♦ DEPARTMENTS CBE REVIEWS EDITED BY WALTER PAGEL A Trip to Stonesville: Andrew Weil, the Boom in Alternative Medicine, and the Retreat from Science [In this issue of CBE ReViews, I have systematic advocate. things,” by which he means a tolerance for chosen to abridge a long review written Until now, alternative medicine has “the coexistence of opposites that appear by Arnold Relman for The New Republic. generally been rejected by medical scientists to be mutually antagonistic.” In Weil’s view, The review covers Andrew Weil’s books and educators, and by most practicing phy- intellect, logic, and inductive reasoning from Ask Dr. Weil; Eight Weeks to Optimum sicians. The reasons are many, but the most observed fact are the limited instruments of Health; Spontaneous Healing; Natural important reason is the difference in men- “straight” thinking, and should be subservi- Health, Natural Medicine; Health and tality between the alternative practitioners ent to guidance by the intuitive insights that Healing; From Chocolate to Morphine and the medical establishment. The leaders are gained during states of altered con- (with Winifred Rosen); The Marriage of of the establishment believe in the scientific sciousness and “stoned” thinking. the Sun and Moon; and The Natural Mind, method, and in the rule of evidence, and in There is more of this kind of thing in published over the last 15 years. The review the laws of physics, chemistry, and biology the remainder of his “Stonesville” chapter, is published with permission of The New upon which the modern view of nature is much of which defies rational belief or is Republic from the 14 December 1998 issue based. Alternative practitioners either do just plain wrong about the facts. Weil states, of the magazine.—Ed.] not seem to care about science or explic- for example, that “stoned” thinking enables itly reject its premises. One might have us to gain control of our autonomic, or I. expected such thinking to alienate most involuntary, nervous system, and that the Andrew Weil, M.D., is variously people in a technologically advanced society practical application of this thinking in described on the covers on his best-selling such as ours; but the alternative medicine the form of “autonomic feedback control” books as “the guru of alternative medi- movement, and the popularity of gurus enables patients to control high blood pres- cine,” “one of the most skilled, articulate, such as Weil, are growing rapidly. sure more effectively and safely than by the and important leaders in the field of health In 1971 he [Weil] began to write The use of antihypertensive drugs. He claims and healing,” “a pioneer in the medicine Natural Mind, which became a best-seller that allopathic physicians “have no effec- of the future,” and “an extraordinary phe- and launched his career as a writer. tive drug for high blood pressure.” Now, nomenon.” On his website, which records The Natural Mind (1972) is mainly a even in 1972, when The Natural Mind was over two and a half million hits a month, criticism of American drug policy and an first published, this statement was dubious, he is called “America’s most trusted medi- exposition of Weil’s views on the interac- to say the least; and it was certainly false cal expert.” A recent cover of Time, which tion of psychedelic drugs with the mind. in 1985 when the book was republished featured the familiar picture of his bald It also expounds his general philosophy and supposedly updated. Weil tells us that head and bewhiskered cherubic counte- of mind-body relations upon which much patients can be taught to lower their blood nance, announced that “medicine man Dr. of his later writings on health and healing pressure by a form of training called “feed- Andrew Weil has made New Age remedies is based. The seventh chapter, entitled “A back control.” The fact is that “feedback popular.” In the accompanying story, Time Trip to Stonesville,” should be required control” (or “the relaxation response,” tells us that “millions of Americans swear reading for all who would understand the as it is called by Dr. Herbert Benson, its by” his medical advice. origins of Weil’s belief in the healing power chief advocate and another well-known Not all of this is hype. Weil is arguably of the mind. guru of alternative medicine) produces at the best known and most influential of the According to Weil, many of his basic most only small and usually transient reduc- many physician-writers now in the vanguard insights about the causes of disease and tions in blood pressure. Feedback control of the alternative medicine movement. He is the nature of healing come from what he has never been shown to be as effective also one of the most prolific. Since 1972 he calls “stoned thinking,” that is, thoughts in the long-term control of moderate to has written eight books. The first three were experienced while under the influence of severe hypertension as any of a variety of mostly about the effects of natural drugs on psychedelic agents or during other states pharmacological agents prescribed for this consciousness, but the remaining five, all of “altered consciousness” induced by purpose. published in the past fifteen years, are about trances, ritual magic, hypnosis, meditation, health and healing. Read together with one and the like. He cites some of the charac- II. remarkable chapter in his first book, these teristics of “stoned thinking” that give it The Natural Mind was followed by two more recent works provide a comprehensive advantages over “straight” thinking; these more popular books about consciousness description of alternative medicine, as seen include a greater reliance on “intuition” and and mind-altering drugs—The Marriage through the eyes of its most serious and an “acceptance of the ambivalent nature of of the Sun and Moon: A Quest for Unity

CBE VIEWS ♦ VOL 22, NR 4, 1999 ♦ 121 CBE REVIEWS

in Consciousness (1980); and, with Win- ments as arthritis, asthma, hypertension is no doubt that improper use of phar- ifred Rosen, From Chocolate to Morphine: (high blood pressure), multiple sclerosis, or maceuticals, including mistakes in dosage Everything You Need to Know About for many other chronic diseases. . . .” This is and even inadvertent administration of the Mind-Altering Drugs (1983). Neither book a startling list of major diseases to be ruled wrong drug, causes many serious mishaps dealt directly with alternative medicine. His off-limits for conventional medicine. One in hospital and office practice. Even the next book on medicine was Health and wonders which of the remaining chronic proper use of drugs can sometimes cause Healing (1983, republished in 1998). By diseases Weil is willing to concede to the fatal reactions. Misuse of antibiotics can then Weil had established himself in Tuc- allopaths, and how he knows where to draw cause the development of drug-resistant son as a general medical practitioner and the line. strains of bacteria. was on the part-time clinical faculty of the Still, the fact remains that pharma- College of Medicine of the University of III. ceuticals are an essential part of medical Arizona, where he gave an elective course One of Weil’s central themes in Health and practice. Without them there would be no of lectures about alternative medicine. Healing, and in his subsequent work, is his effective treatment or palliation of many Consider Weil’s strange discussion in criticism of mainstream medicine’s reli- serious diseases. On balance, the good this book of sickness and health. “Sickness ance on pharmaceuticals instead of herbal done by modern pharmaceuticals far out- is the manifestation of evil in the body,” he medicines. The latter are presently enjoying weighs the harm, though zealous advocates proclaims, “just as health is the manifesta- a great resurgence in popularity, due largely of “natural” remedies (Weil among them) tion of holiness. Sickness and health are not to the endorsement of prominent advo- insist otherwise. simply physical states. . . . They are rooted cates such as Weil, and to the promotional Weil next considers the healing power in the deepest and most mysterious strata activities of a “natural products” industry of the placebo effect, by which he means of Being.” that received a big boost in 1994, when the faith of the patient and the practitio- Lest we despair of ever knowing in our Congress gave the industry permission to ner in the therapeutic value of whatever heart what health is, Weil unveils the mys- market herbal preparations with less rigor- treatment is being used. He says that all tery: “Health is wholeness—wholeness in ous oversight by the FDA than the agency treatments depend more or less on this its most profound sense, with nothing left exercises over drugs. Manufacturers of faith, and that is why any treatment, real or out and everything in just the right order to herbal preparations can avoid many of the imaginary, may be able to cure any disease manifest the mystery of balance. Far from customary rigors of FDA drug regulation in certain patients by helping them to mobi- being simply the absence of disease, health simply by labeling these products “dietary lize their innate healing powers. Sometimes is a dynamic and harmonious equilibrium supplements.” In 1997, the herbal medicine the result is mainly due to the direct physical of all the elements and forces making up market had sales of nearly $4 billion, and a action of the treatment, and sometimes it and surrounding a human being.” Health, stroll down the aisles of almost any super- is mainly due to the patient’s own belief in it seems, is a mystery explained by another market or chain drugstore will confirm that the treatment, and sometimes it appears to mysterious principle. This is the “mystery business is booming. be a combination of effects. Weil probably of balance.” Weil doesn’t like the modern pharma- believes that herbal remedies, diet, physical Then there is Weil’s typically ambiguous ceutical industry and he wants us to return exercise, and other lifestyle changes belong assessment of conventional, or allopathic, to our former dependence on herbs. His mainly in the first category. Faith healing, medicine. First he concedes that it is not arguments are on balance unconvincing, therapeutic touch, magnetism, and most all bad, and that “regular medicine is the but they are not without some reason. of the other more esoteric alternative heal- most effective system I know for dealing Weil has an arguable case, I think, when he ing methods would probably be placed in with many common and serious problems,” criticizes the pharmaceutical industry for the second category. Meditation, breathing among them acute medical and surgical promoting expensive new drugs that have exercises, biofeedback, acupuncture, mus- emergencies. But then he adds that “regu- little or no advantage over older and less culoskeletal manipulations, and yoga would lar medicine is on very shaky ground” in expensive drugs, and for sometimes being probably be placed in the third category. dealing with other common problems. “I insufficiently attentive to their risks. I also That people usually “get better,” that would look elsewhere than conventional have some sympathy with his criticism of most relatively minor diseases heal spon- medicine for help if I contracted a severe the excessive prescribing of potent phar- taneously or seem to improve with simple viral disease like hepatitis or polio, or a maceuticals by physicians, and the com- common remedies, is hardly news. Every metabolic disease like diabetes. I would not mon practice of prescribing many drugs physician, indeed every grandmother, seek allopathic treatment for cancer, except simultaneously without sufficient attention knows that. Yet before we accept Weil’s for a few varieties, or of such chronic ail- to their toxic or interactive effects. There contention that serious illnesses such as

122 ♦ CBE VIEWS ♦ VOL 22, NR 4, 1999 CBE REVIEWS

“bone cancer,” “Parkinson’s disease,” or perceive them as uninterested in personal gurus of alternative medicine, alternative “scleroderma” are similarly curable, or problems, as inaccessible to their patients and mainstream medicine are not simply respond to alternative healing methods, except when carrying out technical proce- different methods of treating illness. They we need at least to have some convincing dures and surgical operations. The “doctor are basically incompatible views of reality medical evidence that the patients whom he knows best” attitude, which dominated and how the material world works, and they reports in these testimonials did indeed suf- patient-doctor relations during most of the cannot easily be combined into any rational fer from these diseases, and that they were century, has in recent decades given way to and coherent “integrated” curriculum. really improved or healed. The perplexity is a more activist, consumer-oriented view of There is no doubt that modern medicine not that Weil is using “anecdotes” as proof, the patient’s role. Moreover, many other as it is now practiced needs to improve its but that we don’t know whether the anec- licensed health-care professionals, such as relations with patients, and that some of dotes are true. nurse-practitioners, psychotherapists, phar- the criticisms leveled against it by people macists, and chiropractors, are providing such as Weil—and by many more within IV. services once exclusively reserved to allo- the medical establishment itself—are valid. Surely almost all scientists would agree . . pathic physicians. There also can be no doubt that a few of . that, regardless of what theory of nature The net result of all these developments the “natural” medicines and healing meth- we wish to espouse, we cannot escape the has been a weakening of the hegemony that ods now being used by practitioners of obligation to support our claims with objec- allopathic medicine once exercised over the alternative medicine will prove, after test- tive evidence. All theories must conform to health care system, and a growing interest ing, to be safe and effective. This, after all, the facts or be discarded. So, if Weil can- by the public in exploring other healing has been the way in which many important not produce credible evidence to validate approaches. The authority of allopathic therapeutic agents and treatments have the miraculous cures that he claims for the medicine is also being challenged by a swell- found their way into standard medical healing powers of the mind, and if he does ing current of mysticism and anti-scientism practice in the past. Mainstream medicine not support with objective data the claims that runs deep through our culture. Even as should continue to be open to the testing he and others make for the effectiveness of the number and the complexity of urgent of selected unconventional treatments. In alternative healing methods, he cannot pre- technological and scientific issues facing keeping an open mind, however, the medi- sume to wear the mantle of science. contemporary society increase, there seems cal establishment in this country must not to be a growing public distrust of the scien- lose its scientific compass or weaken its V. tific outlook and a re-awakening of interest commitment to rational thought and the Health and Healing, published in 1983, in mysticism and spiritualism. rule of evidence. was the last of Weil’s comprehensive and All this obscurantism has given pow- There are not two kinds of medicine, one broadly conceived commentaries on health erful impetus to the alternative medicine conventional and the other unconventional, and disease. Beginning in 1995, with Natu- movement, with its emphasis on the power that can be practiced jointly in a new kind ral Health, Natural Medicine, he produced of mind over matter. And so consumer of “integrative medicine.” Nor, as Andrew a series of three “how-to” manuals on demand for alternative remedies is rising, as Weil and his friends also would have us wellness and self-care, which established is public and private financial support for believe, are there two kinds of thinking, or his current reputation as the people’s doc- their study and clinical use. It is no wonder two ways to find out which treatments work tor and “America’s most trusted medical that practicing physicians, the academic and which do not. In the best kind of medi- expert.” The next was Spontaneous Heal- medical establishment, and the National cal practice, all proposed treatments must be ing, and the third Eight Weeks to Optimum Institutes of Health are all finding reasons tested objectively. In the end, there will only Health. to pay more attention to the alternative be treatments that pass that test and those The alternative medicine movement medicine movement. Indeed, it is becoming that do not, those that are proven worth- has been around for a long time, but it was politically incorrect for the movement’s crit- while and those that are not. Can there be eclipsed during most of this century by the ics to express their skepticism too strongly any reasonable “alternative”? success of medical science. Now there is in public. Arnold S Relman growing public disenchantment with the As Weil clearly points out in his earlier cost and the impersonality of modern books, alternative healing is based on a con- Arnold S Relman is editor-in-chief emeritus medical care, as well as concern about ception of nature and a theory of learning of the New England Journal of Medicine medical mistakes and the complications the truth about nature that is fundamentally and professor emeritus of medicine and and side effects of pharmaceuticals and at odds with the “straight,” evidence-based social medicine at Harvard Medical School. other forms of medical treatment. For their thinking of mainstream medicine. As part, physicians have allowed the public to defined by Weil, and by most of the other

CBE VIEWS ♦ VOL 22, NR 4, 1999 ♦ 123