October 18, 2012

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Dr. Andrew Weil delivered the keynote address at the 2012 American Academy of Family Physicians Scientific Assembly.  I admit that I don’t know much about him or his wellness empire, but apparently Time Magazine has anointed him one of the top 25 visionaries in the world.  Here is the gist of his keynote address, as heard by someone with a relatively unbiased unfamiliarity.

My first impression of him was influenced by a Santa Claus-worthy white beard. He decried our “disease management system” that masquerades as a health care system.  A true sentiment, yet all the better intentions in the world will not change the fact that there are a lot of diseases to manage.

Dr. Weil scolded the medical profession for its over reliance on medications. Instead, he is a proponent of Integrative Medicine, a concept that emphasizes the body’s own ability to heal, and incorporates such things as botanicals.  I’m not sure how much he promotes supplements or chiropractic, but there is a slippery slope here. On the other hand he is absolutely correct that physicians and patients have come to expect that a pill can cure many problems without the more arduous attention needed to improve our lifestyles. He feels direct to consumer advertising by the pharmacy industry is wrong. It’s hard to disagree with that as well.

He is a proud General Practitioner, and has created an active education curriculum for residents, physicians, medical students to promote his integrative approach. He emphasized the lack of training in nutrition during medical school, and that most courses look more like biochemistry. Dr. Weil stated that his is an evidence-based curriculum (yet later downplayed the importance of evidence based medicine).

He feels we don’t need more rigorous studies of St Johns Wort, but we do need more outcomes studies showing his integrative, lifestyle medicine approach works better.  

His lofty goal is to make his curriculum a standard part of the education of every physician.

He called for a grassroots movement among doctors and patients to reform healthcare outside of government, and feels both political parties offer few inspiring solutions. I would certainly agree with this sentiment, but to build any consensus on what a utopian health care system might look like seems impossible to me.

He blames government subsidies of corn and soy for having made the least nutritious foods the cheapest.  He calls for subsidies for vegetables and fruits instead. Sounds good. Dr. Weil beleives one small step that would create a major positive impact would be eliminating or even outlawing sugary beverages like soda.  

He stated that many people have no idea of the difference between fruit and fruit juice.  Dr. Weil believes we should tell patients they are drinking soda when counseling them about juice. If you compare grams of sugar this is often true. Most breads labeled as “whole grain”  are still pulverized and have an unhealthy glycemic index.

The grand finale of his keynote address was the demonstration of a breathing technique which he touted as a kind of panacea.  By doing this breathing, the voluntary nervous system sets the tone for the involuntary autonomous systems.  He went on to actually demonstrate this breathing technique with elaborate counting, breath holding, and forceful exhaling.  According to Dr.Weil, we must do this twice a day “religiously.” He claims it is almost impossible to have a panic attack while doing these exercises, and cites 5 cases of this technique correcting atrial fibrillation.

While I think the idea of breathing exercises is excellent, and there is good evidence we can reduce stress, anxiety, and the downstream health effects of tension, he inflated this power to curative proportions. I think of breathing exercises as a coping mechanism with beneficial physiologic and health effects, but his method came off as proprietary and ritualistic, admittedly derived as it is from a kind of Yoga.

He ended his speech by pointing out that the word “conspiracy” is derived from the root “breathing together.”

At best I think his heart is in the right place, and his talk has at least piqued my interest in learning more about his integrative curriculum. There are a lot of things wrong with the institution of medicine, and the fight against a robotic system that relies on technology and ignores our own innate capacity to improve our health is righteous. However it seemed from his talk that he glorified the placebo effect, the anecdote, and the wisdom of accumulated clinical experience.  He downplayed the primacy of evidence based medicine, and the authority of the randomized double blind placebo controlled clinical trial – methods which have been invaluable in elevating medicine above the shaman. I think the art of medicine is derived from a continuum spanning rigorous science and respect for our desire to believe, but must always be informed by the scientific method as the best arbiter of truth.

Again, I don’t really know much about Dr. Weil. I do respect the medical blogger ORAC, and he wrote this scathing post about the selection of Dr. Weil as a keynote speaker. The Dr. Weil who showed up here certainly knew his audience, and tempered his more magical thinking, allowing just a hint of quackery to shine through. Thanks ORAC.

Famdoc in MA October 19, 2012 at 10:51 am

I thought he gave a decent address as well, and only spoke in broad terms. I was surprised that during the q/a session no one stood up ask him about some of his more controversial claims and his promotion of a supplement line. I don’t think you can honestly rail against high costs in healthcare if you are personally promoting expensive and unproven treatment adjuncts.

dieta October 22, 2012 at 4:22 am

Weil: Yes, but the priorities of insurance reimbursement are completely backward. We happily pay for interventions, diagnostic tests, and drugs, but we don’t pay for doctors to sit down and teach patients how to eat or how to relax. We talk about prevention, but that’s not where the money is going. One way to change those priorities is to conduct outcomes-and-effectiveness studies. Let’s look at five or ten common ailments that now cost us huge sums of money, such as type 2 diabetes or chronic back pain. Because conventional medicine has no magic-bullet treatment for these conditions, people often try complementary and alternative therapies. We could compare conventional treatment with integrative treatment (which might make selective use of conventional medicine) and assess medical outcomes and costs. I’m quite certain that integrative approaches would produce better results at lower costs. If we could get the data and show it to the people who pay for the nation’s healthcare, then they might change their reimbursement policies and start to pay for preventive and integrative medicine.

trish October 26, 2012 at 10:09 am

He’s kind of a sweet cult of personality type. but oh my, the money!

Katy G December 18, 2012 at 10:32 am

He does have some wonderful information about eating real food rather than crap made in a lab. an old chinese proverb says: “Those who take medicine and neglect their diet waste the skill of the physician.”

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