We often get asked how Slow Medicine aligns with, contrasts, and overlaps with complementary, alternative, and traditional approaches to medical care. Andrew Weil's recent book highlights both the alignments and the divergences.
Weil directs the . He and his fellow integrative medicine practitioners practice standard western medicine, but they also utilize complementary and alternative practices, and advocate for a greater focus on wellness, with a shift away from the medicalization of common ailments.
The book lays out a compelling indictment of our modern healthcare system, which Weil describes as invasive, wasteful, and expensive. Weil underscores how we are too fast to jump to pharmacological solutions, and explains how many of the medications we use trigger unintended consequences that may be as bad or worse than the problems they aim to treat. We couldn't agree more.
Weil's book also highlights the opportunity for alternative approaches as a substitute for medications. For example, after explaining the problems with many commonly used psychiatric medications, including the potential for dependence, he suggests lifestyle approaches for managing mental health conditions, such as meditation and yoga. Similarly, he advocates for dietary approaches for dyslipidemia, rather than early use of medications. So far, this sounds quite consistent with our Slow Medicine philosophy.
But where we lose Weil is when he casually describes the potential for botanicals and natural substances to cure disease, sometimes in the place of standard evidence-based therapies. He claims, for example, that a "freeze-dried preparation of the leaves of stinging nettle" relieves symptoms of hay fever, and that "extracts of the root of valerian" help to treat insomnia. Weil also asserts that extracts of the seeds of milk thistle "protect the liver from toxic injury," and he suggests that red yeast rice is a safe and effective substitute for statin medications for the management of dyslipidemia.
While we are sympathetic to the concept of simple, natural remedies for managing common ailments – particularly as a substitute for expensive, ineffective, and potentially harmful pharmacologic agents – we believe complementary and alternative remedies must be held to rigorous evidence-based standards. Although there may be anecdotal evidence to support some of the claims noted above, the science behind these assertions is weak in many cases.
Thoughtful practitioners of complementary and alternative medicine, such as Weil, often acknowledge this shortcoming. However, Weil and other advocates argue that because these therapies are "natural," the potential for harm is low. Thus, it may be okay to hold these therapies to lower standards.
On this point we differ. Because of the pioneering work of our colleague Pieter Cohen, MD, and others, we now know that even so-called "natural" therapies may be dangerous. For example, CDC investigators estimate that roughly seek emergency care each year due to adverse reactions to supplements.
Moreover, many of the compounds that Weil and other complementary and alternative medicine practitioners promote to consumers as natural remedies, vitamins, and dietary supplements aren't actually all that "natural." Many supplements sold at retail supplement stores in the U.S. contain new drugs similar in structure to , , and even . Many commercial supplements do not even contain the substances listed on the bottle. And even when they do, the concentrations are unpredictable. In one recent analysis, researchers showed that commercially available red yeast rice contains of the active ingredient, making it a sub-optimal therapy for treating dyslipidemia.
Furthermore, because supplements and herbal remedies are , the packages often contain unsupported and misleading claims. This may trigger consumers to forsake proven therapies and waste precious financial resources on ineffective treatments.
All else being equal, we favor simple, natural approaches rather than invasive treatments for both maintaining wellness and managing disease. We also believe in commonsense: we do not need to prove the safety and efficacy of simple lifestyle interventions, such as deep breathing exercises. In many cases, these therapies are beneficial simply because they engage patients in their health, providing psychological benefits (which some might term a "placebo effect"). There is no need for expensive randomized trials to assess how well these approaches work (though there certainly is value in doing so in some cases).
On the other hand, not all "natural" therapies are inherently benign. In fact, they can be outright dangerous. Our Slow Medicine teachings will continue to promote complementary and alternative approaches when we have rigorous supporting evidence – or at least good reason to believe – these approaches are as safe and effective as conventional therapies. But we will not recommend these therapies at the expense of what we know works.
There is great need for more rigor in this burgeoning field.
"Updates in Slow Medicine" applies the latest medical research to support a thoughtful approach to clinical care. It is produced by , of Harvard Medical School, and , of the Keck School of Medicine at the University of Southern California. , is a palliative care fellow at Mount Sinai Hospital in New York. To learn more, .