Daniel Redwood DCAndrew Weil, M.D. has for the past two decades made a unique
contribution to the mainstreaming of natural medicine. He has set a high
standard in a field that needs high standards, presenting a well reasoned,
impeccably documented and intriguingly creative body of work. He is one
of a small number of holistic physicians to hold a faculty position at a
major medical school, and is an internationally recognized expert on medicinal
plants, drugs and drug abuse, altered states of consciousness, and alternative
and natural medicine.
Born in Philadelphia in 1942, Dr. Weil received an A.B. degree in biology
(botany) from Harvard in 1964, and an M.D. from Harvard Medical School in
1968. After completing a medical internship at Mt. Zion Hospital in San
Francisco, he worked for a year at the National Institute of Mental Health,
and then wrote his first book, The Natural Mind.
From 1971-75, as a Fellow of the Institute of Current World Affairs, Dr.
Weil traveled widely in North and South America and Africa collecting information
on drug use in other cultures, medicinal plants, and alternative methods
of treating disease. From 1971-84, he was on the research staff of Harvard
Botanical Museum and conducted investigations of medicinal and psychoactive
plants.
At present, Dr. Weil is Associate Directory of the Division of Social Perspectives
in Medicine of the College of Medicine at the University of Arizona, where
he teaches alternative medicine, mind-body interactions, and medical botany.
He has a general practice in Tucson, focusing exclusively on natural and
preventive medicine and diagnosis of difficult health problems. He is the
President of the Center for Integrative Medicine and the Beneficial Plant
Institute.
Dr. Weil writes a regular column for Natural Health magazine, and is the
author of many scientific and popular articles and five books: The Natural
Mind, The Marriage of the Sun and Moon, Chocolate to Morphine (with
Winifred Rosen), Health and Healing, and Natural Health, Natural
Medicine. His website can be viewed at: www.drweil.com and his email is nathealth@aol.com
Interview with Andrew Weil, M.D.
Dr. Redwood: What led you into the Healing Arts in the first place?
Dr. Weil: I was always interested in things biological. I went to
medical school with the idea of getting a medical education, not of becoming
a doctor. I had an intuition that a medical degree would be very useful
to me, and I wanted that education. It also put off making a decision about
what I wanted to do. So I really didn’t see myself as practicing the healing
arts for a long time. I became very disillusioned with the kind of medicine
that I was being taught, so when I finished my basic clinical training,
I really dropped out of that world, and found ways to travel around. I was
mostly living as a writer, and observing other kinds of healing practices.
It was only after some time that very gradually I was drawn into practicing.
DR: if you were to briefly summarize the principles of natural health,
what would you say they are?
AW: The first is that the body has a healing system, an innate healing
potential that can be accessed in many different ways. That is the foremost
principle of natural health and natural medicine. Secondly, that the optimal
treatment is that which minimally impacts the physical body and maximally
accesses the healing system.
DR: To what degree has our knowledge of body-mind interactions grown
in recent years, and how much of this knowledge is being well-utilized by
physicians and other health practitioners on a daily basis?
AW: There has been a tremendous increase in public consciousness
of mind-body interactions, but I’m not sure we know any more about it than
we ever did. You can look back to the last century and people obviously
had a lot of observations about mind-body interactions. The problem is building
these into our conceptual framework of health and healing. My sense is that
in conventional medicine today, although there is lip service given to the
mind and mind-body interactions, despite all of these books and television
programs, there is very little use being made on a practical level of that
theoretical knowledge.
DR: What kind of changes in medical education and practice do you
think could improve that?
AW: I think they would have to be sweeping. And sometimes, at my
most cynical, I think the only way we’ll see that is if alternative kinds
of medical schools start. I really am deeply pessimistic about the prospect
of curriculum reform. They are constantly talking about reforming the medical
curriculum, and all it is is reshuffling the deck and dealing it out in
a different order. I don’t see fundamental change happening.
I am working on a project now which I’ll give my best shot. We have a unique
chance at the University of Arizona College of Medicine to make some change.
We’re going to start a fellowship program in “Integrative Medicine.”
We’ll start by offering one year fellowships to people who have completed
family practice and internal medicine residencies. This will be a one-year
fellowship in training on how to combine the best ideas and practices of
conventional and alternative medicine, with a strong emphasis on healing,
natural healing, mind-body interactions, and so forth. Our hope is that
this will grow into a residency program, and eventually into a track that
will begin in the first year of medical school. So we’re going to try.
DR: Are there other such pilot projects taking place elsewhere in
the medical education world?
AW: There are individuals like me at various schools, mostly teaching
elective courses. Columbia University was just given a large grant to start
a center in alternative medicine. I don’t know of any place that has the
full institutional support of a medical school, with good prospects for
financial backing, that we have at the University of Arizona. We really
have a very large vision of trying to start a residency training program
in a new kind of medicine.
DR: What were the circumstances at Arizona that brought this about?
AW: Well, an odd combination of things. I am here by pure chance–my
car broke down here 21 years ago. It took six weeks to get fixed, and I
never left.
DR: What a great story.
AW: I would never have thought I would be living in Arizona. I always
had a vision of Arizona being very politically conservative…
DR: Which in some ways it is.
AW: Yes, although Tucson is a liberal pole of it. But the regulatory
laws in Arizona, including the medical licensing laws, have a kind of Wild
West laissez faire flavor which is unique, except for Nevada. Nevada
and Arizona are the only two states that have a Homeopathic Board of Medical
Examiners under which people doing unusual practices can get licensure,
that rivals the regular Board of Medical Examiners. So Arizona has been
a kind of haven for people practicing alternative medicine. The third naturopathic
college in the United States just opened here in Phoenix. Canyon Ranch is
here, which is the spa that has the greatest commitment to preventive and
alternative medicine. And I’m here, and have been teaching courses in alternative
medicine. It’s just a continuing set of favorable circumstances that have
made this possible.
DR: Some holistic medical physicians are pressured by their state
boards to discontinue some or all of their unconventional practices. Some
have lost their licenses. What do you think is a fair way for boards to
both protect the public and allow for something other than lowest common
denominator care?
AW: I think that boards should have consultants who are experts in
alternative medicine, that they should inform themselves about what is legitimate
and what might not be legitimate in alternative medicine. I think the first
criterion always has to be whether there is a potential for harm. In general,
boards are unlikely to take action against physicians unless there are complaints
by patients. A lot of this comes down to the relationship that doctors form
with patients, rather than what they’re doing. But I think there is great
need for education of medical boards.
DR: I want to ask your opinion of the Clinton Administration’s health
reform proposals, and the other health reform plans in congress.
AW: I am delighted that at long last the federal government is looking
at this issue, which should have been addressed a long time ago. It seems
unconscionable to me that the richest nation in the world can’t provide
basic access to health care for all its citizens. At the same time, having
seen a little bit of Medicare, I am not very enthusiastic about the prospect
of having the federal government run this. And also, I think that the Clinton
proposals don’t go to the level at which change needs to happen.
DR: What is that level?
AW: I think there really has to be complete rethinking of the nature
of medicine, and people’s expectations of it. Not simply worrying about
who pays for it, as it’s now set up.
DR: Tell me more about the deeper level at which public policy should
address this.
AW: I think we have an economic crisis in health care because this
is an outward sign that the paradigm from which medicine operates has really
reached the end of the line. The philosophy of medicine that’s in place
now is one that says diseases mostly have external causes, that you deal
with diseases by developing weapons against agents of diseases, that there’s
extensive reliance on technology, and that we don’t look at the natural
healing mechanisms of the body. All of that has led us in a direction that
has us on the edge of bankruptcy. And we’re not going to change that just
by figuring out different ways of reimbursing.
DR: Do you believe that modern Western medicine is a sustainable
system for the long run? And if not, why not?
AW: No just because it’s too expensive. For that simple fact it just
cannot be delivered to the people who need it. And it has become so wedded
to technology and so ignoring of natural healing potentials of other methods
of intervention which are much more cost-effective.
DR: When there’s an emergency situation that requires high-tech care,
I don’t think anyone I know would be in favor of withholding it. But how
do we break out of this cycle where we lurch from crisis to crisis?
AW: First of all, I think a lot of hospitals are going to go bankrupt,
and we’re going to be left with regional centers at which all the high-tech
stuff is done. The main problem is to teach both doctors and patients to
sort out those conditions which should go to conventional medicine. You
know, of the total number of sick people going to doctors, maybe 20 percent
of them have conditions for which conventional allopathic medicine is appropriate.
If we restricted that kind of medicine to that percent, we would not be
in the kind of economic trouble we’re in now. But we’re trying to use this
for every thing, and it doesn’t work for the vast majority of problems.
DR: What do you think are the pros and cons of managed care and HMOs
with regard to these questions?
AW: A major con is that doctors who work in them lose all autonomy.
They are essentially told how to practice, how much time to spend with patients,
what to do in certain conditions. It really has taken away all of the individual
autonomy that has made the practice of medicine very interesting and very
rewarding. I guess on the pro side, as a stopgap measure it has made the
delivery of care economically viable, at least for a time.
DR: Do you see any way in which HMOs could become true wellness centers?
AW: That would be nice. I don’t know. One idea that I have that I’d
like to see happen, something that I’m going to work at, is that I would
like to see a new kind of institution that’s somewhere between a spa and
a hospital coming into existence. I think a lot of people now go as inpatients
to hospitals who could much more profitably be treated in centers of that
sort, where they would learn about what healthy lifestyles is, how to do
it, and come out knowing more than they went in with about how to keep themselves
healthy.
DR: Is there any country whose health care system provides a good
model both for holism and social justice?
AW: I would look at Germany and maybe Switzerland. There are definite
areas in which they’re ahead of us. There is much greater interest in natural
medicine. There are more doctors who practice it, there are natural pharmaceutical
companies, there is s system of reimbursement for stays in spas and healing
centers. So there are certainly things there that we can learn. But with
that possible exception, I don’t know that there are any other models to
look at.
DR: I know that you travel to Japan periodically. What is their health
care system like and what lessons can we learn from the Japanese experience?
AW: A lot. We can see many of the faults of our own system blown
up to even greater proportions. Japan has national health insurance–there
are no competitors. National health insurance in Japan pays 100 percent
for procedures and zero percent for consultations, so there is no incentive
for a doctor to talk to a patient, and there’s a great deal of incentive
for doctors to do expensive tests. The average doctor may see 30 patients
an hour. Two minutes with a patient–they’re called “two-minute doctors.”
Patients never ask doctors questions. That’s just not done. It’s very authoritarian.
There are enormously lengthy hospital stays.
DR: Why?
AW: Because everybody makes money from it. It’s fully paid for by
insurance. It’s very common to put patients in hospitals for four months,
or six months for things where we’d put them in for a few days. But this
is fully reimbursable under Japanese health insurance.
DR: Is there no co-payment? Is it 100 percent reimbursement?
AW: Yes. There is also a very unhealthy relationship between doctors
and pharmaceutical companies in Japan. A pharmaceutical company will often
supply a new doctor in practice with a year’s worth of free drugs, which
the doctor then sells to patients.
DR: In our country we have historically had a division between the
prescribing physician and the dispensing pharmacist, specifically to avoid
this sort of conflict of interest.
AW: Exactly. You can see how that’s a real area of abuse in Japan.
The Japanese build a lot of the machines that we use in our medical centers,
CAT scanners and MRI scanners. Every local Japanese hospital has one. The
same problem exists here, but it’s worse in Japan, because there are more
of the machines around. And in order to recover the costs, there is enormous
incentive to use them, and this is also payable through insurance. So there
is a tremendous amount of [diagnostic] testing.
The rate of coronary heart disease in Japan is much lower than in the United
States, probably because of diet primarily. But the rate of doing coronary
angiograms is the same. So that means that if you have the misfortune to
have chest pain anywhere in the vicinity of a Japanese hospital, they’re
going to do an angiogram on you, whether you need it or not. These are just
some of the ways where you can see the kind of problems we have, blown up
even bigger.
DR: Which traditional healing systems from other cultures do you
have the most familiarity with, and how compatible are they with contemporary
medical practice?
AW: I have a fair amount of familiarity with Chinese medicine, which
I think at root is not very compatible with Western medicine. It’s based
on totally different conceptions of health, illness and energy. And yet
it’s odd that it has become one of the most established in this country.
Acupuncture is practiced by many physicians in medical centers. There is
increasing use of Chinese herbal medicine. It’s become very accepted.
I’m a great fan of manipulative medicine [manual manipulation of the spine
and other joints], and I see that beginning to be incorporated into more
mainstream medicine. I think that’s potentially very compatible with conventional
medicine, as is naturopathic medicine.
I’m really interested in all the mind-body interventions, which I think
are all potentially very compatible with standard medicine. It’s just that
most standard doctors don’t know how they are used or don’t think to use
them.
DR: If you were to attempt to project a generation or two into the
future, what kinds of changes would you anticipate in terms of the boundaries
between the health professions?
AW: I certainly think we’re going to see the appearance of wellness
centers and healing centers. Some will be these inpatient facilities that
I mentioned and others may be clinics where many kinds of practitioners
work under the same roof. I think that’s definitely going to happen. And
we’ll see about this effort that I’m making to create a field of integrative
medicine. There’s high potential there to turn out medical doctors who are
familiar with these other techniques and willing to work with other practitioners.
DR: I’ve found your writings on the placebo effect to be both original
and fascinating. What is your current thinking on placebos and on spontaneous
remission from disease?
AW: I still think that placebos are really the meat of healing interactions.
They are examples of pure healing responses from within that are triggered
through the mind by belief. The mind is only on avenue to the healing system,
but it’s a very interesting one and the advantage of it is that it requires
little external paraphernalia, and there’s no [side effect of] toxicity
involved. So I think the placebo response is the greatest ally that a practitioner
has, and that the best kind of medicine is that which elicits the maximum
placebo response with a minimum direct impact on the physical body. So I’m
a big fan of placebo response, and I really try to get people to think differently
about them.
DR: And remissions?
AW: I’m working on a new book called Spontaneous Healing,
which should be published next year by Knopf. I’m not using the term “remission”
in the title, for two reasons. First of all calling it remission implies
that it’s temporary, that it’s going to come back. And in genuine healing,
the problem is dealt with. Secondly, remission has a strong connotation
of cancer, and I am interested in all healing responses, not just cancer.
One of the problems I see made in the field (such as it is, it’s a very
tiny field) has been to look entirely at cancer. I think that’s a mistake,
because if you look only at cancer, you get very little sense of how powerful
the body’s healing system is, and how widespread are the kinds of conditions
in which it operates.
I’m very much interested in the complete disappearance of back pain, autoimmunity,
allergies, all sorts of conditions, including serious conditions. I’m looking
at all of these examples of healing, I think that in general this is a field
that has been just totally ignored by medical research. When doctors come
across cases of it, they tend to wonder at it, maybe the ignore it, maybe
they look at it, but they tend not to let these kinds of cases influence
their general thinking about health and illness. And I think this should
be a major focus, or the major focus, of medical research and practice as
well.
Daniel Redwood is a chiropractor and writer who lives in Virginia Beach,
Virginia. He is the author of A Time to Heal:
How to Reap the Benefits of Holistic Health, and is a member of
the editorial board of the Journal of Alternative and Complementary Medicine.
He can be reached by e-mail at Redwoods@infi.net.
A collection of his writing is available on the World Wide Web at http://www.doubleclickd.com,
and also on the New Age Forum of the Microsoft Network.
©1995 Daniel Redwood, D.C.
Hyla Cass MD
