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, Abraham 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 resurrection under a more modern slogan, “Functional 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…Functional 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
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.