functional medicine

Those who believe that there are two categories of patients, those who are malnourished or vitamin deficient, and the rest of us, are fundamentally misguided and misinformed given the current depth of understanding about the role of nutrition in health and disease. --Mark Hyman, MD, Director of the Cleveland Clinic Center for Functional Medicine.

I finally see what FM really is: a non-scientific, ineffective, jingoistic, cultic approach to dysfunctional somatiform, non-disease conditions. -- Wallace Sampson, MD

Diseases don’t exist. --Mark Hyman

Functional medicine (FM) is not a branch of medicine. The term 'functional medicine' is a marketing term: it is more like integrative medicine or orthomolecular medicine than, say, translational medicine. In Europe, 'functional medicine' refers to a type of energy medicine known in the U.S. as bio-energetic medicine.* Again, these are not branches of medicine, but branding terms that describe various alternatives to science-based medicine. The basic ideas of those promoting functional medicine are not unique, but nobody has united and packaged the whole collection of questionable medical practices quite like the main defenders of functional medicine such as Jeffrey S. Bland and Mark Hyman.

Many opponents of science-based medicine (OSMs) believe and promote the idea that we live in a toxic world and need detoxification. Many OSMs promote the idea that they treat the patient, not the disease, and that they search for causes to eliminate rather than symptoms to palliate. Many OSMs assert that science-based physicians don't treat patients or care for their patients as persons, nor do they treat them 'holistically.' Many OSMs promote the idea that all illnesses are due to poor nutrition or toxins from the environment. Defenders of functional medicine are not the only OSMs to treat patients by diets, supplements, and detox procedures. Few OSMs have put all these misleading ideas together and packaged them with a cornucopia of jargon and meaningless medical concepts (e.g., 'organ reserve' and 'systems oriented'), while claiming to boldly go where no medicine has gone before with "a new model that focuses on treating your body as a whole system, that treats the causes not only the symptoms, that sees the body as a whole organism rather [than] simply [as] a collection of organs."*

It is not surprising that one of the leading popularizers of functional medicine got his start with questionable weight-loss programs. The term 'functional medicine' was popularized in the U.S. by Jeffrey S. Bland when he created the Institute for Functional Medicine in 1993, a subsidiary of his HealthComm corporation, an outfit that promoted a weight-loss program that came under fire by the Federal Trade Commission in 1991. HealthComm and another corporation owned by Bland were charged with "falsely claiming that their Nu-Day Diet program could change consumers' metabolism and cause them to lose weight without exercising so that fat would be lost as body heat instead of being stored."* The FTC also charged that the program-length television infomercial Nu-Day used to make these claims was deceptive. Bland consented to pay $30,000 and to disclose every 15 minutes during any future showing of infomercials that they are paid advertisements.* Another of Bland's weight-loss schemes was also a target of an FTC investigation.

In 1993, Bland founded the Institute for Functional Medicine, a HealthComm division that oversaw the company's web site, develops educational products, and sponsors an annual International Symposium on Functional Medicine. In 1997, he invited practitioners to join him on the Functional Medicine Section of CompuServe's Natural Medicine Forum, which HealthComm co-sponsored. Brochures accompanying the invitation stated that the company's UltraClear Plus "provides nutritional support for pathological or imbalanced detoxifiers and may be suitable for patients with" chronic fatigue syndrome; chemical and environmental sensitivity; alcohol and chemical dependency; food allergy; "management of endo- and exotoxicity"; and arthralgia and myalgia.*

In 1995, the FTC put out a news release announcing that "HealthComm Inc., and its officer, Jeffrey S. Bland, have agreed to pay a $45,000 civil penalty to settle Federal Trade Commission charges that they deceptively advertised various weight-loss products and diet supplements in violation of a 1992 FTC consent order. In addition to the civil penalty, the settlement would prohibit HealthComm and Bland from future violations of the Commission's order."* Bland's UltraClear dietary program was described as making false claims about how it "reduced the incidence and severity of symptoms associated with gastrointestinal problems, inflammatory or immunologic problems, fatigue, food allergies, mercury exposure, kidney disorders, and rheumatoid arthritis."*

In short, there is nothing original about claims made by proponents of functional medicine that diet, nutrition, and exposure to environmental toxins are the major causes of illness. There's nothing unique about claiming to provide "personal care" or "treating the whole person." There's nothing unique about claiming to treat the causes not the symptoms. There's nothing unique about claiming that vitamin and mineral supplements, as well as alleged detoxification practices, are essential to good health. What makes functional medicine unique among non-scientific health practices is its proponents' claim to understand individual, personal biomechanisms that allow them to determine a unique, optimal diet and nutritional plan for each individual on the planet with a chronic illness. The way they go about this is not unique either: they give each patient a questionnaire, interview them, and, in many cases, give them a set of medical tests. All new patients of any science-based physician do the same, but the questions asked and tests that might be done routinely by an FM practitioner are unique for standard care. Many of the questions have to do with diet and possible or known exposure to environmental toxins, questions a science-based physician would not ask routinely of every new patient. Many of the tests given by FM doctors are done "to assess nutritional status," something a science-based physician would do only if there were good reason to suspect the patient suffered from some sort of nutritional deficiency. FM doctors seem to assume that everybody suffers from some sort of nutritional deficiency and toxic poisoning. Tests for heavy metals are routine among FM doctors. Below is a description of testing at Mark Hyman's Center for Functional Medicine at the Cleveland Clinic:

Testing is frequently done to assess nutritional status including amino acids, fatty acids, oxidative stress, vitamin levels, mitochondrial function, food allergies, and heavy metals. Many other tests are available, including genetic testing for a variety of conditions, hormone evaluations, bone health, gastrointestinal health, adrenal function and many others....While the testing gives a more complete picture of your status, effective care can be implemented without it, or testing can be done over time. You should not let this prevent you from seeing one of the doctors.

I take this to mean that the FM doctors know even without testing you that you are nutritionally deficient and full of poisons that need to be eliminated. The health questionnaire new patients are asked to fill out indicates that this is the case. There is a section called ENVIRONMENTAL AND DETOXIFICATION ASSESSMENT where you are asked such things as

In your work or home environment, are you exposed to: ☐ Chemicals ☐ Electromagnetic Radiation ☐ Mold.

Do you have a known history of significant exposure to any harmful chemicals such as the following:
☐ Herbicides ☐ Insecticides (frequent visits of exterminator) ☐ Pesticides ☐ Organic Solvents
☐ Heavy Metals ☐ Other.

Do you dry clean your clothes frequently? ☐Yes ☐ No

Do you or have you lived or worked in a damp or moldy environment or had other mold exposure? ☐Yes ☐ No

Do you have pets or farm animals? ☐Yes ☐ No

These are routine questions, not aimed at anyone who has come to the clinic with a specific complaint or set of symptoms. Each potential patient is asked about their readiness to change their lifestyle and diet:

Rate on a scale of 5 (very willing) to 1 (not willing):

In order to improve your health, how willing are you to:

--Significantly modify your diet.
--Take several nutrition supplements each day.
--Keep a record of everything you eat each day.
--Modify your lifestyle (e.g., work demands, sleep habits).
--Practice a relaxation technique.
--Engage in regular exercise.
--Have periodic lab tests to assess your progress.

Again, these questions are asked of every potential patient before he or she arrives at the clinic. Also, the lab tests that assess progress test "nutritional status," which you are supposed to assume is meaningful to your health problems whatever they might be. The fact that each patient is required to keep track of what he eats and drinks is another clear sign that the FM folks believe that all health problems are diet related, which, of course, will justify their recommendations for supplements and detox programs.

While good nutrition is essential to a healthy lifestyle, what passes for good nutrition among the FM folks is not based on scientific evidence. As Mark Hyman notes: The “medical nutrition” that [the Cleveland Clinic's] nutritionists practice "is very different from what most nutritionists do." One of the goals of FM clinics seems to be to make things seem so complicated that only their experts know what is a proper, healthy lifestyle for everybody on the planet.

FM proponents claim they are providing a new model for medicine to replace the one we have now. The way FM advocates like Hyman, Bland, and others characterize standard science-based medicine is a model of cherry picking and confirmation bias. Their own model is hideously unsupported by scientific evidence. They claim that all of us should be "treated" for our nutritional deficiencies, genetic makeup, and environmental toxicities before symptoms of our "diseases" show themselves. There is very little evidence to support their notions about the need for supplements or detoxification. There is so much known about nutrition these days that it would be absolutely amazing if the FM folks didn't have much sound advice about what we should or shouldn't be eating on a regular basis. That fact hardly excuses their hubris at pushing their pipedream model of health and disease while denigrating science-based medicine. The belief that diet, supplements, and detox are going to solve all the world's health problems is a pipedream. There is no basis in reality for such a belief. It isn't even plausible given what we do know about nutrition and disease.

It is obvious to anybody with a minimal amount of knowledge of health and disease that we should eat nutritiously, exercise, deal intelligently with stress, avoid smoking, and stop polluting our water and air. FM folks didn't discover these facts. And the FM folks are just plain wrong about everyone needing supplements or detox. It may be true that we in the U.S. have a major obesity problem due to the abundance and availability of high-calorie, low-nutrition food, but it is absurd to connect this epidemic and the diseases connected to it on science-based medicine. Frankly, given the misleading and false claims that the leaders of FM have made about various diets, I would not trust them were I looking for a good nutritional program. I certainly wouldn't go to them to treat my cancer.

See also Energy Healing: Looking in All the Wrong Places, detoxification therapies, theratest machine, radionics, vibrational medicine, Ze'ev Kolman.

further reading

Some Notes on Jeffrey Bland and Metagenics by Stephen Barrett, M.D.

Mark Hyman deceives about “science research deception” by Orac

Paradigm Shift: The End of “Normal Science” in Medicine by Mark Hyman, MD

Interview with Dr. Helmut Schimmel by Stuart Zoll

"Why Bogus Therapies Often Seem to Work" by Barry L. Beyerstein, Ph.D.

Functional Medicine (FM) What Is It? by Wallace Sampsom, M.D.

Functional Medicine – New Kid on the Block by Wallace Sampsom, M.D.

Functional Medicine III by Wallace Sampsom, M.D.

Functional Medicine IV by Wallace Sampsom, M.D.

Cleveland Clinic Center for Functional Medicine

Introduction to Functional Medicine by David S. Jones, MD, and Sheila Quinn

functional medicine - Wikipedia

http://www.ehaxe.com/functional-medicine78123.htm claims functional medicine was developed and originated by Dr. Helmut W. Schimmel. In an interview published in 1992, Schimmel says "I always wanted to become involved in Bio-Energetic medicine, which is referred to as functional medicine in Europe." Obviously, he didn't originate it.

History of Asyra Advanced Bioenergetic Analysis "Dr. Helmut Schimmel, a medical and dental physician and clinical researcher from West Germany, worked with BFD [Bio-electronic Functions Diagnosis & Therapy] for nearly a decade until, in 1978, he developed a third incarnation of the system. The “VEGATEST-Method” or VRT (Vegetative Reflex Test) was the culmination of some thirty years development and experience of German Electro-Acupuncture. The new technology and practices became hugely popular in Germany and spread overseas to the USA, England and Australia."

Schimmel says he's "been inspired by many people. Mainly Prof. A. Pischinger (Austria) who had done a lot of research in the field of connective tissues. Then Dr. Reinhard Voll, the inventor of electro-acupuncture and Dr. Samuel Hahnemann who established homeopathy and Dr. H. Motoyama from Japan who wrote about chakra-testing, and finally Dr. Johannes Goebel, a German physician, who gained a lot of experience in the field of neural therapy." As unorthodox and anti-scientific as Schimmel is, one might think his form of functional medicine would be in harmony with that of Bland and Hyman, but they seem to be coming from two different incoherent paradigms.

Gabe Mirkin, M.D. Good Food Book (and it's free!) If you are searching for some sensible advice on eating and nutrition, take a look at this free book from an expert who will not try to hype you.