Now there is some functional dentistry!
The great philosopher Deepak Chopra wrote: “I do not believe in meaningless coincidences. I believe every coincidence is a message, a clue about a particular facet of our lives that requires our attention.” So when SBM author extraordinaire Jann Bellamy emailed me last week with an article about so-called “Functional Dentistry” with the comment “Blog fodder?”, I looked it over with interest and then promptly filed it away in my brain along with other things that I might get around to doing but probably won’t. The very next day, Dr. Clay Jones – also an SBM bloggist extraordinaire – asked me if I’d mind pinch-hitting and write a blog post for his upcoming Friday morning time slot while he was away on vacation.
Coincidence?
Personally, I find it more plausible that Jann and Clay secretly conspired to have me write this article in order to lure me into a rage spiral, than the notion that The Universe was sending me a message about a particular facet of my life that required my attention. But we are at Point B now, are we not? Regardless of whether the first domino was pushed by The Universe or by Jann and Clay, I suppose it is now incumbent upon me to share with the SBM readership yet another way where pseudo-scientific practices and deceptive branding and marketing tactics have trickled down from medicine into dentistry.
In this blog post, I will review what Functional Medicine (FM) is, what is wrong about it and what is right about it (yes, there are aspects of FM that are legitimate, if not admirable), and how it has infiltrated (some say contaminated) the field of dentistry. I think you’ll find that, when you pull back the curtains, the reality of FM as a “new and improved” medical/dental paradigm is vastly embellished and overstated, and the Great and Powerful Functional Medicine Oz is really just an old geezer pulling the levers of spin and hyperbole and pushing the buttons of pseudo-science.
What is Functional Medicine?
Functional Medicine, according to the Institute for Functional Medicine’s website:
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.
Functional Medicine has been covered thoroughly in SBM by the late Wally Sampson, and the not yet late David Gorski and Steve Novella, among others; consequently, I need not delve too deeply into it here. However, a cursory unpacking of the above definition reveals a recurring logical fallacy, namely the Unstated Major Premise or Unstated Assumption. When it is claimed that FM “…addresses the underlying causes of disease,” or “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,” the unstated premise is that “regular” doctors don’t do any of these things; they must be only symptom-oriented, not preventive in their outlook, and don’t take all of a patient’s personal, medical, and social factors into consideration before arriving at an invidualized course of action. This, of course, is false, and is what any good physician will do. I know mine does, and he does not identify as a Functional Medicine physician. This dubious technique is employed by most if not all CAM providers in an attempt to set themselves apart from the crowd.
Where does FM get it right?
Where FM gets it right is that, from all appearances, FM physicians as a whole tend to leave more appointment time for the history and physical exams, and claim to do a more thorough genetic, environmental, and lifestyle evaluation of their patients than a typical primary care physician. Functional Medicine practitioners emphasize healthy lifestyles, good nutrition, exercise, good sleep habits, smoking cessation, and so on, in addition to the normal comprehensive physical examination and lab tests, which is a good thing. This, of course, typically comes at a cost, as FM patients often (but not always) have higher out of pocket co-payments due to some tests and fees not being covered by medical insurance. However, patients state that they feel they are heard by their FM health care team, and the chances of some illness or condition being overlooked potentially could be reduced with the extra time spent and tests performed (although this hasn’t been demonstrated). Patients don’t want to wait hours in their “regular” doctor’s reception room, only to feel as though they are herded like cattle into cold examination rooms, then to wait another eternity until their nurse or physician gives them the proverbial seven minutes of their time before scribbling out a prescription that treats a symptom only. And while I hope you see through my above Straw Man scenario, you can see where the perception of individualized, caring medicine would be appealing to a significant percentage of the population, particularly those who are proactive and preventive in their health care decisions, those who may have a mistrust of “mainstream” medicine, and the worried well.
They are also right when they point out that the incidences of chronic diseases (such as cancer, heart disease, diabetes) have risen and that the health care costs associated with these diseases are burdening health care systems in many nations. Further, many if not most of these chronic disease are lifestyle related (smoking, poor sleep hygiene, sedentary habits, poor diet, etc.) and are thus preventable. Again, this is just good medical practice, and not a recent innovation of Functional Doctors.
Another area where FM is winning in the marketplace of perception and image is that they have branded themselves as progressive, a new paradigm in medicine. They throw around such enticing buzz- words and phrases as “powerful new operating system”, “empowerment”, “biochemical individuality”, “high touch/high tech”, et. al. while demonizing “conventional” medicine by describing it as “doctor centered”, “disease oriented”, “expensive”, and an “acute care model.” This message is indeed powerful, and has resulted in the integration (pardon the pun) of FM into such esteemed institutions as The Cleveland Clinic and George Washington University, and others. Even in my neck of the woods, The University of Kansas Medical Center has an Integrative Medicine department, where they boast of such quackery as vitamin C infusions and neurofeedback, the latter of which promises to “rebalance your brain.” Yes, those exact words are on the official University of Kansas Medical Center website. Sigh. Well, at least my alma mater still has the best college basketball program in the world.
What is wrong with Functional Medicine?
What is wrong with Functional Medicine is that it often promotes many CAM practices which have been shown to be of questionable therapeutic value, or outright ineffective. Reiki, acupuncture, chiropractic adjustments, “detoxification” programs, the aforementioned vitamin C infusions (unless you’re a bescurvied 18th century sailor fresh off the boat), and many other CAM modalities are offered as “holistic patient centered” options (again, at a significant cost and not without risk). Individualized care based on biochemical and genetic markers have some merit in some situations, and I’ve no doubt that this will become more prevalent in the future as techniques improve and applications are demonstrated scientifically. For now, however, it is an idea whose time has not yet come on a broad scale, and it is disingenuous to state or imply otherwise.
The other area where FM is a bit misleading is in how they frame their message. As stated earlier, the concepts of treating the cause of disease instead of just the symptoms is the foundational basis of all health care. I’m sure that Mark Crislip, an infectious disease doc, actually tries to kill the bugs that cause his patients’ diseases; he doesn’t just treat the symptoms. Often, however, treating the cause isn’t possible. For example, with many auto-immune diseases, there is no cure for the underlying pathophysiology, therefore managing the patient symptomatically is the best modern medicine can do at the present time. Using deceptive rhetoric and logical fallacies to their advantage, they frame FM as cutting edge and (ironically) science based, while portraying the mainstream medical community as closed minded, archaic, and behind the times.
Functional Dentistry – Coming to a theatre near you
Not wanting to feel left out, some dentists who have for years called themselves “biologic” or “holistic” dentists decided that a cool new word would really help separate themselves from the “ordinary” dentists who recommend such poisons as fluoride and amalgam fillings. Originally, “alternative” was the word of choice, but over time it grew stale and was subsequently replaced by “complementary”, a kinder and gentler term that implied a sort of truce between science based medicine/dentistry and non-traditional practices. After a while, the term “integrative” became fashionable, as complementary and alternative medicine attempted to insert itself into mainstream medicine. Thanks to promoters like Mehmet Oz, Andrew Weil, Deepak Chopra, and Joltin’ Joe Mercola, integrate it did. Not only into university-based medical centers, as mentioned above, but into private medical and dental practices worldwide. Within the past couple of years, some dentists have seized upon the “Functional” moniker and have co-opted it for their own use. Mind you, for these dentists, there has been no change in philosophy or standard of care from when they were only bioholisticompleternative dentists, it is a marketing/branding term only, which they presumably hope will help their websites’ Search Engine Optimization.
To date there are no “official” Functional Dentistry organizations, although I wouldn’t be surprised if one was founded in the near future. However, many individual dentists’ websites blatantly ride FM’s coattails. One dentist’s website states:
Functional Medicine Based Dentistry is the application of the principles and practices of Functional Medicine with the practice of the art and science of Dentistry. Philosophical differences exist today between traditional Evidence-Based Dentistry and Biological Dentistry, which have an impact on all patients and their oral and systemic health. Functional Medicine believes that a patient’s history, physiology, and lifestyle are fundamental factors when evaluating a patient’s health. Examination and interpretation of a patient’s individual biochemistry and genetics can give clues and hence better understanding of a patient’s chronic disease.
When we apply these concepts in the course of dental examination, diagnosis and treatment, the “one size fits all” philosophy of standard American dentistry becomes outdated and dentists transform from “molar mechanics” to true “physicians of the mouth.”
(emphases in the original)
Just like in Functional Medicine, statements like the above are disingenuous and fairly drip with the Unstated Assumption fallacy. As a non-Functional dentist, I can honestly say that I too believe that a patient’s history, physiology, and lifestyle are fundamental factors when evaluating their oral health. In fact, I know of no dentist who believes otherwise. Further, “examination and interpretation of a patient’s individual biochemistry” is a bit vague; while there are some useful genetic and salivary tests (when indicated) that are available in dentistry, they shouldn’t necessarily be utilized routinely and indiscriminately as screening tools until the evidence justifies it. And last, there is no such thing as a “one size fits all” approach to dentistry. Every person, every mouth, every situation is unique, and every prudent dentist takes all of these factors into consideration when determining a course of action for a patient, involving them in their treatment decisions. This is in our code of ethics and is not the domain of any one particular brand of dentistry.
Conclusion: Choose substance over marketing
All that said, most “alternative” or “functional” dentists are very conscientious dentists who sincerely want the best for their patients. If your dentist claims to be “holistic” or “functional” or “biologic”, you may want to put your antennae up if you are a science-based consumer of health care, but don’t throw the baby out with the bath water and summarily reject him/her. He or she may be a fantastic, science based dentist who is merely adapting the cloak of Functional Medicine Based Dentistry because they believe they are indeed “whole person” centered, want to appear to be cutting edge and progressive, and to gain a marketing advantage on their competition. There’s nothing wrong with that per se. To that end however, never hesitate to ask for good evidence if your dentist recommends something that seems “non-traditional.” The Center for Evidence Based Dentistry is a great resource for patients and health care providers alike. By being aware of what labels are being employed by physicians and dentists, what these labels mean, and why they are being used will help health care consumers make sound, science based decisions for themselves and their loved ones.