Good clinical practice in holistic medicine

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Acknowledgements

Support of our research on global quality of life and holistic medicine 1989-2005

The studies were supported by grants from the 1991 Pharmacy Foundation and IMK Almene Fond, as well as by supplementary grants from the Goodwill Foundation, the JL-Foundation, E. Danielsen and Wife's Foundation, Emmerick Meyer's Trust, the Frimodt-Heineken Foundation, the Hede Nielsen Family Foundation, Petrus Andersens Fund, Wholesaler C.P. Frederiksens Study Trust, Else and Mogens Wedell-Wedellsborg's Foundation in Denmark and the Israel Foundation for Human Development.

Our research has been approved by the Copenhagen Scientific Ethical Committee under number (KF)V.100.2123/91, and the Israel Foundation for Human Development.

About the Quality of Life Research Center in Copenhagen

The Quality of Life Research Center in Copenhagen was established in 1989, when the physician Søren Ventegodt succeeded in getting a collaboration started in response to his project ?Quality of life and causes of disease? together with the Department of Social Medicine at the University of Copenhagen. An interdisciplinary ?Working group for the quality of life in Copenhagen? was established and with raised funds made it possible for the State University Hospital of Copenhagen (Rigshospitalet) in 1991 to open its doors for the project.

The main task was a comprehensive follow-up of 9,006 pregnancies and the children delivered during 1959-61. This Copenhagen Perinatal Birth Cohort was established by the a gynecologist and a pediatrician, the late Aage Villumsen, MD. PhD and the late Bengt Zachau-Christiansen, MD, PhD, who had made intensive studies during pregnancy, early childhood and young adulthood. The cohort was during 1980-1989 directed by the pediatrician Joav Merrick, MD, DMSc, until he moved to Israel. The focus was to study quality of life related to socie-economic status and health and compare with the data collected during pregnancy, deliverty and early childhood.

The project continued to grow and later in 1993, the work was organized into a statistics group, a software group that developed the computer programs for use in the data entry and a group responsible for analysis of the data.

Quality of Life Research Center at the University Hospital

The Quality of Life Center at the State University Hospital generated grants, publicity with research and discussions among the professionals leading to the claim that quality of life was significant for health and disease. It is obvious that a single person cannot do much about his/her own disease, if it is caused by chemical defects in the body or outside chemical-physical influences. However, if a substantial part of diseases is caused by a low quality of life, we can all prevent a lot of disease and operate as our own physicians, if we make a personal effort and work to improve our quality of life. A series of investigations showed that this was indeed possible. This view of the role of personal responsibility for illness and health would naturally lead to a radical re-consideration of the role of the physician and also influence our society.

An independent Quality of Life Research Center

In 1994, The Quality of Life Research Center became an independent institution located in the center of the old Copenhagen. Today, the number of full-time employees have grown. The Research Center is still expanding and several companies and numerous institutions make use of the resources, such as lectures, courses, consulting or contract research. The companies, which have used the competence of the reseach center and its tools on quality of life and quality of working life, include IBM, Lego, several banks, a number of counties, municipalities, several ministries, The National Defense Center for Leadership and many other management training institutions, along with more than 300 public and private companies. It started in Denmark, but has expanded to involve the whole Scandinavian area.

The center's research on the quality of life have been through several phases from measurement of quality of life, from theory to practice over several projects on the quality of life in Denmark, which have been published and received extended public coverage and public impact in Denmark and Scandinavia. The data is now also an important part of Veenhoven's Database on Happiness at Rotterdam University in the Netherlands.

New research

Since The Quality-of-Life Research Center became independent a number of new research projects were launched. One was a project that aimed to prevent illness and social problems among the elderly in one of the municipalities by inspiring the elderly to improve their quality of life themselves. Another a project about quality of life after apoplectic attacks at one of the major hospitals in Copenhagen and the Danish Agency for Industry granted funds for a project about the quality of work life.

Quality of life of 10,000 Danes and the philosophy of life

There is a general consensus that many of the diseases that plague the Western world (which are not the result of external factors such as starvation, micro-organisms, infection or genetic defects) are lifestyle related and as such, preventable through lifestyle changes. Thus increasing time and effort is spent on developing public health strategies to promote ?healthy? lifestyles. However, it is not a simple task to identify and dispel the negative and unhealthy parts of our modern lifestyle even with numerous behavioural factors that can be readily highlighted harmful, like the use of alcohol, use of tobacco, the lack of regular exercise and a high fat, low fibre diet.

However there is more to Western culture and lifestyle than these factors and if we only focus on them we can risk overlooking others. We refer to other large parts of our life, for instance the way we think about and perceive life (our life attitudes, our perception of reality and our quality of life) and the degree of happiness we experience through the different dimensions of our existence. These factors or dimensions can now, to some degree, be isolated and examined. The medical sociologist Aaron Antonovsky (1923-1994) from the Faculty of Health Sciences at Ben Gurion University in Beer-Sheva, who developed the salutogenic model of health and illness, discussed the dimension, ?sense of coherence?, that is closely related to the dimension of ?life meaning?, as perhaps the deepest and most important dimension of quality of life. Typically, the clinician or researcher, when attempting to reveal a connection between health and a certain factor, sides with only one of the possible dimensions stated above. A simple, one-dimensional hypothesis is then postulated, like for instance that cholesterol is harmful to circulation. Cholesterol levels are then measured, manipulated and ensuing changes to circulatory function monitored. The subsequent result may show a significant, though small connection, which supports the initial hypothesis and in turn becomes the basis for implementing preventive measures, like a change of diet. The multi-factorial dimension is therefore often overlooked.

In order to investigate this multifactorial dimension a cross-sectional survey examining close to 10,000 Danes was undertaken in order to investigate the connection between lifestyle, quality of life and health status by way of a questionnaire based survey. The questionnaire was mailed in February 1993 to 2,460 persons aged between 18-88, randomly selected from the CPR (Danish Central Register) and 7,222 persons from the Copenhagen Perinatal Birth Cohort 1959-61.

A total of 1,501 persons between the ages 18-88 years and 4,626 persons between the ages 31-33 years returned the questionnaire (response rates 61.0% and 64,1% respectively). The results showed that health had a stronger correlation to quality of life (r= 0.5, p<0.0001), than it had to lifestyle (r=0.2, p< 0.0001).

It was concluded that preventable diseases could be more effectively handled through a concentrated effort to improve quality of life rather than through n approach that focus solely on the factors that are traditionally seen to reflect an unhealthy life style.

Collaboration with others and across borders

The project has been developed during several phases. The first phase, 1980-1990, was about mapping the medical systems of the pre-modern cultures of the world, understanding their philosophies and practices and merging this knowledge with western biomedicine. A huge task seemingly successfully accomplished in the Quality of Life (QOL) theories, and the QOL philosophy, and the most recent theories of existence, explaining the human nature, and especially the hidden resources of man, their nature, their location in human existence and the way to approach them through human consciousness.

Søren Ventegodt visited several countries around the globe in the late 1980s and analysed about 10 pre-modern medical systems and a dozen of shamans, shangomas and spiritual leaders noticing most surprisingly similarities, allowing him together with about 20 colleges at the QOL Study Group at the University of Copenhagen, to model the connection between QOL and health. This model was later further developed and represented in the integrative QOL theories and a number of publications. Based on this philosophical breakthrough the Quality of Life Research Center was established at the University hospital. Here a brood cooperation took place with many interested physicians and nurses from the hospital.

A QOL conference in 1993 with more than 100 scientific participants discussed the connection between QOL and the development of disease and its prevention. Four physicians collaborated on the QOL population survey 1993. For the next 10 years the difficult task of integrating bio-medicine and the traditional medicine went on and Søren Ventegodt again visited several centers and scientists at the Universities of New York, Berkeley, Stanford and other institutions. He also met people like David Spiegel, Dean Ornish, Louise Hay, Dalai Lama and many other leading persons in the field of holistic medicine and spirituality.

Around the year 2000 an international scientific network started to take form with an intense collaboration with the National Institute of Child Health and Human Development (NICHD) at the Faculty of Health Sciences, Ben Gurion University of the Negev in Israel, which has now developed the concept of ?Holistic Medicine?. We believe that the trained physician today has three medical toolboxes: the manual medicine (traditional), the bio-medicine (with drugs and pharmacology) and the consciousness-based medicine (scientific, holistic medicine). What is extremely interesting is that most diseases can be alleviated with all three sets of medical tools, but only the bio-medical toolset is highly expensive. The physician, using his hands and his consciousness to improve the health of the patient by mobilising hidden resources in the patient can use his skills in any cultural setting, rich or poor.

Contact address

The Quality of Life Research Center

Teglgårdstræde 4-8

DK-1452 Copenhagen K

Denmark

E-mail: ventegodt@livskvalitet.org

Website: www.livskvalitet.org

About the National Institute of Child Health and Human Development in Israel

The National Institute of Child Health and Human Development (NICHD) in Israel was established in 1999 as a virtual institute under the auspicies of the Medical Director, Ministry of Social Affairs in order to function as the research arm of the Office of the Medical Director. During the period 1999-2003 the NICHD was very active with research projects on a local basis in several locations around Israel with a main focus in the south, on a national basis and internationally. During this period several hundred publications have been published by NICHD faculty.

In the year 2000 the International Journal of Adolescent Medicine and Health (Freund Publishing House, London and Tel Aviv) and in the year 2003 the Child Health and Human Development Domain of the Scientific World Journal (Los Angeles), both Medline indexed peer-reviewed journals, were affilated with the NICHD.

In the year 2002 affiliation was established with the Division for Community Health and the School of Continuing Medical Education at the Faculty of Health Sciences (FOHS) at the Ben Gurion University of the Negev (BGU). In 2002 a full course on ?Disability? was established at the Recanati School for Allied Professions in the Community, FOHS, BGU and twice a year seminars for specialists in family medicine. In 2002-3 an affiliation with the Zusman Child Development Center at the Pediatric Division of Soroka University Medical Center was established and collaboration on the establishment of the Down Syndrome Clinic at that center. In 2003 an affiliation with the Saban Children's Medical Center at Soroka University Medical Center was established and in 2005 the institute became located at the Faculty of Health Sciences, Ben Gurion University of the Negev in Beer-Sheva.

The vision

The vision of a National Institute for Child Health and Human Development in Israel is to seek to assure as far as possible that every individual is born healthy, is born wanted and has the opportunity to fulfill his or her potential for a healthy and productive life unhampered by disease or disability. The Institute should become an international leader in child health, welfare and human development and an advocate for the children, the disabled and persons with intellectual disability of our society.

Target areas of interests

The interest areas of the NICHD are child health, disability and human development. The NICHD will alone or in collaboration have local, national, regional and international responsabilities in research, academics, model clinical service and policy.

Contact address

Professor Joav Merrick, MD, DMSc

Medical Director

Division for Mental Retardation

Ministry of Social Affairs

POB 1260

IL-91012 Jerusalem

Israel

E-mail: jmerrick@internet-zahav.net

Website: www.nichd-israel.com

About the authors

Søren Ventegodt, MD, is the director of the the Quality of Life Research Center in Copenhagen, Denmark. He is also responsible for a Research Clinic for Holistic Medicine in Copenhagen and used as a popular speaker throughout Scandinavia. He has published numerous scientific or popular articles and a number of books on holistic medicine, quality of life and quality of working life. His most important scientific contributions are the comprehensive SEQOL questionnaire, the very short QoL5 questionnaire, the integrated QOL theory, the holistic proces theory, the life mission theory, and the Danish Quality of Life Research Survey, 1991-94 in cooperation with the University Hospital of Copenhagen and the late pediatric professor Bengt Zachau-Christiansen. E-mail: ventegodt@livskvalitet.org . Website: www.livskvalitet.org

Joav Merrick, MD, DMSc, is professor of child health and human development affiliated with the Zusman Child Development Center, Division of Pediatrics and Division of Community Health at the Ben Gurion University, Beer-Sheva, Israel and presently the medical director of the Division for Mental Retardation, Ministry of Social Affairs, Jerusalem and the director of the National Institute of Child Health and Human Development. Numerous publications in the field of child health and human development, rehabilitation, intellectual disability, disability, health, welfare, abuse, advocacy and prevention. Received the Peter Sabroe Child Award for outstanding work on behalf of Danish Children in 1985 and the International LEGO-Prize (?The Children's Nobel Prize?) for an extraordinary contribution towards improvement in child welfare and well-being in 1987. E-mail: jmerrick@internet-zahav.net . Website: www.nichd-israel.com