ärzte bot KM an, und 77% bzw. 69% überwiesen Patienten zu KM-Behandlungen. Die wichtigsten Prädiktoren der KM-Befürwortung waren eine zertifizierte KM-Ausbildung und unerwartete positive bzw. negative Verläufe unter einer KM-Behandlung (R22011 = 0,44, p < 0,001). 25% der Ärzte hatten Erfahrungen mit der neuen KM-Sprechstunde, die überwiegend positiv waren. Schlussfolgerung: Die teilnehmenden Ärzte aus einer ländlichen Region der Schweiz zeigten im Durchschnitt eine neutrale und klare Einstellung zur KM, die sich im eigenen KM-Angebot bzw. in der Überweisungspraxis spiegelte.

Since 1995, there is an institute for complementary medicine at the university of Bern, Switzerland, with a faculty for homeopathy. Since 1998, we have a consulting service for in- and out-patients of the university clinics of the ”Inselhospital”. Most of the consultations take place in the child care-unit of the university, initially in collaboration with neuro-pediatricians, neonatology and presently hematology/oncology. Adult patients are consulted, too, allocated mainly from the sections for oncology and radiotherapy.

Though there exists a considerable amount of placebo-controlled trials and several meta-analyses of ultra-low doses (ULD) and high dilutions (HD) of active ingredients, their benefits remain unclear due to the variety of homeopathic interventions, and to limited transferability of homeopathic practice into experimental conditions of randomized controlled trials (RCTs) and vice versa.

S POSTER PRESENTATIONS Use of homeopathy in patients with organ transplant in Switzerland: first results and further steps Martin Frei-Erb*, Klaus von Ammon and Loredana Torchetti Institute of Complementary Medicine IKOM, University of Bern, Bern, Switzerland Correspondence: Dr Martin Frei-Erb, Institute of Complementary Medicine IKOM, University of Bern, Bern, Switzerland. E-mail: martin.frei@ikom.unibe.ch (M. Frei-Erb) Objective: To investigate retrospectively use of Complementary and Alternativemedicine (CAM), in particular homeopathy, in the treatment of patients with organ transplantation in Switzerland and to present a roadmap to follow-up. Methods: Members of the Swiss transplant association were asked to complete a questionnaire about CAM use retrospectively. Results: Of the 267 patients contacted, 124 (46%) completed the questionnaire, and data of 118 (44%) participants could be analyzed: 55 were women (47%), mean age was 56 years, and 64 (54%) indicated CAM use. Different CAM methods were most common, with classical homeopathy being the most popular during the underlying disease leading to transplant (15% of all participants), but loosing importance before, during and after the transplantation itself. About 25% CAM users had informed their treating physicians about CAM use. Family doctors were mostly supportive, while specialists were more cautious about CAM use. Among the 54 non-CAM users, the most frequent reasons for not choosing CAM were insecurity about interactions with conventional treatment (46%), and lack of information about this option (28%). Conclusion: The results point to the need of more information on possibilities and limits of CAM as add-on in the treatment of patients with transplantations for both, treating doctors and concerned patients. This could be achieved with mixed methods research: qualitative studies to gain knowledge about the attitude and needs of patients and physicians; clinical studies on the effectiveness and safety of CAM for transplant patients based on the present results. The effect of disclosing information about prescribed homeopathic medicine to patients on their clinical outcomes: a comparative study Mahsa Asasi* and Nazila Assasi Classical Homeopath Clinic, Ontario, Canada Correspondence: Mahsa Asasi, Pharm.D., DHMHS, Canada. E-mail: Info@classicalhomeopath.ca (M. Asasi) Background: Dispensing homeopathic medicines in a homeopathic office setting is very common among homeopaths. However, some homoeopaths feel uncertain about how and what to disclose to patients about the prescription. Based on findings of our previous study most of the homeopaths do not openly communicate the prescription details because they are concerned about possible negative impact of patient’s knowledge of homeopathic medicine on the treatment outcomes. Objectives: Our study aims at finding evidence about negative or positive effects of the current dispensing methods among homeopaths in Canada. Methods: A comparative study was performed. The study groups consisted of the patients who had received basic information about their medicines and those who had not. Information on actual practice of prescription, dispensing methods and related patient’s reactions, and the treatment outcomes was recorded during the course of treatment, and compared between the two study groups. Results: Based on the results of our study, there was no statistically significant difference between the patients who received a labeled homeopathic medicine and those who did not in terms of expected treatment effects. Our findings showed that a high proportion of patients receiving a nonlabeled remedy who asked about their medicine’s name became more anxious and concerned about taking the prescribed medicine when the homeopath refused to provide the requested information. Conclusion: In our study the negative effects of not labeling homeopathic medicines on treatment outcomes dominated its positive effects. It seems to be essential to develop regulations and standards for prescriptions or office-based dispensing of homeopathic medicines, and to include these standards in training of homeopaths.

BACKGROUND:Though complementary and alternative medicine (CAM) are frequently used by children and adolescents with cancer, there is little information on how and why they use it. This study examined prevalence and methods of CAM, the therapists who applied it, reasons for and against using CAM and its perceived effectiveness. Parent-perceived communication was also evaluated. Parents were asked if medical staff provided information on CAM to patients, if parents reported use of CAM to physicians, and what attitude they thought physicians had toward CAM.STUDY DESIGN:All childhood cancer patients treated at the University Children's Hospital Bern between 2002-2011 were retrospectively surveyed about their use of CAM.RESULTS:Data was collected from 133 patients (response rate: 52%). Of those, 53% had used CAM (mostly classical homeopathy) and 25% of patients received information about CAM from medical staff. Those diagnosed more recently were more likely to be informed about CAM options. The most frequent reason for choosing CAM was that parents thought it would improve the patient's general condition. The most frequent reason for not using CAM was lack of information. Of those who used CAM, 87% perceived positive effects.CONCLUSIONS:Since many pediatric oncology patients use CAM, patients' needs should be addressed by open communication between families, treating oncologists and CAM therapists, which will allow parents to make informed and safe choices about using CAM.

Introduction: Job satisfaction and therefore wellbeing of physicians is an important issue in high quality and safety of health care provision. The role of additional qualification in complementary medicine (CM) for job satisfaction of general practitioners (GPs), however, has not been explored. This study compared job satisfaction of conventional and homeopathic Swiss GPs. Methods: Participants of the Swiss Family Doctors Conference 2013 and members of the Swiss Association of Homeopathic Physicians participated in the survey. They indicated the extent of job satisfaction on 17 questions covering patient care, work-related burden, income-prestige, personal rewards, and professional relations. Results: Data of n = 125 GPs with homeopathic proficiency certificate and data of n = 143 GPs without any proficiency certificate in CM were analyzed. Overall job satisfaction was high and did not differ between the groups. However, due to lower number of patients per day, homeopathic GPs reported higher satisfaction in relations with patients and with workload, and lower satisfaction with income and in relations with peers compared to conventional GPs. Controlling for further confounding variables (e.g. working hours per week, practice setting), homeopathic GPs reported less satisfaction with their income than their conventional colleagues. Conclusions: Longer consultation time and lower number of patients homeopathic GPs see per day, may allowthem to unfold a deeper and more satisfying relationship with their patients and to lessen the workload. However, this comes along with financial discontent compared to conventional GPs. Certification in homeopathy and increased consultation time, respectively, may represent a way to enhance GPs’ job satisfaction.