The evolution of integrative medicine
Integrative medicine has become fully accepted in academic discourse and yet an awful lot of people today have no idea what integrative medicine is, said Andrew Weil, MD, taking the stage at the 2022 Integrative Healthcare Symposium in New York City.
Weil, who is the founder and director of The Andrew Weil Center for Integrative Medicine at the University of Arizona, started his keynote by tracing his personal journey on how he came to develop the field of integrative medicine.
It was his interest in plants that led him to concentrate on botany during his time as an undergraduate at Harvard University. He was particularly interested in psychedelic plants and was shocked to find out the people who taught him pharmacology had no idea where these plants came from.
Weil also talked about his long-standing interest of the mind and consciousness, and how it interacted with the body. He said one of the physician courses that was most interesting to him early on in his career at Columbia University was on medical hypnosis as it showed him the power of mind-body interventions.
He ultimately decided not to continue in the medicine he had been taught because he saw it caused too much harm. Weil said the biggest black mark on conventional medicine today is that just in the hospital population there are between 300,000 to 400,000 deaths directly due to medication – and that medication had been properly prescribed.
“That’s totally unacceptable,” he said. “It also infuriates me when I see articles about the dangers of herbal medicine and herbal supplements.”
One of the principals Weil teaches in integrative medicine is that he’s not opposed to medication, as it has its place, but the lowest dose should be prescribed to start, and it should be combined with an integrative lifestyle change. He said most patients feel they are not getting treated if they are not prescribed medication and often times for physicians, it can be the only tool they know to use. Weil said one of the great contributions of integrative medicine is that it involves minimal use of medication.
Weil said he didn’t learn about health, healing, or how to keep people from getting sick in medical school and he always thought he should teach people about how to stay healthy. To the dismay of his classmates and friends, he decided to drop out of medicine and make his living as a journalist and writer. He traveled the world, learning about other types of healing practices and medicines. Then his vehicle broke down in Tucson, Arizona.
It was in Tucson where he met Robert Fulford, DO, FCA, who Weil described as the person who “I had the most to learn from and the most effective healer I ever met.” And from there, he fell in love with the city.
Fulford, Weil shared, would say, ‘all you have to do is make these little adjustments and let mother nature do her work.’ He said Fulford had remarkable success with all types of conditions.
Weil said science begins with observations and if something doesn’t fit a person’s preconceptions, it’s important to not hold onto those preconceptions, but to look at them.
Fulford also made Weil aware of the power of nature, he said. Healing is fundamentally intrinsic to the organism and organisms have the capacity to maintain equilibrium to regenerate, which is one of the most wonderful things. Good medicine begins with recognizing this, according to Weil.
When Weil sits with patients, he said he always thinks why is healing not happening here and what can he do to facilitate it.
Weil said the best treatments work by allowing the healing mechanisms to express themselves. “Healing comes from within,” he said. “And it’s your job as a practitioner to facilitate.”
When he settled in Tucson, Weil said he did not intend to practice medicine, as he said he didn’t know what he was good at. He wrote his first book about the intrinsic nature of healing, which ultimately brought patients right to his doorstep. “It was not an easy doorstep to get to,” Weil said. “I was reluctant to get pulled into practice.”
Weil said the first thing he discovered he was good at was diagnosis, which he did by listening to people.
“If you listen, people will make the diagnosis in their own words,” he said, adding that assumes practitioners know how to ask questions and can listen. “Unfortunately, time is really the problem. If you have a few minutes with a patient, it’s unlikely you can ask the questions for diagnosis.”
Weil said the other discovery he made was that he was good at being a therapeutic marriage broker. “I know who goes with whom,” he said, whether it’s inside conventional medicine or outside. “The people who came to me were fascinating as both people and patients. They had not been helped by conventional medicine, in some cases they were harmed and were looking for guidance and answers. I cannot tell you what a pleasure it is to work with motivated patients,” Weil said.
Weil talked about feedback he received from patients. Often, he was the only physician that told them they could get better. “It makes me very sad in some ways,” he said.
One of the most powerful ways to convince a person they can get better is to introduce them to an individual who used to have the condition they are suffering from but who is now healthy. Weil said he believes a useful service of the U.S. government would be to create a national registry of remissions so people can connect with those who have the same diagnosis and have healed.
Weil also talked about the language that is associated with integrative medicine. He said he doesn’t like the term “alternative medicine” as it implies replacing conventional medicine, which was never his intention.
“I think it’s important to teach people when and when not to use conventional medicine,” he said, adding it's also a mistake to go to conventional medicine in circumstances where conventional medicine doesn’t work well.
He also doesn’t like the term “complementary medicine” because it suggests conventional as the centerpiece and other modalities as garnishes around the plate.
“I have always said as this movement succeeds, we’ll be able to drop the word ‘integrative’ and it will just be good medicine," he said.
Weil spoke about his family doctor growing up, who not only had the respect of his community but who enjoyed tremendous autonomy. “That has gone up in smoke today,” he said. “I don’t understand why doctors aren’t marching in the streets. Your autonomy has gone away.”
He also added that practitioners are often mired in paperwork or electronic records and have no time to treat patients. They are often told when it comes to treatment, what can and can’t be done.
“We don’t have a healthcare system in this country,” he said. “We have a disease management system.” Weil also added that we spend more on health than any other country in the world, which is “completely unsustainable.” He added that the U.S. has the worse health outcomes than any other developed country. “What is wrong with this picture?” he said. “We are spending more and more and having less and less to show for it.”
Weil said the U.S. has epidemics of chronic disease that conventional medicine simply can’t deal with, along with an aging population, an epidemic of childhood obesity, followed closely by type 2 diabetes.
The absence of nutrition in medical education has been glaring, according to Weil, who said medicine in the U.S. is heavily dependent on technology, which is very costly. “We don’t train people for low tech intervention.”
To the male academic mind, nutrition looks like home economics, not like real science, according to Weil. He said instead of testing drugs against placebos it would be more useful to test against lifestyle change. “That kind of data would be very useful to guide policy,” he said.
Weil talked about how people are not aware of how dysfunctional the U.S. healthcare system is, and they are not angry enough. He said it would take a grassroots social political movement where people elect different representatives who are not beholden to pharmaceutical interests.
My hope is that enlightened health professionals would catalyze that social political movement, he said, adding that if we can generate enough feeling about it, we could change that situation.
Weil talked about the necessity of creating effectiveness studies where integrative medicine is compared head-to-head with conventional healthcare. When it comes to a variety of conditions including migraines, chronic back pain, and allergies, integrative healthcare would shine, he said. He said today, the type of data that is needed is outcomes of effectiveness. The problem, he said, is that these studies are expensive and it’s not clear who will conduct them. “My thought is if we can engage the private sector, if we could get some corporations to at least start some pilot studies of this sort and generate some data, that would lead to bigger studies.”
Weil also shared his pride for the Andrew Weil Center for Integrative Medicine, now at the University of Arizona. When he started the center in the mid-90s, there was no money, only one assistant and he was given space in a trailer. They then advertised and offered space for four physicians to come and study for two years. Over time, that number increased and more importantly, Weil said, they were able to develop a robust curriculum to cover all the subjects that should be a part of medical training.
He said the goal of the center is to have this curriculum be a required part of residency training so when a patient goes to see a practitioner, they know the basics of nutritional medicine, mind-body interaction, and the strengths and weaknesses of conventional medicine.
“I am absolutely confident that integrative medicine is the way to the future,” he said. “I hope our current healthcare system doesn’t have to collapse totally for something new to come, but that is possible for it to happen.”