A Trip to Stonesville
by Arnold S. Relman
the boom in alternative medicine,
and the retreat from science.
Andrew Weil, M.D., is variously described on the covers of his best-selling books as "the guru of alternative medicine," "one of the most skilled, articulate, and important leaders in the field of health and healing," "a pioneer in the medicine of the future," and "an extraordinary phenomenon." On his website, which records over two and a half million hits a month, he is called "America's most trusted medical expert." A recent cover of Time, which featured the familiar picture of his bald head and bewhiskered cherubic countenance, announced that "medicine man Dr. Andrew Weil has made New Age remedies popular." In the accompanying story, Time tells us that "millions of Americans swear by" his medical advice.
Not all of this is hype. Weil is arguably the best known and most influential of the many physician-writers now in the vanguard of the alternative medicine movement. He is also one of the most prolific. Since 1972 he has written eight books. The first three were mostly about the effects of natural drugs on consciousness, but the remaining five, all published in the past fifteen years, are about health and healing. Read together with one remarkable chapter in his first book, these more recent works provide a comprehensive description of alternative medicine, as seen through the eyes of its most serious and systematic advocate.
If Deepak Chopra is the mystical poet-laureate of the movement, then Weil is its heavy-duty theoretician and apologist. He directs a large and astonishingly successful medical marketing enterprise that might be called Dr. Andrew Weil, Inc. No longer the angry young rebel, he has become the urbane and supremely self-assured CEO of alternative medicine, who is seeking to reshape the medical establishment that he once scorned. The popularity of his teachings, and the spreading wave of interest in alternative remedies that he and others have inspired, are forcing mainstream medicine to deal with a counterculture that it would have preferred to ignore.
"Alternative medicine" is the term generally used to designate a varied collection of methods for the prevention, the diagnosis, or the treatment of disease that are not generally accepted by regular (or "allopathic") physicians and have not been part of the standard medical school curriculum in the United States. Some of these methods are very old. Acupuncture and other kinds of traditional Chinese medicine, as well as the Ayurvedic medicine of ancient Hinduism, were practiced before the Christian era, and they still flourish. Native American shamans and medicine men used herbal and ritual healing before the European conquest of America, and such practices still exist. In the nineteenth and early twentieth centuries, many healing cults were contending with allopathic physicians for popular support. These included homeopathy, naturopathy, and herbal medicine, psychic and faith healing, magnetic therapy and chiropracty and osteopathy. More recent twentieth-century additions to the alternative medicine family include therapeutic touch, guided imagery, biofeedback, and various forms of diet therapy. In the past few years, two new terms have come into use: "complementary medicine" and "integrative medicine." They identify a recent development in the alternative medicine movement championed by Weil and others: the idea that alternative medicine should be used in conjunction with, rather than instead of, mainstream allopathic methods.
Until now, alternative medicine has generally been rejected by medical scientists and educators, and by most practicing physicians. The reasons are many, but the most important reason is the difference in mentality between the alternative practitioners and the medical establishment. The leaders of the establishment believe in the scientific method, and in the rule of evidence, and in the laws of physics, chemistry, and biology upon which the modern view of nature is based. Alternative practitioners either do not seem to care about science or explicitly reject its premises. Their methods are often based on notions totally at odds with science, common sense, and modern conceptions of the structure and the function of the human body. In advancing their claims, they do not appear to recognize the need for objective evidence, asserting that the intuitions and the personal beliefs of patients and healers are all that is needed to validate their methods. One might have expected such thinking to alienate most people in a technologically advanced society such as ours; but the alternative medicine movement, and the popularity of gurus such as Weil, are growing rapidly.
Weil's writings are ambiguous about the conflict between science and alternative medicine, as they are about many other issues in alternative medicine. Yes, he thinks that all healing methods ought to be tested; and yes, modern science can make useful contributions to our understanding of health and disease. Yet the scientific method is not, for Weil, the only way, or even the best way, to learn about nature and the human body. Many important truths are intuitively evident and do not need scientific support, even when they seem to contradict logic. Conventional science-based medicine has its uses, but they are limited. Like so many of the other gurus of alternative medicine, Weil is not bothered by logical contradictions in his argument, or encumbered by a need to search for objective evidence.
This habit of thought was evident early in Weil's career. He was educated at Harvard College and Harvard Medical School in the '60s, but he revolted against those academic bastions. Like many other students of his generation, he experimented with mind-altering drugs. He was a botany major and, not surprisingly for those days, he became interested in the psychedelic properties of certain plants. Later, in medical school, he participated in studies of the clinical and psychological effects of marijuana, which led to a few publications in scientific journals. He also developed a strong antipathy toward many of the basic concepts of conventional medicine, and the traditional pedagogical methods then employed to teach them.
We learn a little about Weil's postgraduate years from the brief autobiographical comments in the preface to The Natural Mind, his first book. After a one-year internship at Mount Zion Hospital in San Francisco in 1968-69, he began what was supposed to have been a two-year tour of duty at the National Institute of Mental Health. He resigned after a year. He says it was because of official opposition to his work with marijuana. He then left the world of allopathic medicine entirely, to go off to an Indian reservation in South Dakota to study with a Sioux medicine man and learn about herbal medicine and ritual healing. "On the reservation," he says, "I participated in sweat lodge ceremonies, grew a beard, and 'dropped out.'" At home afterward, "I started to practice yoga, experiment with vegetarianism, and learn to meditate." In 1971 he began to write The Natural Mind, which became a best-seller and launched his career as a writer.
The Natural Mind (1972) is mainly a criticism of American drug policy and an exposition of Weil's views on the interaction of psychedelic drugs with the mind. It also expounds his general philosophy of mind-body relations upon which much of his later writings on health and healing is based. The seventh chapter, entitled "A Trip to Stonesville," should be required reading for all who would understand the origins of Weil's belief in the healing power of the mind. It is a startling document -- a sharply drawn manifesto of New Age biology, a direct challenge to the scientific basis of conventional medicine, and a revealing window on Weil's style of thought. And, since a theory of mind-body relations is central to most current formulations of alternative medicine, this chapter must be considered one of the movement's most important philosophical statements. It merits a detailed examination.
According to Weil, many of his basic insights about the causes of disease and the nature of healing come from what he calls "stoned thinking," that is, thoughts experienced while under the influence of psychedelic agents or during other states of "altered consciousness" induced by trances, ritual magic, hypnosis, meditation, and the like. He cites some of the characteristics of "stoned thinking" that give it advantages over "straight" thinking; these include a greater reliance on "intuition" and an "acceptance of the ambivalent nature of things," by which he means a tolerance for "the coexistence of opposites that appear to be mutually antagonistic." In Weil's view, intellect, logic, and inductive reasoning from observed fact are the limited instruments of "straight" thinking, and should be subservient to guidance by the intuitive insights that are gained during states of altered consciousness and "stoned" thinking.
Weil tells us that "the history of science makes clear that the greatest advancements in man's understanding of the universe are made by intuitive leaps at the frontiers of knowledge, not by intellectual walks along well-traveled paths." He neglects to add, unfortunately, that to be successful these "intuitive leaps" had to explain all of the relevant observed facts. Intuition can be a valuable tool for interpreting the facts, and even for guessing what the facts will prove to be, but it cannot substitute for the facts. Yet Weil may not agree with this. He asserts that "there exists within us a source of direct information about reality that can teach us all we need to know." Does he mean that this inner "source" need not conform to observed facts? Apparently so, because chapter seven's main thrust is to assert the primacy of intuition over observation. In Weil's mind, intuition, no matter how bizarre and unsubstantiated, rules the day. But if intuition rules, how would we find the truth when one person's intuition conflicts with another's? Weil does not appear to consider that a problem, either. For, as "stoned thinking" reveals, there is not one truth, but many truths. Reality itself is basically "ambivalent."
Weil notes that the wisdom of "stoned thinking" is reflected in the teachings of Oriental philosophies and religions, which have always understood the essentially "ambivalent" nature of reality. He further contends that, with quantum theory, modern physicists have pursued this idea about the paradoxical ambivalence of reality into the subatomic world, "where they find that entities like electrons and photons can exist either as waves or particles, energy or matter." "Ordinary consciousness" cannot accept such riddles, he says, but modern physicists can, and so can those who learn "stoned thinking." In states of "altered consciousness" we wipe out contradictions and resolve perplexities such as the mind-body problem. We see that "mind and body are really the two expressions of the same phenomenon -- just as waves and particles are two phases of expression of the entity called an electron." I will return to Weil's invocation of quantum physics in support of his arguments, because it reflects a basic misunderstanding that underlies much of the present revolt against science and science-based medicine.
There is more of this kind of thing in the remainder of his "Stonesville" chapter, much of which defies rational belief or is just plain wrong about the facts. Weil states, for example, that "stoned" thinking enables us to gain control of our autonomic, or involuntary, nervous system, and that the practical application of this thinking in the form of "autonomic feedback control" enables patients to control high blood pressure more effectively and safely than by the use of antihypertensive drugs. He claims that allopathic physicians "have no effective drug for high blood pressure." Now, even in 1972, when The Natural Mind was first published, this statement was dubious, to say the least; and it was certainly false in 1985 when the book was republished and supposedly updated. Weil tells us that patients can be taught to lower their blood pressure by a form of training called "feedback control." The fact is that "feedback control" (or "the relaxation response," as it is called by Dr. Herbert Benson, its chief advocate and another well-known guru of alternative medicine) produces at most only small and usually transient reductions in blood pressure. Feedback control has never been shown to be as effective in the long-term control of moderate to severe hypertension as any of a variety of pharmacological agents prescribed for this purpose. There are always risks of side effects with any active pharmaceutical, and antihypertensive agents are no exception. When properly used, however, they have proven beyond reasonable doubt to be a major advance in medical therapeutics. In fact, they are one big reason for the significant decline over the past three decades in the incidence of stroke, heart failure, and kidney failure, all of which can result from uncontrolled, severe hypertension. Weil would have been correct if he had simply observed that anti-hypertensive drugs are often used excessively, particularly when blood pressure is only mildly elevated. He would also have been correct had he suggested that a reduction in stress and a change in diet and lifestyle will often help in the management of such cases. But in The Natural Mind he suggests that self-treatment is the treatment of choice in many if not most cases. In his more recent books about self-healing approaches to health care, he is more prudent: he advises patients to check their own blood pressure and to seek guidance from an allopathic physician if simple remedies are not working. Unfortunately, the antiallopathic thrust in his teaching is more apt to be heeded than his cautions and his qualifications. Seriously hypertensive patients who delay seeking proper medical treatment may, as a result, suffer great harm. The neglect of available and often effective standard medical treatment for many kinds of illness would seem to be an inevitable consequence of the dogma promulgated in the seventh chapter of The Natural Mind.
Here are other examples of Weil's casual dismissal of common sense and medical fact in this chapter, and of his penchant for sweeping generalizations that cannot stand analysis. "My intuitions about disease are: first, that its physical manifestations are mostly caused by nonmaterial factors, in particular by unnatural restraints placed on the unconscious mind; and second, that the limits to what human consciousness can cause in the physical body are far beyond where most of us imagine them." Or, again: "Since leaving the world of allopathic practice, I have witnessed a number of impressive nonallopathic cures of ... dramatic illnesses, including cancer and life-threatening infections." And later: "To the straight mind nonallopathic healing sounds very mystical. Faith healing is held in contempt by most rational people, despite the abundant evidence of cures." (The italics are mine.)
Weil's later books make many claims for such "cures," as we shall see, but despite his reference to "abundant evidence," he almost never gives us anything more than the claim itself -- unsupported by objective and documented observations. To Weil, subjective belief, if persuasive enough to the patient, should be adequate to support the claim of reality. And by "reality" he does not refer simply to the patient's state of mind, but to the physical dimensions of the disease itself. The allegedly miraculous "cures" are not simply dramatic improvements in symptoms, but the disappearance of all physical evidence of disease. And why shouldn't this be reasonable if one believes, like Weil, that consciousness is the primary reality and that the physical aspects of disease, indeed the entire material world itself, are simply another aspect of mind?
The extent to which Weil reveres consciousness regardless of its thought content is revealed in the final sections of his "Stonesville" chapter. Here he favors us with his views on psychosis, on the Jungian theory of shared universal consciousness, and on the reality of mental telepathy, extrasensory perception, and hallucinatory experiences. On psychosis: "Psychotics are persons whose nonordinary experience is exceptionally strong ... every psychotic is a potential sage or healer." With regard to the National Institute of Mental Health's research efforts to find the physical basis of psychosis: "If it sticks to its present course, nimh will be the last institution in America to recognize the positive potential of psychosis -- a potential so overwhelming that I am almost tempted to call psychotics the evolutionary vanguard of our species. They possess the secret of changing reality by changing the mind; if they can learn to use that talent for positive ends, there are no limits to what they can accomplish." With respect to C.G. Jung's ideas, Weil says: "It appears that at some level of the unconscious we pass beyond personal awareness into a universal awareness unlimited by time and space. Most of us may think we never experience such a thing, but it may be that we simply never pay attention to it. I am convinced it happens." He then cites examples of such experiences caused by the ingestion of hallucinogenic herbs in Indian sacramental rituals. About shared consciousness and mental telepathy, he has this to say: "Not only do I think each of us can share consciousness, I think all of us are already doing it all the time.... Extrasensory perceptions are not unusual talents possessed by specially gifted individuals. They are normal unconscious events, and scientists who attempt to document them by laboratory experiments will never get to experience them directly."
One might think that this kind of talk, written more than 25 years ago by a youthful and angry rebel against medical scientific orthodoxy, would be an embarrassment to the 56-year-old leader of a movement that aspires to integrate alternative concepts into the curriculum and the practice of conventional medicine. Not so. In a brief preface to the edition of The Natural Mind that appeared this year, Weil explicitly reaffirms his early views: "The philosophy of my first book is the same philosophy that underlies my writing about health." To be even more specific, he adds: "The seed of my thinking about conventional and alternative medicine can be found in Chapter 7 of this book."
So we must take him at his word: he really does believe in miracles and in faith healing, in the ability of mind to cause and to cure disease, and in the existence of a consciousness that is in some real sense independent of the brain. In fact, these ideas reverberate in all of his later writing. The seventh chapter of The Natural Mind is simply the first and most forceful statement of a philosophy that has softened and blurred a bit, as Weil's career has progressed, but is fundamentally unchanged. And this philosophy poses serious intellectual problems for Weil's current attempt to integrate alternative and conventional medical practices.
The Natural Mind was followed by two more popular books about consciousness and mind-altering drugs -- The Marriage of the Sun and Moon: A Quest for Unity in Consciousness (1980); and, with Winifred Rosen, From Chocolate to Morphine: Everything You Need to Know About Mind-Altering Drugs (1983). Neither book dealt directly with alternative medicine. His next book on medicine was Health and Healing (1983, republished in 1998). By then Weil had established himself in Tucson as a general medical practitioner and was on the part-time clinical faculty of the College of Medicine of the University of Arizona, where he gave an elective course of lectures about alternative medicine.
Health and Healing was the first of a series of five books he was to write in the years from 1983 to 1998 and, like most of them, it was a national best-seller. It established Weil as a leading figure in the alternative medicine movement. More than any of his writings before or after, it provided a broad and fairly systematic exposition of his opinions on the nature of health and healing, on allopathic medicine, and on the varieties of alternative or unconventional medicine. In the preface to the 1998 edition of Health and Healing, Weil remarks that "it remains the philosophical and theoretical basis of all my subsequent work in medicine."
Consider Weil's strange discussion in this book of sickness and health. "Sickness is the manifestation of evil in the body," he proclaims, "just as health is the manifestation of holiness. Sickness and health are not simply physical states.... They are rooted in the deepest and most mysterious strata of Being." He introduces these ideas in the context of his views on the connection between religion, magic, and medicine. "In our society," he observes, "the commonality of religion, magic, and medicine is obscured. Our medical doctors have narrowed their view to pay attention only to the physical body and the material aspects of illness. As a result ... they do not see or integrate the nonphysical forces that animate and direct the physical body," and they do not realize that "health and illness are particular manifestations of good and evil, requiring all the help of religion and philosophy to understand and all the techniques of magic to manipulate. Science and intellect can show us mechanisms and details of physical reality -- and that knowledge is surely of value -- but they cannot unveil the deep mysteries. You cannot restore health in yourself or in others until you know in your heart what health is."
Lest we despair of ever knowing in our heart what health is, Weil unveils the mystery: "Health is wholeness -- wholeness in its most profound sense, with nothing left out and everything in just the right order to manifest the mystery of balance. Far from being simply the absence of disease, health is a dynamic and harmonious equilibrium of all the elements and forces making up and surrounding a human being." Health, it seems, is a mystery explained by another mysterious principle. This is the "mystery of balance."
Weil follows this revelation with an additional "ten principles of health and illness," the most mysterious of which is the last: "Proper breathing is a key to good health." He explains that breathing, since it can be voluntary or involuntary, is a "bridge between the conscious and unconscious minds as well as between mind and body. Proper breathing nourishes the central nervous system, establishes a harmonious pattern for other bodily rhythms, and also regulates moods and emotions.... Improper breathing is a common cause of ill health. By decreasing general vitality, it increases susceptibility to agents of disease. It can also directly cause problems in many different systems of the body. Learning how to breathe and working consciously with breath is a simple, safe, effective, and inexpensive way to promote good health of mind and body."
"Breathing" is an important and recurring theme in Weil's prescriptions for health and healing, and it holds a prominent place in Eight Weeks to Optimum Health, which appeared in 1997. As far as I can see, his opinions on this subject are largely nonsense. There is not the slightest medical evidence that "improper breathing is a common cause of ill health." All the clinical and physiological evidence points to exactly the reverse relationship. It suggests that many types of disease and physiological dysfunction can affect breathing. Sometimes this secondary change in breathing can be serious enough to change the normal intake of oxygen or the normal elimination of carbon dioxide in ways that further impair health; but the primary causes of the problem are the diseases or the physiological disturbances that cause the abnormal pattern of breathing, not the breathing itself.
While it is true that conscious attention to breathing can help individuals to relax, there is no evidence that the breathing exercises Weil advocates have any special advantage over any other techniques for relaxation, or that they have any special therapeutic powers. Like so many of his other pronouncements, Weil's claims about breathing come ex cathedra from his own self-asserted authority as guru and healer. Much of what he has to say about health and healing in this book and in his later works is just like this fanciful section on breathing -- a bald assertion without any credible rationale or supporting objective evidence.
Then there is Weil's typically ambiguous assessment of conventional, or allopathic, medicine. First he concedes that it is not all bad, and that "regular medicine is the most effective system I know for dealing with many common and serious problems," among them acute medical and surgical emergencies. But then he adds that "regular medicine is on very shaky ground" in dealing with other common problems. "I would look elsewhere than conventional medicine for help if I contracted a severe viral disease like hepatitis or polio, or a metabolic disease like diabetes. I would not seek allopathic treatment for cancer, except for a few varieties, or for such chronic ailments as arthritis, asthma, hypertension (high blood pressure), multiple sclerosis, or for many other chronic diseases...." This is a startling list of major diseases to be ruled off-limits for conventional medicine. One wonders which of the remaining chronic diseases Weil is willing to concede to the allopaths, and how he knows where to draw the line.
Some of Weil's criticisms of medical practitioners in this and other books are nonetheless valid. I agree with him that conventional physicians are often too interested in the disease and not enough interested in the patient; too inclined to use expensive technology and potent pharmaceuticals when simpler and more conservative approaches would work at least as well. And he is correct in noting that mainstream medicine, despite its many successes, still has only a limited ability to change the course of many serious chronic illnesses. Yet that hardly justifies Weil's sweeping and irresponsible dismissal of allopathic medicine's role in the diagnosis, the management, and the palliation of all the serious illnesses that he enumerates and the indeterminate list to which he alludes. He implies that alternative medicine could do better, but there is no published evidence to support that opinion.
And even if Weil's assertions about the superiority of alternative methods for the treatment of some diseases were correct, how could patients be expected to know when to seek help from alternative healers unless they knew in advance what was wrong with them? One of the main reasons to consult a physician is to determine whether symptoms need to be taken seriously and what might be causing them. Weil's advice could result in dangerous delays in the diagnosis and the treatment of serious illness, unless he were also to recommend that patients first seek competent medical evaluation and advice before considering unconventional treatments. That may be what he had in mind in recently establishing an "integrative medicine" clinic at the University of Arizona, in which allopathic physicians prescribe both conventional and unconventional treatments. Still, without credible evidence that unconventional treatments are equivalent to, or better than, standard medical care, even that eclectic approach is seriously flawed.
One of Weil's central themes in Health and Healing, and in his subsequent work, is his criticism of mainstream medicine's reliance on pharmaceuticals instead of herbal medicines. The latter are presently enjoying a great resurgence in popularity, due largely to the endorsement of prominent advocates such as Weil, and to the promotional activities of a "natural products" industry that received a big boost in 1994, when Congress gave the industry permission to market herbal preparations with less rigorous oversight by the FDA than the agency exercises over drugs. Manufacturers of herbal preparations can avoid many of the customary rigors of FDA drug regulation simply by labeling these products "dietary supplements." In 1997, the herbal medicine market had sales of nearly $4 billion, and a stroll down the aisles of almost any supermarket or chain drugstore will confirm that business is booming. A cover story in Time magazine a few weeks ago was all about this burgeoning new herbal remedy business and the popular craze for "natural" medicines.
Weil's preference for herbs and his dislike of synthetic pharmaceutical products probably stem from his earlier training in botany and his long interest in the psychedelic properties of plants. It also reflects his belief in the virtues of "natural" healing methods that patients themselves can employ without recourse to physicians or expensive medical technology. Herbs can be purchased without prescription and are relatively inexpensive in comparison with prescription drugs. In earlier times herbs were the only medicinal remedies available, and botany was a part of the medical school curriculum. But then scientists learned how to extract and synthesize the active constituents of medicinal herbs, and medical botany was replaced by modern pharmacology.
Modern pharmacological science now provides physicians with a vast armamentarium of clinically effective synthetic compounds, many derived from or closely related to substances found in nature, others created in the laboratory. These pure compounds can be standardized and tested for purity, clinical potency, and safety far more easily than the complex and highly variable natural plant materials doctors formerly prescribed. In some advanced Western countries -- in Germany, for example -- herbal medicines are still widely prescribed, but the manufacture, the purity, and the potency of these preparations are far more carefully regulated by the government than in the United States.
Weil doesn't like the modern pharmaceutical industry and he wants us to return to our former dependence on herbs. His arguments are on balance unconvincing, but they are not without some reason. Weil has an arguable case, I think, when he criticizes the pharmaceutical industry for promoting expensive new drugs that have little or no advantage over older and less expensive drugs, and for sometimes being insufficiently attentive to their risks. I also have some sympathy with his criticism of the excessive prescribing of potent pharmaceuticals by physicians, and the common practice of prescribing many drugs simultaneously without sufficient attention to their toxic or interactive effects. There is no doubt that improper use of pharmaceuticals, including mistakes in dosage and even inadvertent administration of the wrong drug, causes many serious mishaps in hospital and office practice. Even the proper use of drugs can sometimes cause fatal reactions. Misuse of antibiotics can cause the development of drug-resistant strains of bacteria.
Still, the fact remains that pharmaceuticals are an essential part of medical practice. Without them there would be no effective treatment or palliation of many serious diseases. On balance, the good done by modern pharmaceuticals far outweighs the harm, though zealous advocates of "natural" remedies (Weil among them) insist otherwise. Even in Germany, where botanical medicines are widely used by allopathic physicians, pharmaceutical drugs are the mainstay of treatment for serious illnesses.
Weil claims that the presence of many different active and inactive ingredients, known and unknown, makes natural botanical products safer and more effective than synthetic pharmaceuticals. This is mostly speculation, since there have been very few clinical trials directly comparing herbs with pharmaceuticals in the treatment of specific ailments. What Weil does not mention, here or elsewhere in his books, are the problems created by the lack of purity and standardization of herbal products. A recent issue of the New England Journal of Medicine contained several reports of serious clinical complications resulting from adulterants or contaminants in commercial preparations of herbs. As an accompanying editorial in the Journal noted, there can be no safe and rational use of herbal medicines without regulation of their purity and their potency -- even assuming that there were evidence of potentially useful clinical effects.
Weil has a good word to say for almost all alternative healing methods, except for some practices used by so-called "holistic" physicians. "Holistic medicine" is an outdated term that formerly referred to many of the same methods in common use by today's alternative healers, but also included other less widely used methods of diagnosis and treatment that have not attracted much attention recently. Why Weil singles the latter out for disapproval is not entirely clear, since his criticisms would seem to apply equally to many of the alternative methods that he does endorse. In any case, after a general review of the latter, he concludes that the belief of the healer and the patient in the effectiveness of the various forms of alternative treatment is the common explanation that ties them all together. This is his conclusion: "Since belief alone can elicit healing, the occasional success of treatments based on absurd theories is not mysterious."
Weil next considers the healing power of the placebo effect, by which he means the faith of the patient and the practitioner in the therapeutic value of whatever treatment is being used. He says that all treatments depend more or less on this faith, and that is why any treatment, real or imaginary, may be able to cure any disease in certain patients by helping them to mobilize their innate healing powers. Sometimes the result is mainly due to the direct physical action of the treatment, and sometimes it is mainly due to the patient's own belief in the treatment, and sometimes it appears to be a combination of effects. Weil probably believes that herbal remedies, diet, physical exercise, and other lifestyle changes belong mainly in the first category. Faith healing, therapeutic touch, magnetism, and most of the other more esoteric alternative healing methods would probably be placed in the second category. Meditation, breathing exercises, biofeedback, acupuncture, musculoskeletal manipulations, and yoga would probably be placed in the third category.
How does Weil know that any of these alternative methods, or any combination of them, regardless of the way they work, can cure disease? Because he has been told about, or thinks that he has seen, apparent cures of supposedly incurable diseases that could not be otherwise explained. And where is the documented, objective evidence of such cures? There isn't any. We simply must trust Weil's opinion, and the belief of those who report these events to him. Weil's books are full of such stories, none supported by anything resembling scientific evidence.
Here are some examples. In Eight Weeks to Optimum Health, Weil tells about a letter he received from a patient who wrote: "Six years ago (I'm now twenty-seven) the doctors threw the ugly 'C-word' at me and made it sound like a death sentence. (It was bone cancer.) They decided that they were the authorities and I was the victim and the only way was their way. I walked out of their offices never to return. I took up biking (about five hundred miles a week) and running (about sixty miles a week), and ate fresh fruit, juices, and whole grains ... nothing else. Too bad more people out there won't acknowledge what a little self-determination and using one's subconscious can do to return a person to wholeness." The patient goes on to say that he or she is now entirely well and hopes to "work toward developing programs for others to offer them alternative pathways toward health and wholeness." How do we know that this person really had "bone cancer" and what really happened? We don't know, of course, but that doesn't seem to concern Weil, who cites the case without further comment as evidence of self-induced healing of a serious disease.
In the same book, Weil tells about a woman patient who had "an unusual form of Parkinson's disease" which caused her to have frequent seizures during sleep. Presumably in response to Weil's advice, she tried "acupuncture, yoga, massage, meditation and other stress-reduction work," and finally "respiratory biofeedback," which eventually caused the seizures to stop. Here again, there is no medical documentation of the diagnosis or the alleged effects of the alternative treatments.
A final example comes from Spontaneous Healing (1995). It concerns a man with scleroderma (a usually progressive and fatal disease of the skin and internal organs, thought to be an autoimmune disorder) who cured himself with vinegar, lemons, aloe vera juice and vitamin E. How does Weil know this really happened? Apparently, the patient told him so. It was only a testimonial but, as Weil explains in Spontaneous Healing, he finds these stories meaningful. "I collect this material, save it, and take it seriously. In its totality and range and abundance it makes one powerful point: People can get better ... from all sorts of conditions or diseases, even very severe ones of long duration."
That people usually "get better," that most relatively minor diseases heal spontaneously or seem to improve with simple common remedies, is hardly news. Every physician, indeed every grandmother, knows that. Yet before we accept Weil's contention that serious illnesses such as "bone cancer," "Parkinson's disease," or "scleroderma" are similarly curable, or respond to alternative healing methods, we need at least to have some convincing medical evidence that the patients whom he reports in these testimonials did indeed suffer from these diseases, and that they were really improved or healed. The perplexity is not that Weil is using "anecdotes" as proof, but that we don't know whether the anecdotes are true.
Anecdotal evidence is often used in the conventional medical literature to suggest the effectiveness of treatment that has not yet been tested by formal clinical trials. In fact, much of the mainstream professional literature in medicine consists of case reports -- "anecdotes," of a kind. The crucial difference between those case reports and the testimonials that abound in Weil's books (and throughout the literature of alternative medicine) is that the case reports in the mainstream literature are almost always meticulously documented with objective data to establish the diagnosis and to verify what happened, whereas the testimonials cited by alternative medicine practitioners usually are not. Weil almost never gives any objective data to support his claims. Almost everything is simply hearsay and personal opinion.
To the best of my knowledge, Weil himself has published nothing in the peer-reviewed medical literature to document objectively his personal experiences with allegedly cured patients or to verify his claims for the effectiveness of any of the unorthodox remedies he uses. He is not alone in this respect. Few proponents of alternative medicine have so far published clinical reports that would stand the rigorous scientific scrutiny given to studies of traditional medical treatments published in the serious medical journals. Alternative medicine is still a field rich in undocumented claims and anecdotes and relatively lacking in credible scientific reports.
The growing interest of the medical establishment in studying alternative medicine may soon establish the credibility -- or the incredibility -- of alternative medical notions. In the absence of supporting evidence, however, skepticism is surely in order, particularly since belief in much of what Weil is saying about mind and body, and the ability of consciousness to operate in the physical world, requires a rejection of the fundamental physical laws upon which our current views of nature and the human body are based.
This does not appear to ruffle Weil, who believes that these laws have already been changed. Indeed, he argues that physicians need to understand that modern quantum physics has overturned much of classical physical theory and is revealing a new perspective on nature, in which the observing mind is the primary reality, and can cause natural phenomena to behave oddly. It is time for us to reject the old-fashioned scientific materialism, says Weil. "What most medical doctors do not know is that the scientific model of reality has changed radically since 1900 and no longer views the universe as an orderly mechanism independent of the consciousness observing it."
In one of the final chapters of Health and Healing, called "What Doctors Can Learn from Physicists," Weil offers his interpretation of the revelations of quantum physics. Experimental data have shown that when observed one way, light seems to be acting like a wave, and when observed another way, it acts like a stream of particles. Quantum theory embraces that paradox in a probabilistic, mathematical description of subatomic physical phenomena that seems incomprehensible to common sense and ordinary experience, but that accords with the experimental data. Weil's interpretation of quantum theory is that it forces us "to consider consciousness [by which he presumably means the mind of the observer] as an active agent in the formation of reality, inseparable from it." And so he concludes that "in the world of ordinary experience, the materialistic and mechanistic theories of the past may continue to seem right and work as reasonable approximations, but if consciousness has to be included to explain observed properties of atomic particles, it cannot be independent of systems composed of those particles, whether rocks, stars, plants, or, especially, human beings." According to Weil, quantum physics in effect validates his "stoned thinking," because it demonstrates that ultimate reality is in the mind of the observer, and thoughts can make anything happen. Thus Weil can believe in miraculous cures even while claiming to be rational and scientific, because he thinks that quantum theory supports his views.
Yet the leading physicists of our time do not accept such an interpretation of quantum theory. They do not believe quantum theory says anything about the role of human consciousness in the physical world. They see quantum laws as simply a useful mathematical formulation for describing subatomic phenomena that are not adequately handled by classical physical theory, although the latter remains quite satisfactory for the analysis of physical events at the macro-level. Steven Weinberg has observed that "quantum mechanics has been overwhelmingly important to physics, but I cannot find any messages for human life in quantum mechanics that are different in any important way from those of Newtonian physics." And overriding all discussions of the meaning of quantum physics is the fundamental fact that quantum theory, like all other scientific law, is only valid to the extent that it predicts and accords with the evidence provided by observation and objective measurement. Richard Feynman said it quite simply: "Observation is the ultimate and final judge of the truth of an idea." Feynman also pointed out that scientific observations need to be objective, reproducible, and, in a sense, public -- that is, available to all interested scientists who wish to check the observations for themselves.
Surely almost all scientists would agree with Feynman that, regardless of what theory of nature we wish to espouse, we cannot escape the obligation to support our claims with objective evidence. All theories must conform to the facts or be discarded. So, if Weil cannot produce credible evidence to validate the miraculous cures that he claims for the healing powers of the mind, and if he does not support with objective data the claims he and others make for the effectiveness of alternative healing methods, he cannot presume to wear the mantle of science, and his appeal to quantum theory cannot help him.
Some apologists for alternative medicine have argued that since their healing methods are based on a "paradigm" different from that of traditional medicine, traditional standards of evidence do not apply. Weil sometimes seems to agree with that view, as when he talks about "stoned thinking" and the "ambivalent" nature of reality, but more recently -- as he seeks to integrate alternative with allopathic medicine -- he seems to acknowledge the need for objective evidence. This, at least, is how I would interpret one of his most recent and ambitious publishing ventures, the editorship of the new quarterly journal Integrative Medicine.
Integrative Medicine describes itself as a "peer-reviewed journal ... committed to gathering evidence for the safety and efficacy of all approaches to health according to the highest standards of scientific research, while remaining open to new paradigms and honoring the healing power of nature." The Associate Editors and Editorial Board include prominent names in both alternative medicine and allopathic medicine, who presumably support that mission. Yet the first two issues will disappoint those who were looking for original clinical research based on new, objective data. Perhaps subsequent issues will be different, but in any case it is hard to understand the need for Weil's new journal if he truly intends to hold manuscripts to accepted scientific standards: there already exist many leading peer-reviewed medical journals that will review research studies of alternative healing methods on their merits. During the past decade or so, only a few such studies have passed rigorous review and have been published in first-rate journals. Recently, more studies have been published, but very few of them report significant clinical effects. And that is pretty much where matters now stand. Despite much avowed interest in research on alternative medicine and increased investment in support of such research, the evidentiary underpinnings of unconventional healing methods are still largely lacking.
Health and Healing, published in 1983, was the last of Weil's comprehensive and broadly conceived commentaries on health and disease. Beginning in 1995, with Natural Health, Natural Medicine, he produced a series of three "how-to" manuals on wellness and self-care, which established his current reputation as the people's doctor and "America's most trusted medical expert." The next was Spontaneous Healing, and the third Eight Weeks to Optimum Health.
These volumes follow the familiar, commercially tested patterns of health care manuals by offering their readers "proven programs" for achieving health and warding off disease. Advice on nutrition, herbal therapy, lifestyle, and environmental modifications, plus suggestions for psychological self-help, are liberally interspersed with anecdotes and testimonials about patients who are alleged to have achieved dramatic -- sometimes apparently miraculous -- results through the use of the recommended methods. The recommendations range from commonsensical, generally accepted, and medically sound advice on nutrition and modification of lifestyle to odd, almost bizarre recommendations that have nothing more than Weil's confident assurances and putative "experience" to back them up. Statements are usually made about the curative or preventive powers of some food or herb or healing practice, without the citation of any published evidence. Recipes abound, as do step-by-step guides for certain ritualistic health practices. The rituals and meditations contribute a quasi-religiosity to these practices, which undoubtedly enhance their appeal. All of this is pretty familiar stuff in the self-help medical literature, but Weil manages to make it dramatic and fresh enough to attract vast numbers of followers.
The most recent of Weil's publications is Ask Dr. Weil, a compilation of questions and answers that have appeared on his website. To judge from the range of questions and the confidence with which they are answered, Weil considers himself an authority on almost every field in medicine. Like his previous books, it includes strong, unqualified recommendations for unlikely and totally unproven remedies, such as massive intravenous doses of Vitamin C to hasten the healing of surgical wounds, and homeopathic medicines and hypnotherapy for the treatment of lupus. It also includes perfectly sensible advice about diet, exercise, and stress reduction that would be given by almost any competent medical practitioner and would find abundant support in the standard medical literature.
In addition to his books, other channels for the dissemination of Weil's medical wisdom include audio cassettes and compact discs on such subjects as "Eight Meditations for Optimum Health" and "Sound Body, Sound Mind: Music for Healing with Andrew Weil, M.D." His influence is also spread through videotapes of lectures and seminars, and appearances on television shows such as "Larry King Live." Even when compared with the ballyhoo surrounding the other icons of alternative medicine, the marketing success of "Andrew Weil, M.D." is extraordinary. To understand it, one has to appreciate the synergistic interaction between the special talents of the man and the current momentum of the alternative medicine movement.
The alternative medicine movement has been around for a long time, but it was eclipsed during most of this century by the success of medical science. Now there is growing public disenchantment with the cost and the impersonality of modern medical care, as well as concern about medical mistakes and the complications and side-effects of pharmaceuticals and other forms of medical treatment. For their part, physicians have allowed the public to perceive them as uninterested in personal problems, as inaccessible to their patients except when carrying out technical procedures and surgical operations. The "doctor knows best" attitude, which dominated patient-doctor relations during most of the century, has in recent decades given way to a more activist, consumer-oriented view of the patient's role. Moreover, many other licensed health-care professionals, such as nurse-practitioners, psychotherapists, pharmacists, and chiropractors, are providing services once exclusively reserved to allopathic physicians.
The net result of all these developments has been a weakening of the hegemony that allopathic medicine once exercised over the health care system, and a growing interest by the public in exploring other healing approaches. The authority of allopathic medicine is also being challenged by a swelling current of mysticism and anti-scientism that runs deep through our culture. Even as the number and the complexity of urgent technological and scientific issues facing contemporary society increase, there seems to be a growing public distrust of the scientific outlook and a reawakening of interest in mysticism and spiritualism.
All this obscurantism has given powerful impetus to the alternative medicine movement, with its emphasis on the power of mind over matter. And so consumer demand for alternative remedies is rising, as is public and private financial support for their study and clinical use. It is no wonder that practicing physicians, the academic medical establishment, and the National Institutes of Health are all finding reasons to pay more attention to the alternative medicine movement. Indeed, it is becoming politically incorrect for the movement's critics to express their skepticism too strongly in public.
Weil would seem at first to be ideally suited to be a leader of the alternative medicine movement at this juncture. He is articulate, self-assured, intellectually nimble -- and wonderfully ambiguous. Ambiguity, after all, should be helpful to those who would defend systems of healing that are based on irrational or non-existent theories and are supported by no credible empirical evidence. But Weil wants to do more than to defend and to advocate the use of alternative healing. He wants to reform the medical establishment. His goal, he says, is to change the "paradigm" of medicine by integrating alternative methods and modes of thought into the teachings and practice of mainstream medicine. That is his declared mission at the University of Arizona College of Medicine.
He seems to believe that he is qualified to accomplish this great reform because he has no difficulty in arguing on both sides of the debate between alternative and traditional healing. In an interview he gave last year, when asked whether he sometimes feels torn between his traditional medical training at Harvard and the new alternatives, Weil replied: "I really think I'm in the middle. Sometimes I'm attacking traditional medicine, sometimes I'm defending it; sometimes I'm defending alternative medicine and sometimes attacking it, so I think I'm pretty even-handed in my criticism. I'm unique in that I'm not aligned with any one school of thought." That may be how Weil really thinks about himself and his "integrative" approach, but on close examination his position makes little sense. He cannot have the argument both ways.
As Weil clearly points out in his earlier books, alternative healing is based on a conception of nature and a theory of learning the truth about nature that is fundamentally at odds with the "straight," evidence-based thinking of mainstream medicine. As defined by Weil, and by most of the other gurus of alternative medicine, alternative and mainstream medicine are not simply different methods of treating illness. They are basically incompatible views of reality and how the material world works, and they cannot easily be combined into any rational and coherent "integrated" curriculum.
Is there an objective real world out there, of which human bodies are a part? If so, how do we learn about it? How do we determine whether a method of healing is effective or not? Do we follow the universal rule of science, as explained by Feynman, that objective, verifiable observation is the ultimate and final judge of the truth of an idea, or do we use the subjective methods advocated by the alternative medicine gurus and described by Weil in his "Stonesville" chapter? Without agreement on such basic issues, it is hard to know what Weil means by being "even-handed" in dealing with the two types of medical practice. Sometimes he seems to believe in the primacy of objective evidence and talks like a scientist, but more often he does not. This is inconsistency and confusion, not even-handedness. It is hardly a useful basis for the "new paradigm" of "integrative medicine" that Weil is promoting.
There is no doubt that modern medicine as it is now practiced needs to improve its relations with patients, and that some of the criticisms leveled against it by people such as Weil -- and by many more within the medical establishment itself -- are valid. There also can be no doubt that a few of the "natural" medicines and healing methods now being used by practitioners of alternative medicine will prove, after testing, to be safe and effective. This, after all, has been the way in which many important therapeutic agents and treatments have found their way into standard medical practice in the past. Mainstream medicine should continue to be open to the testing of selected unconventional treatments. In keeping an open mind, however, the medical establishment in this country must not lose its scientific compass or weaken its commitment to rational thought and the rule of evidence.
There are not two kinds of medicine, one conventional and the other unconventional, that can be practiced jointly in a new kind of "integrative medicine." Nor, as Andrew Weil and his friends also would have us believe, are there two kinds of thinking, or two ways to find out which treatments work and which do not. In the best kind of medical practice, all proposed treatments must be tested objectively. In the end, there will only be treatments that pass that test and those that do not, those that are proven worthwhile and those that are not. Can there be any reasonable "alternative"?
Arnold S. Relman is editor-in-chief emeritus of The New England Journal of Medicine and professor emeritus of medicine and social medicine at Harvard Medical School.
(Copyright 1998, The New Republic)