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About Functional Medicine

Improving Prevention and Management of Chronic Disease:
The Functional Medicine Model

A consensus is emerging today among many key stakeholders – patients, providers, and policymakers – that our healthcare system requires a comprehensive overhaul. Physicians are disenchanted; patients are dissatisfied with treatment outcomes; employers can’t continue to absorb double-digit increases in prescription drug spending; and despite spending $1.6 trillion per year on health care (2002 figures) , the U.S. ranks 37th in quality of health outcomes. The situation is increasingly insupportable – and yet, we continue to support it.

Despite the fact that non-genetic factors that are modifiable – including diet, overweight, inactivity and environmental exposures such as smoking – account for 70-90% of mortality in the U.S., physician education, training, and reimbursement are focused on treating disease using drugs and surgery rather than comprehensive patient-centered treatments focused on the individual. This emphasis should give us all cause for serious concern, because it is perpetuating a system that is far too costly and increasingly ineffective for the prevention and management of chronic diseases whose root causes are to be found in a much more complex perspective on patients’ lives.

The 20th century took on – and, to a great extent mastered – the challenges of providing healthcare for acute conditions (injury and life-threatening illness). At the same time that our healthcare system was focusing primarily on acute care, other influences were superseding acute conditions as the greatest threats to American health: increasingly stressful and sedentary lifestyles , industrial pollution of air, water, and earth leading to devitalized (and sometimes dangerous) food, overconsumption (rising rates of obesity) but undernutrition, and fragmented family and community ties (social isolation). Over time, these influences have helped to create an overwhelming burden of chronic disease that we do not yet train our healthcare providers to treat or prevent effectively. Effective prevention of chronic disease today requires understanding individual genetic vulnerabilities (20-30% of chronic disease risk) and the effect of lifestyle upon those individual variations (70-80% of the risk). This is the domain of functional medicine.

In addition to prevention strategies, many complex, chronic diseases are very responsive to dietary and various lifestyle interventions. But clinicians without these skills are literally at the mercy of the pharmaceutical industry. “…doctors are taught about drugs by agents of the pharmaceutical industry, which works hard to persuade them to select the newest and most expensive medications – even in the absence of scientific evidence that they are any better than older, less costly ones.” Or, we would add, even in the presence of evidence that many non-drug interventions are therapeutically effective and significantly less expensive.

Functional medicine is not a unique and separate body of knowledge, but it does represent a different way of applying the scientific and clinical information that emerges from the research literature and from the clinical practices of many disciplines. Functional medicine emphasizes a definable and teachable process of integrating multiple knowledge bases within a pragmatic intellectual matrix that focuses on functionality at several levels as the key to health. Functional medicine uses the patient’s story as an essential 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.

Chronic illness and multiple comorbidities are difficult to handle because the fundamental, underlying clinical imbalances have not been clearly delineated as the starting point. Functional medicine can substantially improve the existing Chronic Care Model, by providing an intellectual matrix that can filter research and clinical evidence to achieve a coherent focus applicable to the unique set of signs and symptoms presented by the individual patient.

Rabinowitz and Poljak commented in 2003 that we are seeing the emergence of a new primary-care model built on the molecular medicine discoveries of the last 50 years. This model integrates the concept of host/environment interaction in framing a better understanding of the origin of disease and its potential treatment, individualized to the patient. One major environmental factor that modifies gene expression is the individual’s nutritional status. Both macro- and micronutrients can influence the expression of genes, the translation of the genetic message into active protein, and that protein’s ultimate influence in controlling metabolic function. Functional medicine incorporates these critical concepts into an organized, patient-centered, and science-based approach to improving the management and prevention of complex, chronic disease.

The Institute for Functional Medicine (IFM) educates physicians and other healthcare providers in understanding the etiology, prevention, and treatment of complex, chronic disease. IFM is an independent, nonprofit educational organization dedicated to integrating the science-based best practices of established and emerging care into an effective and cost-efficient approach to treatment that can be taught to practitioners and delivered to patients using the Functional Medicine Matrix Model.© For more than a decade, the Institute has functioned as a credible, effective, multidisciplinary voice for improving health care. IFM recently received reaccreditation with commendation (six-year approval) from the Accreditation Council for Continuing Medical Education (ACCME), and has published the first-ever Textbook of Functional Medicine.

References

  1. Levit K, Smith C, Cowan C, et al. Health spending rebound continues in 2002. Health Aff. 2004;23(1);147-59.
  2. O’Connor K. We can corral health costs by keying on prevention. Seattle Times, June 7, 2002.
  3. “For most diseases contributing importantly to mortality in Western populations, epidemiologists have long known that nongenetic factors have high attributable risks, often at least 80 or 90%, even when the specific etiologic factors are not clear.” Willett, WC. Balancing life-style and genomics research for disease prevention. Science. 2002. 296:695-97.
  4. Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Arch Intern Med. 2004;164(3):249-58.
  5. Kaplan JR, Manuck SB. Ovarian dysfunction, stress, and disease: a primate continuum. ILAR J. 2004;45(2):89-115.
  6. Ishizaki M, Morikawa Y, Nakagawa H, et al. The influence of work characteristics on body mass index and waist to hip ration in Japanese employees. Ind Health. 2004;41(1):41-49.
  7. Pohanka M, Fitzberald D. Urban sprawl and you: how sprawl adversely affects worker health. AAOHN J. 2004;52(6):242-46.
  8. Valent F, Little D, Bertollini R, et al. Burden of disease attributable to selected environmental factors and injury among children and adolescents in Europe. Lancet. 2004;363(9426):2032-39.
  9. Weisburger JH. Hazards of fast food. Environ Health Perspect. 2004;112(6);336.
  10. Hightower J. Methyl mercury reference dose: response to Schoen. Environ Health Perspect. 2004;112(6);337-38.
  11. Silbergeld EK. Arsenic in food. Environ Health Perspect. 2004;112(6):338-39.
  12. Fletcher RF, Fairfield KM. Vitamins for chronic disease prevention in adults. JAMA. 2002;287(23):3127-29.
  13. Albus C, Jordan J, Herrmann-Lingen C. Screening for psychosocial risk factors in patients with coronary heart disease – recommendations for clinical practice. Eur J Cardiovasc Prev Rehabil. 2004;11(1):75-79.
  14. O’Keefe JH, Poston WS, Haddock CK, et al. Psychosocial stress and cardiovascular disease: how to heal a broken heart. Compr Ther. 2004;30(1):37-43.
  15. Linfante AH, Allan R, Smith SC, Mosca L. Psychosocial factors predict coronary heart disease, but what predicts psychosocial risk in women. J Am Med Womens Assoc. 2003;58(4):248-53.
  16. Yach D, Hawkes C, Gould CL, Hofman KJ. The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA. 2004;291(21):2616-22.
  17. Herman WH, Hoerger TJ, Brandle M, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142:323-32.
  18. Relman AS. Your doctor’s drug problem. The New York Times, November 18, 2003. [http://www.nytimes.com/2003/11/18/opinion/18RELM.html?pagewanted=print&position=]