A frequent question asked by parents of patients, professional colleagues, and friends is “What is functional (or integrative) medicine? This is an important question worthy of discussion. The answer is difficult only in the sense that these terms refer to a completely different paradigm for the practice of medicine as we know it. The increasing demand for this kind of healing approach is evidenced in the following summary from an overview of integrative medicine:
Presently, the expansive growth of Integrative medicine has been fueled in part by a public discontent with conventional medicine and increasing consumer demand for medical advice on the subjects of lifestyle, nutrition, exercise, and natural therapies. Patients want more emphasis on health, healing and prevention of chronic illness rather than just diagnosis and treatment. Numerous peer-reviewed, published studies in the literature reflect the increasing popularity and use of integrative therapies in the populations of the United States and developed countries. The appearance of many Integrative and Complementary and Alternative Medicine (CAM) departments in major medical centers and schools (such as Harvard, Memorial Sloan-Kettering Cancer Center, Stanford, Duke, University of Maryland, Scripps, MD Anderson and many others), speaks to the wide acceptance and increasing public demand for these services.[i]
What explains the rapid growth in this form of care? The reasons are many, but among the most fundamental are the following:
- Functional or integrative care looks for underlying physiological processes going on at the cell level and assumes that multiple or chronic disease syndromes stem from common underlying causes rather than seeing clinical diseases as separate entities.
- Basic biochemical processes are identified, and, in many cases, genetic influences are identified for which there are available remedies. These are usually in the form of nutrients or supplements that target identified functional imbalances.
- Pharmaceutical agents (medications) are utilized when appropriate and necessary, but natural agents such as nutrients, supplements, vitamins, and natural (“bioidentical”) hormones, are used when possible.
- The traditional model of medical care typically identifies diseases that are viewed as separate, discreet entities, each with specific, mostly drug-related therapies. Functional medicine looks for patterns of dysfunction among organ systems, underlying biochemical processes gone awry, and seeks to identify underlying dysfunctions that may explain a number of what otherwise appear to be discreet diseases. An example of this would be a patient with a history of migraine headaches, chronic gastrointestinal symptoms labelled as “IBS” or irritable bowel syndrome, and anxiety or depression. This hypothetical patient is a common pattern in practice, and usually includes a history of the patient having been evaluated and treated by specialists (such as a neurologist, a gastroenterologist, and a psychiatrist) – each having prescribed pharmaceutical agents, often taken for years and with significant adverse effects. It is common, furthermore, for additional drugs to have been prescribed to counter side effects from others. The patient ends up being on multiple drugs over extended periods of time – a process recognized as “polypharmacy.” The latter history is representative of a patient who would quite likely be found to have gluten sensitivity or celiac disease if looked at carefully with the right kind of gluten antibody panel described in my recent article “Could it be Gluten” (Natural Triad November 2013). Genetic variations known as single nucleotide polymorphisms, or, “snips”, likewise might be found and specific vitamins or other nutrients prescribed to address biochemical pathway impairment and consequent neurotransmitter imbalance.
- Using the example above, the representative patient (based upon real patients in the aggregate), if remaining within the traditional medical care system, would likely continue to face ongoing multiple specialist office visits, prescriptions, side effects of prescribed drugs, and yet face potentially years of ongoing care, never resolving the problems. If a unifying underlying cause such as celiac disease or gluten sensitivity in this case is identified, however, a gluten-free diet would quite possibly lead to resolution of all three of the clinical syndromes or disease entities and the ability to withdraw many if not all the medications otherwise relied upon to suppress symptoms. The average time patients ultimately diagnosed with celiac disease have symptoms before the diagnosis is made in the United States was reported to be 10 years in 2007.[ii]
The fact that natural treatments are often utilized in a FM (functional medicine) approach that have not been subjected to the kind of controlled clinical trials typical of FDA approved drugs leads to one of the objections often raised by professionals who are not familiar with the evidence base underlying the principles of FM. As a practitioner within the traditional medical paradigm for over 30 years, as well as spending 11 years in academic pediatrics, I shared this skepticism myself until plunging into the FM model in recent years. To my great surprise, the science underlying the major tenets of FM is vastly more extensive and complex than that upon which conventional approaches and pharmaceutical agents are based. Thirty hours of formal CME (continuing medical education) training under the auspices of the Institute for Functional Medicine and the North Carolina Integrative Medical Society, along with extensive reading in the functional medicine literature, revealed to me what proved to be an astounding depth and complexity of basic biochemistry upon which these practices are based.
This contrasts with reliance upon pharmaceutical agents to suppress symptoms rather than identifying and providing correction for underlying causes of most chronic diseases within the traditional medical model. It is important to realize that FDA approval of a new drug requires only that two properly designed clinical studies show statistically significant benefit compared to “placebo controls” – inert or inactive “dummy” substances given to comparison subjects in the study. Furthermore, approval does not require direct comparison with effectiveness of existing ones, and this is rarely if ever done. In many cases, a newly approved drug has failed to demonstrate efficacy compared to placebo in the large majority of studies done by the pharmaceutical company, but the negative trials were never published. This is known as the “file-drawer” phenomenon, whereby negative trials are hidden from view by never being published. Drugs are important, sometimes critical and life-saving, but it is important to understand that commercial interests and the kinds of disclosure described above often exaggerate perceived effectiveness and understate real-world adverse effects. Every drug is a “xenobiotic” or foreign substance to the body. This means that effective metabolism is required, and this involves the complex detoxification pathways that are often impaired in the course of chronic disease.
A Los Angeles Times article (9/17/2011) cited U.S. CDC data showing that drug deaths exceeded motor vehicle accident deaths in the United States in 2009. Deaths from prescription and non-prescription drugs have continued to increase according to numerous reports. The Times article points out that increasing prescribing of pain-killers and anti-anxiety drugs has contributed to these alarming numbers.
The traditional medical care model has served well in many advances that have prolonged life and enabled widespread increased survival and provided solutions for previously untreatable diseases such as infectious disease and fatal nutritional deficits (like vitamin C for scurvy and vitamin D for rickets). The increasing cost of health care and a disproportionate percentage of disease burden has shifted during current times to chronic diseases, however, the traditional model which served so well in the past increasingly fails to stem the tide of contemporary disease morbidity – autoimmune diseases, degenerative diseases, cancer, cardiovascular disease, and steadily increasing morbidity and mortality from adverse effects of drugs. Functional medicine is well suited for this trend, and many believe it represents the hope for progress in the future.
Dr. Bose Ravenel
Robinhood Integrative Health
Dr. Bose Ravenelretired from his former general pediatrics practice in October, 2013 and now provides pediatric functional medicine consultations as a member of Robinhood Integrative Health in Winston Salem.
After taking an integrative and non-pharmacological approach to ADD/ADHD beginning in about 2005, he has taken the research knowledge and experience gained from that to broaden his interest and practice focus to other chronic health problems. He has recently published his experience using a functional medicine approach to chronic diseases within his former pediatric practice over the past two years prior to joining Robinhood Integrative Health.
Dr. Bose, as he is known to his friends and colleagues, has two adult married children, a son who in is his former pediatric practice and lives in High Point, and a daughter living outside of Charleston, S.C. He and his wife, Susan, live in High Point, North Carolina and enjoy their three grandchildren: one grandson age 16 months, and two grand-daughters ages eight months and 4 ½ years.
[i] Integrative Medicine History, Overview, and Applications to Pain Management. Joseph Mosquera. From Contemporary Pain Medicine: Integrative Pain Medicine: The Science and Practice of Complementary and Alternative Medicine in Pain Management. Ed: J.F. Audette and A. Bailey. Humana Press, Totowa, NJ.
[ii] Celiac Sprue Association. http://www.csaceliacs.info/celiacdiseasefacts.jsp
[iii] The True Cost of a Flawed Health Care Paradigm. Dr. Joseph Mercola. October 5, 2013. http://articles.mercola.com/sites/articles/archive/2013/10/05/us-health-care-system.aspx
[iv] Your Simplified Road Map to Health. Dr. Amy Yasko. http://www.scribd.com/doc/132017201/Dr-Amy-s-Simplified-Road-Map-to-Health