Health and Healing: Understanding Conventional and Alternative Medicine, by Andrew Weil, Boston: Houghton Mifflin, 296 pp., $13.45
"Mystification may seem a reasonable way to protect the trade secrets of a medical guild, but it is not really in the larger interests of either doctors or patients," says Andrew Weil in Health and Healing. Orthodox medicine predominates only because of its wealth and political power, according to Weil, a licensed physician. The public, increasingly disenchanted with medicine's materialistic basis, has been turning to alternate forms of practice that claim to minister to human spiritual needs and encourage patient autonomy.
In Health and Healing, Weil refers to orthodox medicine as "allopathy," a term coined in the days when bleeding and purging were the mainstays of therapy. Such treatment, along with the arrogance of its practitioners, spurred the Popular Health Movement, which managed to repeal medical licensing laws in most states in the 1840s (although they were later restored). Gentler, if no more effective, treatments such as homeopathy became legitimate.
Despite the undeniable successes of science and technology in alleviating many ills, the limitations of medical science have disappointed initially unbounded expectations. As in the past century, the monopoly of organized medicine is again being challenged. Today, the battle is not for delicensure but for extending the state's imprimatur to many other styles of practice. The banner may be autonomy, but the motive is in most cases access to the vast store of other people's money (insurance funds and government subsidies), available only to accredited "providers." Weil himself comments only briefly on licensing laws. Primarily, he challenges the legitimacy of orthodox medicine's exclusive claim to the mantle of science, one of the strongest arguments of the medical guild.
Weil asserts that all of medical science is based on outmoded physics. While admonishing doctors to learn from modern physics that the interactions of mind and matter can no longer be ignored as "unscientific," his own understanding of the subject is suspect. He incorrectly attributes our knowledge of electricity and magnetism to Isaac Newton. From the unquestioned fact that an observer perturbs the motions of electrons, his conclusion that the mind shapes external reality is possible but by no means necessary. Most physicists would still place the ancient mind-body problem in the realm of philosophy.
Weil's belief that physicians, in contrast to physicists, feel threatened by mysticism is unfounded in my experience. The portal of the Columbia-Presbyterian Medical Center in New York bears the inscription: "For of the Most High cometh healing." Cynics have long said: "God heals, and the doctor takes the fee." Scientific medicine, like physics, has a limited range. The physician may well acknowledge that a patient needs a priest for spiritual comfort and a grandmother for nurture and affection, while denying that the physician can or should fulfill these roles. Weil, however, places no boundaries on the physician's responsibilities. Furthermore, he takes the astonishing position that medicine is poor science because of its lack of attention to unmeasurable, indefinable factors. Thus, Weil seeks scientific knowledge from a study of alternative, often mystical systems.
Much of Health and Healing is devoted to an interesting description of homeopathy, Christian Science, shamanism, faith healing, chiropractic, Chinese traditional medicine, naturopathy, and a variety of other theories. All may have something to contribute to the art of medicine, or may be valuable techniques in certain circumstances, but they all claim to be comprehensive in scope. Testimonials of amazing cures can be found for all of them. However, the very existence of so many different systems must raise the suspicion that none of them work very well.
Naturally, one must inquire, as Weil does, how to tell a genuine healer from a quack: "I may not be able to define quackery simply, but as with pornography, I know it when I see it." The key seems to be the intention to deceive: "Practitioners who genuinely believe in their methods and who are able to create belief in patients about the possibility of cure are not quacks in my judgment." Faith, then, is the unifying principle in successful treatment and probably explains the placebo effect. The validity of one's faith is irrelevant. Though it is wrong to deceive others deliberately, it may be morally laudable to deceive ourselves unconsciously.
The Roman Catholic Church, which canonizes saints on the basis of miraculous cures, insists upon a Devil's Advocate to scrutinize the diagnosis and prognosis of the illness and to try to discredit the miracle. Paradoxically, Weil does away with this functionary in the name of science. He calls Chinese medicine between the 10th and 13th centuries a "true science"—although it prohibited the autopsy, medicine's "altar of truth." Similarly, his "investigations" of anecdotes of many other systems of healing do not insist upon a pathologically confirmed diagnosis.
As Weil states, science is primarily a method, characterized by reproducibility, communicability, and self-correction. However, he does not insist on these features when evaluating whether or not an alternative therapy is worthy of study. Students asking for guidance in this matter are advised to pursue "whatever grabs you, whatever you think you might use." One of the practitioners to whom he refers his private patients claims to be able to detect the pulsations of the cerebrospinal fluid through the skull—although he is unable to teach this skill to others because they are "insufficiently sensitive." Similarly, Edgar Cayce, a popular psychic who practiced medicine based on his revelations, was unable to transmit his method to his disciples.
Characteristics that do attract Weil to a system include its ability to "satisfy a patient's needs." Unfortunately, this may depend upon a practitioner's willingness to tell the patient whatever he wants to hear. Also, he is impressed by a "clear and unified theory" of "health as wholeness, perfection, and balance." Certainly, Chinese traditional medicine has an internally consistent theory, even if its concepts of "energy flow" do not seem to correspond to any material reality. Of course, the adherents of bleeding and purging had equally logical theories.
In other ways, Weil is inconsistent, criticizing features of orthodox medicine that he praises in other contexts. He believes that physicians' preferences for potent drugs trade a dramatic, rapid effect for the risk of adverse reactions. (The heart-failure patient drowning in the fluid in his lungs is even more interested in rapid action than is his physician.) On the other hand, Weil is favorably impressed by an Ingano Indian healer named Luis who indiscriminately gives hallucinogens to pregnant women, children, and patients who are delirious with fever. Whereas Samuel Hahnemann, founder of homeopathy, recommended the use of pure drugs, Weil himself believes in the superiority of plant extracts, whose unknown impurities supposedly protect patients from toxicity, although they probably evolved in order to kill insects. Weil is not unvarying in his approbation of the unorthodox. Naturopaths who rely on the inaccurate technique of hairshaft analysis to prescribe bizarre dietary regimens are considered to be no different from allopaths who rely too heavily on laboratory results, even if the latter are at least reproducible and based on correct concepts of biochemistry and physiology.
Health and Healing emphasizes the importance of faith in promoting recovery from illness. Faith implies the existence of an authority. Replacing the authority of impersonal science with that of the personality of the healer, as in many alternative systems, has disturbing implications. Unlike the grandmother who cures with chicken soup, the shaman has a vested interest in keeping his patient dependent on him. Even if the herbs were free of side effects (a dangerous and unproved assumption), this very dependence can harm the patient. Suppressing the ability to reason and encouraging faith in nonsense, however laudable the intention to heal, makes the patients susceptible to the very authoritarianism and mystification that Weil claims to oppose.
William James, founder of scientific psychology, said before the Massachusetts Legislature in 1898: "Certainly every nation has the…medical practice it deserves. A people that loves quacks will have them, laws or no laws." The claims of the shamans could not withstand an objective scientific inquiry, but such practitioners thrive in spite of regulations and licensing. They have even found in Andrew Weil a proponent with scientific credentials, who lectures in a required course in an orthodox medical school. Rather than conferring the approval of the state upon whatever claimants can arouse popular support, it might be well to recall the salutary results, cited by Weil, of the earlier delicensure: the practices of bleeding and purging died a natural death.
Jane Orient, a medical doctor, has a private practice in Arizona.
This article originally appeared in print under the headline "Healers or Quacks?".