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Functional Medicine II

In searching for just what FM is, one has to in a way read between lines. Claiming to treat the “underlying cause” of a condition raises the usual straw man argument that modern medicine does not, which of course is untrue. It also implies that there are underlying causes known to them and not to straights. FM claims to treat chronic disease which FM claims is inadequately treated by medicine.  FM claims to be a more advanced approach both in conceptual thinking and in practical management. Such claims are on the face doubtful, but hard to disprove. The way to find out would be to analyze cases they manage and critique them.

I tried to see specific examples of treatments but the web page text book links were not working at the time. I understand others have seen the contents and perhaps can add some information.   I sense a difference between “CAM” and FM – at least among the MDs and DOs -  is that FMers tend to use methods and substances with some degree of scientific or biochemical rationale, even if not proved, moreso than many of the CAMers.  Many seem to practice both systems or do not distinguish between the two systems.  In order to get a sense of the degree to which FM is known, I requested from the web page the names of practitioners in a 50 mile radius of my home (near Palo Alto, Calif.). The names ranged from Santa Cruz (40 miles) to Berkeley (50) and San Francosco (40) and Marin County (Sausalito – 50 miles) The population of that area is about 5 million. They sent 46 names:   MD/DO  31 – (including a nephrologist formerly on the staff of my teaching hospital)   PhD 1   DC 8   Lac 3   ND 2   RN 1   Because I had become aware of FM only 1-2 years ago, I thought 46 was a relatively large number.  The Web page lists four text books published in the past few years. A manuscript of the first one is available on line for downloading (not functioning when I tried.) .  21st Century Medicine: A New Model for Medical Education and PracticeMonograph Set – Functional Medicine Clinical Monograph Set – CME Available Textbook of Functional Medicine Clinical Nutrition: A Functional ApproachAs mentioned, I could not activate the links to those books, and did not have time to get to them individually.  No authors were listed.

The following paragraph is part of the advertisement for the book set:

The transformation of 21st century medicine from the prevailing acute-care model to a far more effective chronic-disease model will succeed only if we attack the underlying drivers of the epidemic – the complex lifelong interactions among lifestyles.

FM also produces professional seminars:

Applying Functional Medicine in Clinical Practice (AFMCP)™

From the AFMCP seminar  description: AFMCP is not a typical medical meeting.  Now in its 12th year, this five-day course has been rigorously designed, critically evaluated, and continuously refined by our outstanding core faculty, each of whom brings diverse and subject-specific clinical expertise to the application of functional medicine.  AFMCP is a well-orchestrated, comprehensive, patient-centered educational program that helps you deepen your clinical understanding and practical application of the Functional Medicine Matrix Model as applied to:

♦ GI dysfunction                                          ♦ Metabolic syndrome
♦ Hormonal imbalance                                 ♦ Nutritional status
♦ Inflammation                                              ♦ Adrenal & thyroid fatigue
♦ Orthopedic issues                                    ♦ Therapeutic relationship
♦ Immune dysfunction                                 ♦ Toxins & biotransformation
♦ Food allergies
    DATE:   September 21-25, 2009
LOCATION: Hyatt Regency Baltimore, MD - 410-528-1234 or 800-233-1234
Price:  
Physician
(MD, DO, DC, ND)
Early Bird
through Aug. 12
   $3,195
Regular registration:             $3,550

The brochure claims 37-75 CME credits, but does not state for which occupations. It does not mention physician  CME. Credit.
Interested people.  The Institute for Functional Medicine was apparently founded by Jeffrey Bland, PhD. For simplicity, here is reproduced his section from quackwatch.com:

Jeffrey S. Bland, Ph.D., of Gig Harbor, Washington, has been one of the health-food industry’s most prolific interpreters of nutrition-related scientific developments. His interpretations consistently favor the use of supplements. A former chemistry professor, he has appeared frequently at trade shows [1], written and edited publications, produced audio and video tapes, and conducted seminars for health professionals. He has also been a research associate at the Linus Pauling Institute of Medicine and has directed its nutrient analysis laboratory. In 1991, the FTC charged that Bland and two of his corporations (HealthComm and Nu-Day Enterprises) had falsely claimed that their diet program could cause weight loss by changing consumers’ metabolism and cause them to lose weight without exercising so that fat is lost as body heat instead of being stored. The Nu-Day Diet Program, which cost about $30 per week, included instructional materials, a meal-replacement formula, and a fiber-containing formula said to be a “natural appetite suppressant.” The Nu-Day program was promoted with a 30-minute television program entitled “The Perfect Diet,” which offered “amazing true stories of people like yourself losing 20, 30, 50 pounds or more, safely, quickly and naturally.” Although the television program appeared to be an independent consumer news show that used interviews to report on its discovery of the Nu-Day Diet, it was actually a paid ad. The program identified Bland as “one of the nation’s leading nutritional biochemists.” The case was settled with a consent agreement in which Bland agreed to pay $30,000 for redress and to refrain from making the claims that had been challenged. The consent order also requires future programs of 15 minutes or longer to display messages identifying them as paid ads for the products offered [2].

In 1995, the FTC charged Bland and his companies with violating the consent order by making unsubstantiated weight-loss claims for several products. In addition, their UltraClear dietary program had been falsely claimed to reduce the incidence and severity of symptoms associated with gastrointestinal problems, inflammatory or immunologic problems, fatigue, food allergies, mercury exposure, kidney disorders, and rheumatoid arthritis. The settlement agreement included a $45,000 civil penalty [3].

In 1996, Natural Foods Merchandiser reported that HealthComm had acquired a minority interest in Keats Publishing of New Canaan, Connecticut, and that Bland had joined its board of directors. Keats has probably been America’s most prolific publisher of questionable information about health, nutrition, and “alternative” health methods. Established in 1971, it has issued more than 400 books, of which over 200 are still in print. It has also published more than 100 “Good Health Guides,” most of which promote the types of products sold through health-food stores. In 1999, HealthComm sold its interest in Keats publishing to the Chicago Sun-Times [4].

In 1993, Bland founded the Institute for Functional Medicine, a HealthComm division that oversaw the company’s web site, develops educational products, and sponsors an annual International Symposium on Functional Medicine. In 1997, he invited practitioners to join him on the Functional Medicine Section of CompuServe’s Natural Medicine Forum, which HealthComm co-sponsored. Brochures accompanying the invitation stated that the company’s UltraClear Plus “provides nutritional support for pathological or imbalanced detoxifiers and may be suitable for patients with” chronic fatigue syndrome; chemical and environmental sensitivity; alcohol and chemical dependency; food allergy; “management of endo- and exotoxicity”; and arthralgia and myalgia. The Web site has carried similar claims that I consider improper.

The FTC and FDA have since 1995 ordered several other Bland-associated companies to cease false advertising. A Medline search over the past 2 years showed about six Bland-authored articles, mainly published in secondary nutrition journals and in Alternative Therapies in Health and Medicine. Most were reviews, some actually trials or surveys. Mark Hyman MD has his institute in Lennox, Mass.  His website shows about ten books, four on “Ultra-Mind, two on “Ultra-Metabolism”, then “Ultra-Nutrition”.  His approach largely is dietary with supplements, plus avoiding “toxins” in the environment. One lecture is about intestinal toxicity. I assume heavy metals are in that bunch.  I listened to several FM doc radio programs and Hyman is held I high regard in that circle.

Others: I mentioned a nephrologists from my former teaching faculty. He took an unusual route.  A competent subspecialist in a technical field, he began an interest in “alternative medicine” 15 years ago, left his position, and set up an internal medicine practice specializing in chronic diseases and seemed to attract people with functional disorders (better, dysfunctional ones.)  I assumed that technical medicine such as running dialysis units and personnel became burdensome,  and that he felt his efforts might be appreciated better by medicine’s chronic complaining rejects.  At least that was my impression at the time. I never got to ask.

Another FM practitioner is a physician in a nearby small community who has a local radio program (“Ask Dr. Dawn.”)  This physician seems well grounded in biological science, speaks well, and explains complex matters in simple analogies that the audience can understand. In that capacity she performs a social service for the community. But I find hard to understand her affinity for recommending unproved and often implausible treatments such as “pro-biotics” for irritable bowel syndrome (IBS) and acupuncture when all else fails (she is a graduate of the UCLA post-grad acupuncture course.) I am trying to form a general explanation for why physicians become involved in such off-the-trail health schemes like FM.  So far as I can sense, most feel they are doing the right thing, filling a social and medical gap ignored by “the system” because it’s not where the money and fame are. I detect a great amount of resentment toward the “system” and against their straight colleagues as well. Net entry I will record a typical Q&A radio segment that may illustrate how FMers perceive disease, medicine and their roles.

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

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3 thoughts on “Functional Medicine II

  1. Tim Kreider says:

    My professors and preceptors in Family Medicine will be shocked to hear that they are part of a “prevailing acute care model” that does not consider lifestyle factors when managing chronic diseases.

    I was able to read some of the online text, and it sounded like my local naturopath. Indeed, several sections in the GI chapter were written by NDs. I hope you will be able to get ahold of it, Dr. Sampson.

  2. shadowmouse says:

    Check out this FM whackaloonie:

    http://ecopolitan.com/doctor-t

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