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.