The best way to explain my embracing the concept of functional medicine to you is probably to tell you a personal story. When I entered medical school in 1982, I was interested in becoming a "healer." I was interested in preventative medicine and finding the basic keys to good health and longevity. In medical school, I was confronted with a bewildering array of facts: information about anatomy, biochemistry, genetics, physiology, pharmacology, epidemiology, microbiology and many other topics. The model we were taught for dealing with this information, at least in so far as it attached to being a physician was incomplete, as are all models.
The model of conventional medicine is a filtering model. Information is deemed relevant or irrelevant and quickly pruned away from awareness, holding only those facts that seem to be important discriminators with a view to first narrowing down the organ system affected and then reaching a diagnosis. It is an analytic, reductionist approach. It is best suited to crisis thinking: a broken leg, an abdominal pain with fever, a mysterious rash. These sort of acute medical problems respond very well to a paring-away, reductionist approach. It is in these urgent, acute situations that extra facts are confusing. And since the interventions are generally themselves acute and intense, a surgery, an antibiotic, and limited in time, it's the right approach to use for that circumstance.
As I entered the hospital wards in the second phase of my training, I became aware that most people do not become sick in the way that is described in our textbooks. That is to say that most people have several "diseases" coexisting in the same body. Here's where the first danger rises. By its very nature, our science and therefore the information we've gathered about our pharmaceuticals requires a simple, straightforward plan: a group of close to identical people, half receive a drug, half receive a sugar pill, and you measure the difference. The basic assumption is that the individuals are more or less the same, and therefore will react to the drug in more or less the same way. The more I practice medicine, the more I realize that this is a flawed assumption. A second paradox, immediately obvious if one examines it, is that most surgical procedures are never studied for placebo effect. In fact, in recent years when this has been attempted very few of the most common surgeries can be proven better than placebo.
All of my patients in my career have been complex, multidimensional individuals. The conventional medical paradigm seemed to pare away all of this individuality and ignore it. This was the source of a great deal of frustration to me, until in the mid nineties, I began to study acupuncture. In acupuncture, the basic assumption is that everyone has somewhat different system, unique to themselves, partially determined by their genetics, partially determined by their mental attitude, partially determined by the circumstances that have occurred during their life. It is much more of a biological approach to thinking about health and disease, and one that felt quite comfortable to me because it matched my experience. The acupuncture model first seeks to understand the individual's intrinsic strengths and weaknesses and then engage the current problem with a tailored approach, supporting the body in areas where there is underactivity and calming the body in systems with overactivity.This balancing approach is quite powerful and is much more suited to chronic disease.
The two models were very incompatable and I found myself having to separate my acupuncture practice more or less completely from my family medicine practice. It was then when I encountered the concept of "functional medicine." Functional Medicine is a "reframing of scientific knowledge". I found that it shared with acupuncture the strengths of first seeking to understand the individual, their strengths, their weaknesses, their myriad influences on their responses to the environment and how that might manifest as illness. Functional medicine seeks to address the underlying functioning of the individual as a complex interplay of various functions. Examples of critical functions are the taking in and absorption of nourishment, the elimination of toxins, structural integrity and hormonal signaling. I see the approach as one of identifying where the compromises are greatest and determining where the best possibility for supporting recovery of balanced function lies.
Functional Medicine is not a filtering mechanism in the way that conventional medicine filters out and discards information. It's more properly thought of as a filing format. All information is kept and filed away in the appropriate file drawer. For example, a history of childhood sexual abuse might be filed away in the psychological drawer. This particular bit of history would be of little use in treating a sore throat. But should the individual require emergency surgery, the loss of control and the sense of being overwhelmed by events could trigger a state of physiological arousal that would complicate their course. The ability to anticipate this and address it proactively could significantly improve the person's outcome. There are many clues to the underlying physiological state of the individual that are routinely discarded in conventional medicine because they are not discriminators in reaching a diagnosis. But later on in the course of caring for this patient this information could be useful. A good example would be a tendency toward abdominal bloating after a large meal, can give important information about the functional status of the gastrointestinal tract, which could then prove useful in the context of a chronic skin rash. In conventional medicine, the rash would be examined to see if it fit the pattern of one of the rare diseases. That possibility being eliminated, the cause of the rash would be dismissed, and a treatment, usually topical cortical steroids, would be administered. But rashes are clues to underlying systemic disruptions in both functional and oriental medicine. I always feel that when two independent systems of complex modeling arrive at a similar conclusion, that conclusion, even if not "falsifiable" by scientific means, must be given some weight and consideration.
This brings to mind the most serious shortcoming of conventional medicine, its tendency to treat symptoms instead of causes. While relatively safe and effective if there is, in fact, just one disease process going on, this approach can prove disastrous as people reach their midlife and have multiple chronic problems. Mathematicians tell us that when you go above three pharmaceuticals, the possible number of drug interactions is incalculable. Many of our seniors find themselves on half a dozen different medications, all of which have the potential to interact adversely, and this in a body whose ability to process and detoxify pharmaceuticals is being compromised through aging. It's no wonder that properly-administrated drugs and the reactions they create is estimated to be the fourth or fifth greatest cause of death in the United States. This is not the fault of the drugs. This is the fault of the way in which they are administered and a flawed basic assumption, that being, that we can extrapolate from our scientific evaluation of drug safety, the effects of multiple drugs in a unique individual.
Functional medicine uses conventional pharmaceuticals cautiously and seeks to do so for a limited amount of time, reasoning that the adaptations that come with long term use of pharmaceuticals may themselves endanger the patient. Many chronic diseases can be reversed or greatly diminished using functional medicine's paradigms of lifestyle and nutrition as primary therapies. It is the obvious first place to start.