A New Method Based on Electron Diffraction for Detecting Nanoparticles in Injectable Medicines.

A new method for detecting and characterizing nanoparticles in an injectable pharmaceutical solution is presented. The method is based on the simultaneous use, on those nanoparticles that are crystalline, of three-dimensional electron diffraction tomography and energy dispersive X-ray spectrometry. With three-dimensional electron diffraction tomography, the unit cell and the crystal symmetry of the nanoparticles are determined, while with energy dispersive X-ray spectrometry, the chemical composition is derived. With these data, through an inspection of a crystallographic database, it is possible to determine the crystal phase of the nanoparticles. The knowledge of the crystal phase is a valuable element for understanding the provenance and the formation of the nanoparticles, helping the researcher in solving any quality control issue related to the presence of nanoparticles in an injectable solution.

Overview of Integrative Medicine Practices and Policies in NATO Participant Countries.

Background: CAMbrella is a European research network for complementary and alternative medicine (CAM). Between January 2010 and December 2013 the CAMbrella consortium reviewed the status of CAM in Europe from the perspectives of: (1) terminology for description; (2) citizens' needs and expectations; (3) patients' usage patterns; (4) providers' practice patterns; and (5) regulatory and legal status in Europe. Together, this data was used to form a set of recommendations to the European Commission, the European Parliament, and national policy makers and civil society stakeholders. These recommendations can serve as a roadmap for European CAM research. Objective: This article aims to inform the reader about CAM prevalence, usage perspectives, and the future roadmap for CAM practices and research within the European Union. Method: This overview describes CAM status in the European Union, using the CAMbrella consortium projects as the source of information. Conclusions: The North Atlantic Treaty Organization is positioned as a potential foundation for inclusion of CAM modalities within the militaries as well for as collaborative research on safe and cost-effective practices.

Person-centred healthcare and medicine paradigm: it's time to clarify.

The person-centred healthcare and medicine paradigm is in need of a strong theoretical framework not only to explain what it is but to prevent dangerous confusions of terminology or reductive oversimplification of its true scope: for example, it may be integrated into biomedicine, whereas person-centred medicine and Traditional Systems and Complementary and Alternative Medicine (TCAM) actually stand in the position of interacting with the conventional health system. Emphasis on person-centred care is also in line with World Health Organization (WHO) policy and the International Declarations of Beijing and Alma Ata. Interaction of TCAM and person-centred approach to all forms of medicine will ensure variety of therapy in tackling the intrinsically complex and multifaceted issue of health and healing. It will also prevent inestimable traditional knowledge from being lost.

Ménière's disease treatment: a patient-centered systematic review.

Ménière's disease is a disorder of the inner ear affecting hearing and balance to a varying degree. It is characterized by episodes of vertigo, low-pitched tinnitus, and hearing loss. There is currently no gold standard treatment for Ménière's disease. We conducted a systematic search of the Cochrane Database, as a high-quality source of evidence-based therapies, for reviews on the efficacy of etiological therapy or on Ménière's disease or its symptoms. Following recent positive experiences reported by other research teams, we decided to involve a patients' representative in the assessment and analysis of the evidence retrieved in the literature in order to achieve a more patient-centered evaluation of the therapies. Evidence confirms that an effective treatment of Ménière's disease is still missing, but recent discoveries on the microvascular etiology of Ménière's disease may be assimilated by new evidence-based therapeutic approaches.

Personalization of multiple sclerosis treatments: using the chelation therapy approach.

Though Multiple Sclerosis (MS) sufferers are probably genetically predisposed, toxic metal poisoning (TMP) does seem an increasingly likely environmental trigger. The technique for measuring and clearing TMP was chelation therapy using ethylene-diamine-tetracetic acid (EDTA), which revealed aluminum accumulation in both cases. The first patient, initially benefiting from removing dental fillings that had leaked mercury, also showed gadolinium accumulation from scan contrast medium, and a genomic deficiency of glutathione transferase M1. Glutathione production was impaired and hence also liver detoxification functions. The personal protocol involved glutathione administration and deutrosulfazyme to enhance oxygenation and alleviate oxidative stress. As aluminum began to clear with EDTA infusion, the extracellular/intracellular water ratio was carefully monitored, and carbohydrates limited. In the second case, aluminum poisoning responded to EDTA chelation therapy with eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA), multivitamins, and glutathione administration, again followed by deutrosulfazyme, water ratio control, and dietary correction. The two personalized protocols presented here tend to confirm the hypothesis of TMP as an environmental or iatrogenic trigger for MS, especially when inadequate detoxification lies at the root. Cleansing by chelation therapy, properly understood, can be efficacious, especially bearing in mind the altered cellular water ratio.

Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine-person-centred medicine.

Traditional, complementary and alternative medical (TCAM) systems contribute to the foundation of person-centred medicine (PCM), an epistemological orientation for medical science which places the person as a physical, psychological and spiritual entity at the centre of health care and of the therapeutic process. PCM wishes to broaden the bio-molecular reductionistic approach of medical science towards an integration that allows people, doctors, nurses, health-care professionals and patients to become the real protagonists of the health-care scene. The doctor or caregiver needs to act out of empathy to meet the unique value of each human being, which unfolds over the course of a lifetime from conception to natural death. Knowledge of the human being should not be instrumental to economic or political interests, ideology, theories or religious dogma. Research needs to be broadened with methodological tools to investigate person-centred medical interventions. Salutogenesis is a fundamental principle of PCM, promoting health and preventing illness by strengthening the individual's self-healing abilities. TCAM systems also give tools to predict the insurgence of illness and treat it before the appearance of overt organic disease. A task of PCM is to educate people to take better care of their physical, psychological and spiritual health. Health-care education needs to be broadened to give doctors and health-care workers of the future the tools to act in innovative and highly differentiated ways, always guided by deep respect for individual autonomy, personal culture, religion and beliefs.

Towards a pan-European definition of complementary and alternative medicine--a realistic ambition?

BACKGROUND: The terms used for defining complementary and alternative medicine (CAM) including the methods, procedures and therapies vary greatly. The task of the CAMbrella working group on terminology was to explore the existing CAM terminologies and to develop a pragmatic definition of CAM that is acceptable Europe-wide. This can then be used to systematically research, e.g., its prevalence and legal status and to investigate the citizens' demands on CAM and the perspectives of providers of CAM in Europe. METHODS: Terms and definitions were collected from both scientific and non-scientific sources. The terms and definitions identified were analysed and discussed among the CAMbrella working group participants on several occasions with the aim of arriving at a consensus. RESULTS: We developed a proposal for a pragmatic European definition of CAM: 'Complementary and alternative medicine (CAM) utilised by European citizens represents a variety of different medical systems and therapies based on the knowledge, skills and practices derived from theories, philosophies and experiences used to maintain and improve health, as well as to prevent, diagnose, relieve or treat physical and mental illnesses. CAM has been mainly used outside conventional health care, but in some countries certain treatments are being adopted or adapted by conventional health care.' CONCLUSION: Developing a uniform, pragmatic pan-European definition of CAM was complicated by a number of factors. These included the vast diversity of existing definitions, systems, disciplines, procedures, methods and therapies available within the EU.

Legal status and regulation of complementary and alternative medicine in Europe.

OBJECTIVE: The study aims to review the legal and regulatory status of complementary and alternative medicine (CAM) in the 27 European Union (EU) member states and 12 associated states, and at the EU/European Economic Association (EEA) level. METHODS: Contact was established with national Ministries of Health, Law or Education, members of national and European CAM associations, and CAMbrella partners. A literature search was performed in governmental and scientific/non-scientific websites as well as the EUROPA and EUR-lex websites/ databases to identify documents describing national CAM regulation and official EU law documents. RESULTS: The 39 nations have all structured legislation and regulation differently: 17 have a general CAM legislation, 11 of these have a specific CAM law, and 6 have sections on CAM included in their general healthcare laws. Some countries only regulate specific CAM treatments. CAM medicinal products are subject to the same market authorization procedures as other medicinal products with the possible exception of documentation of efficacy. The directives, regulations and resolutions in the EU that may influence the professional practice of CAM will also affect the conditions under which patients are receiving CAM treatment(s) in Europe. CONCLUSION: There is an extraordinary diversity with regard to the regulation of CAM practice, but not CAM medicinal products. This will influence patients, practitioners and researchers when crossing European borders. Voluntary harmonization is possible within current legislation. Individual states within culturally similar regions should harmonize their CAM legislation and regulation. This can probably safeguard against inadequately justified over- or underregulation at the national level.

Complementary and alternative medicine provision in Europe--first results approaching reality in an unclear field of practices.

BACKGROUND: The demand for complementary and alternative medicine (CAM) treatment in the European Union (EU) has led to an increase in the various CAM interventions available to the public. Our aim was to describe the CAM services available from both registered medical practitioners and registered non-medical practitioners. METHODS: Our literature search comprised a PubMed search of any scientific publications, secondary references and so-called grey literature, a search of government websites and websites of CAM organisations to collect data in a systematic manner, and personal communications, e.g., via e-mail contact. Due to the different reliability of data sources, a classification was developed and implemented. This weighted database was condensed into tables and maps to display the provision of CAM disciplines by country, showing the distribution of CAM providers across countries. RESULTS: Approximately 305,000 registered CAM providers can be identified in the EU (~160,000 non-medical and ~145,000 medical practitioners). Acupuncture (n = 96,380) is the most available therapeutic method for both medical (80,000) and non-medical (16,380) practitioners, followed by homeopathy (45,000 medical and 5,800 non-medical practitioners). Herbal medicine (29,000 practitioners) and reflexology (24,600 practitioners) are mainly provided by non-medical practitioners. Naturopathy (22,300) is dominated by 15,000 (mostly German) doctors. Anthroposophic medicine (4,500) and neural therapy (1,500) are practised by doctors only. CONCLUSION: CAM provision in the EU is maintained by approximately 305,000 registered medical doctors and non-medical practitioners, with a huge variability in its national regulatory management, which makes any direct comparison across the EU almost impossible. Harmonisation of legal status, teaching and certification of expertise for therapists would be of enormous value and should be developed.

Black Cohosh Hepatic Safety: Follow-Up of 107 Patients Consuming a Special Cimicifuga racemosa rhizome Herbal Extract and Review of Literature.

European Medicines Agency (EMEA) and the Committee on Herbal Medicinal Products (HMPC) on July 2006 have released an alert to get European sanitary authorities aware of 42 cases of suspected hepatotoxic reactions in patients consuming Cimicifuga racemosa rhizome. In the public statement EMEA itself considered reliable as hepatotoxic reactions only four cases, on the base of RUCAM score: two were considered possible and two probable. Lacking in almost all of them a precise description of cases, especially a botanical-chemical analysis of the suspected substance, we think there is no real proof of supposed C. racemosa rhizome hepatotoxicity. In our department we administer from about 10 years C. racemosa as special herbal dry extract as single substance or mixed with other medicinal plants at the dose of 500-1000 mg daily, for treatment of menopause related disorders without any reported adverse effect. After EMEA's official signal we have contacted all our patients using a C. racemosa rhizome herbal extract continuously from more than 12 months to verify possible hepatotoxic effects. We followed-up 107 women, and asked them by telephone (33/107) and/or after anamnesis and clinical examination (74/107) to undergo a blood sample examination. In all the patients there was no sign of hepatic disease, or worsening of already altered but stable parameters. We think on the base of these data and current literature C. racemosa rhizome extract should not be considered a potential hepatotoxic substance.

Advent of a Link between Ayurveda and Modern Health Science: The Proceedings of the First International Congress on Ayurveda, "Ayurveda: The Meaning of Life-Awareness, Environment, and Health" March 21-22, 2009, Milan, Italy.

The First International Congress on Ayurveda was held in Milan, Italy in March 2009 and it has been the first scientific event of this kind in western world. This groundbreaking international congress was devoted to human being as the product of interactions between Awareness, Environment and Health, subjects that the West tends to consider separate and independent, but that are believed deeply connected in Ayurveda, whose interdependence defines "The Meaning of Life". The Congress established a bridge between indian and western philosophy, scientific and biomedical thinking in order to expand knowledge and healthcare. Main attention and address of the invited speakers was on the concept of "relationships" that, connecting living beings with environment, shape Nature itself. This concept is central in Ayurveda but is also common to other western scientific disciplines such as quantum physics and epigenetics that, in the four Sessions of the Congress, were represented by eminent experts. The importance of this event was underlined by the attendance of more than 400 participants and by noteworthy institutional endorsements, that added a significative political dimension of high social impact due to the topical period for CAM acceptance and integration in Europe.

Looking for a person-centered medicine: non conventional medicine in the conventional European and italian setting.

In Italy, the use of non conventional medicines (NCMs) is spreading among people as in the rest of Europe. Sales of alternative remedies are growing, and likewise the number of medical doctors (MDs) who practise NCM/complementary and alternative medicine (CAM). However, in Italy as in other countries of the European Union, at the present time the juridical/legal status of NCM/CAM is not well established, mainly due to the lack of any national law regulating NCM/CAM professional training, practice and public supply and the absence of government-promoted scientific research in this field. This is an obstacle to safeguarding the patient's interests and freedom of choice, especially now that dissatisfaction with biomedicine is inclining more and more people to look for a holistic and patient-centered form of medicine.

Allopathic versus Homeopathic Strategies and the Recurrence of Prescriptions: Results from a Pharmacoeconomic Study in Italy.

This is a pharmaeconomic study to assess the impact of different, cost-specific pharmacological strategies on the recurrence rate of prescriptions in the treatment of cold symptoms. Data were obtained from a prospective cohort study reporting individual prescriptions histories of subjects experiencing cold symptoms, obtained by a stratified random sample of 316 subjects, clustered into 139 Italian families, followed up for 40 months. Costs of homeopathic and allopathic treatments were recorded within each prescription. A Cox proportional hazards model with random effects was exploited to regress time elapsed between subsequent prescriptions over the relative difference between homeopathic- and allopathic-related costs, adjusting for age and gender and accounting for unobserved individual heterogeneity. Relative risks of event (prescription) re-occurrence have been estimated. The recurrence rate of prescriptions raise when allopathic strategies are preferred to homeopathic alternatives. No significant differences were observed between gender groups, while age was marginally significant. Inter-subjects heterogeneity was not significant.

Why we need integrative medicine.

Over the last few years the scientific debate on Non Conventional Medicines and their integration with the academic or dominant medicine in our western society has activated a cultural transformation process. This article discusses the main reasons of the need for an integration between the supposed only scientific, mainstream medicine and other cheaper, more holistic, more person-centred expertise.

The need for higher education in the sociology of traditional and non-conventional medicine in Italy: towards a person-centered medicine.

Italy is being forced to re-think her health plan as the national health service moves towards regional systems, individuals take more active responsibility for their health, the demand grows for traditional and non-conventional medicine and immigrants join the user list. Person-centered medicine and ever-wider skills attainable with the tools of analysis and research have made a new professional update indispensable. The proposed Master-Course on "Health systems, traditional and non-conventional medicine", first of its kind in Italy, fits this bill. The new forms of treatment that state and international bodies are prepared to recognize depend entirely on the universities training our professionals with concrete skills in planning, research and health management. Our paper performs an epistemological critique of the new health requirements and goes on to outline the reasons behind this training imperative.

Towards salutogenesis in the development of personalised and preventive healthcare.

The purpose of this review is to discuss how a salutogenetic approach that takes into consideration the human being as physical, psychological and spiritual entity may provide some answers to the difficulties faced by healthcare systems. The choice of medical intervention needs to take into account the technological advances of biomedicine but tailor them to the physical, psychological and spiritual needs of the patient in the context of their biography. Such person-centred medicine aims to strengthen Antonovsky's concepts of resilience and sense of coherence with each therapeutic intervention so that overcoming illness becomes the foundation for better future health. Appropriate evaluation parameters need to be developed and included in order to evaluate the success of interventions in a person-centred, salutogenetic system.

Tibetan medicine: a unique heritage of person-centered medicine.

With a history going back approximately 2,500 years, the Tibetan medicine, known as Sowa Rigpa in the Tibetan language, is one of the world's oldest known traditional medicine. It originally developed during the pre-Buddhist era in the kingdom known as Shang Shung. As a traditional medicine, the future development of Tibetan medicine in Western countries is linked to being recognized as a popular and viable healthcare option providing an alternative clinical reality. Its inherent ability to incorparate predictive diagnostics, targeted prevention, and the creation of individualized medical treatment give Tibetan medicine great potential for assessing and treating patients.