Iccm2014sciencedayscientificprogram

ICCM 2014 Science Day

בחסות התכנית המשולבת להכשרת חוקרים ברפואה משלימה בשיתוף מכללת רידמן עם כללית רפואה משלימה

ICCM 2014 Science Day Scientific Program

Chair : Amos Ziv Moderators : Keren Sela, Amos Ziv

בחסות התכנית המשולבת להכשרת חוקרים ברפואה משלימהבשיתוף מכללת רידמן עם כללית רפואה משלימה

Speaker Affiliation & Institutions involved: Asaf Harofeh Medical Center, Tel Aviv Yafo Academic College, Sirbal, Ziv Medical Center, Bar Ilan University, Or Haganuz,

Hadassah Medical Hospital, Reidman College, Hebrew Univ. of Jerusalem, Sheba Medical Center, Belinson Medical Center, Clalit Complementary Medicine



9:15 – 9:30 Gathering

9:30 – 9:45 Welcome and Opening remarks: Breakthrough TCM research and Integration in 2014 – Amos Ziv L.Ac, M.Sc

9:45 – 10:05 Practical Research – Putting it all together in a fertility clinic - Keren Sela L.Ac, M. Sc

10:05-10:25 Meridian Balance Acupuncture treatment is both specific and efficient for treating patellar tendinitis- A Randomized Controlled Study – Dorit Parnas PhD

10:25-10:45 From an Anecdotal patient to clinical trial- Research & Development in the Field of Chinese Medicinal Herbs - Nadav Shribom L.Ac, M.S

10:45-11:05 Acupuncture for post-tonsillectomy pain control in children: a single-blinded, randomized, controlled study – Preliminary Results. Yaniv Avraham Dipl. Ac

11:05-11:15 Coffee Break

11:15-11:35 Curcumin Add-on Therapy for Induction of Remission in Mild to Moderate Active Ulcerative Colitis: Interim Results of an International, Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Study. Nir Salomon Dipl. Ac

11:35-11:55 A Traditional practitioner in a Modern Health System – Is it Possible? Opher Caspi MD PhD and David Wizansky BSc Lic. Ac

11:55-12:15 A Randomized Controlled Trial of Acupuncture for the treatment Back and Neck Pain in the Emergency Department. Adi Fromm Dipl. Ac

12:15-12:35 Research Education in the field of Integrative Medicine – Moti Levi, MD

12:35-13:30 Discussion panel, open questions session and concluding remark Dorit Gamus MD PhD, Keren Sela, Amos Ziv,



1.Practical Research – Putting it all together in a fertility clinicKeren Sela L.Ac, M. Sc Clinical research in the field of Chinese Medicine and it’s impact on fertility treatments is increasingly popular. This interest sparking in 2002 with the publication of an article in the prestigious journal “Fertility and Sterility” showed a positive correlation between acupuncture immediately before and after embryo transfer (ET) and increased pregnancy rates. These results gave rise to extreme popular demand and opened the door to acupuncture in fertility clinics. Since 2002 at least 11 RCT’s have investigated the efficacy of acupuncture during embryo transfer and 2 Cochrane systematic reviews and meta-analysis have been conducted. Although the results of the individual studies have been inconclusive, acupuncture and Chinese Medicine are still regarded as extremely beneficial in the fertility process and many MD’s refer patients to receive CM treatment as part of the fertility program.The research has also impacted CM practitioners as well. Public demand for acupuncture in close proximity to ET has forced CM fertility experts to address the well known 2002 Paulus protocol and rethink it’s role in the course of treatment.In this short lecture I will describe my personal understanding of acupuncture before and after ET. I will explain in detail the Paulus protocol and it’s modifications in my clinic, and it’s role in the overall treatment of women during IVF procedures.



2.Curcumin Add-on Therapy for Induction of Remission in Mild-to-Moderate Active Ulcerative Colitis: Interim Results of an International, Multi-Center, Prospective, Randomized, Placebo-Controlled, Double-Blind Study

Lang A.¹, Salomon N.¹, Lahat A¹., Har-Noy O.¹, Kopilov U¹., Avidan B.¹, Gamus D³., Kaimaklotis J4, Eliakim A.¹, Ng SC² , Ben-Horin S¹ 1) Gastroenterology Unit, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Israel. 2) Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong. 3) Gastroenterology Unit, Cypress IBD Center, Cypress4) Complementary Medicine Service, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Israel Background and Aims: Curcumin is an active phytochemical compound present in tumeric whose pharmacologic actions may be efficacious in the treatment of ulcerative colitis (UC). In this study we investigated the efficacy of curcumin for inducing remission in patients with active mild-to moderate UC. Methods: In this single center randomized, placebo controlled double-blind study, 32 patients with active mild-moderate UC (defined by score of 5 to12 in the Simple Clinical Colitis Activity Index (SCCAI)) were allocated to receive 2 gr of curcumin capsules or placebo twice daily for one month on top of their regular treatment (5ASA and/or immuno-suppressants). Clinical index (SCCAI), endoscopic index (Mayo) and serological parameters were determined at entry and conclusion of study period. Results: In the intention-to-treat analysis, 8 of the 18 patients who received curcumin, achieved clinical remission (SCCAI ≤2) whereas none of the 17 patients receiving placebo achieved remission (P=0.002). Twelve of the 18 patients receiving curcumin showed enhanced clinical response (reduction of ≥3 points in SCCAI) compared to 2/17 in the placebo group (P=0.004). The mean change in the endoscopic part of the Mayo score was (-0.5) versus 0.15 for the curcumin and placebo groups respectively (P=0.04). No serious adverse events were recorded. Conclusion: Curcumin as add-on therapy was superior to placebo for inducing remission in mild-to-moderate active UC with no apparent adverse effects. Curcumin may be a safe and promising agent in the treatment of inflammatory bowel diseases.



3.Acupuncture for post-tonsillectomy pain control in children: a single-blinded, randomized, controlled study – Preliminary Results.

Dr Peter Gilbey1,2, Dr Shlomi Bretler1, Mr Yaniv Avraham1,3, Ms Adi Sharabi-Nov4, Prof. Anthony Luder2,5 1) Otolaryngology, Head & Neck Surgery Unit, Ziv Medical Center, Safed, Israel. 2)Faculty of Medicine in the Galilee, Bar-Ilan University, Israel. 3)College of Complimentary Medicine, Or Haganuz, Israel. 4)Research Wing, Ziv Medical Center, Zefat, Israel.5)Department of Pediatrics, Ziv Medical Center, Safed, Israel.

BackgroundTonsillectomy is one of the most common procedures in pediatric surgery. Tonsillectomy is also associated with significant post operative pain( POP).As of now no consensus exist on the best protocol for treating tonsillectomy POP, in terms of medication or other practices.Acupuncture has been found to be an effective treatment for various pain situations. The NIH has concluded in 2008 that " acupuncture is a safe complementary/alternative medicine modality for pediatric patients ".Sertel et al (2008) showed reduction of tonsillectomy POP with acupuncture in adult patients. ObjectivesTo evaluate the efficacy of acupuncture in treating POP in children undergoing tonsillectomy. Patients and MethodsA randomized, controlled, single-blinded study comparing regular postoperative analgesia, to regular care combined with acupuncture.Study population: otherwise healthy children aged 3-12, indicated for tonsillectomy with or without adenoctomy.Acupuncture was performed 3 times during hospital stay.Pain was assessed using the FLACC and Wong-Baker scales.ResultsUntil now 48 children have been enrolled. The acupuncture group showed a significant reduction in pain compared with the control group. The analgesic intake was also lowered with the acupuncture group. Conclusions:At this stage, it seems that acupuncture may be an effective treatment for post-tonsillectomy pain.Acupuncture increases parental satisfaction with post-operative pain control. Acupuncture seems to be a safe treatment, well received by children aged 3-12 years and by their parents.



4.From an Anecdotal patient to clinical trial - R & D in the field of Chinese Medicine Herbs. Nadav Shribom L.Ac MS Currently there is considerable interest among researchers and oncologists to find anticancer drugs from medicinal herbs. In the past, clinical data showed that some herbs possessed anticancer properties, but western scientists have doubted the scientific validity of this due to the lack of scientific evidence from their perspective. Recently there have been encouraging results, from a western perspective, in the cancer research field regarding the anticancer effects of medicinal herbs. Experiments showed that certain herbs played their anticancer role by inducing apoptosis and differentiation, enhancing the immune system, inhibiting angiogenesis, reversing multidrug resistance (MDR) and more. Clinical trials have demonstrated that some of these herbs could improve survival, increase tumor response, improve quality of life, or reduce chemotherapy toxicity, although much remained to be determined regarding the objective effects of herbal medicine in humans in the context of clinical trials. Interestingly, both laboratory experiments and clinical trials have demonstrated that when combined with chemotherapy, poly-herbal mixtures could raise the efficacy level and lower toxic reactions. These facts raised the feasibility of the combination of herbal medicines and chemotherapy, although much remained to be investigated in this area. Our company combines in depth knowledge of traditional herbal medicine with the state of the art scientific tools of experimental medicine, to develop drugs based on herbal medicine for cancer & inflammatory diseases. SIRB-001 is the first product of the company. It is a well characterized tri-herbal anticancer & anti-inflammatory product with the potential to treat certain leukemias and solid cancers, psoriasis & other inflammatory diseases. It has been shown to be safe for systemic administration, was well tolerated, and has a well defined mechanism of action mediating its anticancer & anti-inflammatory activity.The investigation of SIRB-001 was extended to Sirbal's 2nd product - SIRB-002. Two known molecules from the constituent herbs of SIRB-001 wereselected for investigation of their potential for anticancer & anti-inflammatory activity. These two compounds were denoted Compound M8 & Compound M1. The mixture of the two compounds was named SIRB-002. SIRB-002 derived from SIRB-001 also showed promising anticancer activity with synergistic interactions between its two constituent compounds. Further, SIRB-002 also showed promising anti psoriatic activities. Both SIRB-001 and SIRB-002 have shown proof of concept for their anticancer / anti-inflammatory activities and are ready for IND enabling studies. Ten years of clinical experience with SIRB-001 where the drug was administered to over 70 patients showed a very promising result with 40 patients responding to the treatment. The first patient was administered SIRB-001 in the year 2003 and was undergoing treatment for 7 years. In 2008 we started in vitro and in vivo studies and we are now about to complete preclinical development. Our mission is to combine traditional herbal medicine, subjected to rigorous



experimental conventional medicine, thus developing a selective, non-invasive, oral or topical, easy to handle, beneficial and gentle drug, aiming for treatment of Leukemia and Melanoma (and potentially other cancers) and inflammatory diseases like Psoriasis & R.A., avoiding adverse or toxic effects on one hand, and increasing the patient’s recovery and survival rates, on the other.



5.Meridian Balance Acupuncture treatment is both specific and efficient for treating patellar tendinitis

Parnas D1., Karlsbrun B.2, Friedman A3., Davidson E.3, Tal M.41) Tel Aviv Yaffo Academic College and Balance Method acupuncturist. 2) Chinese Medicine student, Reidman College. 3) Hadassah Medical Hospital. 4) Hebrew University of Jerusalem

Recently, several large-scale acupuncture studies showed that acupuncture is efficient in treating painful conditions such as migraines or low back pain, but the effect is not very large, nor does it depend on the location of needling (e.g. the GERAC trials). The Meridian Balance acupuncture method is highly suitable for clinical studies for various reasons. First, it relies on distal needling and generates immediate pain relief. This enables immediate assessment of the effect of various needling points. Second, the Balance Method relies mainly on anatomical rules, so it is possible, given the right pathology, to devise one needling protocol that will potentially be suitable for the great majority of patients.

We studied the effect of Balance Method needling on patellar tendinitis (PT), a highly localized chronic condition. We show that needling points in the elbow region results in a robust and immediate pain relief in the patellar ligament, with an average of 60% pain reduction (n=13 patients, 8 sessions per patient, 75 data points). In contrast, needling the wrist region on the Heart meridian reduces knee pain by only 17% (n=7 patients, 4-8 sessions per patient, 32 data points). The difference between the two treatments is highly significant, with p<0.001. Similar results were obtained for the long term effects as assessed by using the WOMAC knee score questionnaire. All measurements were taken in a double blind fashion. We further show that the immediate needling analgesic effect does not depend on the level of pain inflicted by the needle (n=11 patients, 27 data points).



6. A Randomized Controlled Trial of Meridian Acupuncture for the treatment Back and Neck Pain in the Emergency Department

A. Ziv(1), Y. Moritz(1), G. Almog(1), A. Fromm(1), G. Polak(1), R. Cardush(3), Y. Mirovski(3), S. Bar Chaim(2)

1) Shiram Integrated medicine Services, Asaf Harofeh Medical Center. 2) Departent of Emergency Medicine, Asaf Harofeh Medical Center. 3) Orthopedic Department B. Asaf Harofeh Medical Center, Affiliated with Sackler School of Medicine Tel Aviv Israel

Background: Patients attending the Emergency department for acute back or neck pain are often discharged with severe pain and limitation. Exploring additional pain relieving methods may be beneficial. Acupuncture has been documented to reduce acute back pain.

Purpose: The purpose of this study was to assess the effect on pain and range of motion of one acupuncture as an add-on treatment to medication in patients with back or neck pain admitted and discharged to the ED at the same day.

Methods: 67 patients received standard ED analgesic medication and were randomly assigned to either real acupuncture, placebo acupuncture or no acupuncture (rest-only) groups. Numeric Rating Scale (NRS) pain scores and spinal mobility in degrees were evaluated before medication, after medication and after acupuncture. Anxiety was measured by the short symptom checklist (SCL) questionnaire.

Results: Similar NRS pain score reductions were observed in all three groups after standard ED medication (-1.48 , -1.57 and -1.4 ;between group p=0.123). Greater NRS reductions were observed in real meridian acupuncture (-2.59,p<0.001) compared to placebo (-0.83, p=0.007) and no acupuncture groups (-0.68, p=0.06; between group p=0.02). Real meridian acupuncture NRS reduction was greater than placebo acupuncture (net difference –1.76 ; P<0.001). Only real acupuncture increased spinal and cervical flexion (23.4;p<0.01 and 7.2;p=0.05 respectively). Both real and placebo acupuncture demonstrated a decrease in anxiety SCL score.

Conclusion: Real Meridian acupuncture showed significant pain reduction and increased range of motion and may be beneficial as an add-on therapy to routine medication treatment for patients with acute back or neck pain admitted and discharged from the ED at the same day.



7.

A Traditional practitioner in a Modern Health System – Is it Possible?

Opher Caspi MD PhD and David Wizansky BSc LiAc. Integrative medicine unit, Beilinson medical center

One of the most significant challenges posed by the integration of complementary and institutional medicine is the quality of training undergone by complementary practitioners.

Although professionals in their fields of complementary medicine, many of which are traditional in their techniques, it is not entirely clear whether or not these traditional practitioners are sufficiently qualified to work within a modern health system.

The main concern centers around five factors or tangential concerns which join together to create a particularly complex and challenging reality. ,

(1) A lack of familiarity on the part of traditional practitioners with the complexities and subtleties of modern western medicine.

(2) The professional generic training in a care giving profession, such as Chinese medicine, often provides no specialized training in specific medical fields, such as Oncology.

(3) Complementary practitioners often have limited experience working in professional cooperation with other practitioners in a multi pronged integrative environment. In such an environment each discipline may treat a symptom, such as pain or anxiety with varying techniques which requires coordination.

(4) There are Questions as to the ability of the practitioner to integrate into a system possessing an institutional organizational culture very different from the patient-practitioner model customary in the private clinic.

(5) There is a lack of clarity as to the professional status and responsibilities held by the practitioner in a multi and inter-disciplinary environment including doctors of different disciplines, nurses, psychologists, social workers, nutritionists and others.

The lecture will focus on an analysis of these processes. We will introduce the layout and the lessons derived from our accumulated experience with three cycles of students who participated in our training course in Integrative Oncology and Hemato-oncoloy for practitioners of Chinese medicine at the Beilinson Integrative Medicine Unit.

Iccm2014sciencedayscientificprogram

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