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I was asked to write an article for Slate, the on-line magazine, about Andrew Weil’s selection as the keynote speaker for the 2012 AAFP annual scientific assembly. The science and health editor, Laura Helmuth, was initially enthusiastic about what I wrote, but eventually decided not to publish it. Here is the initial draft of my article. My comments follow.

Original Draft of Article for Slate

The American Academy of Family Physicians picked Andrew Weil to be the keynote speaker at its annual scientific assembly October 16-20 in Philadelphia. What were they thinking? That’s like having an astrologer give the keynote speech at an astronomy meeting.

The AAFP stands for the best in conventional medicine, for the standard of care as determined by physicians and scientists. Weil doesn’t. The AAFP stands for evidence-based medicine. Weil doesn’t.

Perhaps those who invited him didn’t know he had made pronouncements like this:

I would look elsewhere than conventional medicine for help if I contracted a severe viral disease like hepatitis or polio, or a metabolic disease like diabetes. I would not seek allopathic treatment for cancer, except for a few varieties, or for such chronic ailments as arthritis, asthma, hypertension (high blood pressure), multiple sclerosis, or for many other chronic diseases….

In his article “A Trip to Stonesville: Some Notes on Andrew Weil” Arnold Relman, former editor of The New England Journal of Medicine, shed some light on Weil’s background and his thought processes. Weil earned an MD from Harvard, but instead of choosing a specialty and following the usual path into residency training he dropped out, experimented enthusiastically with a variety of psychedelic drugs, and lived on an Indian reservation to learn from a shaman. Then he re-invented himself as America’s guru of integrative medicine, established a commercial and educational empire, wrote books, and appeared on the cover of Time.

According to Relman, Weil accepts science, but only to a degree. He has openly promoted “stoned thinking,” alleging that thoughts experienced while under the influence of psychedelic drugs or in altered states of consciousness are as valid as, or more valid than, scientific evidence. He has been known to reject clear evidence from clinical trials when it conflicted with his beliefs. He considers reality to be ambivalent; he tolerates mutually antagonistic ideas. He frequently dismisses common sense and medical fact. He believes in miracles and in the ability of mind to cause and to cure disease.

Weil has snowed a lot of people because he offers so much excellent science-based information and advice that is consistent with what other doctors say. But he promiscuously mixes that good advice with questionable advice in a way that makes it impossible for the average consumer to tell which is which. The textbook Consumer Health: A Guide to Intelligent Decisions characterizes Weil’s advice as “a mixture of sense and nonsense.” The Quackwatch website lists Weil under “nonrecommended sources of health advice.”

Some of Weil’s advice is frankly dangerous. He encourages self-care and irresponsible trial-and-error experimentation. For example, he recommends that patients with rheumatoid arthritis avoid pharmaceuticals and experiment with a series of lifestyle changes, dietary manipulations, alternative treatments, and diet supplement products. Patients who follow this advice risk joint deformities and disabilities that might have been prevented by taking disease-modifying anti-rheumatic drugs (DMARDs) early in the course of their disease. It is irresponsible for a doctor to recommend that rheumatoid arthritis patients try unproven treatments like bee-sting therapy, feverfew, and homeopathy while avoiding any mention of the proven benefits of DMARDs.

Weil is the public face of “integrative medicine,” an unfortunate movement that tries to infiltrate medical practice with treatments that have not been adequately tested for safety and effectiveness and in some cases have even been tested and shown not to work. Dr. Marcia Angell, former editor of The New England Journal of Medicine, has called integrative medicine “the new snake oil.” Dr. Steven Novella, Yale neurologist and founder of the Science-Based Medicine blog, has said it is “used to lend an appearance of legitimacy to treatments that are not legitimate.” Dr. Arnold Relman has said:

There are not two kinds of medicine, one conventional and the other unconventional, that can be practiced jointly in a new kind of “integrative medicine.” Nor… are there two kinds of thinking, or two ways to find out which treatments work and which do not. In the best kind of medical practice, all proposed treatments must be tested objectively. In the end, there will only be treatments that pass that test and those that do not, those that are proven worthwhile and those that are not.

Dr. Mark Crislip put it more bluntly:

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.

“Integrative medicine” is a marketing term rather than a meaningful scientific discipline. Weil is a better marketer than doctor. He appeals to consumers who are suspicious of “the medical establishment” and “Big Pharma,” or who have succumbed to the naturalistic fallacy (the idea that artificial drugs are bad and anything natural is good, a myth easily refuted by examples like strychnine).

Weil has developed a thriving business selling vitamins and supplements. And he has run afoul of the FDA for making unsubstantiated claims for his products. What he does is inconsistent with the position of the AAFP that:

The decision to provide special dietary intervention or nutrient supplementation must be on an individual basis using the family physician’s best judgment based on evidence of benefit as well as lack of harmful effects.

The Medical Letter also discourages routine vitamin supplementation for the general population. After their unbiased panel of experts reviewed all the available evidence, they said:

Supplements are necessary to assure adequate intake of folic acid in young women and possibly of vitamins D and B12 in the elderly. There is no convincing evidence that taking supplements of vitamin C prevents any disease except scurvy. Women should not take vitamin A supplements during pregnancy or after menopause. No one should take high dose beta carotene supplements. A balanced diet rich in fruits and vegetables may be safer than taking vitamin supplements. No biologically active substance taken for a long term can be assumed to be free of risk.

Weil acknowledges that the best nutrition is obtained through diet but says it is essential to take supplements as insurance against gaps in the diet. His website features a “Vitamin Advisor” questionnaire that formulates individual recommendations; its deficiencies have been exposed on Quackwatch. The word “vitamin” is used loosely, since most of the recommendations are for non-vitamin diet supplements. Rather than just an advisor, it’s a marketing tool that puts the Weil brand of recommended supplements in a shopping cart. It recommended that my healthy 27-year-old daughter take a daily multivitamin, a daily antioxidant, a calcium/magnesium pill, evening primrose oil, milk thistle, omega 3, and 1000mg vitamin C, at a total monthly cost of $99.90. No reputable medical authority would agree. I have reason to think she will remain just as physically healthy without those products, and she will definitely be financially healthier.

As if that weren’t enough, Weil has now embarked on a new endeavor: a collaboration with Innate Response Formulas to develop a system of “Seasonal Therapeutics” with seminars and a new line of products tailored to the seasons:

Autumn: Season of Harvest: focuses on liver and GI

Winter: Season of Reflection: focuses on immune and mood

Spring: Season of Renewal: focuses on purification and allergy

Summer: Season of Vitality: focuses on cardio and joint health.

The seminars promise to teach attendees how to:

Use evidence-based, targeted nutritional supplementation to restore integrity to the gastrointestinal mucosa, enhance digestive function, repopulate the microbiome, and optimize immune function

Utilize seasonal changes in the diet to assist the body’s detoxification mechanisms

Integrate stress management strategies that encourage the exploration of gratitude and meditation

This program claims to be evidence-based, but there is no scientific evidence that winter is the season of reflection, that the average person’s gastrointestinal mucosa has lost integrity and needs to be restored, that digestion needs to be enhanced, that the body needs help with its detoxification mechanisms or that diet changes would assist it, that any regimen of supplements is capable of optimizing immune function, that training in exploring gratitude improves health, or that a seasonal approach to diet and supplements offers any health benefits. This is speculation, pseudoscience, imagination, and marketing genius, not science.

The annual AAFP Scientific Assembly used to stand for the best in scientific medicine. It used to be a great opportunity for family physicians to learn about new developments, to review current standards of practice, and to brush up on their skills. By inviting Weil, the AAFP has descended to a new low and has sadly tarnished its reputation. I’m a life member of the AAFP, but I won’t be attending this meeting, and I have written a strong letter of protest to its organizers. We need good medicine based on good evidence; we don’t need medicine based on speculation or “stoned thinking.”

Other Protests

I was not the only one to object. Back in August, Orac also criticized the AAFP for selecting Weil. The Institute for Science in Medicine wrote a letter to the AAFP and received an answer with flimsy excuses that Orac promptly demolished. Both letters are published on the ISM website. Others, including the Dutch Society Against Quackery, wrote letters of protest. In online forums, many commenters from the US and other countries have expressed their astonishment that the AAFP was allowing him to speak.

Editing Changes

During the editing process, there were several deletions, additions, and questions raised. The editor deleted the quote from Relman about “there are not two kinds of medicine” because she felt it was redundant. She changed my characterization of integrative medicine from “trying to infiltrate medical practice with treatments that have not been adequately tested” to “treatments that in many cases have not been adequately tested.” She suggested trimming Weil’s statement about not seeking help from conventional medicine “since he’s saying that he would not use allopathy for the latter things, just the first few.”(I really don’t understand this. If anything, I suppose the comma placement in the quote might lead to confusion and to the misinterpretation that he would accept conventional treatment for chronic diseases along with “a few varieties” of cancer; but it is clear from his other writings that he wouldn’t. He consistently recommends alternative treatments for all of those chronic diseases. My example of rheumatoid arthritis is a case in point). She asked for a stronger quote. She thought the point wasn’t as strong as it could be “since there aren’t great treatments for some viral diseases.” (Viruses were only one item on his long list, and there are effective evidence-based conventional treatments for many viral diseases, and alternative medicine has nothing better to offer.)

She had 3 main areas of concern:

She said the lawyers would want me to contact Weil for comment. I didn’t see why this was necessary; but I complied, sending an e-mail to a publicity link on his website. I didn’t get an answer, so we could legitimately say “Weil could not be reached for comment.”

She said the lawyers would object to some of my statements so she made me tone down my language. For instance, I could not say some of Weil’s advice was “dangerous.” (Even though I think I demonstrated that it was.) And she objected to my saying “Weil doesn’t” in the second paragraph; I revised that and added 2 links to demonstrate that he doesn’t. I was not allowed to say Weil was a better marketer than doctor.

Her biggest concern: I had not provided original sources for everything I said.

Primary Sources

I had relied on both primary and secondary sources. Mainly one secondary source; and that one, Arnold Relman, was a trustworthy one. I had also relied on having long ago read library copies of couple of Weil’s books, on what I read on his website, and on my observation of his activities over many years. I was unable to provide links to primary sources for a few of my statements.

I had taken Marcia Angell’s “snake oil” quote from a secondary source but I was unable to verify it from the primary source, so I offered to substitute this:

Marcia Angell, former editor of The New England Journal of Medicine, said “One of the things that’s so amazing to me is the way a lot of proponents of alternative medicine will follow anything… Andy Weil says without any evidence whatsoever, faithfully on his word alone.”

She asked me to provide a link or an example for my statement that Weil has rejected evidence from clinical trials. I couldn’t find a link but I provided an example where he rejected credible evidence against osteopathic manipulation for ear infections because he had “seen it work.” He describes that in one of his books, but I read it a long time ago and can’t even remember which book.

She wanted a link to Weil’s own words showing that he believes in miracles and the ability of the mind to cure disease. I couldn’t locate any specific links. Relman reported that after reading Weil’s books, and the texts of his books are not available on the Internet.

She made me delete the quotation from The Medical Letter simply because it is not available online without a subscription. (Since when are print sources not acceptable references? Most articles from journals like JAMA , NEJM , and Lancet aren’t available online without a subscription either, except for abstracts on PubMed). She asked for a link to another source questioning daily multivitamins, and I provided two of them. She did not want to use my quotation of the AAFP’s position on multivitamins because she thought it was not strong enough to support my point.

After considerable editorial back-and-forth, she announced that she couldn’t run the story on Slate after all. It would need “a lot more primary reporting of Weil’s misdeeds” and there was not enough time left before the AAFP meeting to seek those out (partly because she took so long to get around to editing my draft after I submitted it!). I thought I had enough primary sources to establish that he was guilty of misdeeds (his run-in with the FDA, his flawed Vitamin Advisor, his seasonal supplements, his recommendations for rheumatoid arthritis, etc.). And I considered Relman to be eminently reliable as a secondary source. She said:

I agree that the Relman article was a good one to reference, and it was a good idea to link to it and other articles. But we do want to provide readers with primary sources, at least for a story’s strongest claims. I agree with your interpretation of the data, but in part for the sake of readers who don’t agree or aren’t convinced, it’s best to provide the raw data (in this case, Weil’s own words) so readers can judge for themselves.

One problem with that is that readers are not good at judging for themselves. If they were, Weil could never have risen to such prominence.

I’m Not Cut Out for This

I am not an investigative reporter but a doctor who comments on the news from a science-based medical perspective. The editor knew that when she originally approached me to write for Slate after reading my work on SBM and elsewhere. Before she rejected my Weil article she had accepted and published my article on acupuncture in the military. The editing process for that article was relatively painless. She tightened and improved my text, and she even made it more forceful and controversial by giving it an inflammatory title and calling acupuncture “quackery” (I had deliberately avoided using that word but I let her persuade me to use it, which I now regret).

This was my second foray into popular media after my painful experience with O, The Oprah Magazine. I thought this time it was going to be better. I was disappointed. She did say she would be happy to run other stories by me in the future, but I don’t know…I don’t need the money (a token $100 per article) and I don’t need the hassle. My writing on SBM is unpaid, and it doesn’t reach as many readers; but it maintains my independence and integrity. Like Frank Sinatra, I can be proud that “I did it my way.”