by John Weeks
In his most recent book, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future, author and integrative medicine leader Andrew Weil, MD calls for a “radical change” in US health care.
Weil shifts his focus from the two passions that have shaped his work: transforming personal health practices and changing US medical education. Here Weil’s ambitious eye is trained on the gold ring of transforming healthcare itself. Weil presents his “argument that integrative medicine is the key to solving the healthcare crisis.” He enjoins “leaders of this new medicine to make people aware of the facts presented (in the book) and motivate them to join us in working for real reform.”
Unfortunately, Weil’s success in engaging the leaders on whom such a grassroots movement rests may be limited by the MD-centrism and protectionism in the otherwise compelling vision in Why Our Health Matters.
Weil’s influence on consumers and medical schools
Weil’s influence on shaping consumer understanding of natural healthcare and integrative practices is hard to over-state. Millions have bought his books, heard him on Public TV, seen his bearded visage on the cover of Time magazine and subsequently explored and begun new healthy practices. One I relish: taking news holidays. Weil has driven untold throngs to explore complementary and alternative healthcare self-care practices and to sample the services of diverse integrative care professionals.
Weil’s influence on the emerging field of integrative medicine in the schools that educate MDs has been as profound. The small program he founded 15 years ago is now the thriving Arizona Center for Integrative Medicine. The Center’s fellowship program to train MDs is the standard for education in the field. Over 600 Fellows in Integrative Medicine have completed the training, with many in leadership roles throughout US healthcare. The Center leads integrative medicine in other ways such as attracting whole systems researchers and connecting with large employers. There is nothing quite like this in the other medical school integrative medicine programs.
Weil’s top seven recommendations
With Why Our Health Matters, Weil takes on the challenge of significantly impacting the transformation of healthcare. He presents the book as not just a case statement, but a call to action.
Weil offers seven recommendations that we can “demand immediately.” One pictures Weil, conductor’s baton in hand, surveying medicine’s principal stakeholders and directing thusly: First, you, big pharma, shush, stop your direct-to-consumer marketing and advertising. Then: Medical schools, it’s time to start teaching health promotion and integrative medicine. Insurers, you insurers (are you listening?): Cover health promotion and integrative care for gods-sake. He then turns to 3 huge federal agencies: NIH, create an Institute of Health and Healing; Department of Health and Human Services, create an Office of Health Promotion; and Department of Education, establish an Office of Health Education. Get funded appropriately, generously. Finally, sotto voce, you consumers, c’mon, learn how to take care of yourselves.
It’s a fine, huge agenda, encompassing a global view of health creation. I honor Weil for jumping in with both feet. I particularly like the trio of big agency health initiatives. One can almost see, with just the right Aaron Copland-esque flourishes parting the clouds of health reform despair and opening the emergence in the United States of the healthy land of Oz which Weil’s friend, US Senator Tom Harkin, calls “a society of wellness.”
Getting there from here
Somewhere in my journey through Weil’s compendium of horrendous present priorities and recommendations for a healthy future, I got impatient. Maybe it was because I was reading the book at the end of the cynicism-breeding process of 2009’s medical payment reform debate. This is a different time than the hopefulness of the 2008 election year in which Weil was likely writing.
Weil’s recommendations are fine. But if this is Weil’s prescription for our nation’s health, how are we going to guarantee stakeholder compliance? How are we going to be able to count the votes to push the legislation that we need in order to support most of the major changes Weil recommends?
Weil offers the kernel of the answer by calling for a popular movement. Practically, politically, therapeutically, this means building huge coalitions and creating the powerbase to get us across the great divide. Here is where Why Health Matters fails its mission.
Lost to the coalition
The book’s short-coming can be reduced to a simple phrase: MD-centrism and protectionism. This characteristic, tragically, hinders the coalition building we need. Here are three significant losses due to the approach.
First, while Weil takes on pharma and insurers, he is kind to his fellow MDs who benefit handsomely from our disease-oriented resource allocation: namely, tertiary care-based medical doctors and their in-patient allies. Tertiary care interests like keeping resources where they are, in their hands. Sick is good. Integrative health, by contrast, drives resources toward outpatient care, community and public health.
Taking sides with primary care providers - counting votes with them when there are disputes, and there are - is a necessary foundation for a successful coalition to transform US medicine. Had Weil highlighted this transformation of resource allocation to the community setting, his argument would draw other outpatient practitioners whose contributions are under-funded and under-utilized in the current scheme.
Second, Why Our Health Matters does not sufficiently focus on the importance of medical doctors transforming their relationships with other allied health professionals. The new healthcare requires MDs to get off their pedestals, recognize their own limits, share power, help lift other disciplines, and expand collaborative teamwork. Many allied health practitioners are deeply wounded in these areas. Highlighting the importance of this transformation would stimulate activism by members of these professions.
Third, the licensed practitioners of chiropractic medicine, acupuncture and Oriental medicine, naturopathic medicine, direct-entry midwifery and massage therapy are barely present in this book. The exclusion is confounding. Weil has repeatedly advocated for most of these professions. (My own work with the Academic Consortium for Complementary and Alternative Health Care has benefitted). As a group, these 350,000 licensed practitioners are philosophically very much aligned with Weil’s argument. They are skilled in grassroots citizen action. That’s how their professions have expanded. Yet the book’s 226 pages have but a half dozen mentions of any of these fields. Nowhere does the book include significant advocacy of their potential value in creating health or their pioneering roles as agents of health in the U.S.
The inclusive movement is for integrative health care
Finally, Weil’s focus in Why Our Health Matters on “integrative medicine” rather than the more inclusive “integrative health care” is exclusionary. To most non-MDs, whether conventional or natural health disciplines, this sounds familiar, discomforting, more of the same guild-based practice. Reading this book, one can reasonably ask if Weil has anyone from non-MD professions in mind when he speaks to “leaders of the new medicine” and asks them to “motivate (others) to join us in working for real reform.” Would you enroll your patients and colleagues in a movement which doesn’t seem to include you? Invisibility and servitude do not inspire action.
Weil’s Why Our Health Matters gives us a great map toward the wellness society that Senator Harkin envisions. But it missed an opportunity to draw out the connective groundwork for the coalitions we’ll need to get Harkin and his colleagues to champion the changes that will get us there. And that’s too bad.
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