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Functional Medicine – New Kid on the Block

New Kid on the Block

Well, I’m not sure how new, but it was to me 6 months ago when I heard about Functional Medicine (FM) on a doc call-in program originating in Santa Cruz, Calif. The doc often presents a plurality of approaches to the callers’ problems, most of whom call because they seek self-help methods, supplements, or other short-cuts to help, or who share the utopian dream/meme of sectarian health claims through rearranging implausible ideas on the deck of the good ship Nature. (There could be a mixed metaphor in there somewhere but I go on…)

The radio call-in host, a middle-age sounding woman with a holistically oriented practice in a nearby town seems quite intelligent, grounded in real physiology, biochemistry, and mechanics of the body. I sometimes can catch her in errors but not as often as one could a more typical quacky doc, such as a chelationist. What I can hear is an intermittent string of recommendations I had never heard of, or sometimes had heard of and known to be false.  The program beams to a wide area – from Santa Cruz/San Jose area to the central coast in San Luis Obispo. It broadcasts on KUSP FM Saturday mornings at 9 AM Pacific time for those who want to listen on the net (Ask Dr. Dawn.)

When she first spoke about Functional Medicine, the term was new to me, but some of the advice and principles sounded familiar. Standard supplementing. But always with some obscure physiological reason. A look at the FM home page of the web site gives clues to what FM is about. Here is their list of defining terms…

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 that 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.

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.”

Dynamic balance of internal and external factors.

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

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

Let’s do what we like to do – deconstruct the message and the language – simply and briefly.

“Personalized medicine” is a code for leeway for departure from proved methods and into treating with unproved methods tailored at the discretion of the physician rather than at the need of the patient.

“ Primary prevention” is a standard medicine, but “underlying causes” implies those naturopathic and other sectarian creeds that state biologically based medicine does not concern either one, and that a special kind of medicine is required – which the FM physician happens to have.

“Biochemical individuality” is a slogan invented by Roger Williams of U. Texas fifty years or more ago that was the forerunner of “Orthomolecular Medicine” of Linus Pauling, Avram Hoffer and Humphrey Osmond… and their megavitamin therapies, now discredited. Williams’s theory stated that because every human is different, each one’s vitamin requirement is as well, so one has to take massive quantities of all vitamins to cover each person’s presumed specific higher than “normal” requirement. I may deal with this concept in a later post on this same subject, although all bloggers here do not need such instruction. .

“Patient centered” medicine implies that medicine and physicians do not concern themselves with the patient as a person, but as a disease – a political myth popular for nearly a century, to rationalize all sorts of bizarre pluralistic approaches from homeopathy to orthomolecular to chiropractic.

“Dynamic Balance” recalls ancient Greek and traditional Chinese concepts of external forces (External Q’i) and internal forces (internal Q’i) and Yin/Yang, all abandoned for want of a piece of evidence for their existence.

“Health” as more than absence of disease: a concept dating from the 1970s “Holistic Medicine” era, still meaningless and without existential proof.

“Promotion of organ reserve” – new one to me, but another concept that is without meaning. I know of no way to promote a reserve in an organ. Do they mean exercise to improve heart or skeletal muscle function? Or, meditation and relaxation to reduce stress, adrenal function, brain activity…what? Anyone with any answer?

What we see here is a collection of word collections that at most are slogans, rather than concepts. Most are abandoned concepts, and one is surprised to see their reusrresction under a more modern slogan, “Functinal Medicine.”

We read on :

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.

So here we read that an animal body has a variety of networks and that those networks interact – a revolutionary idea I first learned in undergraduate courses in physiology and endocrinology back in …ummmm…1949?

But we are also told that immunological dysfunctions can promote cardiovascular disease (huh?) and dietary imbalances hormonal disturbances – say what? What other than malnutrition you might ask? Which hormonal disturbances? That might get too technical, so we can leave that out. And environmental exposures can precipitate neurological syndromes such as Parkinson’s…? Say, who? What besides synthetic speed drugs has induced Parkinson-like syndrome? Educate me.

The paragraph is necessary to rationalize the taking of supplements and herbs with distant effects that can then through undefined network connections, but we know are there, can affect a patient‘s call-in complaint…and without either physiological rationale or proof by clinical trial…Functonal Medicine at its best.

They go on:

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

This stopped me. I got the same blankness of feeling I got when I first faced calculus. What the hell is this all about? The difference is that one can use some math – a bit of trig and a bit more algebra, form some graphs, and see what it’s about. But none of this FM lays out a map from which one can get from here to there. From detoxification to biotransformation imbalances? What is either one of them? No statement can be solved or applied by any physiological principles I could call on. And I know just enough biology and physiology to know that this is blowin’ smoke.

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.

Thanks for reading this far.

Clearly, this is an organization with claims cloaked in the language of science, but with the distinguishing characteristics of sectarianism – pluralities of approaches to illness, absence of evidence for efficacy, a unifying concept of illness as a body out of sync with Nature (with the capital N,) undecipherable babble and descriptive word salad. And note the last sentence, a bow to postmodernism, “transform the practice…” A transformative what?

Apparently the formers of the organization put on educational programs for physicians and others. Perhaps a pony or an Esperanto dictionary is required. What other activities FM produces I do not yet know. I’ll bring some examples of questions and answers in a few weeks.

Posted in: Science and Medicine

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12 thoughts on “Functional Medicine – New Kid on the Block

  1. Karl Withakay says:

    You had me hooked on this post with your second sentence.

    A few observations:

    >>>Functional medicine is personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease.

    &

    >>>Patient-centered medicine emphasizes “patient care” rather than “disease care,

    First it says conventional medicine treats symptoms, not diseases; then it says conventional medicine treats diseases, not patients. Are you allowed to shift goal posts wile the ball is still in play?

    >>>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.”

    It sounds cool, but so does Doctor Seuss; a witty turn of a phrase doesn’t make truth.

  2. daijiyobu says:

    Dr. S.,

    here’s an interesting blurb concerning “functional medicine” from that most prestigious of naturopathy textbooks, the Textbook of Natural Medicine [the 2005 3rd. ed. edited by NDs Pizzorno and Murray; ISBN 0443073007]:

    “naturopathy recognizes a vital force — vis medicatrix naturae or healing power of nature — that is present in all living things, including the human body. For naturopaths, this vital force is ultimately responsible for healing [...] naturopathic medicine has consistently aligned itself with the vitalistic side [...] ‘functional medicine’ [...] views disease as part of something that is purposeful and is proceeding actively in accordance with some design [teleology- finalism...] the concept of function must be viewed in the same category as the concepts of ‘purpose’ and ‘design’ [...] telos (end purpose) [...] functional practitioners recognize purpose and design in physiologic events [...] the functional medicine emphasis on purpose and design is closely related to this recognition of vital force in naturopathy [p.014].”

    -r.c.

  3. It interests me how attached some people are to the notion that everybody is biochemically different. Personally, I don’t want to be biochemically different from other humans! We’ve got great drugs for many different medical necessities, and by golly, I want the drugs prescribed for me to work on me within normal parameters! Yay, statistically speaking I probably won’t have horrible complications! I take comfort in that math!!!

    What would scare me is the thought that my biochemistry might require me only to take Drug X with a glass of purified aloe vera juice while facing east and holding a rutilated quartz sphere in my left hand– NO, NOT THE RIGHT!!! Quick, deploy the sage wand, stat!!!

    Altmed woo– it’s all about the fear.

  4. aproudfather says:

    My introduction to functional medicine came about a year ago when we took our now 5-year old ASD son to a doctor at a large well-known hospital/clinic in the Houston area (but not, however, the Medical Center and its concentration of well-known and respected hospitals and medical schools). She appeared to start out her career as your basic family practice doctor.

    What did she do after that, it seems ? (Multiple-choice question)

    1. Hang a small sign at the entrance to the clinic that said “Autism Clinic”.
    2. Take advanced training in “allergies”.
    3. Study and become a practitioner of “functional medicine”.
    4. Become a follower of Amy Yasko.
    5. Want to order tons of genetic tests.
    6. Sing the praises of the methylation cycle and how ASD kids’ cycles are all screwed up
    7. Hire a nurse who claimed to be chelating her autistic child for 2 *YEARS*.
    8. All of the above.

    Yes, the correct answer is (8). Fortunately, although I wasn’t aware of these people’s involvement in this quackery going in, I was able to spot the c**p in about 10 seconds. For us anyway, it just turned out to be “DAN! with a difference.”

    BTW, these func med people seem to be very slick at weaving their nonsense into science-based medicine. Buyer beware.

    A Proud Father

  5. Wallace Sampson says:

    Karl Withakay: Thanks for that perseptive pickup. It’s thinking like yours that distinguishes your sensible critiques from the aberrant thinking processes used by sectarian advocates. But I missed it also. Ouch.
    Daijiyobu: Good addition – thanks. From the radio doc’s program there was noytmuch of the Nature talk, but more a pluralistic approach and recommendations, some rational and some wthout much evidence. Her fascination with Functional Medicine seemed more selective through loosely connected physiological facts than ideological. So this bow to Nature surprised me.
    Perky Skeptic: Yes, the individuality thing appeals to some as as rationalization for woo. Makes it easier to do irrational things. But individuality as reason for massive vitamin doses is irrational itself, of course, as you imply. Nutrient requirements for a polulation follow a normal distribution curve, like most things, and a requirement for > 30 percent of the mean (for most vitamins) signifies a rare metabolic disorder of some sort.
    Not to be shorted though is the new field of pharmacogenomics, the ideal for which would be to tailor drug doses to the individual’s pharmacologic handling of each drug. We’re not there yet.
    aproudfather: Would that there were more with your abilities especially when faced with strong personal interest.
    Thanks for the comments, all.
    WS

  6. That’s a VERY good point– thanks for the mention of pharmacogenomics! It’s a fascinating field, and I’m watching it with great interest. As much as I myself do tend to respond normally to meds, I do have family members who have wacky reactions to things, like my mother-in-law, who had the most extreme reaction to chemotherapy that her oncologist had ever seen in his career– it killed off her lymphoma so fast that at one point during treatment she had to have emergency surgery to remove all the dead tissue, which was going septic! It was crazy and scary for all of us. Her dose response has always been wacky, well out of proportion from what her body weight would seem to dictate. For people like her, tailored dosages would be ideal! That’s one reason I suppose for my detesting the individuality excuse being used lightly by altmed supporters.

  7. sweeks says:

    Perhaps you should sit in the waiting room of a reputable functional physician and ask the patients about their experiences.

    I brought my borderline Autistic 4 year old son to a functional physician and the results have been miraculous. It would take all night to describe what we’ve seen, but I will say that I had many nay-sayers roll their eyes at me (family, friends, my husband, even my son) when I started his protocol. But now they are singing my praises as they see that we are getting to know a normal little boy for the fist time. He went from being clinically autistic to now being borderline add/normal. We are still not done with his treatment and I see that he will most likely lose all diagnoses in the near future.

    No, I am not a “clinical study” (although I worked for Big Pharma, so I know first-hand how those go), and I am not even an MD, but I am a mom who once had lost hope of ever having a normal child (or ever getting my sanity back). Now, not only do I have hope, but I have witnessed a miracle take place before my eyes, with many witnesses!

    Try to remember who funds the “clinical trials”, folks. (again, this coming from a former big pharm representative).

  8. Dr Benway says:

    sweeks,

    Four year-olds are growing and learning all the time. It’s possible your son might have made progress without the treatment you describe.

    Please read this account by Jim Laidler, a physician with an autistic son. He was for a time a speaker on the DAN! circuit.

    Many of these functional medicine practitioners have ties to supplement companies. They often sell the supplements they prescribe right out of their own offices. They appear in news blurbs on the radio, TV, or in print, hyping up the benefits of the supplement. This is advertising, and I would suspect they’re getting paid for their time in some fashion. They sound more like detail men than doctors to my ear.

    Dr. Sampson,

    Nice article. Calling people on their overly-vague language ought to be an ethical imperative shared by every citizen in a free society.

  9. khan says:

    These descriptions are reminiscent of the Dilbert Mission Statement Generator.

  10. sweeks says:

    Dr. Benway, my son lost his Autism diagnosis overnight…he did not grow out of his highly dysfunctional behavior. We could not leave our house with our 4 year old – that is not normal.

    These are the types of things that you need to see to believe (I wouldn’t have believed it had I not witnessed it and lived it). That is the problem, most MD’s do not live with an autistic child and recover an autistic child within their own homes. Yes, I have heard about the DAN doctor who later shunned the protocol. Maybe it didn’t work for his son (just like chemo, nothing is 100% but you do it because you have to and you pray for your miracle).

    I understand about the supplements and yes my DAN sells his own supplements. He also performs fundraisers and hands out large grants to families in need. What I care about is results and he is the first MD who brought me results.

    I would also like to comment on the fact that not only is the autism in recovery, but within 2 days of the gfcf diet my son’s chronic urticaria disappeared – 2 DAYS (after 7 months of daily hives). His pediatrician and allergist gave me zyrtec (which worsened his behavioral symptoms) and didn’t “heal” his condition.

    Also, his chronic constipation which lasted 2 YEARS (and required 1.5 years of daily Miralax) was gone within 10 days of the gfcf diet. That tells me that he has multiple system problems within his body which are related. By fixing one problem, others where “accidentally” fixed.

    Also, in the past 2 months of gfcf diet, my son gained weight for the first time in a year. He no longer has dark circles under his eyes, he no longer needs almost monthly antibiotics.
    You can talk about coincidence, and I agree that it is all very hard to believe, at times I’m simply dumbfounded by the immediate results. It is almost too good to be true and sometimes I am afraid that the old “E” will come back at any moment. But I hold the proof. I was looking for results, and that’s what I got.

    Is my son one of the lucky ones? Maybe. But back to my chemo analogy, if he had cancer and I was told that there is a 20 % chance that chemo works – you better believe that we would do it. Why would it be any different with autism? Maybe there have not been enough appropriately funded clinical trials about these CAM interventions…

    Like I said in the beginning, maybe you should sit in the waiting room at one of these MD’s and talk to the patients (they are usually well-educated individuals who are spending a lot of money, only half of which is reimbursed by insurance. Why do they keep coming back? Results). Maybe you should get on one of the DAN message boards. The stories of healing that the other moms tell brings me to tears. Maybe we are in the minority, but it is a crime that not every parent is at least made aware of the possibility of mental and physical healing for their child that traditional therapies just can’t provide in some circumstances.

    All due respect…S

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