Functional Medicine? Dysfunction in Disguise ;-)

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I am formally trained in the western medicine (WM) philosophy of treating human disease and injury as a Physician Assistant (take note that I am not a Physician's Assistant... that little apostrophe can kiss my... sorry... back on track!). I'll be the first to admit that there are some flaws to WM but in the same breath, I cannot begin to describe the emotion feel when listening to the beating of a donor's heart in the chest of patient who would otherwise be dead. The feeling is a combination of awe, inspiration and a bit of pride to be a member of a system that made something like this possible. I have learned so much in my practice and I have developed a deep respect for this centuries old art. The truth is, no matter what criticisms you bestow upon WM (I admit there are plenty), you cannot deny the substantial victories it has claimed against the onslaught of human pathology.

With that said...

   ...where does WM fail? We are really really good at TREATING DISEASES. I mean crazy good. Like Lebron... no... JORDAN good at it. But we seem to only focus on the end game which is disease. Time for a sports metaphor? Sure! Lets say you're a golfer and you go to a practice putting green ever day and to spend hours honing your short game. You learn to analyse subtle dips and rolls of the short cropped grass and perfect the very slight power adjustments and angular trajectories in order to get the ball in the hole. It is the perfect problem solving scenario ripe with analyzing the physical world and controlling the mental. Your time and energy on the green should pay off in your ability to sink the ball with precision and perfection time and time again! But, in a typical par 5 course, the green should only represent about 20% of the game? What about the 80% of the course which came before it? How did you move the ball 300 yards to the putting green in the first place? 

 Jason Seib - One of the best Paleo coaches on the planet! Read his books!   

Jason Seib - One of the best Paleo coaches on the planet! Read his books!

 

Well, WM is quite similar. Most of the time, people come to me when they are already sick (on the putting green). I still like to hear about how they played through the green (this is called the Patient History). Getting this right is important... like REALLY important. In fact, back in PA School, we were taught that the "history is 90% of the diagnosis." But history is history, the damage is already done and I am typically forced to treat conditions with a host of medical interventions to include medications and physical therapy and maybe even surgery. To keep with the metaphor, ideally, I sink the ball with as few strokes as possible. I love chalking up "Wins" in the "Cured" column! The problem is that the "Win's" can be hard to come by (see Jets 2017... sorry), especially in the realm of chronic disease. So how do we improve our "Wins"? We focus on the rest of the game! In medicine, this translates to identifying contributing lifestyle factors that increase chances of developing disease states. This is fine and most medical practitioners are aware of this. But keep in mind, most practitioners are running a business and they need profits to grow and make payroll. Today's fee for service, insurance brokering, overcharging, inconsistent medical payment atmosphere, if you spend the necessary 60-120 minute encounter with patients, then your business will fail. So yes, we need to improve and everyone is aware of this. This also creates a market for "alternatives" to the current paradigm. Is there room for these alternatives? Maybe. Should we give them the same clout as western medical facilities... nope!

Enter Functional Medicine (dysfunction in disguise)

The term "functional" is being added to the beginning of lots of terms these days to denote a sort of better quality/healthier choice. I've heard of functional diets, functional eating patterns, functional yoga, functional exercise, and now functional medicine. The problem with "functional-anything" is that the term is ambiguous and can be used as a marketing scheme to drive customers to a product. Let's focus on medicine. In most cases, functional medicine is a unscientifically verified "medical" methodology claiming good health and vitality to it's users. (yeah... snake oil promises this too). Functional medicine claims to be a developmental practice that addresses the healthcare needs of the 21st century. Instead of treating disease states, functional medicine centers around the causation of disease. So far, this sounds okay but it gets a bit fishy.  Functional medicine was invented by nutritionists Jeffrey and Susan Bland (<- not Medical Doctors... or even lowly PAs!). They founded the Institute for Functional Medicine back in the early 1990s. 

Their site claims:

Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, Functional Medicine addresses the whole person, not just an isolated set of symptoms. Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, Functional Medicine supports the unique expression of health and vitality for each individual.
— Institute for Functional Medicine

This all sounds good on the surface, but Dr. Harriett Hall (real doctor) does a nice job dismantling the claim on Skeptic.com:

 Dr. Berry give a great critique to modern western medicine!

Dr. Berry give a great critique to modern western medicine!

[The claims] sound good, until you realize that it also describes good conventional medicine. Conventional medicine always addresses the underlying causes of disease: when you have appendicitis, you don’t just get morphine for the pain, you get an appendectomy to remove the cause of the pain. Conventional medicine deals with real underlying causes; FM makes up hypothetical, speculative, or imaginary causes.

Conventional medicine uses a systems-oriented approach when appropriate, but it is not helpful for setting a broken bone. Conventional doctors always engage their patients in a therapeutic partnership; the days of paternalistic medicine are long gone. Conventional doctors have always addressed the whole person. As early as ancient Greece, Hippocrates said it was more important to know which person had the disease than to know which disease the person had. Conventional doctors have to spend time with their patients, since the history is 70% of the diagnostic process.

In other words, WE DO THE SAME DAMN THING! Yes, I get it. The current leaders within the paradigm (western medicine institutions) receive the brunt of the criticism and they rightly should. It is only through criticism that we adjust and perfect. And I DO like some premises of functional medicine especially in the evaluation of the entire individual's life, not a single encounter's "snapshot" of their health and I think this is an important concept. Today, a typical family practitioner has around 7 minutes to walk into a room, greet the patient, discuss current medications, ask how they are feeling, perform a physical exam and then make a recommendation. Remember, most medical providers are running a business and they get very little in compensation per patient, so they are forced to fill their schedules. When the suggestion to shift medicine from a fast-paced disease management system to a more patient-lifestyle approach, people are going to feel empowered and folks will respond. From what I have read, these "practitioners" invest a lot of energy with their patients and tune in to their personal histories, while assessing their living environment, lifestyle choices, and hereditary factors. This approach offers patients a one of a kind hands-on personal involvement in healthcare, which prompts higher engagement. That's not a bad thing. 

So, What's My Final Verdict?

I may be hard on functional medicine and I would suggest my critiques are well founded (the whole avoidance of the scientific method really sets off my bullsh!t meter)... BUT... western medicine may want to take a chapter out of the functional medicine playbook. Spending time with patients, listening, and reassuring pays a lot of dividends. Unfortunately, this may not be feasible within the confines of the current model as reimbursement plays a major role. This is why many practitioners are bailing completely from the insurance reimbursement model and opening old-school fee-for-service clinics. 

Let's revisit two things I opened the article with. First, western medicine, for all its faults, is still the Michael Jordan of all medical models. Don't believe me? I would love for you to feel the rhythmic thump of a donor's heart in the chest of a patient that has peaked behind the curtain of death but came out the other side healthy and enjoying life. That would be unheard of without the marvels of modern medical practices. However, I think the western medical model needs some fine tuning and we need to find a way to address the many lifestyle factors that relate to health and wellness. We need to see patients when they are WELL and preempt disease before it leads to death and disability. 

 

Hope you enjoyed the latest Civil Primate Blog post! Looking for a Podcast that inspires and motivates through interviews with authors, filmmakers, and everyday philosophers? Then look no further! Check out The Wait What If Podcast on iTunes, Podbean, or Stitcher.

Cheers - KS