the alternative fix

andew weil, m.d.
the clash
photo of weil

Andrew Weil is a nationally recognized leader in the integration of conventional and alternative medicine. A graduate of Harvard Medical School, he is the founder of the Program in Integrative Medicine at the University of Arizona Health Sciences Center in Tucson. Dr. Weil is the author of eight books, including Spontaneous Healing (1995), 8 Weeks to Optimum Health (1997), and Eating Well for Optimum Health: The Essential Guide to Food, Diet, and Nutrition (2000).

My interest in so-called alternative medicine goes way back before medical school. My love of plants is something I got from my mother. That led me to be a botany major. I remember when I was a teenager becoming very interested in hypnosis and that started me on the path of inquiry about mind-body interactions. I began reading about alternative therapies when I was in college and wrote a paper about them. So these interests long predate medical school. When I finished my internship in it was very clear to me that I did not want to practice that kind of medicine. It just seemed to me that first of all it caused too much direct harm. And secondly, in general it didn't really get at the root of disease processes and change them. And I felt very poorly equipped to teach people how not to get sick. I had essentially learned nothing about prevention, about the role of lifestyle and health.

I didn't know what I wanted to do in its place, so I really was quite confused about what I was going to do at that point. I got a book contract to write The Natural Mind, which sustained me for a year. And then I got a wonderful traveling fellowship from a group called the Institute of Current World Affairs, which was then in New York City, that allowed me to travel around South America, Africa for three and a half years collecting information about indigenous healing practices, psychoactive plants, altered states of consciousness, all those things that I was interested in.

When I came back from that and settled in Arizona which was quite by accident, my car broke down here. I had never had any intention of living in, in the desert in Arizona. I was still making my living primarily as a writer and, and investigating things on my own. And I was rather surprised when patients started showing up at my doorstep, wanting my advice. I never really envisioned myself practicing medicine because I didn't know what I was good at. I gradually discovered I was good at some things. I'm good at diagnosis and I do that mostly by listening carefully to people. And I'm very good at being what I call a therapeutic marriage broker, I know who goes with whom. I can arrange happy therapeutic marriages between patients and practitioners, whether that's within conventional medicine or outside of it. …

If a therapy is not harmful, why not experiment with it? Why not try it?  Especially if conventional medicine doesnt have anything great to offer.

You're also a very popular speaker—some have called you a guru of alternative medicine.

Yeah, I don't like being called a guru, especially not the guru of alternative medicine, which is not what I'm preaching. I think of myself as a teacher and a practitioner and an author. I think for many physicians I have been a role model and a trailblazer. That I've gone into territory that many people have been afraid to go into. And I think that's made it easier for other people to follow in this path. I also think that I speak and write clearly, which people are grateful for, especially in medicine. And I think that my views are balanced. I'm seen as being reasonable, commonsensical and balanced. I think I'm fairly even handed in my criticisms of conventional medicine, alternative medicine. I don't have an axe to grind for or against any particular system.

Why do you think people turn to alternative therapies?

I think one of the great appeals of alternative medicine is that it empowers people more than conventional medicine. I think people are very fed up with being passive recipients of authoritarian, paternalistic medicine. Many of these other systems make people feel that they are more autonomous, more in charge of their own destiny. I think that's a great longing of people today, and so I think that's a major motivation why people seek treatment elsewhere.

I think also there is increasing suspiciousness in this culture with things artificial, synthetic. A lot of people have had very bad experiences, with drugs especially. The statistics are that we're seeing a hundred thousand deaths a year in U.S. hospitals alone directly caused by pharmaceutical drugs. And this is not mistakes, it's not the wrong drug to the wrong person, it's the right drug to the right person and the right dose and the right condition, and a hundred thousand people die. That's not acceptable. It's now between the sixth and fourth leading cause of death. That's no good. So I think that there are an awful lot of people that are just turned off by that kind of medicine and they're looking for something else. …

I also think that a lot of people seek out alternative practitioners in frustration. If their first choice were available, it would be to go to a medically trained person, an MD who was open-minded and had knowledge of things beyond conventional medicine and could advise them about how to use them.

Do you think part of the popularity of alternative therapies is also due to a disappointment with western medicine's inability to deal with many chronic illnesses?

I think it's ironic, in a way, that as we see this new horizon of being able to manipulate genes and really focus on specific mechanisms of disease, it's ironic that just at the time that that's happened there has been this incredible rise of diseases that completely confound medical doctors. We have diseases like chronic fatigue syndrome and fibromyalgia and irritable bowel syndrome, where we really don't see mechanisms. It's very difficult for doctors. Any rheumatologist would rather treat a case of gout than a case of fibromyalgia. Any gastroenterologist would much rather treat a case of peptic ulcer than a case of irritable bowel syndrome. But in fact these are the diseases that are popular today. So if you've got a disease that conventional medicine really doesn't have much to offer for, it seems reasonable to explore and see what else is out there. …

Earlier you told me that you believed that medicine has become dangerously disconnected from nature. Can you talk about that disconnect, and how it's come about?

It's true that the vast majority of drugs in use today are of plant origin, or at least they were originally discovered from plants. But scientists today and medical doctors have no firsthand experience of the plants that they come from. There has been over a hundred years of teaching that plants were equivalent to their isolated active principles or dominant compounds. That's just not so, plants are very rich complex mixtures.

One of the great pitfalls of western science and medicine is reductionism, that is, thinking that the part equals the whole. In pharmacology that has meant isolating single compounds from plants, purifying them, making molecular variations of them, making them even stronger, and then teaching that it's better medicine to give these pure chemicals to people.

In my experience I find better results with the complex natural compounds. … I'm not completely in agreement with the herbalists who just want to use crude preparations of plants. I'm all for preparing plants in ways to make them better, more standardized and so forth. But I think there is fundamentally a different kind of medicine in presenting the body with these complex arrays of compounds that's found in plants. Often in this array there will be compounds that have opposite effects. So in Chinese medicine you find plants that raise low blood pressure and lower high pressure, that make no sense in terms of western pharmacology. We think of drugs as having unidirectional actions. But these plants clearly contain these ambivalent mixtures. When you present the body with this kind of ambivalent paradoxical array, which effect predominates I think depends on which receptors are available for binding. It's not mystical, I think there's a real biochemical mechanism to explain this. But when you do that you're allowing the body to have a choice in how it responds to a treatment.

For example one of the plants that I studied for a long time was coca leaf in South America, the source of cocaine. It's a major medicinal plant for Andean Indians, and one of its main indications is to treat all kinds of stomach disorders. Andean Indians say that coca treats both diarrhea and constipation. Again, that makes no sense in western terms, cocaine is a stimulant, it increases gut motility, so you could imagine it would treat constipation, but how possibly could it treat diarrhea? Well there's fourteen other alkaloids in coca --these are variations on the molecule of cocaine--and if you looked at the cocaine molecule, the shape of the molecule relates it to drugs like scopolamine and atropine that come from higher plants like belladonna, those have a paralyzing action on the gut and have been used to treat diarrhea, and yet isolated cocaine is a stimulant. … So you give the body this ambivalent mixture, it decides what it needs, it takes what it needs. That is a different kind of medicine from giving the body a strong unidirectional push with a powerful purified compound.

I think both kinds of medicine are probably useful. if you're dealing with a critical condition, something very fast moving, it's nice to have these purified compounds that work very dramatically in one direction and quickly. But I think for general purposes, this, it's a whole other way of thinking about medicines and the body, that you let the body decide what it needs, to take what it needs. …

By the way I think this is also very consistent with developments in other areas of science. Right now one of most exciting things going in mathematics and physics is the rise of complexity theory. that we're finding that if you want to describe the natural world, you need complex models, that classical simplistic models don't work. Medicine has shown not the slightest interest in that. I think that medicine is at the moment firmly wedded to reductionism as a tool for dealing with the natural world.

Why do you think medicine is stuck in this way of thinking? Where does the resistance to change come from?

A little over a year ago I was asked to be the keynote speaker at the Council of Deans annual meeting of the American Association of Medical Colleges. I said what I had to say about the radical need for changes in medical education and so forth. I was interested in what the resistance was in that group. And I sensed that there were three different kinds of resistance. The first was enormous resentment that these changes were being dictated by consumers. There was a real feeling that changes in medical education should only come about as a result of advances in medical research. …

The second kind of resistance that I heard was that this is a slippery slope, that if we begin teaching about botanical medicine in medical school, next we'll be teaching about astrology and crystal healing and where will it all end? And the foundations of western science and rationalism will crumble. My answer to that is that that's the whole point of what I'm trying to do in integrative medicine, it's trying to teach discrimination to medical doctors. You look at this whole mixed bag of alternative medicine which ranges from very intelligent to very foolish and some dangerous. And you want to sort through it and separate out the wheat from the chaff to find out what's worthwhile there, what's not worthwhile, what can be incorporated into mainstream medicine and what can't be incorporated. That's the whole point of integrative meditation.

The third kind of resistance which was interesting was I think just simple fear of censure by peers. I'll give you an example of why I think that. The day after my talk I was on a panel with Steve Strauss from NCAM and it was moderated by the dean of the University of Maryland School of Medicine, who I thought rather flippantly asked this group of deans, after we spoke, well now how many of you are ready to start teaching integrative medicine? One hand tentatively went up and immediately came down when the person looked around. A few days later they gave a written poll to these deans and eighty percent of them said that they were in favor of teaching integrative medicine. So there was something about doing it in public and doing it in private. …

Tell me about the Consortium of Academic Health Centers for Integrative Medicine, and what you're trying to do with it.

[The consortium] has been in existence for several years but it's now become quite formalized. At the moment we have twelve member schools, Duke, Harvard, Columbia, Georgetown, University of California, San Francisco, University of Maryland, the University of Arizona, University of Michigan, Jefferson and so forth. … We now have probably another ten schools knocking at the door, wanting to be admitted.

The purpose of this group--really it's quite out there--is to transform health care through radical reform of medical education and merging biomedicine with everything else that's out there. Our hope is that we can get up to twenty-five member institutions at which point we'll say we represent one-fifth of the nation's medical schools. And I think we can then go to institutions like the National Board of Medical Examiners and the American Association of Medical Colleges and begin demanding changes in how medicine is taught.

My focus has always been on the radical reform of medical education. My contention is that the root of the problem is how we're training doctors. We need a new generation of doctors out there who've been trained differently to meet the needs of consumers today. …

How do you think doctors of tomorrow should be taught differently?

I propose teaching nutrition. I propose teaching the basics of botanical medicine and the basics of mind-body interactions, and at least a general survey of alternative medical systems and learning about what their strong points and weak points are, and learning about the body's natural potentials for healing. I mean all those things that are now missing from standard medical education.

Do you think this is realistically going to happen?

Absolutely, I think there's no question. It's still a consumer driven phenomenon. The schools are being dragged, kicking and screaming in this direction but they have no choice because the health care system is in total economic collapse. The market forces dictating this are overwhelming. It's not just that more consumers are spending more money on this than on standard medicine, it's at the same time, these standard medical institutions are imploding. Given that kind of reality I think medical schools, medical educators have no choice but to pay attention to what people are demanding. …

My sense is that if you look at the opposition to this, at least within the academy, there is a clear generational component. There is a group of older academic physicians who really aren't happy at what's happening. I think they will pass from the scene and facilitate acceptance of all this. Then I think there is also some resistance from the basic scientists, as I said earlier. When a movement like this starts at a medical school, usually starts among the clinical faculty. The basic scientists often resist because they have all the prejudices of that world, that this is at best, unscientific and at worst, anti-scientific.

…You will hear from people in the research community that medical education should only change in response to research findings. I don't think that's how things change. My experience is that people believe what they want to believe, and whatever research produces they'll continue to do what they do. In fact there's even been some studies showing that the practice patterns of doctors do not change in response to published results of randomized controlled trials that contradict what they've been doing. I think the way things change is by changing the culture of medicine. …

What do you think has to change in the culture?

To me the major thing that has to happen is to shift the focus of medicine from disease and symptoms and treatment to health and healing. The major thrust of my writing has been about the innate mechanisms of healing in the human body, much more than about alternative medicine. That's why I don't like being called a guru of alternative medicine.

I have tried to call attention to the fact that the body--I mean it's hardly a new idea--has incredible potential for self-diagnosis, for repair, for regeneration. When I approach a patient, my first thought is always why is healing not happening in this person? What's blocking it? What can I do as a physician to facilitate healing? That's a different perspective. …

That's what I mean by this change of perspective: at best, treatment facilitates healing, it impinges on natural healing mechanisms of the body, unblocks them, it allows them to operate. … Similarly I think that looking at people as whole persons, not just physical bodies, that people are also mental, emotional beings, they're spiritual entities, they're community members, all of those other dimensions of human life are very relevant to health and healing. …

What do you think will be the ultimate catalysts that cause the change of perspective toward integrative medicine that you predict is on the horizon?

Well, I think it is true that the agent of change is consumers. It is this public pressure on institutions now expressed through the power of the purse that's forcing change at a time of great economic crisis. I also think that that consumer movement reflects something deeper, that this is really that zeitgeist, it is a change in the spirit of the times--a whole rise of questioning the value of technology, or realizing that technology is not simply a blessing, that it's ambivalent. That things artificial and synthetic have the potential to be harmful to us. It's part of people wanting empowerment in all spheres of life. … I think that this taps into more global, deeper socioeconomic changes. But it's clear that the agency of change is outside, it's not coming from within the medical profession….

As long as things were humming along in medicine it was very easy for them to ignore it and say that this was all fringy and the social workers could go to it and that medical doctors [didn't] have to pay attention. But once the medical institutions really began collapsing--and if you're not in medical institutions today you have no idea how bad it is. I mean it's really bad. Large academic medical centers have had to lay off significant percentage of faculties. Major hospitals, institutions have gone bankrupt. And the whole advent of managed care I think has just compounded all this. Nobody likes that. It's made the actual practice of medicine very unsatisfying for many doctors. For the first time you see practitioners leaving [the field]. This never happened before. … I can't tell you how many doctors I hear say, I would never let a son or daughter of mine go into medicine. That's a big change.

So I think the economic catastrophe combined with the evaporation of so many of the things that made medicine a rewarding profession have suddenly forced doctors and institutions to pay attention to what the consumers have been saying.

What do you say to the argument that medical professionals shouldn't let consumer whims tell them what to do; that it's unethical as doctors to promote treatments and therapies that have not been proven by scientific evidence?

Well again, I think the point of integrative medicine is to be discriminating. It's to look out there and say that's nonsense, this is useful, that's interesting but it doesn't fit within our system so we're not going to touch it. That's what we have to do, is do that kind of sorting out of wheat from chaff. …

You're primarily a practioner, not a researcher. How does that impact your approach to evaluating evidence about whether a particular treatment is effective?

I'm a practitioner and a teacher, I'm not a researcher. … I think there's an enormous difference between medical scientists and medical practitioners. Often that the researchers really have little understanding of the world of the practitioner. I was just on a panel with some Nobel laureate medical researchers and their whole thing is evidence, evidence, we don't want just Andrew Weil's feeling that soy is good for prostate cancer, we want evidence. My response to that is that's great, I'm all for getting evidence, but the reality is that practitioners are working in the trenches of uncertainty. We never have all the evidence and we have to make decisions, often life or death decisions, with inadequate information. I think the best we can do is learn how to play odds and make good guesses.

One concept that I'd like to get across is that I think it would be very useful if people, instead of just calling for evidence based medicine, if we conceived of a sliding scale of evidence that would work this way: that the greater the potential a treatment has to cause harm, the stricter the standards of evidence it should be held to [in terms of] efficacy. … That kind of sliding scale of evidence would simplify things because we don't have the resources to test everything that's out there in the world of alternative medicine using randomized controlled trials. And practitioners are always going to be guessing and operating in the midst of great uncertainty. …

Randomized controlled trials produce one kind of information. There are other kinds of information. You can rate information in terms of quality. We can do outcome studies to get an idea of how effective therapies are. The first consideration always should be harm. If a therapy is not harmful, why not experiment with it, why not try it? Especially if conventional medicine doesn't have anything great to offer.

But how can we know they're not harmful before they've been tested?

There are various ways of estimating the harmfulness of a therapy. One is to look at what it contains. Does a plant have anything in it that looks harmful: does it have a class of molecules which look like molecules that we know to be harmful? What does the epidemiology show? If a plant has been used for centuries in various cultures, and there is no epidemiological evidence of toxicity, that's reassuring. You can try things on yourself, which is a strategy I've always used. I would never give a patient something that I didn't first try on myself. …

It's well known that you've experimented with psychoactive plants and drugs yourself.

When I graduated from medical school I did my internship in San Francisco from 1968 to 1969 … and I was really thrown right into the midst of the counterculture. I was in the Bay area during the time of the San Francisco State upheavals and riots in the street. And experimentation with drugs was certainly a big part of that. I also worked as a volunteer physician at the Haight-Ashbury Free Medical Clinic. So I saw a lot of casualties of drug use as well. That was during a period then and in the years following when I did a lot of self-experimentation with plants and drugs. I've been fairly open about that and I've written a lot about it and, and certainly don't disown that, I think that that had a great deal of influence on how it see the world. …

One of my earliest memories, was [being] lied to [as a child] about why I was going to the hospital. I was tricked into going there, not told that I was having surgery. The anesthesiologist lied to me about what they were doing. They concealed the ether and told me I was going on a merry-go-round and then suddenly clapped this thing over my face. So that instantly instilled distrust of grownups and doctors. I had a very major altered state of consciousness from breathing ether. I remember my consciousness being separated from my body, having incredible visual hallucinations. It was very fascinating and I think it's possible that that was one of the experiences that interested me in studying altered states and psychoactive drugs which was the early part of my career. ……

What is the scientific method?

To my mind the scientific method begins with controlled observation. That is you observe carefully, you note down what you observe. If you suspect a cause and effect relationship, you try to hold all variables constant and manipulate one and then observe to see if there are changes at the other end. So I think it is basically careful observation and experimentation that's then also compared to the experience of others who are trained in that method.

What about the "gold standard," the randomized clinical trial? Why are so few alternative therapies proven by RCTs?

I think a practical limitation of the gold standard is that it's gold: it's very expensive and we just don't have the time or money or resources to test everything by this method. So I think we have to prioritize. This business of running chelating agents into people's veins and saying it's going to remove plaque. That is being done on such a scale, people are paying so much money for it, and it so pushes the buttons of medical regulators, that's one you really want to do a definitive, large-scale randomized controlled trial, to once and for all set it to rest, either it does work or it doesn't work. That would be great.

But for all the other stuff, we don't have time to do that, so we have to have other methods of estimating how things work. Now one of the attitudes that I run into in the research community that just drives me up the wall is people who dismiss what they call anecdotal evidence. And I have challenged some of these people in public to strike the word "anecdote" from the medical vocabulary.

I think it is a trivializing word. If you want to call this uncontrolled clinical observation, that's fine with me. The fact is that the scientific method begins with raw observation. You notice something out there that catches your attention, that doesn't fit your conceptions. You see it again. That gives you an idea that generates a hypothesis which you can then test. It is this kind of uncontrolled observation which is the raw material from which you get hypotheses to test in a formal manner. If you dismiss all that stuff, if you drop it into a mental wastebasket labeled "anecdote," you cut yourself off from the raw material of science. …

But the traditionalists would say anecdotes aren't important enough to publish.

And my response to that would be that you could apply the same thing to these randomized controlled trials. One big randomized controlled trial on St. John's Wort in major depression, that wasn't worth publishing or putting out in the public eye either, it's useless information. … The St. John's Wort studies—there are actually three of them now-- all looked at St. John's Wort in major depression. No one has ever claimed that St. John's Wort is useful in major depression. … It should be looked at in mild to moderate depression which is what it's used for. …

Jim Donlon, who was the former dean at the University of Arizona and is currently the editor of The Archives of Internal Medicine … said that as he was nearing retirement, and having watched what happened, that he was more convinced than ever that what affected scientists' responses to new information was not so much the content of the information as its source. If information came from sources that they weren't used to paying attention to or respecting, their tendency was to ridicule it or dismiss it. An example that he used was the observation, originally an uncontrolled clinical observation, that aspirin had a clinical useful anticoagulant effect. That observation was first made by a general practitioner in southern California in the 1960s who published his observations in a journal of family practice and suggested that aspirin was useful as a heart medication to reduce risk of heart attack. It took almost thirty years before the conventional medical community came around to that point of view. And the reason that it'd ignored it for so long was that this came from a general practitioner and it was published in a journal of family practice, not in a journal of cardiology. …

Let's take the example of osteopathic manipulation for recurrent ear infections in kids. I wrote up my experience with an old osteopath in Tucson, who was a master of method called cranial therapy. He would take a kid, one treatment of this very noninvasive, inexpensive method and they would never get another ear infection. I saw this again and again. So based on my experience there, I have recommended in my writings on my website that kids with ear infections should go to osteopaths and get this method done. …

After something like twenty years of trying to get the research community interested in this, we finally set up some tests of doing this with kids with recurrent ear infections. We were unable in those tests to prove that this had an effect. The problem is, I'm sure there's an effect there. We couldn't capture it in the way we set up the experiment. Part of the problem is that osteopaths have very individual styles of doing this. Were the osteopaths that we used, were they doing it right? Was it the same kind of method as this old man that I saw? I don't know.

The other question is, if you're recommending this, as I said, the first consideration, can it hurt people? No. I think this is a completely benign treatment method. I've never seen any disasters as a result of cranial therapy, it's very gentle. The second question is, is it preventing people from getting legitimate treatment? In the case of recurrent ear infections all we've got is antibiotics--one after another--or putting tubes in the ears. There has been increasing question in the pediatric literature about the value of giving recurrent cycles of antibiotics. It looks as if the kids that get the most antibiotics wind up having the most and worst ear infections. So given that situation, I can see no harm in recommending to people that they try cranial therapy from a qualified osteopathic physician, even though we still have not yet been able to verify this in a randomized controlled trial. …

How do you respond to critics who say that the anecdotal results you see from some alternative therapies are simply the "placebo effect?"

Well, I think when they say it's placebo, what they're saying is that it has no intrinsic effect, so it's a way of dismissing. I think they're contemptuous of placebo effects, also, but it's a way of saying the therapy is worthless, just people believe in it. And it's odd that at the same time that they say that, they're maintaining the mind has no great influence on the body.

… My vision of this is that you've got an intrinsic effect and then you've got a halo of placebo effect and that the placebo effect is very important. In fact to me the best medicine is getting the maximum placebo response with the minimum intervention. Placebo responses are pure healing responses from within that are elicited by belief. The best medicine is getting the maximum healing response with the least intervention. So we should be finding ways of giving people gentler and gentler treatments or at least the gentlest treatments demanded by the situation and getting the maximum placebo response.

Can you talk more about the mind-body connection, the power of the mind to heal?

Well, again I think this comes from my own experience of my own body and from observing friends, family, patients. I reported in Spontaneous Healing one case of a woman that I'd worked with who had advanced lupus and had kidney failure as a result of kidney involvement. She was not in good shape. She fell in love and the disease disappeared. Now I can't often arrange for my patients to fall in love, but that observation is very important. Somehow a dramatic shift in the level of consciousness correlated exactly in time with the disease going into remission. I can't ignore that.

Now a skeptic might say, well the disease would have done that anyway, or she didn't really have lupus, or there's no connection. Fine, let them say that. I know that there's a connection there and that therefore I will work in any way I can to help my patients get into better mental states or to take advantage of that connection between the mind and the body.

This is not mystical; we know all sorts of machinery that connects the mind to the body, whether that's through the autonomic nervous system, or through neurohormones, there is a mechanism there to explain that. The question is how to take advantage of it, how do you access that. I think there's a lot of technologies out there from hypnosis and guided imagery and biofeedback, I mean there are all sorts of ways of doing it, the point is that there is something there to be accessed.

Is there any danger in promoting the idea that there is a connection between health and one's mental state?

Yes. I think there is a danger with this, and it's one that has been very much promoted by a lot of New Age books and tapes. And the danger is creating enormous guilt on the part of people about having illnesses in the first place and being unable to change them. … I think a lot of these popular writers writing about mind-body stuff have inadvertently fostered that way of thinking. And to my mind, guilt is an obstacle to healing. Often, I think you can present to patients, the possibility that there is a mind-body connection and that you can take advantage of this and bypass that whole discussion of why you got the illness and that it's your fault. It's not about blame, it's about taking advantage of a connection that gives you another way of intervening. …

What do you think of the DSHEA law and how dietary supplements are regulated—or not--today?

I don't think anybody's happy with the DSHEA law. It was a compromise and I think at some point it's going to have to go. …

The FDA tried to get it all, to regulate [supplements] as drugs and consumers fought against that and the DSHEA act was the compromise.

Resulting in no regulation of herbs and supplements.

Essentially, extremely inadequate regulation. From my point of view, first of all it just seems stupid that you can't say on the label of a product what it's for or how to use it. … Also I think the DSHEA act has certainly not done anything to regulate the quality of these things. The quality of many of these products in health food stores ranges from mediocre to dismal. I don't think there's a lot out there that's going to hurt you, but there's certainly a lot out there that doesn't do what the manufacturer claims and it's going to cost you a lot of money and not deliver anything. …

I'm strongly in favor of regulation of dietary supplements, not from the point of view of trying to thwart consumer access to them, but of trying to make sure that consumers have access to products of known safety and efficacy. I would like to see the FDA set up a whole new division of natural therapeutic agents that would regulate vitamins, herbs, minerals, dietary supplements, natural products. It would have to be staffed by people knowledgeable of natural products which FDA does not now have… and it also has to be done from the point of view of not trying to thwart consumer access. …

I think at the very least when you go into a health food store and buy something, you should have the assurance that what you're buying is what it says on the label, that there's nothing in there that can hurt you, that it's going to meet the claims made by the manufacturer. That seems to be just basic reasonable consumer protection. And I think the FDA is the agency that should do that. …

[This] is the model that's been done in Germany. The German federal government set up a commission to evaluate the safety and efficacy of herbal products. They published a lot of monographs on different herbs. They identified relatively small number of herbs that they thought were dangerous that should be taken off the market. And they rated others for efficacy. One of the things that they did was to say that we'll admit as part of this process evidence of use in other cultures and historical uses. The FDA has taken the line, the only thing we'll look at is the results of randomized controlled trials. So that's, that has not been a very helpful operational technique. …

What do you say to critics who say that you have a financial interest in encouraging people to try alternative therapies, because you sell vitamins and supplements from your website,

… The website is a commercial venture and it has a group of investors supporting it who want to make money from their investment and want to sell products. For me this always creates a tension in my professional life. My primary function is as an educator and I'm uncomfortable with commercial ventures, except for selling information. I've always made my living mostly by selling information through books and so forth.

I was under a lot of pressure to develop vitamin products. I think these are, by the way, the best quality things out there based on the raw materials and the way they're formulated. One way that I've dealt with this was to set up a foundation so that all of my after-tax profits from these products go to a foundation whose mission is to promote integrative medicine in this country and around the world. So I think that keeps a clean separation between what I do and that.

It must be bringing in a lot of money, though. I consulted the "Vitamin Advisor" and the recommended doses of vitamins would run about $75 per month!

Right. I don't think you should spend that much, I don't think you probably need those pills. If we sat down and I'd go over them with you I'd probably cross off most of them. I have had constant battles with the people over their desire to have people buy as much stuff as possible. … It doesn't fit my philosophy, I'm uncomfortable with it. So I'm working on it. … All I can tell you is this: that's a source of tension which I think is just the reality of my professional life, that I have to deal with investors who on the one hand want to make products and on the other hand, my feeling that I'm trying primarily to put information out there and guide people to products of good quality that they can use selectively. …

People perceive this as a conflict, though.

… It's just the way it is within the academic [world] in general and medical schools in particular, I think there is enormous suspicion of people who are successful commercially. This is true even before there were vitamins. You know, just the fact that I had best selling books, makes me immediately suspect. It's as if my primary motivation for doing this is making money. … If I were out to make money I would not be working half-time for an impoverished state university in a bankrupt state. …

What do you think the landscape of alternative medicine will look like ten years from now?

I think that this will all be mainstream, that there will be significant change in medical education and how doctors are trained. I think a lot of these therapies will be routinely incorporated into conventional medical settings. I think it's inevitably going in that direction.

Doctors will be much more likely to recommend mind-body therapies to patients, things like hypnosis and imagery and biofeedback. I think that there'll be much more attention paid to patients' lifestyles. I think managed care will have disappeared and that some other model will be there that will allow doctors and patients to have more time together so that doctors can inquire into their diets and habits.

I think that there will be routine use of herbal medicines along with pharmaceutical drugs. I think that there will be research in some of the farther out kinds of alternative therapies, things like homeopathy and energy healing. There will be a body of research documenting those effects and looking at possible mechanisms for them. I think all that will happen. …

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posted november 4, 2003

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