Claudia Witt is Full Professor, Chair of Complementary and Integrative Medicine and Co-Director of the Digital Society Initiative (DSI) at the University of Zurich and Director of the Institute for Complementary and Integrative Medicine at the University Hospital Zurich. She is a is a leading expert in complementary and integrative medicine, and her work bridges clinical practice, research, and policy. Her research focuses on evaluation of the effectiveness, cost-effectiveness, and effect moderating factors, including expectations of non-pharmacological therapies, and uses various research methods from clinical and implementation research. 

Professor Dr. Witt has dedicated her career to advancing human-centered, integrative healthcare by leveraging digital health innovations including AI, and participatory research. She recently sat down with colleagues from the Cochrane Complementary Medicine team to talk about her experiences.

Cochrane Complementary Medicine (CAM): Thank you very much for agreeing to speak with us about your experience in integrative medicine. We have a list of questions, but we’re happy to talk about anything else you feel is relevant. To start, could you tell us a little about your background and training, and what led you to work in integrative medicine?

Claudia Witt (CMW): I’m trained as a medical doctor and a clinical epidemiologist. Because of my work in research methods and study design, I also consider myself a research methodologist. As doctor I provide digital self-care options in integrative oncology care.

CAM: How would you describe the level of integration between integrative medicine and conventional medicine in Switzerland, especially in oncology?

CMW: Switzerland is unique. Years ago, there was a public vote that led to complementary medicine being mentioned in the national constitution. This helped bring complementary medicine into the insurance reimbursement system and into the medical curriculum for students.

Many primary care doctors in Switzerland offer integrative treatments like acupuncture or herbal medicine. So I would say integrative medicine is integrated—but not fully. If it were fully integrated, we wouldn’t still call it “complementary.”

CAM: Beyond your clinical work, you’re also involved in Cochrane. How did you first learn about Cochrane and get involved?

CMW: I first came across Cochrane while working at Charité Medical School, where I taught evidence-based medicine. That naturally led me to Cochrane’s work. My deeper involvement began when I became a visiting professor at the University of Maryland’s Center for Integrative Medicine about 20 years ago. There I worked on Cochrane Center grants.

About five years ago, we became a Cochrane satellite for complementary medicine in Switzerland. We have a strong connection with the Cochrane Complementary Medicine Field and appreciate the collaboration.

CAM: Cochrane emphasizes systematic reviews of randomized controlled trials (RCTs) as the best evidence for informed medical decisions. What do you see as the strengths and limitations of RCTs in integrative medicine?

CMW: I’m a big fan of randomization because it makes analysis easier, especially for confirmatory research. But I also know that not everyone wants to be randomized, so trials can have selection issues.

Much of my work looks at the spectrum between efficacy and effectiveness, depending on who is included in the study and how varied the interventions are. I still believe it’s possible to run RCTs with good generalizability. Ultimately, the right design depends on the research question.

People often assume you can’t run blinded RCTs in integrative medicine. It’s often not possible with complex interventions like yoga or mindfulness because they’re difficult to blind. But with supplements, for example, we can create indistinguishable placebos or use double-dummy designs. The challenge of blinding also exist in other fields like rehabilitation and exercise research. This is not unique to integrative medicine.

CAM: Given those challenges, what other types of evidence do you think are valuable in addition to RCTs and systematic reviews?

CMW: I believe in having a broad set of research methods. I’m a fan of qualitative research, and many of my projects use mixed methods. I also use implementation research, and over the last decade I’ve been doing more research on digital health strategies.

Large datasets will become more important, especially for training AI algorithms. These may rank lower on the traditional evidence pyramid, but in the future, based on AI algorithms they will provide valuable insights and better predictions for individual patients. Again, it all depends on the research question.

CAM: Could you share an example of your work in implementation science or big data?

CMW: A recent example is online training program for patients. An eLearning teaches people how to use acupressure for cancer-related fatigue and how to do mindfulness exercises. The whole development process used implementation research methods—participatory methods and mixed methods. It took about a year to develop with stakeholders an intervention that was practical and usable. Many older RCTs in integrative medicine didn’t do this—they tested interventions that weren’t realistic or feasible in usual care. Proper development before testing is essential.

CAM: Evidence is only useful if it’s accessed, understood, and used correctly. How do you think evidence on integrative medicine can best reach clinicians, patients, and the public?

CMW: Outreach and dissemination are critical. Before that, though, we need to make sure we’re producing evidence that actually helps people make decisions. This doesn’t always happen. I’d like to see more stakeholder engagement when we choose research questions and outcomes.

We recently created an evidence gap map for multiple sclerosis. We involved patients and clinicians to identify which outcomes mattered most to them. That helped us see where research is still needed.

We also need to present findings in clear, accessible ways. The Complementary Medicine Field’s “blogshots” are a great example. We translate them into German and share them widely. People tell me they show them to friends or family—like someone who shared our zinc blogshot with her husband. Simple communication tools can have a big impact.

CAM: You mentioned stakeholders. Who are the key stakeholders in integrative medicine, and how should researchers involve them?

CMW: I prefer a broad view. Patients and their relatives are important, but so are policymakers, health insurers, clinicians, hospital managers, and even product developers.

We often form stakeholder advisory boards for clinical trials. We’ve been doing this for years, even before it became common in German-speaking countries. Often stakeholders  - including patients - are co-authors on publications because they meaningfully contributed.

A key lesson is that it’s our job as researchers to speak plainly. Patients shouldn’t have to learn technical language to participate. We can translate concepts like randomization into everyday language. When everyone is on more equal footing, discussions are much more productive.

CAM: Do you think lack of support for this work creates barriers to involving people?

CMW: Yes. Many people feel they’re not “qualified” to contribute. Training can help, but time is also an issue. PCORI in the U.S. is a good model—participants receive funding for their involvement. We budget for this in our own clinical trials. Paying patients and professionals respects their time and expertise.

CAM: We’ve only touched on part of this topic. Are there other issues you think should be part of the conversation about evidence and integrative medicine?

CMW: I’d like to talk about digitalization. It’s bringing major changes to every field, including evidence synthesis. There are opportunities to use AI, especially agentic AI, for searching, data extraction, and updating systematic reviews.

Integrative medicine should keep pace—and sometimes we may even be able to move faster than other fields because we’re smaller and more flexible. AI can save time and money on tasks like data extraction so we can spend more energy on meaningful scientific work.

Digital health apps for yoga, mindfulness, relaxation, and acupressure are another example. We’ve researched apps for more than 15 years, including clinical trials and systematic reviews. But apps change quickly—sometimes faster than a clinical trial can be completed. We need faster ways to update evidence and run trials, especially when the product evolves every few years.

We’ve published recommendations for conducting systematic reviews and clinical trials on digital health interventions. This area needs new skills and clear standards.

CAM: What challenges come with this digital shift?

CMW: One big challenge is defining the intervention. Even how an app displays information or guides the user can affect outcomes. We also need good control groups—should the comparison be no app, or an app with the active elements removed?

In the future, instead of comparing yoga to no yoga, we may compare one yoga app to another. Then we need to understand the “active ingredients” of these very complex interventions.

CAM: The terms alternative, complementary, and integrative have changed over the years. What is the value or limitation of each term today?

CMW: After decades in the field, I’ve stopped worrying about the terminology. People use these terms differently depending on culture.

I’ve become more pragmatic with age. I prefer to focus on the actual intervention—acupuncture, yoga, etc.—rather than the label. Acupuncture, for example, appears in guidelines for oncology and low back pain. Should it still be called complementary or integrative, or just evidence-based?

I still explain the terms to students, but I acknowledge that usage varies even between Switzerland and Germany, and between Europe and the U.S.

CAM: That makes sense, and I agree. Some people feel the labels “complementary” or “integrative” can undermine effective treatments like acupuncture. It would be interesting to debate this in a journal—though the journal itself couldn’t use those labels in its title!

CMW: True. I don’t like the term “alternative,” because what we do in the clinic is not alternative to conventional care. But beyond that, I’ve relaxed about the terminology.

When I entered the field, I cared a lot more about the labels, but now I see that people understand and use them differently.

CAM: One last question: your training was as a conventional doctor. How did you end up practicing and researching in this field?
 

CMW: I’ve always been curious. I’m driven by questions, and I’m comfortable with whatever the results show. I’ve published many negative trials, and they often made me even more curious.
 

I first encountered integrative medicine during my medical studies. I’ve advised on methodology for conventional studies, but my own work has always focused on integrative medicine. It is strongly linked with digital health, which I also enjoy.