Anthroposophic Medicine

Steiner, Wegman and the 1920s

Rudolf Steiner studied the empirical sciences, mathematics and philosophy in Vienna and began developing anthroposophy, his spiritual-philosophical school of thought, in 1901. A 2013 overview by researchers working in the field dates the founding of anthroposophic medicine to the early 1920s and credits it jointly to Steiner and the physician Ita Wegman.

An editorial marking the system's centenary places Steiner's call for an extended, intuitive medicine in 1920. It cites the book he wrote with Wegman, Grundlegendes für eine Erweiterung der Heilkunst, published in 1925 by the Rudolf Steiner Verlag in Dornach, Switzerland, as a founding text. The same anthroposophic movement also produced Waldorf schools and biodynamic farming.

Origins of the main therapies

Mistletoe treatment for cancer arose within anthroposophic medicine, and a United States government cancer summary dates modern interest in mistletoe as an anticancer treatment to the 1920s. A critical editorial explains that Steiner's idea rested on an analogy: like a tumor, mistletoe is a parasitic growth that eventually kills its host.

According to the same 2013 overview, Wegman, who was a physician and physiotherapist, developed rhythmical massage from Swedish massage. Anthroposophic art therapy was developed mainly by Margarethe Hauschka, who founded the first training institution for it in 1962.

Spread and current setting

The 2013 overview describes anthroposophic medicine as established in 80 countries, most significantly in Central Europe, and integrated with conventional medicine in large hospitals and medical practices. Full training curricula were then listed in more than 30 countries, including Germany, Switzerland, the Netherlands, Brazil, Japan, the United Kingdom and the United States. These figures come from authors active in anthroposophic research and have not been independently checked here.

Anthroposophy and its medical branch

Anthroposophy is the wider body of ideas developed by Steiner. Anthroposophic medicine is the medical application of those ideas, and the literature uses both anthroposophic medicine and anthroposophical medicine for the same system. The term covers a whole system of care as well as its separate components, and reviews often assess one component, such as mistletoe extracts or eurythmy therapy, rather than the system as a whole.

Concepts used by practitioners

Practitioners describe the human organism as shaped by four levels of formative forces: physical forces, growth forces that maintain living form, soul forces linked to sensation and movement, and spirit forces linked to the individual mind and reflective thinking. They also describe a threefold constitution made up of a nerve-sense system, a motor-metabolic system and an intermediate rhythmic system. These are concepts of the tradition, not categories used in conventional anatomy or physiology.

Mistletoe and product names

The mistletoe used is European mistletoe, Viscum album L., which grows on several host trees and should not be confused with the American mistletoe Phoradendron. Commercial extracts named in the National Cancer Institute summary include Iscador, Helixor, Eurixor, Isorel, Iscucin, Plenosol and abnobaVISCUM, with sub-types often named after the host tree.

Practitioners and training

Anthroposophic care is provided by medical doctors, therapists and nurses. The 2013 overview gives the German curriculum for physicians as 3 years of postgraduate medical practice, 1 year of study of anthroposophic medicine and 2 years of practice under a mentor. It describes about 5.5 years of training for eurythmy therapists, 4 years of college training plus 2 years of professional experience for art therapists, and 1.5 to 3 years for rhythmical massage therapists. Requirements differ by country, and the sources reviewed here do not describe statutory regulation.

Medicinal products and mistletoe injections

Anthroposophic medicinal products are made from plant, mineral and animal substances and are sometimes potentized, a dilution process also used in homeopathy. Mistletoe extracts are usually given by injection under the skin, most often 2 to 3 times a week, with treatment length varying widely; oral, intravenous, intrapleural and intratumoral routes have also been described. In the Swedish MISTRAL trial, for example, the extract or a placebo was injected under the skin three times a week for nine months alongside standard cancer care.

Eurythmy, rhythmical massage and art therapies

Eurythmy therapy is described as an exercise therapy with cognitive, emotional and volitional elements in which a patient performs specific movements of the hands, feet or whole body. A course usually runs 12 to 15 sessions of 30 to 45 minutes, with daily practice between sessions. Rhythmical massage adds lifting, undulating and gliding strokes and figure-eight patterns called lemniscates to standard massage technique.

Art therapies include clay or sculptural work, drawing and painting, music and a form of speech therapy. Nursing care may add external applications such as embrocations, compresses, hydrotherapy and medicinal baths.

Uses described within the system

Proponents describe anthroposophic medicine as an integrative, multimodal system used alongside conventional medicine rather than in place of it. In one large German observational study, outpatients started anthroposophic therapy for anxiety disorders, asthma, attention deficit hyperactivity disorder, depression, low back pain, migraine and other chronic conditions, which indicates the range of reasons people seek it.

Mistletoe in cancer care

Mistletoe extracts are among the most commonly prescribed complementary cancer therapies in Central Europe. The claims tested most often are that they prolong survival and improve quality of life, including during chemotherapy. A critical editorial notes that some patients may use mistletoe as an alternative to conventional cancer treatment rather than as an addition to it.

Claimed versus studied outcomes

The outcomes actually studied are narrower than the claims. Mistletoe trials measured survival, tumor response, quality of life and chemotherapy side effects in specific cancers. Eurythmy therapy has been tested in chronic low back pain, and rhythmical massage in painful menstrual periods. A result for one component, cancer type or condition cannot be carried over to the whole system or to other uses.

The system as a whole

A 2004 systematic review using seven literature searches found no randomized trial of the whole anthroposophic system that met its criteria, and concluded that whether it does more good than harm could not be answered. A 2011 update of a Swiss health technology assessment, written by anthroposophic researchers, counted 265 clinical studies, 38 of them randomized and 133 on mistletoe. It reported mostly positive results but noted that methodological quality differed substantially.

The Anthroposophic Medicine Outcomes Study followed 1,631 German outpatients without a randomized control group and reported improvements lasting to 48 months. Its authors estimated that bias, natural recovery and other therapies could explain at most 37 percent of the improvement.

Mistletoe and survival

A 2008 Cochrane review included 21 randomized trials with 3,484 patients. Six of 13 survival trials suggested some benefit, but none was of high methodological quality, and the reviewers judged the evidence for survival weak. A 2019 review of 28 publications (2,639 patients) found that most studies, especially the better ones, showed no survival effect.

An open-label Serbian trial of 220 people with advanced pancreatic cancer stopped early after an interim survival analysis favored mistletoe. The double-blind, placebo-controlled MISTRAL trial in Sweden then randomized 290 people with the same cancer and found no survival benefit, with a median survival of 7.8 months on mistletoe and 8.3 months on placebo.

Mistletoe and quality of life

The Cochrane reviewers found that 14 of 16 trials on quality of life or treatment side effects suggested benefit, but only two, in women with breast cancer during chemotherapy, were of higher quality, and the results needed replication. A 2020 meta-analysis pooled a medium effect on global quality of life while noting high or uncertain risk of bias in most studies. A 2019 review found smaller or no effects in better trials, and MISTRAL found no difference in global quality of life.

Eurythmy and rhythmical massage

A 2015 review of eurythmy therapy found 11 studies, mostly uncontrolled or non-randomized and of varying quality. In a randomized trial of 274 adults with chronic low back pain, 8 weeks of eurythmy, yoga or physiotherapy gave similar, clinically small changes in disability. A trial of 60 women found lower menstrual pain after 3 months of rhythmical massage than usual care, but not than biofeedback. No randomized trials of anthroposophic art therapy were found among the sources reviewed.

Reactions to mistletoe injections

The National Cancer Institute lists soreness and inflammation at injection sites, headache, fever, chills, nausea and marked tiredness as side effects of mistletoe extracts. It reports a few cases of severe allergic reactions, including anaphylactic shock, liver damage at high doses that later resolved, and reports of circulatory problems, thrombophlebitis and swollen lymph nodes.

In MISTRAL, local skin reactions at injection sites occurred in 66 percent of people on mistletoe and 1 percent on placebo, while other adverse events were similar between groups. The Cochrane review described the extracts as usually well tolerated, with side effects depending on dose.

Differing safety assessments

Assessments of harm differ by source. A 2006 editorial lists reported serious reactions such as anaphylaxis, breathing difficulty, hemorrhagic colitis and kidney failure, notes laboratory findings that extracts may increase growth of some cancer cells, and points to the high cost of regular injections. Authors working in anthroposophic research describe adverse reactions across the system as infrequent and mostly mild to moderate.

Delayed or replaced care

The main care concern raised in the sources is that mistletoe may be used instead of conventional cancer treatment rather than alongside it. The National Cancer Institute's professional summary states that mistletoe cannot be recommended outside well-designed clinical trials. Anthroposophic therapies are not a substitute for timely diagnosis or necessary treatment, and decisions about cancer care belong with the treating oncology team.