Private lecturer Dr. Matthias Kröz

Complementary medicine is enjoying ever-greater popularity and acceptance: many patients have come to appreciate its gentler methods and alternative approaches. Yet the effectiveness of such approaches has to date not been fully systematically researched. Dr. Matthias Kröz of the Havelhöhe Community Hospital in Berlin has now explored “Psychometric Methods for the Evaluation of Integrative Medicine” in his Habilitation (post-doctoral) thesis. The scientific thesis, completed at the University of Witten-Herdecke, was completed with the support of the Software AG Foundation.

Dr. Kröz, congratulations on obtaining the venia legendi! Could you describe the topic of your dissertation in layman's terms?

Thank you for your congratulations! Simply put, the question is as follows: how can we use patient questionnaires to evaluate the conceptual foundations of integrative, anthroposophical medicine? To compress it a bit more: we wanted to find out how self-healing powers could be recognized and researched in terms of their importance in relation to patients.

In your habilitation thesis your describe how - despite a level of high acceptance for naturopathic treatments - there is a lack of scientific evaluation of so-called complementary medicine. Why is this the case?

In terms of its history, complementary medicine has long been more of an experience-based approach to healing, and for a long time it was not a part of university research. Another factor is that to date, there has been little public funding available in Europe for evaluating complementary medicine. Foundations like the Software AG Foundation have so far enabled especially the foundational research in this field. There have been some groundbreaking studies, such as the ACUSAR acupuncture study by Professor Benno Brinkhaus, the first study on complementary medicine that was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG). The study demonstrated scientifically that acupuncture is effective against hay fever. Overall, one has to say that an academic community interested in this topic has developed only in the last 20 years, and largely made possible by foundations. But we are speaking of pioneering work here in Europe; in the US the situation is different.

Your research is focused on the field of “integrative medicine,” which aims to combine conventional medicine with the various strands of complementary medicine. What is so special about this approach? Is this approach defined by a particular understanding of the human being?

Complementary medicine (in the US and UK often called “Complementary and Alternative Medicine,” or CAM) refers to approaches that exist in conversation with conventional scientific medicine, and which are willing to undergo scientific evaluation. This also includes forms of anthroposophical medicine whose approach is combined with a modern conventional medical approach, and which are in this sense also a form of integrative medicine. With this definition, adopting a wider perspective is critical: how can we support self-healing powers in a specific way that brings the individuality and the biographical situation of the patient into the picture? And what role does the relationship between the doctor and the patient play in this respect?

The pathogenic principle focuses on makes people sick and how they can be helped. The salutogenic principle, on the other hand, asks what keeps people healthy, and how the individual's self-healing resources can be activated. What are the qualitative differences between these two approaches? What roles do they play in your research and in integrative medicine? 

When we examine a patient and find, for example, blood pressure or hormone abnormalities that are making him sick or threatening his health, then the therapeutic goal - from the perspective of pathogenesis - is to bring the deviant blood pressure or hormonal disorder back into a normal physiological range. This principle is naturally fully valid and is the basis for our daily work in the clinic. The other side is the salutogenesis model developed by Antonovsky, which asks what keeps people healthy, and how the self-healing powers of the human soul or personality can be specifically supported. As a third aspect I would like to mention hygiogenesis, which is based on the work of Gunther Hildebrandt, an occupational physiologist from Marburg. This is a matter of identifying the self-organization processes  (adaptation and regulation) in human physiology that support the maintenance and restoration of health. The starting points here are the body's rhythms, so time-bound biological processes such as daily activities as well as sleep and restoration. 

In medicine in general, and in integrative medicine in particular, all of these three aspects are of great importance, as they are very fundamental to our daily work as doctors. Pathogenesis is the foundation of a range of actions of a doctor. Hygiogenesis is activated by, among other things, anthroposophical medicinal approaches such as mistletoe extracts or body-oriented therapies. Artistic therapies, curative eurythmy, or psychotherapies take effect in different ways on the mental and spiritual level and are thus in line with the principle of salutogenesis.

How can the self-healing resources that you just mentioned be understood, and what role does the questionnaire you developed play in this respect?

In oncology research, we evaluated on the one side pathogenetic questionnaires - such as regarding cancer-related fatigue, for example. For the salutogenetic principles we re-evaluated a questionnaire by Grossarth-Maticek and Eysenck that reflected on self-regulation as goal-oriented and wellness-oriented change in behavior. This enabled us to investigate health-promoting behavioral changes which could be used as the basis for our medical intervention in myriad ways.  In short, we wanted to find out how people deal with illness. In a second questionnaire regarding internal coherence (ICS), we asked whether patients have the impression that they are headed in the right direction, whether they have the courage to endure their illness, and to what extent they are in harmony with their innermost desires. 

For the hygiogenetic questions, to date we have largely had physiological or physical measurement techniques. With the questionnaire regarding autonomous regulation we were able to capture, on a patient level, vegetative and physical functions regarding rest/activity regulation, cardiovascular regulation, and digestion. This enabled us to check physical function in a way closely tied to health processes. This is an important extension to a multi-level approach to health and disease.

What new impulses do you hope that your research will bring to science and medical practice?

In the foreground stands the question: what we can learn in the context of integrative medicine? We can better depict constitutional processes and self-healing processes from the perspective of anthroposophic medicine and also better describe the outcome relevance, that is, the effects, of these processes. I hope that we can make a contribution with these methods that will help this direction of medical care to progress further, especially in dialogue with traditional university medicine. This creates a foundation for new studies on the effects and effectiveness of (among other things) the eurythmy therapy, arts or care-oriented therapies of anthroposophic medicine, but also for further medication research.

Thanks for the discussion! 

More Information: Faculty of Health at Witten/Herdecke University.