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Two Pros Duke It Out Over Alternative Medicine

TIMES HEALTH WRITER

Professional relationships in medicine tend to be genteel to the point of boring. Sure, disagreements and ego clashes occur all the time, but they are usually quiet affairs, rarely surfacing outside of hospital, laboratory and medical school corridors of gossip.

So, when two icons of American medicine toss off their white coats and go public with their feud, the issue is bound to be a sizzler.

In this case, it’s alternative medicine.

The skirmish is launched in today’s issue of the liberal opinion journal the New Republic, in which Dr. Arnold S. Relman, former editor of the prestigious New England Journal of Medicine, shreds the career of his onetime medical student from Harvard, alternative medicine guru Dr. Andrew Weil.

Weil has authored several bestselling books on alternative medicine, hosted a hit PBS special and appeared on the cover of Time magazine last year. Not to be cowed by his former teacher, Weil has posted a response on his Web site (https://www.drweil.com) and whipped off a rebuttal letter to New Republic Editor Chuck Lang.

And the debate between the two men over alternative medicine and its role in modern health care won’t end there. Relman and Weil have tentatively agreed to a face-to-face debate in April at a medical ethics conference at the University of Arizona, where Weil teaches.

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It’s enough to make any scientist pull his or her nose out of a beaker and dash to the nearest newsstand.

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The clash comes at a time when many medical professionals are seeking common ground between conventional and alternative medicine. Indeed, the term “integrative medicine,” which signals the blending of both fields, is now in vogue. The melding of the two approaches is apparent in the explosion of alternative benefits, including acupuncture and Chinese herbs, being added to insurance plans. And some of the nation’s most prominent medical schools now offer alternative medicine classes to students.

It’s that type of public acceptance that hard-liners on the issue, like Relman, may find so alarming. The feisty Relman is also known for his pointed criticism of HMOs and their influence on medicine.

“Here is Dr. Weil, who is extremely well-known but whose work raises significant scientific issues, and someone as responsible and well-known as Dr. Relman takes him on,” Lang said. “It’s a battle royale.”

The lengthy New Republic piece--which Relman says he was asked to write about six months ago by New Republic literary editor Leon Wieseltier--is an exhaustive review of Weil’s eight books. The magazine’s cover features an illustration of Weil with the headline: “Should You Trust This Man With Your Life? Why Dr. Andrew Weil’s Home Remedies Are No Alternative to Real Medicine.”

In unsparing terms, Relman describes the gaping faults of the alternative medicine movement and blasts Weil for his role as its leader. Generally, Weil advocates such basic disease-prevention measures as a healthy diet and exercise. He is also a proponent of particular breathing techniques, meditation and the use of vitamin and herb supplements. While he applauds traditional medicine as the best system for acute and emergency care, Weil believes alternative methods may be superior in maintaining health and treating chronic, nonfatal illnesses.

But Relman sees him as trouble.

“If Deepak Chopra is the mystical poet-laureate of the movement, then Weil is its heavy-duty theoretician and apologist,” Relman writes. “No longer the angry young rebel, he has become the urbane and supremely self-assured CEO of alternative medicine, who is seeking to reshape the medical establishment that he once scorned.”

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Relman notes that Weil was trained at Harvard Medical School, where Relman taught. At Harvard, Weil showed himself as an insurgent by choosing to conduct research on the effects of marijuana and other mind-altering substances on health.

“I’ve had some interest in this man who had gone to Harvard College and Harvard Medical School and was obviously a rebel, a maverick who didn’t buy into the ideas of mainstream medicine, and was a serious critic,” Relman said in an interview.

Relman’s article deals at length with a chapter titled “A Trip to Stonesville” from Weil’s 1972 book, “The Natural Mind.” The chapter details Weil’s belief that valuable insights can emerge from altered states of consciousness and that intuitive beliefs can push the frontiers of knowledge.

“That chapter dumbfounded me,” Relman said. “It hit me that this was the explanation for what I consider to be the odd, unconventional and often irrational attitude of people like Weil who champion alternative medicine. It explained a lot about their attitude.”

Weil notes that his first book is now 26 years old and reflects a time in society when there was a fascination with mind-altering substances.

“That is old work of mine,” Weil says. But he adds: “The ideas I develop in that first book were the seeds of my thinking. I said then that these highs come from within the central nervous system. Drugs trigger that. Now I’m saying that health also comes from within.”

Relman defends dredging up Weil’s past.

“You would think that he would say, ‘Oh, well, that was when I was young.’ But in a preface of that book which was reissued this year, Weil says he stands by it!” Relman says, incredulously.

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Relman voices a common criticism of alternative medicine that many of its treatments have not been proved scientifically and are weakly supported by anecdotes. Relman takes Weil to task for failing to document the truthfulness of anecdotes included in his book. (Relman cites as an example a story in Weil’s 1995 bestseller, “Spontaneous Healing,” about a man with scleroderma--a severely debilitating condition in which the skin and internal organs harden--who cured himself with vinegar, lemons, aloe vera juice and vitamin E.)

“Like most good, experienced doctors, I am driven by the scientific evidence,” Relman said. “I say to Andy Weil: ‘Where is your evidence?’ ”

While Relman’s article generally avoids attacking Weil personally, he does write snappishly: “Weil considers himself an authority on almost every field of medicine.”

Why take Weil to the mat now? Relman says it’s coincidence that the piece follows just one month after the American Medical Assn. published dozens of articles on alternative medicine, many of which were fairly positive assessments, such as findings that some herbs may provide better treatments than conventional care.

And both Relman and the New Republic’s Lang deny that the critique stems from any resentment on the part of the Harvard elite that Weil promotes his Harvard training to establish credibility with the public while at the same time disavowing much of his training. Harvard has actually been one of the medical colleges most open to alternative medicine training for its students.

Relman taught at Harvard, and New Republic Editor in Chief and Chairman Martin Peretz teaches there now. Both Lang and literary editor Wieseltier attended Harvard.

“Is this Harvard Medical School getting back at Weil? We do crazy things, but I don’t think we’re that crazy,” Lang said. Weil, however, said he thinks Relman’s article reflects some long-standing animosity dating back to his Harvard days and an attempt by the New England Journal of Medicine to take a stand against alternative medicine that is quite counter to the neutrality of the AMA journals. (AMA officials wouldn’t comment on the controversy.)

Weil points to a sharp editorial in the Sept. 17 issue of the highly regarded New England Journal that also detailed the many pitfalls of alternative medicine, though not mentioning Weil. That editorial was co-written by the journal’s editor, Jerome P. Kassirer, and executive editor, Marcia Angell, who lives with Relman. Relman is editor in chief emeritus at the New England Journal of Medicine.

“I do believe there is something personal about this,” Weil said in an interview. “Relman was a teacher of mine in medical school, but I have had no contact with him since. I think he is fascinated with me.”

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The timing of the article is interesting for another reason, said Weil: “This article reflects the fact that this movement has gotten to the point that the medical establishment can’t ignore this. I am really rather pleased by all this. I sound much more interesting in the article than he does.”

However, opinions on Relman’s critique demonstrate the deep polarization on alternative medicine.

“I thought that Relman gave the devil his due,” Kassirer said. “I thought he scrupulously gave Weil credit for the kinds of approaches he promotes, including exercise and watching what you eat, that we know are important. At the same time, I think Relman was justifiably critical of the unsubstantiated proposals Weil makes.

“Our editorial and Dr. Relman’s point toward the same goal, and that is to expose these practices and treatments for what they are, and that--for the most part--is untested and unregulated.”

Michael Goldstein, a professor of public health at UCLA and the author of an upcoming book about alternative medicine, says that the Relman and Weil fracas is about the weaknesses in both alternative medicine and the faults of conventional care.

“The real battle isn’t between Relman and Weil. The real question is why are so many people using alternative medicine? There is something in Weil’s work that fills a void. Relman doesn’t speak to that void.”


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