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Functional Medicine (FM) What Is It?

Functional Medicine – What is it?

After extensive searching and examination, my answer is still – only the originators of “FM” know. Or, at least one must assume they know, because so far as I can see, I certainly see nothing that distinguishes “FM” from other descriptions of sectarian and “Complementary/Alternative Medicine” practices. A difference may lie in the advocates’ assumptions to have found some “imbalance” of body chemistry or physiology before applying one or more unproved methods or substances. From what I could determine, the “imbalance” or dysfunction is usually either imaginary or at least presumptive. And the general principles are so poorly defined as to allow practioners vast leeway to apply a host of unproven methods.

I figured there would be several ways to find out. One would be to read FM’s material – mainly what “they” placed on the Internet. Another would be to enter the system and find out as a patient or as a prospective practitioner what it is that “FM” claims to be. The third would be to listen to a practitioner or advocate on tape, disk, radio, etc.

I certainly cannot or will not enter as a physician, being retired and a poor spy. So the Net and a local radio talk show host have to suffice. I will take on several of their documents on the Net which one can read oneself, and that I will handle in two truncated reports, and the “FM” practice in a third.

On the Web page (Institute for Functional Medicine), http://www.functionalmedicine.org/index.asp) one finds the following:

Functional medicine is personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease. It is a science-based field of health care.

Stop here. “Personalized medicine”: This is an implied straw man argument, implying that medicine is not personalized. Yet in standard medicine, every person’s case is dealt with as “personalized” by physicians.”

Primary prevention“: This is a valid term originally applied to prevention of disease by modifying the risk factors that contribute to development of disease. There is nothing unique here.

Underlying causes instead of  symptoms”: Another straw man implying that medicine treats only symptoms, not causes – straw man and false.

According to the site, Functional Medicine “… is grounded in the following principles”:

Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals.

“Biochemical individuality” is a trick expression here. It was invented by Dr. Roger Williams of U. Texas 50 years ago to justify administering massive doses of vitamins and other supplements for “optimum health.” Linus Pauling adapted the concept, along with Soffer and Osmond’s massive vitamin concepts of “Orthomolecular Medicine.”  In response to the “orthomolecular” movement, Victor Herbert MD responded that “Orthomolecular Medicine” meant what Humpty Dumpty said about words in Through the Looking Glass: “… it means exactly what I choose it to mean – neither more, nor less. “  No such need for supplements has been discovered.

Patient-centered medicine emphasizes “patient care” rather than “disease care,” following Sir William Osler’s admonition that “It is more important to know what patient has the disease than to know what disease the patient has.”

Another straw man phrasing designed to separate medicine from one of its great teachers, and then to usurp his teaching and turn it into a form he would have rejected.  I have never seen a medical text advising “disease care.”  Diseases are defined and dealt with as entities in order to classify them, analyze them, and to discover treatments for them. This method is called “scientific method.” It is always a patient who is treated, with treatments proved through scientific method.

Dynamic balance of internal and external factors.

This verbiage is too vague and general to allow analysis. It could mean just about anything. To analyze each word combination would not add to understanding. The authors might know what they meant but a reader would not.

Web-like interconnections of physiological factors – an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other. For example, we now know that immunological dysfunctions can promote cardiovascular disease, that dietary imbalances can cause hormonal disturbances, and that environmental exposures can precipitate neurologic syndromes such as Parkinson’s disease.

Here the advocates expose their naivete and lack of comprehension of physiology and patho-physiology.  At the same time they draw conclusions from incomplete and inadequate information (immunologic dysfunction and cardiovascular disease.) A “network of interconnected systems” says nothing other than the body and its organs and tissues are connected and each affects one or more other organs.  Is this new? Only if one misperceives the entire history of science and medicine and the information developed over the past 400 years, then substitutes for that history an entirely fictitious one in which organs are individual organisms that function independently of the others – i.e. the ears are not connected to the brain, which is not connected to the muscles … etc. This false argument is invented in order to present an appearance of special distinction; its purpose being to enable a random, disordered treatment approach of “special,” false distinction.

Health as a positive vitality – not merely the absence of disease.

This definition of “health” as something more than “absence of disease” has been trumpeted for forty or more years and has yet to have developed any meaning, although many people nod their heads in affirmation at its utterance. These are  “Animal Farm” moments, yet a gold mine of them is here in this description.

Promotion of organ reserve as the means to enhance health span.

“Organ reserve?” There is such a thing as “reserve”, but so far as I know there is no “reserve” of an organ that can be built up or augmented by an intentional treatment, diet, life-style change, or supplement. Reserve stores of iron and other metabolic materials and vitamins can be augmented, but reserves of an organ?

The description continues.  Read this section through without interruption if you can. Then read it through again, identifying what is meant by each statement, phrase, and clause.  Reader may see why I will stop the analysis at this point and let the advocate/writer’s words speak. I figured someone must be disguising a leg-pulling exercise here. Or, could it be that someone has misunderstanding of such a degree that would result in such language misuse?

In the next installment I will identify some of the originators and players and try to use examples of how one or more practitioners use “FM”.  Now, try your hand at the following:

Functional medicine is anchored by an examination of the core clinical imbalances that underlie various disease conditions. Those imbalances arise as environmental inputs such as diet, nutrients (including air and water), exercise, and trauma are processed by one’s body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs. The fundamental physiological processes include communication, both outside and inside the cell; bioenergetics, or the transformation of food into energy; replication, repair, and maintenance of structural integrity, from the cellular to the whole body level; elimination of waste; protection and defense; and transport and circulation. The core clinical imbalances that arise from malfunctions within this complex system include:

  • Hormonal and neurotransmitter imbalances
  • Oxidation-reduction imbalances and mitochondropathy
  • Detoxification and biotransformational imbalances
  • Immune imbalances
  • Inflammatory imbalances
  • Digestive, absorptive, and microbiological imbalances
  • Structural imbalances from cellular membrane function to the musculoskeletal system

Imbalances such as these are the precursors to the signs and symptoms by which we detect and label (diagnose) organ system disease. Improving balance – in the patient’s environmental inputs and in the body’s fundamental physiological processes – is the precursor to restoring health and it involves much more than treating the symptoms. Functional medicine is dedicated to improving the management of complex, chronic disease by intervening at multiple levels to address these core clinical imbalances and to restore each patient’s functionality and health. Functional medicine is not a unique and separate body of knowledge. It is grounded in scientific principles and information widely available in medicine today, combining research from various disciplines into highly detailed yet clinically relevant models of disease pathogenesis and effective clinical management.Functional medicine emphasizes a definable and teachable process of integrating multiple knowledge bases within a pragmatic intellectual matrix that focuses on functionality at many levels, rather than a single treatment for a single diagnosis. Functional medicine uses the patient’s story as a key tool for integrating diagnosis, signs and symptoms, and evidence of clinical imbalances into a comprehensive approach to improve both the patient’s environmental inputs and his or her physiological function. It is a clinician’s discipline, and it directly addresses the need to transform the practice of primary care.

Posted in: Basic Science, Herbs & Supplements, Nutrition, Science and Medicine

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14 thoughts on “Functional Medicine (FM) What Is It?

  1. “Functional Disconnection Syndrome” isn’t a perfect match, but there are some similarities: http://bit.ly/EpEcz

  2. pmoran says:

    Annoying stuff.

    Experience shows that it can be difficult enough for the average doctor to home in upon critical patient diagnoses, even after expensive training and despite access to remarkable diagnostic technology.

    How much harder is it going to be for a practitioner whose mind is full of this blather? Important physical diagnoses get missed whenever doctors stop looking for that single, physical diagnosis that best explains the patient’s symptoms and signs. Speaking of “signs”, why is physical examination of the patient not worth a mention in the management plan?

    But of course, this is, as hinted in the text, all about a special kind of “complex, chronic disease”. The author is thinking of prevalent ill-defined illnesses and medical discontents. There is no specific diagnosis and therefore no specific treatment. Keeping the patient busy, preoccupied with suggested causes and “treatment” intricacies may, however, satisfy some patient needs for a while.

    This is also why no specific examples are ever supplied showing how this supposedly unique system of patient management might work in everyday practice. That would expose everything, that treatments are based upon speculative precepts and unproven methods, or else approaches that are routine within doctors’ offices every day.

  3. tanha says:

    I still don’t understand what FM is and why it was created.

    Are FM docs the ones that do hcg shots for weight loss? And who practices FM? Medical docs, osteopaths or naturopaths?

  4. snifferdog says:

    I can’t help but feel that this sort of nonsensical babble is a disingenuous marketing strategy employed by so many peddlers of such garbage. The potential for dire consequences with these half-baked “treatments” and the terrible cost that it can exact on people and their families is immeasurable.

    Surely no reasonable person, even one without any training in science, could sell this muck without having at least some reservations about their therapeutic benefit.

    Deeply disturbing.

    What is even more disconcerting is that “alternative medicine” has been widely accepted as a genuine medicine in the western world, when it has absolutely no solid body of evidence to back up any its claims. As heterogenous as the industry may be it has one colossal commonality: a tremendous load of waffle without any validity.

  5. Sam says:

    Orthomolecular medicine has a slightly different focus than FM. It is definitely science-based and has a simple definition:

    “Orthomolecular medicine describes the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body.”

    Anyone interested can visit the Orthomolecular.org website:

    http://www.orthomolecular.org/resources/omns/

  6. Joe says:

    @Sam on 10 Jul 2009 at 12:37 pm “… Orthomolecular medicine … It is definitely science-based …”

    No, it is definitely quackery. Go to http://www.quackwatch.org and search on the term “orthomolecular.”

  7. David Gorski says:

    Or, for a related deconstruction of the father of Vitamin C’s woo, try this:

    http://www.sciencebasedmedicine.org/?p=188

  8. Wallace Sampson says:

    John Wills Lloyd: “Functional Disconnection Syndrome” isn’t a perfect match, but there are some similarities: http://bit.ly/EpEcz
    WS: Good find. I wonder if the chiropractor had read of “FM”.

    P Moran: …This is also why no specific examples are ever supplied showing how this supposedly unique system of patient management might work in everyday practice. That would expose everything, that treatments are based upon speculative precepts and unproven methods, …
    WS: How true. As we will see in the next two posts, there will be examples, but no specific defining set of principles, methods, or even cases from which one may derive principles that can be applied to the next one.

    tanha: I still don’t understand what FM is and why it was created.
    WS: You are still not alone…
    Are FM docs the ones that do hcg shots for weight loss? And who practices FM? Medical docs, osteopaths or naturopaths?
    WS: The long answers are to come. I divided this set into 3 or more parts because of attention spans and my own time and capacities.
    The short answers: There are no defined methods or categories of methods. Almst anyone can practice “FM” or at least advise people what to do. Why “FM” was created will have 2 answers: theirs and ours. Theirs can be read in the introductory sections quoted in the post. Ours may be at the end.
    OK, I’ll give a little away: FM seems to cover doing varyious speculative alterations of diets, supplements, and physical methods in speculative hopes that the speculative things that are speculated to be deranged will somehow get back to “normal” and the patient will feel better. The methods used will often be unproved (speculative) and sometimes consist of obscure compounds and products of intermediary metabolism.

    snifferdog: [..] Surely no reasonable person, even one without any training in science, could sell this muck without having at least some reservations about their therapeutic benefit. Deeply disturbing.
    WS: As we will see, some otherwise quite normal and potentially successful straight MDs are aboard this train. Why? We think there has to be something wrong with their thinking apparatus – either intrinsically or through some conversion process. Whatever the modus, the scary thing is that we think the mechanisms are normal human behavior, just that the focus is – er, out of focus? Psychologists are not reassuring about this.

    Sam: Orthomolecular medicine has a slightly different focus than FM. It is definitely science-based and has a simple definition…
    Joe: No, it is definitely quackery. Go to http://www.quackwatch.org and search on the term “orthomolecular.”
    David Gorski: Same sentiment.
    WS: I’ll take Joe and David. “OM” has a long and dishonorable history, with some aging advocates still promoting it around here (No Calif., Ore.)

  9. mmarsh says:

    It sounds to me like FM is more-or-less an AltMed catch-all. In addition to the mega-vitamin connection pointed out, I caught shades of chiropractic, chelation therapy, colon “cleansing”, and a vague form of spiritual healing. It could be an attempt to take the “complementary/alternative” label and transform it into a “functional” discipline, possibly with the goal of sitting beside traditional (ie, valid) disciplines in med schools and residencies.

  10. DevoutCatalyst says:

    “WS: I’ll take Joe and David. “OM” has a long and dishonorable history, with some aging advocates still promoting it around here (No Calif., Ore.)”

    When I was young and TRULY naive, an Orthomolecular MD had me go on a 7 day water only fast. I doubt rather seriously he had ever done such a fast himself, the results were extremely unpleasant after about 3 days, and he seemed flummoxed by what I had to report just prior to throwing in the towel. And yet I continued on as his “patient”.

    What the Orthomolecular cult gives the health seeker is a ticket into a world of superior knowledge, and doesn’t that feel good, “and hey, if you buy this Bis-Carboxyethyl Germanium Sesquioxide directly from me, I can save you lots of money”.

    The ethics of used car dealers are superior to those of Orthomolecular medicine. Even if Fair Deal Dan rolls back the odometer, at least you still have a set of wheels, and your dignity.

  11. Sam says:

    Vitamin C, by itself, has not been proven as an effective cancer treatment. But there has positive research for other conditions, like atherosclerosis:

    Oral vitamin C reduces arterial stiffness and platelet aggregation in humans:
    http://www.ncbi.nlm.nih.gov/pubmed/10547085

    A single 2,000 mg. dose, or placebo was given to healthy male volunteers. Six hours after supplementation, platelet aggregation (as stimulated chemically) decreased by 35% in the supplemented group, and measures of arterial stiffness decreased by 10%.

    It’s true that the term “Orthomolecular Medicine” has fallen out of favor, as WS implies, but the approach has been influential. An increasing number of doctors are recommending supplements to their patients:
    http://www.lifesupplemented.org/supplements/healthcare_professionals_impact_study.htm

  12. daijiyobu says:

    Well, if FM’s analysis of ‘what’s going on’ is junk…isn’t this pseudophysiology? sCAM has a lot of junk pseudoanatomy per ‘what’s supposedly there’, may-hap this is simply its corollary in terms of ‘what’s supposedly happening there’.

    Personally, when someone says FM to me, I think of a DC-ND from my personal education past [a person at times my instructor, at times a fellow student back then; who I won't name by name]:

    http://www.amazon.com/Dr-Bradys-Health-Revolution-Healthy/dp/1600370810/

    or

    http://books.google.com/books?id=OOwgB17-xsgC&pg=PA148&dq=1600370810

    Here’s a word association that occurs when I think of this person who shall not be mentioned: Great Smokies lab tests & Metagenics supplements galore, applied kinesiology as a diagnostic tool, functional medicine as an overarching label, a discontinued study in a dog that supports the whole thing [my brief snarky version].

    The book is searchable, though the page views may be rationed.

    There are great jewels in it like:

    “[it's] referred to by many names: functional medicine, metabolic medicine, comprehensive medicine and integrative medicine [...] it is a movement within the scientific-based health care community [...] ‘a patient-centered science-based health care [...blah blah blah] vitality’ [p.160...and additionally] homeopaths believe that illness of the body is fundamentally due to a dis-tunement of the person’s vital energy or life-force [...or] vital force [p.114].”

    I would argue strongly that whenever an ND refers to vitality, they are coding vitalism or a wishy-washy area is literally immaterial / vapid.

    The person goes on:

    “now there is a scientifically-based economical way [an FM way!] to answer all those questions for you [p.121...] the Comprehensive Metabolic Profile [p.122].”

    Here’s a little video of that not-named person in full FM mode on the vendor’s site — who’s motto is “science first” — speaking of ‘toxins, toxins, toxins’ and everyone’s need for a CMP:

    http://www.designsforhealth.com/practicedevelopment_metabolictesting.htm

    Wherein, we’re told, “[the test] goes into a different realm” [I'll say] and that that person is a ‘science professor’.

    I must now de-slime myself.

    -r.c.

  13. nokomarie says:

    HEH. That last bit would read like one of my required texts from my nursing classes if it weren’t for the carping on “imbalance” for absolutely everything going on with the patient. Otherwise the tone and much of the content seems pretty well identical; only the barest step up from high school health.

    Oddly enough, those students who really paid any attention to those texts aren’t in nursing anymore. In fact, one indeed became a masseuse and another a physical therapist. Are you sure this isn’t required reading somewhere?

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