Text: Adrien Kuenzy

“It’s time to reconnect with the human side of medicine”

Chantal Berna Renella studies how pain can be reduced without medication. The specialist says we need to better integrate complementary therapies and strengthen the therapeutic relationship.

Each patient has their own resources that will help them to heal: they need help mobilising them. This attitude towards medical practice interests Chantal Berna Renella, head of the Integrative and Complementary Medicine Centre (Cemic) at the CHUV. The integrative approach views the individual on a biological, psychological, social and spiritual level, taking into account both the tools offered by conventional medicine and those of complementary medicine, as long as they are supported by evidence.

IN VIVO / The pandemic has accentuated people’s distrust of conventional medicine. Why is that?

Chantal Berna Renella / The crisis has revealed lots of things. When we lack knowledge, we must be modest in our medical practice. Unfortunately, some proponents of textbook medicine have deviated from this behaviour, presenting hypotheses as truths. These behaviours have deeply challenged the system and its integrity. Whether in conventional or complementary medicine, conducting therapeutic trials and collecting evidence takes time. While waiting, there is room for diverging opinions and personal trials. In addition, conventional medicine still has little to offer to relieve the effects of long Covid, which can lead to frustration.

IV Could complementary medicine have provided solutions while waiting for a vaccine to be developed?

CBR / At this stage, complementary medicine does not have the tools to treat severe Covid-19 infection. When a patient can no longer use their own lung, they have to be intubated in intensive care. In that kind of situation, complementary medicine can bring more comfort, and perhaps resilience. But unfortunately it cannot solve the pathological mechanism.

IV / Has the situation emphasised the need for collaboration between traditional and complementary medicine?

CBR / There is demand from patients.

For example, in the case of long Covid, complementary medicine offers interesting approaches such as meditative techniques in addition to physiotherapy, to relieve persistent breathing difficulties.

IV / Complementary techniques have integrated hospital practices. How do you choose which treatments to offer?

CBR / We focus on studied practices. One example is clinical meditation, which is used to help patients manage pain or stress associated with chronic illness. There is reliable scientific literature on the subject. For each technique, you have to identify the mechanism of action. For meditation, neuroscience studies have identified visible reactions at the brain level. We therefore need to draw on research and evidence, and distance ourselves from the myths, which only require belief.

IV / What are the obstacles to the scientific evaluation of complementary therapies?

CBR / There are several. First, the costs and the motivation to fund research. New drugs are tested by the pharmaceutical company that developed it. For complementary therapies, the equipment used is often low-tech and not highly developed commercially. Then there is methodology, which requires careful thought. That can mean finding a good control for randomised studies, or conducting research on techniques to understand how they work or that we don’t know how to measure, like body energies.

IV / Do you work with any techniques without scientific evidence?

CBR Partially. For example, research into the mechanisms of the benefits of massage is still nascent.

We use massage technique because effects have been demonstrated, mainly in terms of the subjective experience

But we use this technique because effects have been demonstrated, mainly in terms of the subjective experience. This experience is crucial and can have a huge impact! For cancer patients in palliative care, studies indicate that survival improves with good pain management, therefore due to their subjective experience.

IV / Do complementary medicines always have to be integrated into the conventional medical system to eliminate all risks?

CBR / That’s a key factor. We need to develop a common language to make sure that all practitioners are working in the same direction and that potential risks are taken into account, especially for people with health problems. For example, with cancer, a massage therapist needs to have certain information, such as the patient’s platelet count, to avoid complications such as bruising.

IV / Is the lack of legitimacy of alternative medicine practices also due to the lack of available training?

CBR / There are lots of courses available, but quality can be inconsistent. That said, training is rapidly becoming more formal and professional. Federal diplomas in complementary medicine, such as in therapeutic massage and art therapy, are pushing the field forward. They represent recognised titles that demonstrate that the person has completed several years of training. However, some practices are still poorly regulated. One of these is hypnosis, with lots of schools, and the title of hypnotherapist is not protected. You can take a brief training course and afterwards call yourself a hypnotherapist. As a result, patients can have trouble choosing their practitioners.

IV / In some cases, should we be careful with scientific evidence about complementary medicine?

CBR / Yes, when the person undergoing treatment has a strong will, or deep-seated beliefs, with a therapy that does not have risks. You should always look at the risk/benefit trade-off. Scientific evidence for homeopathy is debated, but risks are minimal if treatment is delivered by a well-trained homeopath. So why ban it from someone who says they have already benefited from it? It is important to listen to the needs and wishes of patients.

IV / Isn’t this new-found interest in alternative medicine also a sign that people don’t feel they’re being listened to enough in the context of conventional medicine?

CBR / There is a need to find more humanity in medicine and to benefit from global care. However, medicine has veered much more towards technology in recent decades. What’s more, it has become more dehumanised, mostly because of the insurance system, reimbursement codes and productivity requirements. This upsets most healthcare providers and doctors. Our system is losing its meaning, and staff often feel they have no motivation or energy. Other limitations are also important factors, such as the lack of conventional treatments for diseases or symptoms. Conventional medicine does not have all the answers. And when it doesn’t have anything to offer, people don’t hesitate to look elsewhere. /




Chantal Berna Renella is a senior physician and has been in charge of the Integrative and Complementary Medicine Centre (Cemic) at the CHUV since 2019. She is also associate professor with the Faculty of Biology and Medicine at the University of Lausanne. She specialises in internal medicine, psychosomatic medicine, interventional pain management and clinical hypnosis. In 2010, she obtained a PhD in pain neuroscience at the University of Oxford. She joined the CHUV’s Pain Treatment Centre in 2015 and is now studying how best to integrate complementary therapies at an academic hospital.