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Thank you for the opportunity to expand on the topic of our systematic review. Naturopathic treatments (NT) was deliberately chosen as the term. It is used in the official catalog of learning objectives for medical studies in Germany (cross-sectoral unit 12: Rehabilitation, Physical Medicine, Naturopathic Treatments) and is the title of the medical additional specialization for this area. It is not correct that NT only includes material measures. Relaxation techniques and “mind body” medicine are a natural part of NT within Ordnungstherapie (a form of lifestyle regulation therapy). Although the term “complementary and alternative medicine” (CAM) has been established in the USA, it falsely suggests the alternative use, which in practice is rare (complementary = supplementary, is what is meant) and has recently been often replaced with “complementary and integrative medicine” (CIM) (1, 2).

Regarding the effectiveness of acupuncture, please note that the database in our work refers to systematic reviews with high quality standards. We used a standardized and Cochrane-recommended instrument for the evaluation, which assesses the planning and execution of the systematic reviews, as well as the quality of the included studies and possible bias factors (3).

The data on adverse effects of acupuncture from large RCTs and cohort studies are very good; however, the studies were only partially processed by the G-BA. The statement of the G-BA does not contradict the statement of the reference cited by us (4). The evaluated reviews and cross-sectional studies came in majority to the conclusion that acupuncture treatment is safe, and that severe adverse effects are very rare. We have deliberately refrained from mentioning specific acupuncture points other than P6 in this article, because this treatment should be carried out by physicians with experience in acupuncture. The article is not a guide to the application, but merely an overview of what is possible.

In order to stay within the limits of an article format, it was necessary to make a selection prior to our systematic search. We thus first carried out an explorative literature review and selected only those methods that have been investigated by a sufficient number of promising clinical studies. Unfortunately, in addition to homeopathy, other areas of complementary medicine, such as anthroposophic medicine, Ayurveda, or Japanese Kampo medicine, have therefore not been mentioned in the article (5).

DOI: 10.3238/arztebl.2019.02223

On behalf of the authors

Prof. Dr. med. Roman Huber
Uni-Zentrum Naturheilkunde, Institut für Infektionsprävention und Krankenhaushygiene, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
roman.huber@uniklinik-freiburg.de

Dr. med. Ann-Kathrin Lederer
Uni-Zentrum Naturheilkunde, Institut für Infektionsprävention und Krankenhaushygiene, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
ann-kathrin.lederer@uniklinik-freiburg.de

Conflict of interest statement

The authors declare that no conflict of interest exists.

1.
U.S. National Library of Medicine – Medline Plus: Complementary and integrative medicine. www.medlineplus.gov/complementaryandintegrativemedicine.html (last accessed on 9 February 2019).
2.
NIH – National Center for Complementary and integrative health: complementary, alternative, or integrative health: What’s in a name? www.nccih.nih.gov/health/integrative-health (last accessed on 9 February 2019).
3.
Cochrane Deutschland, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften – Institut für Medizinisches Wissensmanagement. Bewertung von systematischen Übersichtsarbeiten: ein Manual für die Leitlinienerstellung“. 1. edition 2017
4.
Witt CM, Brinkhaus B, Jena S, Selim D, Straub C, Willich SN: Wirksamkeit, Sicherheit und Wirtschaftlichkeit der Akupunktur – Ein Modellvorhaben mit der Techniker Krankenkasse. Dtsch Arztebl 2006; 103: A 196–202 VOLLTEXT
5.
Lederer AK, Schmucker C, Kousoulas L, Fichtner-Feigl S, Huber R: Naturopathic treatment and complementary medicine in surgical practice—a systematic review. Dtsch Arztebl Int 2018; 115: 815–21 VOLLTEXT
1.U.S. National Library of Medicine – Medline Plus: Complementary and integrative medicine. www.medlineplus.gov/complementaryandintegrativemedicine.html (last accessed on 9 February 2019).
2.NIH – National Center for Complementary and integrative health: complementary, alternative, or integrative health: What’s in a name? www.nccih.nih.gov/health/integrative-health (last accessed on 9 February 2019).
3.Cochrane Deutschland, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften – Institut für Medizinisches Wissensmanagement. Bewertung von systematischen Übersichtsarbeiten: ein Manual für die Leitlinienerstellung“. 1. edition 2017
4.Witt CM, Brinkhaus B, Jena S, Selim D, Straub C, Willich SN: Wirksamkeit, Sicherheit und Wirtschaftlichkeit der Akupunktur – Ein Modellvorhaben mit der Techniker Krankenkasse. Dtsch Arztebl 2006; 103: A 196–202 VOLLTEXT
5.Lederer AK, Schmucker C, Kousoulas L, Fichtner-Feigl S, Huber R: Naturopathic treatment and complementary medicine in surgical practice—a systematic review. Dtsch Arztebl Int 2018; 115: 815–21 VOLLTEXT

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