Pathways to Healing

by Elaine Zablocki

Functional Medicine: A New Approach to Clinical Care

Townsend Letter readers are familiar with a wide variety of healing methods that go beyond conventional allopathic care. We rely on nutritional supplements, mind-body methods, herbs, massage, and acupuncture. Now a report from the Institute for Functional Medicine (IFM; Gig Harbor, Washington) puts all these methods into a new context, a new approach to supporting and encouraging health.

We need health care that focuses on prevention and addresses the whole person, not just an isolated set of symptoms, according to IFM president David Jones, MD. “Our health-care system applies an acute care model to chronic, complex illness. The current model basically says, come see me when you’re broken and I’ll figure out the best pharmaceutical or surgery to help with your brokenness. This is an expensive, nonproductive way to deal with chronic disease. We wrote 21st Century Medicine: A New Model for Medical Education and Practice to discuss a more appropriate model.”

The IFM model looks at the underlying drivers of chronic disease. Practitioners spend more time with their patients, listening to their histories and looking at interactions among genetic, environmental, and lifestyle factors, because these factors influence long-term health.

Jones says that “functional medicine practitioners look ‘upstream’ to consider the complex web of interactions in the patient’s history, physiology, and lifestyle that can lead to illness.” Practitioners assess the patient’s fundamental clinical imbalances related to major biological functions, such as elimination of toxins, digestion and absorption of nutrients, structural integrity, immune system function, and inflammatory responses. When these processes are out of balance, that can lead to symptoms and eventually to disease.

A core clinical imbalance may present as many different conditions. For example, inflammation may present as heart disease or diabetes, arthritis or cancer. Contrariwise, several different imbalances may lead to a given condition. For example, inflammation, genetic patterns, mood disorders and diet/exercise may all contribute to obesity.

Interestingly, Jones doesn’t consider functional medicine to be a form of alternative medicine.

“We maintain that we are what conventional medicine should be,” he says. “We are not complementary, we are not integrative, we are what conventional medicine should be, and often claims to be.”

The first part of 21st Century Medicine articulates our current problems clearly, while the next section analyzes strengths and weaknesses of various proposed solutions. “The last two chapters are really about the one-on-one relationship in a clinical practice,” Jones says. “They ask, what model works so that you emerge with the right answer for each specific person? The current model is defective. ‘Come see me when you’re broken and I’ll give you a drug.’ Well in many situations, that doesn’t answer the problem.”

The model proposed in 21st Century Medicine emphasizes the partnership between clinician and patient, and the importance of listening attentively to each patient. Jones emphasizes our vast body of accumulated scientific evidence, and the challenge practitioners face in matching that evidence to the each patient’s specific circumstances. “As clinicians, we are not scientists,” he notes. “Clinicians are ‘science-using professionals.’ My job as a clinician is to see how general principles apply to the patient’s specific needs. We have an incredible range of scientific evidence, but we also need a degree of humility about what scientific evidence can tell us. We have data from many studies, but we must use that data with caution, because the patient sitting in front of us could fall outside the bell-shaped curve of the study.”

Functional Medicine Considers Many Factors, Yields Individualized Treatments

21st Century Medicine includes two charts that sum up the difference between conventional medical practice today, and its vision for health care in the future. The conventional model includes a history and physical exam, leading to diagnosis and treatment, usually pharmaceutical and/or procedure-based.

Practitioners of functional medicine would do a much broader history and physical. Lab and imaging tests would support an evaluation of functional systems such as immune/inflammatory imbalance, digestive/absorptive imbalance, or hormonal and neurotransmitter imbalances. The practitioner would look for common themes and underlying mechanisms of disease. The end result: an individualized treatment plan that includes dietary, lifestyle, and environmental changes, as well as pharmaceuticals and/or procedures.

[THE FOLLOWING TWO CHARTS SHOULD BE SET IN A BOX, OR IN TWO BOXES]

Outreach and Education

IFM has several initiatives under way designed to bring about change in medical education and health care. A number of opinion leaders in medical schools have attended IFM programs and later carried these insights into their academic centers.

In the past, IFM offered a six-day training course in functional medicine. “However, we realized that getting people to see the world through our lens takes a real commitment and a longer period of training,” Jones says. IFM currently offers a comprehensive two-year certification course in functional medicine, which combines on-site training with distance learning. In 2011, when the first group has completed this course, information on how to find these trained practitioners will be posted on the website.

At the start of the current health-care reform debate, Mark Hyman, MD, chairman of the IFM board, testified before Senator Harkin’s subcommittee, and submitted a copy of 21st Century Medicine. “During the hearing Senator Harkin talked about starting a health coach program,” Jones says. “If we got something like that under way, you could turn this thing around. Keep in mind, we really need two kinds of reform. We need increased access to care, and we also need a different kind of care. We need health care, rather than disease care.”

Resources

The Institute for Functional Medicine: http://www.functionalmedicine.org/index.asp.

For a free downloadable copy of 21st Century Medicine: A New Model for Medical Education and Practice, go to: http://www.functionalmedicine.org/ifm_ecommerce/ProductDetails.aspx?ProductID=174.

To find practitioners who have completed a six-day course, “Applying Functional Medicine in Clinical Practice,” go to http://www.functionalmedicine.org/findfmphysician/index.asp.

For information on the two-year certification course in functional medicine, as well as shorter programs and conferences, check the IFM website under “Educational Programs.”

Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She writes regularly for many health-care publications.

[NOTE TO EDITOR… WE HAVE PERMISSION TO USE THE TWO CHARTS.]