Although the launch of the “integrative medicine” movement in this country may have depended on the face and fame of Dr. Andrew Weil, its rapid spread nationwide is now out of his hands.
His train – built here at the University of Arizona – has left the station.
No longer the solo act of a single doctor, “integrative medicine” – the blending of conventional mainstream Western medicine with more nature-based alternative therapies – is fanning out across the country faster than anyone had predicted.
Though still controversial, it is a medical revolution now fueled by growing legions of doctors burned out by a broken health care system, responding to patients demanding better treatment from them.
Many of these doctors have been trained by Weil – fulfilling his vision that they go forth and multiply after he opened the first university-based integrative medicine, or IM, program in the nation – at the UA – in 1996. Fourteen UA-spawned IM clinics are now operating throughout the country and more than 100 UA-trained doctors are practicing integrated medicine in the United States, Canada, Puerto Rico and Japan.
Others have jumped on the IM bandwagon on their own.
“It was a little unnerving at first – when Andy Weil was the only person showing you this is worthwhile,” said Dr. Karen Koffler, one of the first out-of-state physicians to take the two-year training course in integrative medicine at the UA.
A highly conventional critical care specialist, she was at first filled with doubts during training, feeling that some of the alternative therapies were outright frauds. Today, Koffler is director of her own thriving IM clinic in Evanston, Ill.
“I’ve never seen such good results,” she said, speaking of the many patients she has treated in the Midwest since her clinic opened in 2001.
“I’ve learned how to balance the intellectual processes of medicine with an intuitive understanding of what this person, this patient really needs to gain strength for healing. That is never taught in medical school and is lost entirely from medicine now.”
Working within the system
Koffler was stunned by the early and large demand for this brand of medicine in that region.
“Here I am in the Midwest, where I expected it to be much more conservative, less open to this. But people were finding me even before I left the UA. There is no problem with a shortage of patients at all,” she said, noting her clinic sees about 350 patients a month, even though most of them must – and are willing to – pay out of pocket for this care.
Koffler is one of 28 mainstream physicians from around the country who have chosen to change the way they practice medicine by taking the two-year IM fellowship training at the UA under Weil.
Since the first class of “IM fellows” graduated in 1999, 14 have opened their own IM centers coast-to-coast – from New York City to Portland, Ore. Others have simply blended the integrative therapies into their own private or academic practices.
“The whole goal of Dr. Weil’s program was not to just have us graduate and then hang up our own shingle. It is to send us out to work within the existing health system, with all of our colleagues, to spread an understanding of this kind of medicine,” said Dr. Russell Greenfield, an emergency physician who took Weil’s training after 10 years of ER work in North Carolina. He returned to open the Carolinas Integrative Health clinic in Charlotte in the summer of 2001.
But unlike Koffler’s high-demand experience in the Chicago area, Greenfield ran into a wall of distrust and resistance in the conservative Deep South.
“It has taken us quite a while to pick up steam. We had to spend that first year explaining what we’re not, so people would not be afraid of us. We are not ‘alternative’ medicine. That implies we do these therapies instead of conventional care. Not true. The goal is to find the right combination for each patient.”
Greenfield’s most hostile audiences in the South have been his peers – other physicians.
“I tell them ‘I’m one of you’ and that we have the data – we have the studies, we’re not making this up,” he said. Examples are published studies showing the beneficial effect of saw palmetto on enlarged prostates, and how massage therapy can ease lower back pain with fewer side effects than drugs.
After all this difficult trailblazing, Greenfield’s clinic is finally getting up to speed, drawing enough patients to make it solvent. The trend went positive about a year ago, with this December his busiest month ever.
Like so many IM doctors, Greenfield decided to take Weil’s training after witnessing the disaster of mainstream medicine through the ER.
“We saw people all the time in the ER because they could not get in to see a doctor, and if they did, they only got a few minutes and nobody listened to them. The doctors in the system feel the same way,” he said. “It’s broken.”
Spreading the word
A school with no dropouts, the UA’s on-site IM training was only the first wave of spreading this gospel. What has really sent it far and wide is what the UA calls “associate fellows” distance-training. Taken through the Internet, it does not require physicians to pull up stakes and move to Tucson for two years.
To date, some 166 doctors have done it, with more than 60 practicing some form of integrative medicine in 20 states, and Canada, Puerto Rico and Japan.
“That’s what really swayed me,” said Dr. Raymond Woos-ley, who, as the UA’s vice president for health sciences, is in a position to shut Weil down if he deems the program unworthy or unsuccessful.
“I felt Weil would never be able to succeed if he was training only three or four doctors at a time. It would be almost impossible to create the critical mass to change the culture of medicine.
“But now, with the distance-training, he is having that impact. My only concern now is we need to clone him.”
“One of the skeptics” when he got to the UA in 2001, Woosley said he’s on this IM bandwagon wholeheartedly now.
“Andy wants doctors to care about patients and give them the time they need. He and I are both very concerned about the doctor who writes a prescription just to get the patient out the door,” he said.
Chicago breast cancer patient Cheryl Oulehla, 52, has used diet, energy medicine, acupuncture and massage therapy at Koffler’s clinic to help get her through surgery, radiation and chemotherapy. The result has been a sense of calm and tolerance, deeper sleep, and a decent appetite, she said.
“I spent a lot of my money to do this, but it is a priority and it has changed my life,” she said. “This is the first doctor – and I’ve had a lot of doctors – that ever sat down and talked to me. Somebody actually wanted to know how I felt, who wanted to hear what I had to say. That never happens.”
“It’s not all bad”
Even the harshest critics of Andrew Weil are now conceding he has caught the wave of what’s wrong with medicine and is riding it for all it’s worth.
“I’m not surprised this hasn’t gone away – it has a lot going for it. It’s not all bad,” said Dr. Arnold Relman, a now-retired professor of medicine at Harvard University (Weil’s alma mater) and the former editor of the New England Journal of Medicine. Relman has publicly and repeatedly attacked Weil and integrative medicine as fraudulent from the get-go.
“This is nothing that I think justifies or legitimizes it, but what Weil does plays to the generalized dissatisfaction with current medical care. …
“One of the reasons this movement has made headway is that it recognizes an important truth – that good medicine and healing require compassionate and caring physicians. But we’ve been saying that for 50 years. Andy’s not the first.”
Relman’s faint praise stops there. Mincing no words, he said Weil offers “belief in miracles” to a country that remains largely distrustful of science and still believing in creationism.
“It’s all about thinking and hoping and wishing – the power of the mind to make things happen,” Relman said, calling Weil “just another snake oil salesman.”
“It’s just the latest thing in mankind’s long history of quackery and fakery and hysteria and charlatans. It’s a romance with irrationalism. It’s a step backward. Andrew Weil is not the messiah. He’s just a shrewd operator.”
Changing the system
And shrewd he will have to be if integrative medicine is ever to fully enter our medical system, Weil is the first to say.
The main thing holding back integrative medicine is that, with few exceptions, little of it is covered by traditional health insurance plans. Most patients must pay out-of-pocket for services, including the initial, leng-thy doctor-patient interview, that can run from $100 to $350. That severely restricts who and how many can actually use it.
“That is the greatest frustration for anybody involved in this. None of us wants to practice what some call ‘elitist’ medicine, available only to the weller-off,” said Greenfield. “We want this available to all segments of society. We want to start early with children, to teach them preventive medicine. We want to help people with predisposition to disease, to help them stave it off. We want to make everybody less reliant on the health care system.”
That will one day happen, Weil insists, because consumer demand is out there. But more critical, integrative medicine is going to prove as effective – but considerably cheaper – than conventional care alone.
“Integrative medicine satisfies patients, and it works. But the main thing is the economics – it is going to save money,” said Weil. “Once we do the large-scale outcome studies and economic analyses to show this, the system will change, within the next two to three years.”
Until it does, many IM clinics are surviving hand-to-mouth, no matter how busy they are with eager patients.
Treating more than 1,300 every month in New York City, the Center for Health & Healing – also run by a Weil protégé – spends too much time fund-raising to keep going, says its medical director.
“It is a heroic challenge, because what reimbursement we do get never covers the time spent with patients,” said Dr. Roberta Lee.
“It’s an art keeping it going.”