This research study was designed to evaluate quality of life in patients with breast cancer receiving CAM at the Centre for Natural Healing in Oregon. It was further designed as an audit of clinical practice and was intended to improve patient services and treatment outcomes.

Materials and methods
Screening criteria were applied to approximately 1000 patient files covering many types of cancer. 23 cases were identified for detailed review. Data was extracted about type and stage of breast cancer, conventional interventions, blood work and clinical progression and herbal and nutritional prescriptions. Two validated quality of life (QoL) questionnaires (the MOS SF-36 and the EORTCBR23) and one internally generated questionnaire were sent to the patients. Follow up questionnaires were completed by telephone.

Results
Of the 23 questionnaires sent, 9 patients responded. All patients were 6 months to several years post original cancer diagnosis prior to commencing CAM treatment at CNH. Eight of the 23 screened patients and 4 of the nine responding patients had not received chemotherapy or radiation. Responses were positive in almost all QoL parameters. Patients reported significant and sustained improvement in overall quality of life.

QoL parameters that improved overall:
- Limitations in usual role activities because of health problems
- General health perceptions
- Vitality (energy and fatigue)
- Limitations in social activities because of health problems
- Limitation in usual role activities because of emotional problems
- General mental health (psychological distress and well-being)
- Systemic therapy side effects
- Body image
- Future perspective
- Sexual functioning

QoL parameters that worsened overall
- Limitations in physical activities (functioning) because of health problems
- Bodily pain

The results from the third, non-validated, internally generated questionnaire emphasised the positive experience of the patient – practitioner interaction and how that relationship impacted the patients’ perceived quality of life.

The ability to accurately correlate prescriptions with clinical progression requires greater time and resources than were available for this study although prescribing trends are revealed.

Conclusions
This retrospective case review assessed 23 cases for perceived quality of life and examined the potential correlation with treatment at the Centre for Natural Healing. The study indicates improvement in a majority of QoL parameters and an overall trend towards improvement in quality of life. This disputes the findings of previous researchers and calls into question the role of the personal interaction with the practitioner and the patients’ total therapeutic experience. It is notable that patients in this present study were uniformly positive about the practitioner and their personal interaction with him. Previous research into QoL in women receiving CAM for breast cancer was largely conducted in hospital or outpatient settings and was more concerned with the treatments prescribed than with the total experience of the patient or their feelings about CAM. The impact of practitioner – patient relations on the quality of life outcomes and the role of faith in healing are under-examined and represent promising areas for future research.

The ethnobotanical literature reviewed shows documented, long traditional use in a wide range of infections including tuberculosis, in rheumatism and arthritis, gastrointestinal problems, and pain relief. Strong purgative and emetic properties are also well documented.

An exhaustive review of the scientific literature show in-vitro activity of the plant against bacteria, viruses, mycobacteria and fungi.

Scientific investigations conducted to assess the hypoglycemic effects of devils club are reviewed and found to be inconclusive.

The treatment of diabetes with devil’s club is discussed in traditional, scientific and historical context, and finds insufficient evidence to support claims of a hypoglycaemic action.

The traditional use in treating tuberculosis and the subsequent scientific investigations showing the plant’s significant in-vitro activity against drug resistant Mycobacterium avium are analysed and discussed.

Commercial claims for devil’s club are reviewed. Sufficient evidence was not found in the literature to support use in diabetes, hyperglycaemia, cancer, or as a ginseng substitute. However further investigations for use in diabetes and cancer are warranted.

Traditional preparations of devils club are reviewed. No evidence of traditional use of devils club in tincture or capsule form is found in the literature, nor is evidence found to support safety or efficacy of these types of preparation.

Finally the author reviews ethical considerations, and concludes that it would be unethical to use this plant unless there are sustainable harvesting and management practices, permission from First Nations people to use traditional knowledge and to commercialise this sacred plant, and benefit sharing with First Nations people according to the Convention on Biological Diversity.

A discussion of the conceptual understanding of the mechanisms of cardiovascular (CV) illness is presented as a debate forum for testing the hypothesis. Recent advancements in the development of biomedical theories describing the aetiology of CV illness in a PNE context, provide a comprehensive understanding, which facilitates a comparison based upon broad therapeutic principles.

An analysis of the current PNE concepts of CV illness is presented in order to demonstrate the multi-system approach and to provide a theoretical basis for conceptual comparison.

Examination of the empirical basis of WHM reveals the importance of the vitalistic understanding, and establishes its origin in Humoral Medicine and Phyiomedicalist practice. Explicating the main therapeutic concepts inherent with these systems, an examination of the WHM understanding of cardiovascular illness aetiology is presented as a theme for comparative discussion.

In testing the hypothesis, the comparative discussion demonstrates the aspects of conceptual understanding that reveal a commonality of understanding. These aspects are shown to relate to the vitalistic context dictated by a multi-system approach to understanding the human condition.

The paper concludes by discussing the consequences of this conceptual commonality in relation to the understanding of disease processes, and to the conceptual philosophy of WHM practice.

Two studies were carried out:

Study 1.
A letter was sent to 87 GPs in Enfield, Middlesex, requesting their support in designing a protocol for referral to a medical herbalist. A total of 4 responses were received with 3 stating that they did not wish to take part in the study. 1 GP showed further interest but was unable to be contacted and so the study did not progress.

Study 2.
A co-operative enquiry was carried out between an osteopath and a medical herbalist over a 3-month period in Enfield in order to set up procedures for referral. During the 3 months a total of 4 patients were referred to the medical herbalist in order to test the procedures involved. The outcome of the study identified the areas of need for referral, considered ways of developing an understanding between practitioners involved and considered their concerns and difficulties in referral. The patient’s advantages and disadvantages in referral were also considered, procedures for patient management in a referral process were developed and implemented and patient, practitioner and staff evaluation of the service was carried out. Whilst 2 patients were doubtful at first and would have liked more information on herbal medicine prior to consultation with the medical herbalist, patients were comfortable with practitioners sharing information. They felt positive about their experiences of the procedures involved in referral and felt that they had received an improved level of service.

The osteopath had found the service useful, felt that the level of professional exchange was excellent and felt that he would be more likely to refer in the future. The medical herbalist found the collaboration between practitioners particularly beneficial.

Overall, whilst the referral service with the GP was limited, the procedures involved in the referral service between the osteopath and the medical herbalist were considered useful.

Tree remedies are stronger, more powerful and more sustaining and protective than their therapeutic counterparts from other plants. They are movers of liquid energy and guardians of boundaries. Medical herbalists are more likely to make a distinction between trees and other plant medicine sources if they are already of an ‘intuitive’ bent. Herbalists’ sacred true role as matchmakers between patient and plant is only possible through a process of simultaneous subjective and objective experience of both parties, regaining a resonance with the methods of our ancestors.

By providing an overview of Integrated medicine as it is understood in this country today, a look at the historical development, and by observing how other countries approach this fusion.

Comparing and contrasting orthodox and complementary understanding, research methodologies, and diagnostic criteria for IBS. Leading to the development of a proposal through the design of a pilot Randomised Control Trial (RCT) for evaluating an integrated medicine approach to IBS.

Methodology was primarily a literature review, with additional ethnographic content. In-depth interviews were conducted with a number of professionals as well as the mother of a child with Asperger’s syndrome. A conference on Biomedical Interventions in Autistic Spectrum Disorder was attended.

While current orthodox approaches are based on ASD as a neurological/developmental disorder, alternative theories describe it as a metabolic disorder causing neurological and developmental damage. Although treatments arising from these theories are controversial, enough progress - at least in the alleviation of some symptoms, only rarely in terms of a ‘cure’ - has been reported to encourage many parents to pursue them.

Approaches used in alternative modes of treatment of ASD are similar in terms of basic principles to those used in herbal medicine. Additionally, herbal medicine can treat many common symptoms of ASD as well as supporting dietary treatments.

It was found that herbal medicine has much to offer in the treatment of children with ASD and their parents, in particular in response to issues raised in debates on the condition. However, there is a lack of awareness of what herbal medicine has to offer. Parents of children with ASD and other practitioners need to know what herbal medicine does before it can be viewed widely as an appropriate and readily available resource.

Methodology
Literature Review of neoplasia/cancer aetiology in general, and of multiple myeloma and low grade astrocytomas in particular.

Results
The literature review highlights newly discovered understandings of cancer aetiology relating to the inflammatory response, the role of the nervous system in modulating this response, and a new hypothesised understanding of homeostatic balance through intercellular information mechanisms – all areas in which medical herbalists can play a very active role. The study also highlighted the side effects of orthodox cancer treatment, and the need to maintain function of the organs of elimination in adjuvant cancer therapy.

Conclusion
This study highlights areas in cancer treatment in which members of the National Institute of Medical Herbalists (NIMH) can play an proactive, integrative and autonomous role in cancer treatment, dealing with (I) the inflammatory response; (2) immune status; (3) supporting organs of elimination, such as the liver, kidneys, lungs, lymphatic system, gastrointestinal tract; (4) maintaining homeostasis, using herbal polysaccharides as hypothesised mediators in intercellular communication and (5) the need for medical herbalists to engage in (a) good research in herbal medicine, (b) to devise a new paradigm in health care and (c) a novel approach to research methodology suitable for the holistic approach of medical herbalists.