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The New Face of Medicine

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Jan.17, 00
By Susan Goodman
Modern Maturity
Andrew Weil, M.D., thinks he knows the secrets to good health, and he's doing his best to tell us what they are. He is succeeding. His last two books, Spontaneous Healing and Eight Weeks to Optimum Health, both hit the number one spot on The New York Times bestseller list. The initial print run of his newest book, his eighth, Eating Well for Optimum Health (Knopf, due out in February), is a staggering 1 million copies.
At medical school, he authored one of the first controlled human experiments with marijuana, then went on to investigate drugs and addiction. His Web site: Domain Inquiry receives 5 million page-views a month, making it one of the most popular cyber-addresses in the world. He has an audio CD on the market, Eight Meditations for Optimum Health, and publishes a monthly newsletter, Dr. Andrew Weil's Self Healing.
For many, Weil's beaming earth-father visage has become the face of sane, acceptable alternative medicine. But to think he's just another herbal proponent would be a mistake. His ambition is nothing less than to reform the country's entire medical delivery system by integrating alternative and conventional medicine, by retraining the way doctors are taught in medical school, and by changing the way we look at health and disease.
In his second year at Harvard Medical School in the mid-'60s, Weil led a revolt against what he called its "deadening curriculum." His group petitioned to be excused from all classes, saying they could teach themselves better and would take the comprehensive exam at year's end to prove it. Surprisingly, Harvard complied but then, unannounced, changed the exam's format. Weil's group passed anyway–his first attempt to change the way doctors are educated. He is currently continuing the experiment by designing curricula for his Program in Integrative Medicine at the University of Arizona College of Medicine.
Weil has spent a lifetime assembling a Renaissance approach to medicine. He studied ethnobotany as a Harvard undergraduate, learning the powerful properties and uses of plants. At medical school, he authored one of the first controlled human experiments with marijuana, then went on to investigate drugs and addiction. He studied with a Sioux medicine man in South Dakota and with shamans in the Amazon. The result is a philosophy of medicine that embraces any method that works and does little harm. His detractors, however, see great harm in his ideas. Weil's first book, The Natural Mind, was an outgrowth of his marijuana research. It contended that people have an innate drive to alter their consciousness and that there are no inherently good or bad drugs, just good or bad relationships with them.
Marcia Angell, executive editor of The New England Journal of Medicine, told Discover magazine laqt year, "Like most religions, alternative medicine has prophets–charismatic personalities like . . . Andrew Weil. . . . The authority of the prophets rests almost entirely on faith and personal persuasiveness–how good they look on TV."
Contributing editor Susan Goodman visited Weil at his ranch, southeast of Tucson. Her report: "He greeted me in shorts, Hawaiian shirt, and sandals, and we sat in an office overlooking his organic garden. I found him to be serious, intellectual, and formal. For two days we talked about what's wrong with the way medicine is practiced, what should take its place, and why so many people in power are gunning for him."
MM: What's the principal health message you want people to hear?
AW: That the human organism has great resilience and that we rely on health professionals too much. Prepaid medical plans make this worse by encouraging people to run to their doctor with every twinge.
MM: Is it true that you think conventional medicine is only good for 15 to 20 percent of what ails us?
AW: Yes. The vast majority of complaints people bring their doctor–chronic indigestion, colds, viral upper-respiratory infections, skin problems, kids' ear infections, and insomnia–could be dealt with better through lifestyle changes, natural remedies, stress reduction, changes in diet, or the body just healing itself.
MM: Give us an example of a common condition and how you would treat it differently with alternative medicine.
AW: Take rheumatoid arthritis. The primary conventional treatment is suppressive drugs. Instead, I would try to adjust the person's diet, pattern of exercise, and use of natural anti-inflammatory supplements. I would take advantage of the mind/body connection through Chinese or Ayurvedic [a healing system from India –Ed.] medicine to try and control symptoms. I'd save the suppressive measures only for severe flares when they're really needed.
MM: When should conventional medicine be used?
AW: Standard medicine is best for dealing with traumas, crises, and life-threatening problems. If you have alarming symptoms that might indicate disease in a vital organ, symptoms stronger than any you've had before, or symptoms that last for a longer time, go to standard medicine for evaluation. For other conditions, see if you can change them with dietary changes, relaxation methods, or herbal treatments. Two months is a fair trial. If it's the same or worse after that, then see a standard doctor. MM: You want to create a medical system that uses alternative and conventional medicine. How would that work?
AW: At the University of Arizona we're producing a new generation of physicians who are trained differently and a curriculum that we hope will be adopted by other medical schools–mind/body medicine, alternative practices, spirituality medicine, and nutrition. I want doctors to be aware of all the healing methods out there, their strengths and weaknesses, and how to use them. I envision physicians being more like teachers than interventionists.
MM: How can you bring together systems with such fundamentally different ideologies?
AW: I'm not sure you can, but being a good integrative medicine practitioner is being a good therapeutic marriage-broker. You have to know how to arrange matches between patients and practitioners and systems.
MM: What else would be in your ideal health system?
AW: I'd like to see a new institution I call a Human Center, a clinic/spa hybrid, under the direction of retrained integrative M.D.s with a variety of other practitioners on staff. You could go for a few days or a week for lifestyle analysis, preventive counseling, or adjustment. You could learn how to shop for and prepare food, how to relax, how to exercise, remedies to use, maybe how to garden.
MM: Some doctors may want this new kind of training, but others are rabidly critical of you.
AW: It's somewhat generational. Older physicians are probably most threatened by the breakdown of the traditional "doctor knows best" authoritarian relationship. Even though much of conventional medicine is not founded in good science, they see attempts to bring in other systems as antiscientific. Alternative medicine also represents an economic threat at a time when a physician's financial world is shrinking. And it's especially threatening to have a Harvard-trained doctor saying these things.
MM: It certainly doesn't help that you're also getting rich from your success and notoriety.
AW: People are envious, not only about money, but because I'm relatively free. I don't have to go into the office and sit in committee meetings eight hours a day. If money were a major motivation, I'd be endorsing products and not working for a state university half-time.
MM: What about charges that you endorse alternative treatments that haven't yet been proven to be effective?
AW: There is a lot unproved in alternative medicine and we're working to correct that. I am not an uncritical friend of alternative medicine. There's a lot of junk out there–horrible, dangerous things you wouldn't believe like intravenous hydrogen peroxide and ozone. You'd think the conventional guys would be grateful I'm trying to sort it all out. I find myself in a very lonely position sometimes because I'm in the middle and get it from both sides. But conventional medicine must look at how much of what they do is also unproved. Any intelligent cardiologist will tell you that many of the ways that procedures such as angioplasty and bypass surgery are being used today are not supported by evidence. And they were used long before randomized, double-blind clinical trials were done. If I come across as more harsh toward conventional medicine, it's because it uses methods more productive of harm, so it must be held to stricter standards.
MM: What state of health should we strive for?
AW: The image I use is a knockdown toy–you push it down, it bounces back up. If you've got that inner resilience, you can move through a dangerous world and not get knocked off balance for too long.
MM: You talk about the ability of the body to heal itself and the importance of belief in healing. Does that explain the phenomenon called the placebo effect?
AW: Most doctors are taught to regard the placebo effect as a nuisance, but it's the meat of medicine. Placebo responses are healing responses from within, elicited by belief. In any controlled drug trial, you will find a few subjects in the placebo group who show every change produced in the experimental group. Even when you give people real treatments, including open-heart surgery, a lot of benefit you see may be a placebo response. When surgeons first started treating coronary heart disease in the 1950s, one method was to cut open the pericardium (the sac around the heart), sprinkle talc in, and sew it back up. This was supposed to irritate the heart and make it grow new blood vessels. A ridiculous idea. But some people benefited from it. A more drastic one was to cut an artery in the chest wall and stick it into the heart or just tie it off, thinking that would divert more blood to the heart. Some patients did great on that, too. But when they did "sham surgery," where they cut people open and purposely didn't do anything to them to see what would happen, even some of those patients had good results. There is no drug effect that has been invented that cannot be produced by a placebo mechanism. That's amazing. The art of medicine is learning how to make this happen more often.
MM: How do we?
AW: When patients come to me, they are projecting belief onto me. There is a skill in reflecting that back on the patient in a way that increases the probability of a healing response–by being genuinely confident that they will get better. Many patients who have done well have told me, in retrospect, that the most important thing I did was to tell them they could get better–and that I was the first doctor who had ever told them that. Another path is believing in the treatments you recommend. In our program, all doctors must take the medications they prescribe. A mentor of mine required all of his residents to do this. Afterward, the rates of prescribing medications in that hospital went way down.
MM: Is it also true that patients can be harmed on occasion by a doctor's negativity or lack of confidence?
AW: Yes. Sometimes it's done so blatantly, it's laughable. The worst one I ever heard was from a woman who had an auto-immune disorder that was not so dire, and she pressed her doctor for a prognosis. He said, "Well, let's put it this way. I wouldn't buy any tires with a lifetime guarantee." More commonly, though, it's much more subtle, where the doctor wouldn't even be aware of it. A patient might ask, "How long do I have to take this medicine?" and the doctor says, "For the rest of your life." The implication is that you'll never get better.
MM: So if somebody asked you for the worst-case scenario of their condition, would you give it to them?
AW: I'd say, "I don't know." That's because in many cases there's no way you can know. If a person is 72 hours away from dying, you generally know. But I see a lot of cancer patients who say their doctor told them they had six months, and now it's six years later.
MM: One of the most controversial issues of our day is assisted suicide and euthanasia. Where do you stand?
AW: It's a tricky ethical area that has to be thought out carefully. There need to be safeguards so it's not abused. But a lot of patients turn to doctors for this. I have a friend whose mother-in-law was in a great deal of pain, dying, and wanted to exit. My friend asked several physicians to assist and was rebuffed. The family ended up putting a plastic bag over the woman's head. It was awful.
MM: If assisted suicide were legal, would you? Could you?
AW: I've had patients ask me to prescribe them medicine so they could be relieved of the anxiety, knowing they had the means to get out if they could. I haven't done it. One was a woman near 90 with severe emphysema.
MM: Why didn't you?
AW: I didn't feel right doing it at that time.
MM: Could you now?
AW: It's complicated, but I do think–sure, I think I would facilitate a person's death if I felt that that's what they wanted, if their suffering was unbearable, and if I saw no possibility of them getting better.
MM: You've spent years studying drugs and addiction. What do you think would be an intelligent and successful drug policy for our country?
AW: The cornerstone has to be honest education on the positive and negative aspects of all drugs. When I talk about drugs, I group all the ones that affect mood, perception, and thought together. Whether they're legal (like coffee, alcohol, and tobacco) or illegal is not important. I'd also like to see a gradual backing away from criminal law as the means of dealing with this problem and a gradual restriction of advertising and commercializing legal drugs like alcohol and tobacco. Then we'd make some progress.
MM: Is coffee unhealthy, too?
AW: It's a dangerous drug, a powerful stimulant in the same ballpark as cocaine and amphetamines. The majority of people who drink it are physically addicted to it.
MM: How about alcohol?
AW: When distilled alcohol first appeared in this part of the world, there was an explosion of alcoholism. If you read about the kind of drunkenness that existed in the late 1700s and early 1800s, you realize it was universal. You were either drunk or abstinent, there was no middle ground. As a result of developing rituals around its use, we contained that potential to a great extent. That's one way to successfully use a substance that's difficult to control. Another behavioral shift is happening now with cigarettes–the most addictive product known.
MM: How do you respond to people who are uncomfortable with your position on and experience with drugs?
AW: If people ask me, I'm out there about it. I have never made any attempt to disown that part of my work. I've always said that my insights into health and healing have come directly from the work I did in the field, in the laboratory, and in my own body.
MM: Didn't you once say, "I am a great believer in the value of being high"?
AW: Yes, but by "high," I did not mean being under the influence of a drug. I meant being in an altered state of consciousness where you feel elevated, expanded, connected. There are many spontaneous highs that people have, and you can get there through meditation, exercise, sex, as well as psychoactive drugs. While in that state, you can see potentials and ideas you don't normally see. These states are doorways to the nervous system that might lower your blood pressure, help you deal better with pain, improve your sleep, or even extend your longevity.
MM: The book you're working on next is about aging. What do you hope to learn as you research it?
AW: A while ago I went to my 25th high school reunion. There were people there who looked exactly as I remember them from high school. Exactly. And others who looked infinitely old. What's different there? Genes? Environment? Experiences? Lifestyle? I don't know. It's a question I'm very interested in. The current party line on aging is that it's environmental and we can affect it. I wonder how much of that is wishful thinking. Healthy aging is having the physical faculties, mental faculties, and energy to do what you want as you move through life, and being comfortable with the aging process. There's so much time and money going into denying the aging process–from plastic surgery to fringy doctors recommending human-growth hormone supplements, for which there's little evidence of efficacy. Our culture believes aging is something that happens suddenly after middle life. Aging is a continuous process that you want to adapt to. The first step to achieving that is to accept it. If you deny its existence, by definition you can't accept it.
MM: Do you do anything to slow down your own aging process?
AW: I don't believe in anti-aging. I follow what I think is a healthy lifestyle. I'm careful about what I eat. I try to exercise every day. I try to pay attention to my mental states and stress, and I try to hang around younger people. One of the worst things we do in our culture is isolate ourselves in communities of old people. Just watch dogs–old dogs become rejuvenated when a puppy comes in. There's a lesson to be learned from that.
MM: Do you ever feel pressure being the standard bearer?
AW: No. I feel I've got a mission to change medicine, and the economic collapse of standard medicine is making it possible. You asked earlier why some doctors are so rabidly against me. I'm the point man. I'm the one taking the heat. And I'm willing–and equipped–to do it. But I'm a reluctant celebrity. I hadn't realized this before, but I'm rather shy and private, and it's been difficult to have people watching me. There have been some funny scenes. Once I was at the supermarket because I was cooking for my dogs and my basket was filled with nothing but packages of the cheapest stew beef. I sailed into the checkout line and the girl said, "Oh, Dr. Weil, I followed every step in your book on health . . ." and then just stopped. I didn't say a thing.
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