Functional Medicine

The escalating public debate over the troubled U.S. healthcare system ignores one vital solution: functional medicine. Most experts agree that real emphasis on prevention would lower costs; yet public dialogue is missing serious discussion of conventional healthcare’s fundamental aversion to disease prevention.

The nature of the debate, as well as any proposed legislation, would be dramatically impacted if there existed broader awareness of the functional approach to medicine, emphasizing prevention and treating the whole person rather than merely symptoms. This approach requires time and thoughtfulness, two qualities that are conventionally discouraged by physician training, the business demands of medical practices and general public misinformation about healthcare.

Physicians are primarily trained to diagnose disease and write prescriptions to alleviate symptoms. If unable to make a confirmed diagnosis, a physician typically orders tests, makes a working diagnosis, writes a prescription, and refers the patient to a specialist.

The training responsible for this approach of course begins in medical schools, where drug companies have enjoyed practically carte blanche influence over medical education. Professors double as paid industry consultants, some deans sit on corporate boards and drug companies fund medical school research and facilities.

Recently this long-term corruption has prompted U.S. Senate investigations, the passage of new state laws and a student revolt of sorts. In 2002 the American Medical Student Association (AMSA) launched a campaign against “marketing-based prescribing practices” and “conflict of interest in medicine.” The AMSA now issues the PharmFree Scorecard designed to measure medical school efforts to limit conflicts of interest. Such pressure has forced many positive changes at top medical schools. For example, Harvard Medical School has succeeded in changing its initial F on the AMSA Scorecard to a B. However, strong ties between medical schools and industry persist and some students, faculty members, and administrators argue for strengthening these ties even further. Unfortunately the many policy changes at these schools, however admirable, have not fundamentally changed the legacy of symptom-centered physician education created by the long-standing Faustian bargain between medical schools and the drug industry. Medical school curricula continue to emphasize pharmacology over nutrition and other prevention-related topics. And the influence of drug companies and their disease and drug centered agenda continues to extend beyond medical schools to continuing medical education for physicians, aggressive marketing efforts directed at practitioners and funding for many of the medical journals and research studies that physicians rely on in the provision of patient care. Is it any surprise that the typical U.S. physician writes more prescriptions for pharmaceuticals than any other physician in the world?

The stress of modern practice management also discourages preventative approaches in conventional medicine. Maintaining a medical practice is expensive and practice overhead increases yearly. The average physician has expenses for pay-roll, supplies, mortgage or lease, medical equipment, taxes and employee benefits. Most physicians also pay escalating malpractice premiums, and face decreasing reimbursement from insurance companies. Counterbalancing these demands often requires increasing patient load, which in turn, decreases the quality and quantity of time spent with each patient. As noted above, disease prevention requires time and thoughtfulness, but the conventional practice management environment typically permits only the time necessary to make a diagnosis and write a prescription. The emergence of consumer-driven healthcare marketing has also had fateful implications for preventative health strategies.

Although it was not the first prescription drug commercial, the popular Claritin commercial that first aired in 1996was credited by the Journal of Healthcare Management with “transform the pharmaceutical industry into a multibillion dollar enterprise that spends twice as much on promotion as on research and development.”

Since then, drug companies have mastered the art of appealing to the general public and encouraging people to petition their doctors for drugs. These marketing practices have dramatically impacted doctor-patient relationships by dictating patient expectation, most prominently the expectation that a doctor’s sole function is to make diagnoses and dole out pills.

Functional medicine actively resists this model of medical practice. Contrary to the conventional emphasis on the three D’s—disease, diagnosis, and drugs—functional medicine focuses on early assessment and intervention to correct core imbalances before they can develop into disease. Thus, the functional approach involves exploration of a patient’s life story in pursuit of the origin of potential disease states.

The core principles of this approach are an understanding of the biochemical individuality of each person, based on the concepts of genetic and environmental uniqueness; a patient-centered rather than disease-centered approach to treatment, which entails a pursuit of balance among internal and external factors affecting a patient’s body, mind, and spirit; a recognition of the interconnectedness of physiological factors; seeing health as a positive state, not merely the absence of disease; an emphasis on the dynamic balance of internal and external factors; promotion of organ reserve, i.e., optimum functionality of individual organs, as a means to enhance the health span, not just the life span, of each patient.

The Institute for Functional Medicine is a professional association training member physicians and other health care providers to prioritize the time necessary to heal the imbalances underlying disease. Along these lines, the intake form of the functional practitioner extracts a remarkably detailed patient profile, covering environmental factors like diet, nutrients, exercise and trauma, as well as internal factors related to the mind, emotions, genetic predispositions, attitudes and beliefs. The functional medical practitioner typically reviews the intake form prior to the first visit and schedules lengthy consultation and lengthy follow-up visits in order to determine whether these factors are functioning in a manner that could be responsible for an existing or potential disease state. That the conventional approach often ignores these factors in favor of the “quick fix” of writing a prescription, usually obscuring rather than eliminating the underlying dysfunction. Clearly patients and physicians both benefit from the priority that the functional model places on the time necessary to develop effective strategies for true, comprehensive disease treatment and prevention.

The functional model also prioritizes the thoughtfulness necessary to successful treatment and prevention of disease. In this model, the physician investigates the patient’s physiological processes, including: cellular communication; bioenergetics - the transformation of food, air, and water into energy; maintenance of the structural integrity of cells and organ systems; elimination of waste; immune functioning; and circulation. Such complex assessments require in depth study of biochemistry and physiology, as well as a commitment to critical thinking, as opposed to the conventional over-reliance on algorithms, diagnoses, and drug and surgical interventions.

Next, the functional physician looks for core clinical imbalances, which are usually precursors to the signs and symptoms that are conventionally detected and labeled as disease. They include hormonal and neurotransmitter imbalances; oxidation-reduction imbalances and mitochondriopathy; detoxification and bio-transformational imbalances; immune and inflammatory imbalances; digestive, absorptive, and microbiological imbalances; and structural imbalances, e.g., in cellular membrane functioning and the musculoskeletal system. As precursors to the signs and symptoms used to diagnose organ system disease, these imbalances alert the functionally focused healthcare provider to the potential for disease.

Blood analysis is the critical tool for assessing these imbalances. Datis Kharrazian, DC, says that “there is no general screening test that is more efficient, effective, and affordable than a comprehensive blood chemistry panel. A comprehensive blood panel will allow the healthcare provider to quickly assess the degree of health or disease in a patient. It is the ultimate tool in biomedical laboratory sciences to evaluate new patients. Allowing the healthcare provider to establish a baseline of biomarkers, it is used to track the patient’s health immediately and over a period of time.” Most patients received several comprehensive blood chemistry panels performed on them. Unfortunately conventional medical training teaches physicians to evaluate blood chemistry in comparison to ranges that determine pathology. If pathology is not present, according to these ranges, the patient is considered “healthy.” While the conventional, pathological range is used to diagnose disease, the functional range is used to assess risk for disease before it develops. The major distinction between the functional and pathological ranges is the degree of deviation allowed. Conventionally trained physicians are usually not alerted to the dysfunction which will eventually lead to disease because they are not trained to decipher labs that are outside of the functional range but also remain outside of the pathologic range. When lab results fall within the patterns of a functional imbalance, the functionally trained physician prescribes lifestyle changes, e.g., changes in nutrition and other noninvasive therapies. Much of the research guiding the assessment of functional ranges has been conducted by well-respected organizations like the American Association of Clinical Chemists (AACC), assuring the patient that functional blood analysis is not some alternative to science, but actually typifies evidence-based medicine instead.

There is every indication that the healthcare debate will rage on, with some of the energy going to substantive battles over issues like cost and deficit reduction measures and industry regulation, as well as less substantive battles over myths and industry-sponsored lies. There will also continue to be mention that America has some of the best physicians and medical technology in the world. It is true that conventional medical care excels in responding to trauma and to resuscitation, and that it has extended average life expectancy in large part through the proliferation of pharmaceuticals. However, there must be passionate debate about the quality of those lives sustained by drugs. In short, amidst all of the passion and clamor, there must begin to be some kind of emphasis on the need to change the current healthcare model from one focused on treating disease symptoms to one dedicated to the optimal functioning of the human body.

Vol 29 Issue 3 Page 24