160 Invited Lectures / European Journal of Integrative Medicine 2 (2010) 159164
experiential and didactic course to medical students in mind-
body medicine skills. The purpose is to expose students to a
variety of mind-body approaches (e.g., mindfulness meditation,
autogenics and biofeedback, guided imageries, movement, and
writing exercises), as well as group sharing that involves lis-
tening generously and without judgment. The overall goal is
to enhance professionalism by fostering student self-awareness,
self care and improved stress management skills. The course
integrates basic science with experiential learning, and each
group of 10 students is facilitated by two trained faculty mem-
bers, who come from across the medical center (educators,
researchers and clinicians). Outcomes include increased student
empathy and mindfulness, as well as a reduction in students
perceived stress in medical school. In addition to involving over
one-third of the students, the program has expanded to include
specific offerings for faculty and staff. Dr. Haramati will outline
the imperative for moving medical education in this direction.
doi:10.1016/j.eujim.2010.09.201
Trends in integrative medicine: A U.S. perspective
D.M. Eisenberg
Harvard Medical School, Osher Research Center, Boston,
United States
Trends to be summarized will include: (1) the continued high
prevalence of use of Complementary and Integrative Medical
(CIM) therapies by the U.S. population; (2) continued high out-
of-pocket expenditures in this area; (3) a sizeable recent increase
in the popularity of mind-body therapies and the use of non-
vitamin, non-mineral natural products; (4) continued substantial
funding by the U.S. National Institutes of Health for research in
this area and the recent publication of a new 5 year NIH research
plan; (5) a rather mixed portfolio of completed, federally funded
trials evaluating the efficacy of individual complementary ther-
apies for targeted conditions; (6) a paucity of pragmatic studies
looking at coordinated access to a combination of both conven-
tional and complementary therapies (aka, Integrative Care) for
common, expensive conditions; (7) a growing number of U.S.
(and Canadian) medical schools, hospitals and Academic Health
Centers with mature programs in Integrative Medicine research,
education and/or clinical care; (8) a continued lack of invest-
ment in U.S. based cost-effectiveness studies involving CIM
and a concomitant continued lack of third party reimbursement
for CIM care options; (9) a recent enhanced interest in compar-
ative effectiveness research and research assessing the effects of
CIM on disease prevention, wellness and health promotion (as
well as disease treatment) all of which have been consistent
with Obama Administration priorities; and, importantly, (10) an
escalation in the debate and heated rhetoric as to the value of
CIM research, its relevance to the scientific community, to the
education of health care practitioners, and its rightful place
if any in current and future mainstream health care delivery
models.
These controversies are fueled, in part, by struggles for scien-
tific and academic legitimacy, struggles to produce unequivocal
evidence of disruptive scientific innovation and incontrovertible
evidence of cost containment. Are these achievable? Scien-
tists and clinicians demand plausible mechanisms in addition
to robust evidence of clinical effectiveness, while economists,
policy makers and CEOs demand cost containment and a return
on investment. After 15 years of collective international research
in this area, skeptics appear to be more skeptical while advocates
contend that enhanced research methods and more provocative
evidence are just beginning to emerge in light of lessons learned.
Might these various trends, perspectives, controversies and
challenges be sufficiently similar across international bor-
ders to warrant a bold, new, multi-national commitment to
develop a shared, focused research agenda? Might there be
a few high priority areas of research which lend themselves
to multi-site, international collaboration and systematic study?
Such an international agenda, if thoughtfully planned and exe-
cuted, with support from both governmental and private (i.e.
entrepreneurial) stakeholders, just might inform and improve
models of mainstream comprehensive health care delivery for
our children and grandchildren. If not now, then when?
doi:10.1016/j.eujim.2010.09.202
Role of Ayurveda in integrative medicine
R. Babu
Central Council for Research in Ayurveda and Siddha (CCRAS),
Ministry of Health & Family Welfare, New Dehli, India
Integrative medicine is healing-oriented medicine that takes
account of the whole person (body, mind, and spirit), including
all aspects of pharmacotherapy and lifestyle. It emphasizes the
therapeutic relationship and makes use of all appropriate ther-
apies, both conventional and alternative. It concentrates only
on the get-the-patient-better philosophy. This approach is also
known as Holistic Medicine, which is the hallmark of Ayurvedic
Science. All the concepts described in Ayurveda revolve around
three components Sharir, Indriya and Sattwa which is truly an
holistic in nature.
Some of the principles of integrative medicine and Ayurveda
are strikingly similar:
A partnership between patient and practitioner in the healing
process
Appropriate use of comprehensive treatment modalities both
for preventive and curative health care aspects.
Consideration of all factors that influence health, wellness and
disease, including mind, spirit and body
Recognition that good medicine should be based in good
science, be inquiry driven, and be open to new paradigms
Use of natural, effective, less-invasive interventions whenever
possible
Use of the broader concepts of promotion of health and the
prevention of illness as well as the treatment of disease
There is an urgent need to incorporate theories of holis-
tic approaches to address chronic intractable diseases. Holistic
 Invited Lectures / European Journal of Integrative Medicine 2 (2010) 159164
Medicine comprise complementary and alternative systems
of medicine that emphasize the need to look at the whole
person, including analysis of physical, nutritional, environ-
mental, emotional, social, spiritual and lifestyle values. In
the Indian perspective, Ayurveda is an important whole med-
ical system that can effectively contribute to achieving this
goal.
Ayurveda is derived from two Sanskrit words ayuh (life) and
veda (science) meaning Science of life. It was propounded to
fulfil objectives of swasthya rakshana (protecting the health)
and aturasya vikara prashamana (to heal the sick). It is a whole
medical system revolving around upkeep of the shareera (body),
indriya (sensory and motor faculties), satva (mind) and atma
(soul). The plan of management of disorders in Ayurveda is
three pronged, Yuktivyapashraya (pharmacological), Daivavya-
pashraya (spiritual), and Satvavajaya (psychotherapy). The
uniqueness of this approach has earned it the repute of being
a holistic medical science.
It is known that the conventional medical care has not been
successful in containing many chronic disorders, particularly
in the field of Cancer, Autoimmunity, Rheumatism, immune
mediated, degenerative medicine, geriatrics, endocrinology,
psychiatry and neurology. Ayurvedic approaches have stood
the test of time and can offer better quality of life, indepen-
dently as well as an adjuvant to conventional therapies. Despite
the potential in these fields, there is a dearth in systematic
research and documentation with modern objective parame-
ters which is the need of the hour. The paper will discuss in
detail some of the areas in which Ayurveda and the conven-
tional modern medical care can contribute together for human
health care.
doi:10.1016/j.eujim.2010.09.203
The role of placebo in clinical trials
I. Kirsch
University of Hull, Department of Psychology, Hull, United
Kingdom
When people improve after being given a physical treatment,
the improvement can be due to the physical characteristics of
the treatment, the psychological characteristics of the treatment,
or a combination of both. The placebo effect can be defined as
those effects that are produced by psychological characteristics
of a physical treatment. Placebos are physically inert treat-
ments that are designed to have psychological characteristics
that are indistinguishable from a corresponding physical treat-
ment. Treatment effects are assessed as the difference between
the response to treatment and the response to its placebo. Thus,
the implicit assumption underlying randomized clinical trials
(RCTs) is that physical treatment effects and placebo effects are
additive, such that the response to a physical treatment is com-
posed of two components: the physical treatment effect and the
placebo effect. Data indicate that this is often, but not always the
case. There is a need for more data on the additivity of physical
treatment effects and placebo effects.
161
The magnitude of the placebo effect varies greatly and is
affected by such factors as the appearance of the treatment, its
mode of delivery, the perceived dose, the price, the instructions
accompanying it, and the condition being treated. The placebo
effect may account for 100% of the response to antidepressant
drug and 50% of the effects of analgesics.
Psychological mechanisms underlying placebo effects
have been hypothesized to include classical condition,
self-confirming response expectancies, and the therapeutic
relationship. Data indicate that most conditioning effects are
mediated by expectancy. Personality and other individual dif-
ferences have been hypothesized to moderate the effects of
placebos, but data supporting this are week, and some data sug-
gest that there may be no such thing as a consistent placebo
responder.
Similar to conventional medicine, complementary treatments
can produce placebo effects as well as physical treatment effects.
For that reason, RCTs are as important in evaluating the effects
of these treatments as they are in evaluating the effects of con-
ventional treatments. The results of those evaluations need to be
held to the same standard in both domains. Instances of double
standards are presented.
Finally, the administration of placebos in clinical practice can
be considered as a complementary intervention. The challenge
is to find methods of harnessing the placebo effect ethically,
without deception.
doi:10.1016/j.eujim.2010.09.204
The neurobiological bases of placebo responses
F. Benedetti
University of Turin Medical School, Department of Neuro-
science, Turin, Italy
The placebo effect, or response, has evolved from being
thought of as a nuisance in clinical and pharmacological research
to a biological phenomenon worthy of scientific investigation in
its own right. The study of the placebo effect and of its neg-
ative counterpart, the nocebo effect, is basically the study of
the psychosocial context around the treatment and the patient,
and it plays a crucial role in the therapeutic outcome. In recent
years, different types of placebo responses have been analyzed
with sophisticated biological tools, such as neuropharmacol-
ogy, neuroimaging, in vivo receptor binding, and single-neuron
recording from awake subjects, that have uncovered specific
mechanisms at the anatomical, physiological, biochemical and
cellular level. Most of our knowledge about the neurobiologi-
cal mechanisms of the placebo response comes from pain and
Parkinsons disease, whereby the neuronal circuits involved
in placebo responsiveness have been identified. In the first
case, opioidergic, dopaminergic and cholecystokinergic net-
works have been found to be involved. In the second case,
dopaminergic activation in the striatum and neuronal changes in
basal ganglia circuitry have been described. This recent research
has revealed that these placebo-induced biochemical and cellu-
lar changes in a patients brain and body are very similar to the