Andrew Weil looks comfy. Clad in a hemp-fiber sports shirt and grungy cotton gardening pants, he's kicked off his boiled-wool clogs, propped his bare feet on his desk, and is on the phone, fielding personal questions from callers for his popular Internet audio program DocTalk
. Bob seeks relief from ulcerative colitis; Weil suggests quaffing a slurry of aloe vera, activated charcoal, powdered psyllium seed, and acidophilus. Susan suffers from sinus headaches; Weil advises acupuncture. Elaine wonders if a purported natural breast-enlargement product made of eight organic herbs will promote a "womanly" figure; Weil doubts it. "Breast size is mostly genetically determined," he says. But the bad news goes down easily; Weil's basso is as warm as the Tucson, Arizona, sunshine outside his home office.
Some 2,300 miles away, on a drizzly afternoon in Philadelphia, Arnold Relman looks aggravated. Wearing a dark business suit and tie, the editor emeritus of the New England Journal of Medicine maintains a proud professorial posture as he rails against the Weil menace at the “Science Meets Alternative Medicine” conference—essentially a 200-person support-group meeting for alternative-medicine bashers. “Weil is devious,” Relman says. “He’s a manipulator. He’s a zealot, and a lot of what he says is just off the wall.” Relman’s colleague Wallace Sampson, clinical professor of medicine at Stanford, projects a slide depicting a huge pile of human excrement and a can of shoe polish. The slide sums up the conference’s thrust: Alternative-medicine proponents in general—and Andrew Weil in particular—don’t know one from the other.
Weil and Relman exemplify the escalating war for the soul of American medicine. Allopathic medicine—the modern drugs, surgery, and high-tech regimen of most M.D.’s—is under assault by a bewildering variety of so-called alternative therapies. Fed up with what they view as a heartless, invasive, confusing, expensive, and sometimes even deadly medical system, patients are swarming to chiropractors, naturopaths, herbalists, acupuncturists, and other formerly out-of-the-loop practitioners; in 1997, more Americans visited an alternative therapist than a primary-care physician. Meanwhile consumer demand for herbal medicines is skyrocketing; the American Botanical Council estimates 1997 sales at nearly $4 billion.
Even the medical establishment itself is changing. These days, 118 of the nation’s 120 medical schools offer courses in alternative therapy. Insurance companies are increasingly reimbursing for hypnotherapy, acupuncture, and similar once-fringe therapies.
How much of this change can be attributed to Weil? “The culture just caught up with me,” he says. But as a bona fide, Harvard-trained M.D., Weil has used his credibility to do plenty of pulling. His eight books have sold 6 million copies. Time magazine splashed his Santa-bearded face on its May 12, 1997 cover and later named him one of the 25 most influential Americans. “Andrew Weil’s Self Healing” newsletter has 450,000 subscribers; his Web site (www.drweil.com) garners a half-million hits per week. To anyone teetering between, say, St. John’s Wort and Prozac to ease depression, Weil’s imprimatur on the herbal choice can easily be the deciding factor.
Weil’s influence continues to spread because he’s claimed the middle ground. Much of alternative medicine is a nut farm, featuring warmed-over nineteenth-century quackery that ranges from worthless to lethal. But hard-core allopathic medicine has its own hall of shame: profit-driven research that virtually ignores unpatentable plant-based medicines, antibiotic overkill that yields invulnerable super-pathogens, and—according to a lead article in the April 15, 1998 issue of the Journal of the American Medical Association—an estimated 100,000 deaths a year in U.S. hospitals directly caused by adverse reactions to pharmaceutical drugs.
Weil espouses what he calls integrative medicine, which aims to cherry-pick the best therapies from all medical philosophies. He embraces the utility of high-tech medicine, particularly for emergencies. “If I were hit by a truck, I’d want to go to a modern emergency room,” says Weil. But he contends that “gentler, nature-based systems” can shore up, and in some cases replace, allopathic treatments, especially for chronic conditions such as skin problems, autoimmune disorders, and gastrointestinal-tract illnesses—the very conditions allopathic medicine seems largely helpless to remedy. And many of his healthy lifestyle recommendations—exercise daily, eat high fiber and low fat, take vitamins, and practice stress reduction—have been widely, if belatedly, embraced by mainstream physicians.
So, increasingly, the zeitgeist is Weil’s, but the medical establishment is fighting back. In her keynote address at the Philadelphia conference—which is rewarded with a standing ovation—Marcia Angell, executive editor of the New England Journal of Medicine, proclaims that alternative medicine is inferior, but popular because it is user-friendly. “Visits are leisurely, and treatment is gentle. It is also empowering. People are said to heal themselves,” she says. “People assume alternative medicine is better because it feels better to get it.”
Angell adds, “People who dislike science—and that’s a lot of people—are drawn to alternative medicine. Science is hard. How nice not to have to deal with anatomy, physiology, pathology, and the rest.” Most Americans, Angell says, are content with a “gloss of science. So when skeptics ask for evidence, advocates of alternative medicine can throw at them some gibberish about quantum mechanics.”
What rankles Relman, Angell, and other critics about Weil in particular is his tendency to speak ex cathedra: to endorse therapies based only on anecdotal evidence rather than on scientific research. As Weil’s star has risen, so have attacks on his veracity. The most resonant recent broadside was Relman’s “A Trip to Stonesville” in the December 14, 1998 issue of the New Republic. In the article, he hammers Weil’s tendency to trumpet single-case, credulity-stretching alternative-therapy cures—such as bone cancer thwarted by diet and exercise, or scleroderma healed with vinegar, lemons, aloe vera juice, and vitamin E—without providing “anything resembling scientific evidence.”
Having dispatched the last caller on his Internet audio program—Mark had whiplash; Weil recommended osteopathic manipulation, acupuncture, and massage—Weil leans back, rubs a hand over his famous bald pate, and considers Relman’s objection. “My point was not that you can cure scleroderma with lemons but to make people aware that there is a potential for scleroderma to be healed,” he says. “Same with bone cancer. Being aware of these kinds of healings can inspire people that there is hope, and to search for something that might work for them.”
As for the science behind alternative medicine in general, “The peer-reviewed research is coming. The body of evidence is growing every day, particularly for botanicals and mind-body medicine,” says Weil. One example: A consensus panel convened by the National Institutes of Health, after reviewing medical literature, concluded in November 1997 that “there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting, nausea of pregnancy, and postoperative dental pain.”
“Medicine has always operated in uncertainty,” says Weil. “The Office of Technology Assessment of the U.S. Congress estimated that fewer than 30 percent of procedures currently used in conventional medicine have been rigorously tested. While waiting for further tests, we do the best we can, trying not to hurt people, trying to make educated guesses.”
The term anecdotes, continues Weil, is trivializing: “It suggests some old codger sitting on a porch telling a story.” Weil prefers to call what he has seen “uncontrolled clinical observations.” In a written response to Relman’s critique, Weil noted that the University of Arizona recently landed a $5 million National Institutes of Health grant to study, among other things, the value of cranial therapy (manual manipulation of the skull bones) in treating children’s ear infections. “If I had dismissed the successes I saw with [the treatment] as anecdotes, we would not be in a position to take the next step and gather the data that Relman wants to see.”