Vital Signs

Dr. Andrew Weil Diagnoses Western Medicine

In a career spanning four decades, physician Andrew Weil has gone from the sixties counterculture to the mainstream world of best-selling books and television appearances. Along the way he’s refused to compromise his essential view on medicine: that natural cures, lifestyle changes, and our own minds can match and even surpass the medical results of modern science.

Weil was born in Philadelphia in 1942 and had a childhood fascination with plants and herbal remedies. He received a bachelor’s degree in biology from Harvard University in 1964 and went on to get a medical degree there, despite his misgivings about the profession and what he perceived to be its limited approach to healing. He was nearly alone then in theorizing that whole plants, having coevolved with humans over millenniums, are more effective at treating illness than isolated or synthetic compounds.

During his time at Harvard, Weil began researching mind-altering substances found in nature. As an undergraduate he encountered Timothy Leary and Richard Alpert (now Ram Dass), who were studying the effects of lsd through the Harvard Psilocybin Project. Weil wrote his undergraduate thesis on the narcotic properties of nutmeg, and the journal Science published the results of his clinical study of marijuana while he was still in medical school.

After graduation Weil spent time at Mount Zion Hospital in San Francisco and at the National Institute of Mental Health before embarking on three years of travel in North and South America and Africa, where he studied traditional indigenous medicine. His experiences using psychedelics with shamans confirmed for him the importance of the mind in determining our health and even shaping our reality. In his first book, The Natural Mind (Mariner), Weil makes a case for the beneficial properties of hallucinogens and other drugs that he says expand consciousness and open new pathways in the brain.

In 1983 Weil published a comprehensive account of his views on medicine. Health and Healing (Mariner) proposes an approach that blends plant-based remedies and mind-body techniques with modern scientific methods. The book became a bestseller, and that same year Weil joined the faculty at the University of Arizona College of Medicine. In 1994 he established the Program in Integrative Medicine at the university — the first of its kind — with a goal to explore preventive practices, natural diets, botanical cures, and the mind’s ability to promote wellness. In 2008 the program became the Arizona Center for Integrative Medicine, of which Weil is the program director. Today there are more than forty similar programs at medical centers around the country, including the Mayo Clinic, Duke University, and Weil’s alma mater, Harvard Medical School.

Once a traveler on the outskirts of respectability, Weil has gained acceptance from many of his colleagues despite his continued critique of the medical establishment. He’s also found a large popular audience through his books, which include Natural Health, Natural Medicine: The Complete Guide to Wellness and Self-Care for Optimum Health (Mariner), Healthy Aging: A Lifelong Guide to Your Well-Being (Anchor), and Why Our Health Matters: A Vision of Medicine That Can Transform Our Future (Hudson Street Press), and through his appearances on Larry King Live and The Oprah Winfrey Show. His latest venture is True Food Kitchen, a health-food restaurant he opened in Phoenix, Arizona, in 2008 with restaurateur Sam Fox. The menu is eclectic, regional, and based on Weil’s own dietary principles. A second location has since opened in California, and more are planned.

At the age of sixty-eight Weil continues to push for an overhaul of institutional medicine in the U.S. He wants to establish integrative-medicine programs in every medical residency in the country and claims the integrative approach could cut the nation’s bloated healthcare budget by promoting inexpensive preventive measures instead of expensive drastic interventions. Though many still find his ideas controversial, few would question his influence on the debate over health in the U.S.

Weil and I spoke a few months before President Obama signed the healthcare-reform bill into law. Weil was visiting my hometown of San Rafael, California, to deliver a keynote address at the twentieth annual Bioneers Conference. Though he was relaxed, his responses were deliberate and carefully worded. He tempered his outrage over our current medical system’s dysfunctions with hopes for a more practical nature-based approach to healthcare in the future.

Kupfer: How did you first come to appreciate the mind’s role in the healing process?

Weil: In the early 1970s I spent a lot of time in South America with native peoples, including shamans and healers. When Native Americans use the word medicine, it has a much bigger meaning than in our culture. Medicine men and shamans do not separate medicine, magic, and religion; it is all one. Their medicine has a capital M and includes a lot of what we would put under the category of superstition.

I had experiences with psychedelics and sweat lodges in both North and South America. These altered states of consciousness helped me see more clearly the limitations of treating only the physical body. Physiology is just one place to intervene. Good shamans are master psychotherapists, and I learned a lot from them.

Psychologist and philosopher William James said that normal consciousness is just one point on the spectrum of reality, and there are many, many others. I have found it possible to shift into these other states of consciousness and reality. I believe one may conceive of the world behind the veil without any detriment to one’s understanding of the world we know on this side of it. Bodies are important, but so are the mental and spiritual aspects of health. At the Arizona Center for Integrative Medicine our students — physicians, nurse practitioners, and medical residents — learn about meditation, sweat lodges, and other traditional medicine practices.

Doctors are the shamans of our technological culture. They have access to arcane knowledge and govern the province of life and death. But doctors are not trained to do the essential task of a shaman, which is to mediate between the invisible world and the visible world. How can you do that if you don’t believe there is an invisible world?

Kupfer: So you believe in a world we cannot see?

Weil: The Western scientific paradigm is materialistic, meaning that scientists do not believe in anything that cannot be perceived or measured. Look how restrictive that belief is. It’s the reason for the limited acceptance of mind-body medicine. The nonphysical causation of physical events is not allowed for in the reigning scientific paradigm. If you talk about nonphysical causes of changes in physical systems, materialists either ignore you or make fun of you or, if you keep at it, get angry with you.

Kupfer: But hasn’t interest in those topics increased in the decades since you were a medical student?

Weil: Yes, in the early 1970s I felt like a total loner. Now a lot of the ideas that fascinated me have become fairly mainstream. The change within the medical profession has been recent — I’d say since the early 1990s. It correlates with the economic 
deterioration of the healthcare system. As their financial situation has worsened, medical institutions have opened up to new ways of thinking.

Kupfer: Where do you see the nation’s healthcare system going?

Weil: Unless we transform it, it’s going to steer us into bankruptcy. At the moment the debate is mostly about health insurance, but that’s not the root problem. The root is cost, and I don’t think we can look to politicians to bring costs down. Both Republicans and Democrats are so beholden to the big-insurance and pharmaceutical lobbies that they are not free to act. If Congress can stop the big insurers from disqualifying people on the basis of preexisting conditions, that’s great, but these are little steps. Real change is going to come only if people get aroused enough to start a movement that shifts the balance of political power.

Also, if we don’t get serious about our health, it’s going to bankrupt us as a society. We already have the worst healthcare outcomes of all the developed nations, and we spend more on healthcare than anybody else. We’re spending something like 17 percent of the gross domestic product on it, and it could soon be 20 percent. That is simply not sustainable. And this is before the baby boomers reach old age and become the heaviest consumers of healthcare. We want universal healthcare, but we cannot extend our present disease-management system to all of our citizens. No one could pay all those bills.

Kupfer: Specialized medicine is the most expensive. How did we end up with so many specialists and so few generalists in American medicine?

Weil: The reason is obvious: specialists get paid more and have more prestige. But research has shown that countries and states with more primary-care providers have healthier citizens. To balance the system we could try forgiving student loans for people who go into primary care, but we need political organizing to promote these ideas.

Kupfer: Do you think there’s an opportunity now to get holistic practices covered by national health insurance?

Weil: Yes, but the priorities of insurance reimbursement are completely backward. We happily pay for interventions, diagnostic tests, and drugs, but we don’t pay for doctors to sit down and teach patients how to eat or how to relax. We talk about prevention, but that’s not where the money is going. One way to change those priorities is to conduct outcomes-and-effectiveness studies. Let’s look at five or ten common ailments that now cost us huge sums of money, such as type 2 diabetes or chronic back pain. Because conventional medicine has no magic-bullet treatment for these conditions, people often try complementary and alternative therapies. We could compare conventional treatment with integrative treatment (which might make selective use of conventional medicine) and assess medical outcomes and costs. I’m quite certain that integrative approaches would produce better results at lower costs. If we could get the data and show it to the people who pay for the nation’s healthcare, then they might change their reimbursement policies and start to pay for preventive and integrative medicine.

Kupfer: That will hardly be profitable to the corporate medical-industry establishment.

Weil: How do we make it profitable to practice prevention? I don’t know the answer to that. But it makes me very sad that healthcare is routinely referred to as an “industry” today. It never was in the past.

Kupfer: Do you believe a medical industry motivated by profit will ever act in patients’ best interests?

Weil: The interests and objectives of people who run for-profit healthcare institutions are fundamentally at odds with those of patients and doctors. One example is the overuse of expensive diagnostic scans. The people who own the equipment have to make their investment back, and they place enormous pressure on practitioners to order these tests, even when they’re not medically justified. Doctors should be able to make reasonable livings, and drug companies ought to be allowed to make fair profits, and maybe insurance companies, too, but not the outrageous profits that they are making now.

Kupfer: Is the medical orthodoxy starting to get worn down by alternative medicine?

Weil: Yes, but the orthodoxy is still focused on evidence-based medicine, which takes a scientific-reductionist view of healthcare. In practice, scientific reductionism has had damaging effects because it limits our ability to understand the natural world. It leads us to value isolated chemical compounds more than their complex sources in medicinal plants, which leads to overuse of powerful drugs that can cause harm. Evidence-
based treatments are invariably pharmacological, because drugs are the only treatment the evidence-based community studies. In many places now you can’t present a lecture unless you submit in advance a summary to be approved by an evidence-based medical committee.

One of my colleagues in Norway, a research methodologist, is convinced that the way evidence-based medicine is practiced is a conspiracy of the pharmaceutical companies. It certainly works to their benefit, but the profit motive isn’t unique to drug companies. It pervades all aspects of American healthcare — orthodox, alternative, and otherwise.

Kupfer: What exactly is “integrative medicine”?

Weil: The general public thinks it’s the same as alternative and complementary medicine, but it isn’t. Alternative therapies are just one part of it. Integrative medicine first and foremost focuses on the body’s natural healing potential, which has been ignored in conventional medical education and training. To me the most wonderful feature of human biology is that our bodies can regulate themselves and repair and regenerate their components.

Integrative medicine looks at the whole person, because patients are more than physical bodies. To understand health and illness you’ve got to look at the mental and emotional and spiritual dimensions, not to mention the person’s involvement in a community. If you pay attention only to the physical body, you limit your interventions to those that are often the most expensive and the most potentially harmful.

Integrative medicine focuses on preventing disease and promoting health. Conventional medicine has failed us here, and that is one cause of the healthcare crisis. We are too occupied with managing cases of established diseases, most of which are lifestyle related and preventable. The essence of prevention is not colonoscopies and mammograms; it is understanding how our life choices reduce or increase the risk of disease. As a society we need to be helping people make better choices.

Integrative medicine emphasizes the doctor-patient relationship, which was once a major reward of practicing medicine. In the era of for-profit medicine, that relationship has been sabotaged. If you work in a corporate practice that requires you to spend only five to seven minutes with each patient, you can’t form the kinds of relationships that foster healing and provide emotional satisfaction. I think that’s a big reason many doctors are leaving the practice of clinical medicine. I know some who say that they would never let their child go into medicine today. Doctors are now as unhappy as patients.

Finally, integrative medicine embraces all therapeutic options that may be of value. That includes many that aren’t even on the radar of conventional medicine — simple, low-cost interventions like breath work and laughter therapy. The preference is for more-natural, less-invasive, less-expensive options whenever possible.

Kupfer: What inspired your interest in integrative medicine?

Weil: I came into the world very curious. A childhood interest in plants led me eventually to study botany, and then medical botany. I was also fascinated by the mind and how it affects the body. I tried to pursue those interests in medical school, but my studies were limited to standard fields. I was glad to get medical training, but I knew I didn’t want to practice the kind of medicine that I’d learned. So I began traveling to other cultures and learning about topics that I was interested in — mostly the relationship between what’s inside our head and what’s outside our head, and the possibility of changing external reality by changing internal reality.

Kupfer: Could you elaborate on the difference between plants and the powders distilled from them?

Weil: Because my early training was as a botanist, and because I had firsthand experience with medicinal plants, it was easy for me to see the differences between whole plants and molecules isolated from plants. But scientific reductionism declares the part to be equal to the whole. It is a convenient tool, as it makes it much easier to study the world, but it fails to capture the complexity of nature. Plants are master chemists that put human chemists to shame. Nature loves to invent molecules and elaborate on them exuberantly, trying out all sorts of variations. Typically medicinal plants contain families of related molecules. Often one molecule will account for most of the plant’s effects, like the morphine in opium, for example, or the cocaine in coca leaf. But the other molecules within the plant are variations on that main one, and within that complex mixture are what pharmacologists call “agonists and antagonists” — that is, molecules that push and those that pull, having opposite physiological effects. This accounts for the ambivalent action of some whole-plant drugs. There are plants used in Chinese medicine that are said to both lower high blood pressure and raise low blood pressure. That makes no sense to Western scientists. Our ideal drug is a magic bullet that has a specific effect. If drugs have multiple, especially paradoxical, effects, then we lose interest in them, because we think it means they don’t work by a specific biochemical mechanism.

Chinese medicine’s aim is to “dispel evil and support the good,” meaning the body’s natural defenses. In Western medicine we work only to dispel evil by fighting disease. Chinese philosophers classified drugs into three categories: superior, middle, and inferior. Inferior drugs are those that have specific effects in specific conditions, which is the ideal in Western medicine. A superior drug for traditional Chinese doctors is one that is good for everything, a panacea. They believe such drugs increase our bodies’ innate resistance.

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