White Coat Underground

The wild Weil world of woo

Dr. Weil is often seen as the smiling “mainstream” of alternative medicine. He’s a real doctor (unlike, say, Gary Null), and much of what he advocates is standard and uncontroversial nutritional advice. But Weil illustrates the two biggest problems with so-called alternative medicne: once you’ve decided science is dispensible, the door is open to anything, no matter how insane; and no matter how altruistic you may start, sooner or later you start selling snake oil. Most doctors out there are working hard to help their patients prevent and overcome disease use the available evidence.  Others decide that science is too constraining and start practicing at the periphery of knowledge, throwing plausibility and ethics to the wind.  

The fact that Weil claims to donate to charity all of his ill-gotten gains does not mitigate the harm he causes.  

The flu pandemic has been challenging to all of us who practice medicine.  We try to keep up day to day with the latest numbers, evidence, and best practices, while trying not to worry about getting ill.  And since the vaccine isn’t widely available yet, we also worry about our family’s health.  So we go about our work every day, wearing masks when appropriate and washing hands frequently.  If the numbers reach a certain threshold, we will implement sophisticated pandemic plans.

All of that is rather hard, though, so perhaps we should just throw caution to the wind and start selling flu snake oil just like the smiling Dr. Weil.

The FDA and FTC have let Weil know in very clear terms that his fake flu remedies are being marketed illegally.  Weil has taken the site down, but here’s a relevant screen shot:

i-0e6b38e9d8564227276dd3dd6d95d210-weilwoo-thumb-130x104-20927.jpg

  Click to embiggen

If you’ll recall, quacks are allowed to market just about any health product as long as they use their “get out of jail free card”, the Quack Miranda Warning.  The warning itself is a travesty, allowing any kind of absurd claims.  But Weil apparently forgot to use it recently. The FDA’s letter, dated October 15, 2009, states:
 
This is to advise you that the United States Food and Drug Administration (“FDA”) and the United States Federal Trade Commission (“FTC”) reviewed your website at the Internet address www.drweil.com on October 13, 2009. The FDA has determined that your website offers a product for sale that is intended to diagnose, mitigate, prevent, treat or cure the H1N1 Flu Virus in people. This product has not been approved, cleared, or otherwise authorized by FDA for use in the diagnosis, mitigation, prevention, treatment, or cure of the H1N1 Flu Virus.

That’s bad. What language did they object to?  The CDC has asked the FDA and FTC to help protect consumers from medical fraud due to flu fears.  The letter lays out all of the specifics, but  basically Weil claimed that some particular supplements that he sells will prevent the flu.  

Worried About Flu? Dr. Weil’s Immune Support Formula can help maintain a strong defense against the flu. It contains astragalus, a traditional herb that boosts immunity. Buy it now in one click, and start protecting your immune system against flu this season. 

 [...]

[L]earn more about Dr. Weil’s Immune Support Formula, which contains astragalus – an herb Dr. Weil recommends to help ward off colds and flu.

This is bad. The altmed folks often complain that the medical community doesn’t have much evidence to support some of our flu claims. One intervention frequently targeted is the use of masks, for which data is limited. But why be picky about masks, vaccination (for which data isn’t limited) and oseltamivir, while at the same time boosting a botanical with no evidence behind it’s use? There are two reasons. One is financial. The multi-billion dollar alternative pharmaceutical industry like it’s profits, and uses them to protect their market share through the support of such friendly officials as Tom Harkin and Orrin Hatch

The other is religious.  The altmed community believes in this stuff.  They take it on faith that various botanicals will be effective, whether or not testing confirms this.  They object to the modern approach to health that eschews shamanism and demands professionalism.  They see it as elitist, exclusionary, and unfair. They want personal wisdom to be taken seriously as an alternative to science-based medicine. This wisdom can and is taken seriously.  That’s how we come up with hypotheses to test.  But if an hypothesis doesn’t pan out, it’s time to move on.
Or, you can just ignore the evidence and use a current health scare to promote your beliefs and sell a product.  Bravo, Dr. Weil, and welcome to the Dark Side. 

Comments

  1. #1 Denice Walter
    October 18, 2009

    Pal, you hit on a very important fact: those who yell,”Pharma shill!” the loudest are often those who are extremely well-to-do because of their *own* shilling of pseudo-pharmacopaeia. While Adams has proved more slippery to research (and believe me, this is quite a slippery, slimey lot),I found some financial data on Null worth repeating: (from Spoke.com) total yearly sales, “between $1 and $10(million)”,employing ” between 50 and 100 people”;from his own website, sales can be inferred to a more realistic “between $1 and $5 (million)”-see his “economic stimulus plan”(sic); marketing agreements.A quick scan of the aforementioned idiots’ websites, as well as that of Mercola,shows the expanse of their entrepreneurship :web catalogues of products,”educational”(sic) offerings,offices,personal properties,employee searches,and “charity”(sic) ventures.Not small-time snake-oil at all.

  2. #2 craig
    October 18, 2009

    don’t take anything pal says seriously. read some of his political rants in the archives. the man is off.

  3. #3 Katharine
    October 18, 2009

    Craig, I bet you’re an antivaxxer.

  4. #4 chad
    October 18, 2009

    I think it is short sighted to dismiss all altmed views. I think the conventional medicine doctors want the best for people but they are often too closed minded to really give the ‘best’ treatment. One example is asthma, the current conventional treatment is to put kids on inhaled steroids and rescue inhalers when needed. Then they say a child ‘may’ outgrow the asthma. How would you know? Conventional care calls for continuously increasing dosage of the inhaled steroids as the child ages. I have personal experience with this and it wasn’t until we found a ND and like minded MD that we actually got our child off asthma medication. Turned out that food allergies, air allergies, and poor diet were all contributing factors. We found a clinic that does sub lingual allergy drops to de-sensitize the allergies and we followed the advice of the ND for diet and exercise. Guess what.. No medication for the last 3 years. Now that is what I call medical care. People need to take more personal responsibility for their own health and stop relying on pills and medicine to cure every thing that ails them

  5. #5 chad
    October 18, 2009

    @craig I could not agree more with you

  6. #6 KT
    October 18, 2009

    Chad,

    Having just come off a pediatrics rotation at a busy inner-city community hospital where asthma is the most common peds ED presentation, I’d like to point out how very wrong your statements on asthma are.

    The 2009 asthma treatment guidelines are very similar to those for the last decade. Treatment is based on the severity of the asthma and whether or not the child is well-controlled (ie, not having symptoms). If the child is symptom-free, the guidelines call for reduction in a step in treatment to see if they are still well-controlled. Guess what? If they are still well-controlled, you go down another step, and so forth. Pediatricians in this poor neighborhood routinely try to wean children off asthma medications. No one argues for stepping up treatment unless the child isn’t responding to current treatment.

    Either your child truly outgrew the asthma, or you’re undertreating your child because you don’t recognize his/her asthma symptoms. But your one pediatrician who increased the meds “because the child aged” was either doing so because he thought the kid wasn’t well-controlled, or because he was blatantly ignoring treatment guidelines. If it’s the latter, he should be seen as an anecdote of bad medicine and not generalizable to the entire population.

  7. #7 chad
    October 18, 2009

    @kt I guess for us we discovered our chid had food allergies that would excerbate her asthma. When we identified and avoid the foods, de-sensitize air allergans, take fish oil and probiotics we do not have any issues. We still keep albuterol with us just in case but we have no need for it as long as we keep our diet clean and avoid triggers. Our pediartician NEVER mentoned any of this with us and was quick with a prescription rather than teaching us how to avoid medication. I will be the first to admit lifestyle change is difficult but if you take it serious the health benefits are life changing.

  8. #8 chad
    October 18, 2009

    I would also like to mention that our entire family followed the lifestyle change. I lost 80 lbs, my wife lost weight in additition I have not taken medicine, including OTC, in 5 years

  9. #9 David
    October 18, 2009

    Pal, good post. The fake claims by people like Weil make me sick. He should know better (he does have a degree and works at a legitimate medical center side-by-side with real doctors). But you didn’t close the loop. Weil went to far on this one, by actually claiming to prevent a disease. Had he just used the usual quack format “supports immune function which is vital in staying healthy during a flu epidemic” he wouldn’t have gotten the FDA wrist-slap. This is the closure in the loop: the quack community has quack-friendly congressmen & senators who protect their interests by writing laws that exclude them from FDA regulations, so long as they keep to the bland wording.

    The full loop is: quack claims make money -> quack businesses become profitable -> donate to Senators Harkin et al -> get laws made that exempt them from standards of evidence -> make evidence-free claims to enhance their revenue. And all the while they pat themselves on the back for avoiding the evil “conventional medicine.”

    Read http://www.fda.gov/Food/DietarySupplements/default.htm

  10. #10 David
    October 18, 2009

    forgot my disclaimer: I actually am a pharma shill. I work for a small pharma company. My company doesn’t manufacture vaccines or any flu treatments. My opinion is not necessarily the opinion of my employer. etc, etc…

  11. #11 titmouse
    October 18, 2009

    chad, it may be that the interventions you described are helpful for the conditions you mention.

    Why don’t we require that those advocating for these treatments prove their safety and efficacy with appropriate controls, so we can have confidence in these things?

  12. #12 chad
    October 18, 2009

    @titmouse I would agree that it would be good to have control studies on lifestyle/supplements but unfortunately I don’t feel it is possible because a large number of people would have a hard time following the life style changes. I am fortunate enough to have a good job and my wife stays home with our kids. She does a LOT of cooking, we make most things from scratch and we don’t eat frozen or prepared foods. In the typical household where both parents work full time they don’t have the time to prepare all the foods from scratch so they resort to convenience foods such as frozen meals, microwave meals or eating out. If my wife worked full time it would be difficult to eat the way we do now. We also spend a large portion of our money on fresh organic produce, grass fed meats and other high quality foods that tend to cost more than your typical groceries. Unfortunately if you don’t have access to a good co-op you have a hard time even finding the good quality local produce and meats. My feeling toward the lifestyle change is what is the harm? You are not going to make your health worse by eating better an exercising so why not give it a try and see how you feel

  13. #13 chad
    October 18, 2009

    @kt I am wondering why the average doctors do not mention nor advise asthma patients to get tested for food allergies and sensitivities? Is this to ‘woo’ for most doctors? Same with vitamin D testing or advising intake of fish oil for the inflammatory disease. The doctors are very quick at yelling ‘quak’ whenever some treatment is not the norm. Perhaps the pediatrician we were seeing is not representative of all doctors, on the same token, perhaps these so called woo doctors are not representative of all ND’s or other non traditional doctors.

  14. #14 history punk
    October 18, 2009

    “We also spend a large portion of our money on fresh organic produce, grass fed meats and other high quality foods that tend to cost more than your typical groceries.”

    You pay extra for antique, medieval technologies? Nice.

  15. #15 Diane
    October 18, 2009

    Just to trade anecdotes–our child outgrew his asthma with no intervention by an ND, no probiotics, no food restrictions, no crazy diet. So how do you know that your child got better because of what you did?

  16. #16 daijiyobu
    October 18, 2009

    Chad, here’s my asthma-ND anecdote: I outgrew my childhood asthma, actually went to ND school for four years in CT, was disgusted with their SO LOW academic standards and their lack of ethics…

    And I’d never visit one, never mind subject a child to one.

    -r.c.

  17. #17 Adam Cuerden
    October 19, 2009

    There be charities and there be charities. According to that screenshot, all profits go into a charity set up to promote quackery.

    It’d be better had he kept the money.

  18. #18 micheleinmichigan
    October 19, 2009

    history punk – medieval techniques, I don’t know. Some of us have concerns that increased antibiotic use in livestock and diary animals is increasing antibiotic resistance strains of bacteria. Does medival mean not feeding cattle the remain of sick cattle (and the same for chickens)? I don’t think that all modern agriculture is bad, but I do think it has it’s problems and I think consumers looking at foods that are grown in a healthier or more sustainable way is appropriate.

    Chad – I have asthma and the first thing you do for asthma is treat it with medication. A lot of pediatrician try to avoid long term use of asthma medications when possible. I have found working with a pediatrician has to be a partnership. They will not predict all your concerns. You need to ask. You could have asked about what to do about triggers, asked for a referral to a specialist or switched doctors. Allergy testing, Immunotherapy and researching triggers are certainly not outside the realm of Science Based Medicine.

    To be perfectly honest, I can’t imagine an exercise regime that could have much effect on reducing asthma and unless there are specific food allergies, I don’t see going totally organic/homemade as essential. Eliminating one trigger can do a world of good though. One of my triggers is mold. I stopped working in a place with a leaky roof and wow, I hardly ever need my medication. My BIL has severe asthma, but is generally good unless there’s a cat around.

  19. #19 chad
    October 19, 2009

    @micheleinmichigan I would agree that working with a doctor should be a partnership. This is the reason we asked about the possibility of food allergies causing the asthma and was told by the pediatrician diet has nothing to do with it and she was not willing to accept that it did. In addition, she felt that medication was the only way to treat it. We did find a new pediatrician and we have worked with her since. My child still has asthma but with the Immunotherapy and better diet (she is allergic to wheat, gluten) we hope to avoid it. Like I said we still have Albuterol on hand if needed but it is very rare that we need it.

  20. #20 bob
    October 19, 2009

    chad, I frankly just don’t believe you or your stories. I had childhood asthma, and the first thing the doctors did was figure out what I was allergic to. Then, they told my parents to do everything possible to avoid these allergens (which could trigger an asthma attack) and began allergy shots.

    I have a hard time believing your child’s doctors didn’t do this. I’m guessing they weren’t nice enough, and the ND you went to spent more time talking to you and listening to your “theories” about what was happening.

    Also, the ND told your whole family to be healthy in general … whoop-de-doo. I’m sure your regular doctor also told you to eat healthily, you just weren’t listening.

  21. #21 chad
    October 19, 2009

    @bob eating healthy is common sense.. What is not common sense it finding foods you are allergic too. This is where the ND helped us. The IGE tests show high response to wheat and gluten. Typical doctors (in my experience) may do a RAST test for mold, pollen but they tend to dismiss food allergies. This is the reason celiac disease was undiagnosed for so long IMHO.

  22. #22 BB
    October 19, 2009

    One can have asthma in the absence of allergies; it’s called intrinsic asthma by some and it needs to be treated the same way as allergic asthma.
    A child with allergies needs appropriate anti-allergy medication; what happens at friends’ houses, in school, etc where SAHM isn’t there to provide food from co-op?
    Disclosure: I’m an asthmatic, my entire family are asthmatics and we keep breathing because we take appropriate meds. If you keep your child off anti-asthma/anti-allergy meds, you are keeping potentially life-saving tools away from your child.

  23. #23 bob
    October 19, 2009

    chad, I’m sorry to say that you aren’t helping your credibility. What does celiac disease have to do with asthma? I’m not a doctor, but I really don’t see any connection, or even any chance of there being a connection. Also, your story seems to be getting inconsistent: did your original doctor screen for allergies or not?

    As for eating healthy being common sense, what is you point? If eating healthy was merely common sense, why are you singing your ND’s praises for recommending it?

    BB, my bad if I implied asthma necessarily implies allergies. But, I have to imagine that they’re routinely tested for when someone goes to the doctor with asthma symptoms.

  24. #24 chad
    October 19, 2009

    @bob celiac has nothing to do with asthma, all I was trying to point out was that your typical doctors usually do not think of food allergies as a problem. Our pediatrician did not do allergy testing nor recommend it. We had RAST blood test done at the allergy clinic that we do immune therapy. This clinic was recommended to us by the ND and this allergy clinic is part of the Mayo clinic. What our ND did for us was to suggest food may be part of the problem and get us a blood test for IGE and IGG and helped with an elimination diet for some time. The clinic with sublingual immune therapy has been wonderful and they actually agree with the treatment our ND suggested (the supplements and diet). All I am saying is some ND’s do give good sound advice and are very helpful. It is foolish to dismiss anybody that doesn’t have an MD as woo doctors

  25. #25 Calli Arcale
    October 19, 2009

    chad: I have asthma, and would like to offer some helpful advice. ;-)

    It is not that uncommon for asthma to go completely into remission for years at a time. I was diagnosed with exercise induced asthma when I was in grade school. By the end of high school, it wasn’t really a problem anymore, and by the time I got married, I only carried an inhaler “in case” and never even used it. It’s back now, and worse than ever. I just finished a course of prednisone. I’m really hoping I don’t get influenza this year!

    So keep an eye out; the asthma may return. You may want to get a peak flow meter while your child is healthy, to establish a good baseline reading, so you can tell when the ability to move air becomes impaired. If you didn’t have the chance to find out what your child’s triggers were, it would be good to watch for that if/when the asthma returns. Many times, asthma can be controlled just by being careful with the triggers. Allergies can be a trigger, but there are other possibilities. (They don’t trigger my asthma, for instance. Mine’s exercise-induced.)

    Allergy tests are usually not recommended unless the symptoms are sufficiently severe, the patient requests it, and/or it’s not been possible to deduce the cause already. There are two basic kinds of allergy tests. One is the blood tests your familiar with. The other kind is what I had — your back is marked out in a grid, then allergens are poked into it so they can see how you react. Not a lot of fun. ;-) I think that challenge-response type test is the gold standard, but it’s fairly traumatic for a little kid. (Took three nurses to hold me down. I was *not* happy about it. But I was glad of it afterwards, even if it did mean saying goodbye to the family cat.)

    BTW, celiac disease isn’t even an allergy. It’s far more insidious than an allergy, and cannot be treated by antihistamines. The *only* solution is to avoid gluten entirely. (Basically, the immune system itself has a defect where it can’t tell the difference between the “kill me now!” chemical signals given out by infected cells and digested gluten absorbed through the cilia. So it dutifully goes and kills cells in the intestinal lining. Nasty. I have a cousin with that, and it’s REALLY hard to diagnose. Allergy tests don’t reveal it.)

    Oh, and although I confess to some skepticism on this one, my doctors have been saying there’s a connection between asthma and acid reflux disease. Indeed, I do have GERD. It runs in the family. However, severity of the symptoms has, for me, had no relationship with severity of my asthma symptoms, and I don’t see why they’d be related. Still, may be worth keeping an eye out for that too. Notably, while the one celiac sprue case in my family has no other allergy/asthma/GERD problems, it suddenly occurs to me that there *is* a strong correlation between allergy/asthma/GERD in my family. Curious. (Only one person in my family has GERD but not asthma, and he does have allergies. And the worst GERD cases are all asthmatic. Still, it’s a small sample, and it might just be a genetic coincidence.)

  26. #26 Calli Arcale
    October 19, 2009

    Heh — I’m too verbose; my comment is in moderation. ;-) chad, I have asthma and have posted some suggestions that may be helpful. Short version: asthma can come back (mine was in remission for years) so always keep an eye out for it, just in case.

  27. #27 chad
    October 19, 2009

    @Calli Thank you for your insight I appreciate it

  28. #28 craig
    October 20, 2009

    #3 katharine. sorry, you be wrong. just got my n1h1. and i still think palmd is one sandwich short of a picnic.

  29. #29 Philip Tan-Gatue, MD
    November 18, 2009

    Just a quick note about astragalus: research has shown it may make cell division more efficient, but I agree that to market it as some cure-all flu remedy isn’t going to work, even from a Chinese perspective. Chinese Medicine would classify H1N1 as a “warm” disease, marked by inflammation. It would classify it, depending on stage, into one of four “levels”, each with it’s own methods of treatment (which PalMD won’t accept but I mention it more to show why it’s dangerous to generalize that astragalus is a cure all)

    some evidence on how astragalus might work
    http://www.jimmunol.org/cgi/content/full/181/10/7400

    sloan kettering site talks about astragalus
    http://www.mskcc.org/mskcc/html/69128.cfm

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