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Dr. Robin Berzin, functional medicine concierge practices, and the marketing of medical pseudoscience

Dr. Robin Berzin founded a concierge functional medicine practice, Parsley Health. Her practice is growing and has expanded to three major cities thus far, and she’s begun a foray into pediatrics? Are holistic concierge medical practices the future of “integrating” quackery into medicine, be it functional medicine or other models?

I’ve written a fair amount about “functional medicine.” After all, the Cleveland Clinic has embraced it, hiring one of the godfathers of functional medicine, Mark Hyman, in 2014 to set up a clinic. Unfortunately, reportedly that clinic has been wildly successful, and the Cleveland Clinic has been good at sneaking credulous laudatory stories into Ohio media about patients experiencing the “miracle” of functional medicine. That the Cleveland Clinic did this around the same time that the antivaccine book that Robert F. Kennedy, Jr. had co-authored with Dr. Hyman was released and he appeared on The Dr. Oz Show to promote it. Unfortunately, the illusions that functional medicine sells appear to be popular. I just saw an article advertising a functional medicine concierge practice, Parsley Health, founded by Dr. Robin Berzin. The story’s headline asks if “holistic primary care” is the “future of medicine.” All I can say is that I hope not:

The doctor doesn’t quite make house calls, but this “Uber for blood” guy was the first indication that this was going to be an entirely different checkup. My Parsley Health experience started with a kindly bloodwork technician coming to me to draw a sample, pack it in his duffle bag, and drive away to the lab. The whole thing took less than five minutes—all while I was still in pajamas.

Later, I booked an in-office doctor’s visit online via a streamlined site that was more a Slack/ClassPass hybrid than any MyChart health portal. The only real work? An online medical questionnaire, covering everything from what type of birth my mother had (vaginal or C-section) to whether I ever had an eating disorder. The dozens of personal questions went far beyond the medical norm: Are you happy? Would you describe your childhood as secure? Are you satisfied with your sex life?

Once I arrived in the doctor’s office inside an L.A.-area WeWork, my appointment ran for 1.5 hours. A doctor, with my blood results already in hand, explored the physical and emotional issues affecting my well-being beyond the numbers. That can run the gamut from potential food allergies and environmental toxins to insomnia and stress.

You can recognize that this “holistic” practice is heavily into nonsense because of the mentions of certain buzzwords that give it away, buzzwords such as “food allergies” and “environmental toxins.” The article, as you might expect, is littered with such buzzwords and catchphrases, along with others like “holistic”; a Parsley doctor “doesn’t just prescribe drugs”; focusing on the “root causes of disease” (whatever that means); and that Parsley does a better job at treating chronic disease. In other words, these are the same claims that pretty much all “complementary and alternative medicine” (CAM) and “integrative medicine” advocates trot out when trying to claim that their embrace of pseudoscience and unproven treatments is better than conventional medicine.

But don’t call Parsley founder Dr. Robin Berzin a practitioner of “integrative medicine.” No, she insists on being called a functional medicine doctor:

“Functional medicine is not Eastern medicine, it’s not integrative medicine,” stresses Berzin. “It’s just taking best practices for conventional medicine but focusing on the root causes of disease.” For example, she adds, “You’re not an insomniac lying awake at night because of an Ambien deficiency.”

Actually, this is disingenuous. Functional medicine itself might not be “Eastern medicine” or traditional Chinese medicine, but it sure as hell is a form of “integrative medicine,” because if there’s one thing functional medicine does a lot of, it’s “integrating” the unproven and quackery with conventional medicine. Indeed, I’ve often characterized functional medicine as the “worst of both worlds” because it combines the massive overtesting and overtreatment to which conventional medicine can sometimes be prone with—you guessed it!—quackery. That includes homeopathy, traditional Chinese medicine, and, above all, a boatload of supplements. I once discussed a functional medicine case report describing the care of an 80 year old woman with locally advanced breast cancer. The care involved the assessment of well over 100 minerals, metabolites, hormones, and the like in the blood and the addition of a whole bunch of supplements.The results take up more than two pages of the case report, and include amino acid levels, “gut immunology” markers, secondary bile acids, parasite tests, pancreatic enzyme levels, heavy metal levels, and, of course, the most beloved lab tests of FM practitioners and autism quacks, oxidative stress markers like glutathione and coenzyme Q10. She got huge doses of intravenous vitamin C three times a week plus 18-24 g of oral vitamin C every day.

In the end, I concluded that there were probably a couple of things the functional medicine doctors did that added anything to her care other than the surgery, chemotherapy, and radiation: exercise, a personal care giver, counseling, and perhaps the sleep log she was asked to keep. For everything else, there’s no evidence that it added anything to her care at all, other than expense, inconvenience, and additional risk above and beyond the risks that she already faced due to the harshness of her conventional treatment and her advanced age. This is the same as it usually is with functional medicine. The things functional medicine co-opts, like diet, exercise, weight loss, and improvements in sleep are primarily responsible for good outcomes, while the shotgun testing and quackery get all the credit.

That’s not all, though. You should see a particular functional medicine protocol that claims to treat Alzheimer’s disease. Known as the MEND™ protocol for Alzheimer’s disease, it claims to slow the cognitive decline due to Alzheimer’s disease by simultaneously treating “the dozens of pathology drivers of age-related cognitive decline,” including “metabolic issues, toxicity, inflammation, and mitochondrial damage,” which sounds exactly like functional medicine. That’s why I’ve referred to the MEND™ protocol as functional medicine on steroids, because, whether the scientists at Muses Labs know it or not, that’s exactly what functional medicine does: Measure a lot of markers that basic science and/or epidemiological studies have tentatively linked to various diseases without regard to whether these markers have been shown to have a causative role in these diseases, and then try to fix their abnormal levels. In doing so, functional medicine ignores an adage I’ve been taught since I was a resident: Treat the patient, not the lab values.

Whenever I discuss functional medicine, I like to try to remind my readers just what the heck functional medicine is. I always have a hard time explaining it; so I usually end up going to the source, the Institute for Functional Medicine, which quickly reveals that functional medicine is a lot of nonsense mixed with some sensible advice. Functional medicine claims to be guided by six core principles:

  • An understanding of the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness;
  • Awareness of the evidence that supports a patient-centered rather than a disease-centered approach to treatment;
  • Search for a dynamic balance among the internal and external body, mind, and spirit;
  • Familiarity with the web-like interconnections of internal physiological factors;
  • Identification of health as a positive vitality not merely the absence of disease emphasizing those factors that encourage the enhancement of a vigorous physiology;
  • Promotion of organ reserve as the means to enhance the health span, not just the life span, of each patient.

The above list is the sort of thing that sounds reasonable on the surface but doesn’t stand up to close scrutiny. I could (and would) point out that the “understanding of the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness” seems custom-made to cater to the belief among some of the woo-prone that they are special snowflakes, so utterly unique that treatment must be tailored to their finest uniqueness. Alternatively, as Wally Sampson once pointed out, “biochemical individuality” is an expression invented by Dr. Roger Williams of the University of Texas 50 years ago to justify administering massive doses of vitamins and other supplements in order to achieve “optimum health.” Linus Pauling, proving that Nobel Laureates can be taken in by pseudoscience, adapted the concept, along with other treatments involving massive doses of vitamins, into the idea of “orthomolecular medicine,” a type of medicine that seems to have at its very core the concepts that all disease is due to some sort of vitamin or nutrient deficiency (or “imbalance”) and that, if some vitamins are good, massive amounts more are even better. It’s no wonder that functional medicine frequently goes hand-in-hand with orthomolecular medicine. Unfortunately, functional medicine has some famous believers, such as Bill and Hillary Clinton—and Bernie Sanders.

Oh, and did I mention that all the doctors at Parsley are certified by the Institute for Functional Medicine?

Here’s a video of Dr. Berzin explaining her practice:

In it, you’ll hear Dr. Berzin talking about genomics (functional medicine docs love to abuse systems biology), the microbiome, stress pathways, all the usual stuff that functional medicine doctors think that they understand but make abundantly clear that they do not through the ways that they approach patient care, which is basically to measure every marker they can think of, whether relevant or not, whether validated or not, and then to try to correct the lab values.

In any event, when you get past all the holistic buzzwords and standard rhetoric about “disruption,” what you’re left with here is a fairly standard concierge practice, or, if you would prefer, a concierge functional medicine practice run by Dr. Robin Berzin. It’s a practice that’s expanded to three cities already, San Francisco, Los Angeles, and New York. Guess who’s backing it as well? Come on, guess:

This past April, the startup announced a $10 million round of Series A funding, led by FirstMark Capital, with additional investments from Amplo, Trail Mix Ventures, Combine, and The Chernin Group. Individuals included Mark Hyman, MD, director of the Cleveland Clinic Center for Functional Medicine, and Warby Parker cofounder Dave Gilboa.

Moving forward, Parsley Health intends to open more clinics across the country, as well as beef up its online content platform. The biggest challenge, says Berzin, is educating the public about the benefits of functional health.

Mark Hyman? Surprise, surprise!

I did say, however, that this functional medicine practice started by Dr. Robin Berzin is a concierge practice:

That, and convincing people to adopt an alternative payment model. Most consumers aren’t too well versed in options beyond health insurance–or just depending on the emergency room.

“You have to educate people about how they’re already spending their money in ways that they’re not aware of themselves . . . they are already spending hundreds if not thousands of dollars on unnecessary medications, unnecessary specialists, and ‘healers,’” says Berzin.

With Parsley Health, membership equates to a little under $5 a day. That’s a small price, says Berzin, for preventable health strategies that encompass all of one’s physical and emotional well-being. These are doctors who won’t ever say, “‘We have 15 minutes with you. Here’s your prescription for drugs. Off you go.’”

But what does this mean? If you wander over to the Parsley Health website, you’ll find two plans and a service. The first service costs $500 and includes a 75 minute doctor visit, 45 minute coaching session, and “basic biomarker testing,” access to an online portal, among other things. The “basic biomarker testing” claims to look at “inflammation, nutrient status, heart health and more”; in other words, the usual functional medicine “throw everything at the wall and see what sticks” approach. This plan goes for three months.

Next up is the “Complete Care” plan, which is $150 a month and includes so much more, including, of course, something Parsley calls “advanced bimarker testing,” which includes a “curated testing program” that includes “microbiome, genomics, toxin, heavy metal, hormone, nutrient and immune analyses as indicated.” (Pro tip: Any time someone proposes testing you for heavy metal levels in the absence of an exposure or symptoms, they’re quacking. Ditto testing you for “toxins” in the absence of a clear indication.” (Heck, Parsley even brags that you can get over 1,000 biomarkers tested, which, let me remind you, makes it very likely that they’ll find at least a few dozen “abnormal” labs if the cutoff for abnormal is more than two standard deviations away from the mean, as is usually the case.) Going up to the $250/month “premium care” plan just gets you more visits and access to “priority visits” within 48 hours of calling, which hardly sounds very “priority” to me given that my doctor’s practice can often see patients the same or the next day when necessary.

Then there’s this:

Toxins!
Dr. Robin Berzin: Retweeting antivaccine nonsense.

Yes, you saw that right. Dr. Berzin was retweeting antivaccine and antifluoridation nonsense. Elsewhere, she talks about how she tested high in mercury before getting pregnant and therefore did a “heavy metal detox” before trying to have a baby:

She also parrots a whole lot of antivaccine nonsense at around the 1:00 mark while claiming that she’s “not antivaccine.” For instance, she talks about comparing the 1980 CDC recommended vaccine schedule to the current one and being appalled that children receive “10X” more vaccines now, all while invoking big pharma and the profit motive as the reason. Of course, she’s unhappy over the birth dose of hepatitis B vaccine. Overall, she comes across as what I’d call “soft antivax,” of the “too many too soon” variety, saying she’s planning on following a “delayed vaccination schedule.” She does also invoke hygiene and public health as being more important. She even heaps disdain on pediatric practices that brag about close to 100% vaccination rates and promises that the pediatric practice Parsley will be starting (actually, has already started—this interview is from 2017) won’t vaccinate everyone. She even invokes thimerosal and implies she’s sympathetic to the “toxins gambit.” All the while, she tries to portray herself as being the “moderate” and “reasonable” one, as compared to all those radical pro-vaccine doctors. This is, of course, bullshit.

Of course, practices like Parsley Health have to be made more appealing and glitzy by adding the latest bells and whistles. Don’t get me wrong. I like some of the technology Parsley has applied, such as:

Apart from the in-depth diagnosis and treatment model, Parsley also differs in its emphasis on technology. The entire booking process is done online, with doctor’s notes, medical records, and health coach messages available on an easy-to-navigate dashboard.

“Everyone is busy,” says Berzin of Parsley’s 100% open notes policy. “You shouldn’t beg us to fax you something. All your data should be online so that you can view it 24/7 and download it yourself. We believe you own your data.”

Additionally, Parsley built data tracking into its system to assess and compare outcomes–a method rarely found in general primary care. Before each visit, patients fill out a survey that helps the medical team monitor progress and outcomes. Over the course of a year, Parsley’s digital system then adds thousands of data points to a patient’s charts, which enable them to change course should a method or treatment show little improvement.

Well, not everything. This latter tracking feature sounds to me custom-designed to track mainly subjective symptoms, which are most prone to placebo effects. Also, what good are thousands of data points if you don’t know what to do with them or don’t have the tools to make sense of them?

If there’s one thing this article drove home yet again, it’s that one reason why woo is flourishing these days is because those selling unproven treatment methods are so much better at marketing than conventional doctors are. They have the patient portals that go beyond what most other practices and hospitals have. They make their clinics look like spas that cater to a patient’s every whim. Add to that something like functional medicine, a specialty that tells each patient that he or she is so biologically unique that the treatment must be equally unique (whether that’s true or not), and it’s a message most people won’t be able to resist because they won’t see the emptiness at its core.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

60 replies on “Dr. Robin Berzin, functional medicine concierge practices, and the marketing of medical pseudoscience”

Ugh. I had to deal with a lot of functional medicine nonsense in my Women’s Health rotation. There’s something about pregnancy that really brings the incredulous out of people when it comes to health care.

I think that you either added a zero to one number or removed it from two numbers when discussing the cost of the treatment plans. I’m going to assume that it’s $50.00 for the 75 minute waste of your life, and the other two are the “better” plans.

The scariest thing from this posting is the idea that it is a good thing to have all the patient notes online and accessible via the internet. I’ll bet a years pay that these idiots have as good a grip on their IT security as they have on their medical skills. That being the case, I give it maybe a year before some enterprising cracker opens their patient database to the world, or uses its contents to blackmail/steal the identity of the patients (Questionnaire looks like an ID thiefs wet dream). There is a reason that no important personal or national security information should ever be accessible via the internet, too many opportunities for errors or incompetency to expose the information to all and sundry. Then again, maybe I’m wrong and they supply a bio-metric fob along with a one-time key-pad to all their patients.

The $150 and $250 plans are per month. The $500 plan covers what sounds like the equivalent of an annual checkup–a one-time visit with some follow-up if needed.

Fifty dollars for two hours (75 + 45 minutes) cannot be correct, as you would know if you have seen labor charges anytime in the last couple of decades. That would be $25 per hour. My furnace guy charges more than that–I just got the annual cleaning/tuneup for my furnace, which took a little less than two hours, and I paid quite a bit more than $50 for it (OK, some of that was parts, but his labor is a big chunk of the cost).

I stand corrected. My HVAC guy charges ~127/hour, but he also provides a useful service. The steep discount for a yearly plan threw me. I assumed (Yes I know,, bad me) that it was a by month charge, not a year contract.

I noticed something unusual in Dr. Berzin’s video, a very large crystalline rock on the table to her right. Wondering about its purpose. Are energy rocks part of functional medicine?

No argument with any of the criticism of FM quackery, BUT, more discussion of what feeds this, please. Victims are not all rich snowflakes–well maybe only the rich ones buy into this specific practice, but loads of people simply dislike their doctors lack of interest in anything beyond their blood pressure. I’ve been keeping track, and in the last ten years, not one of my PCP’s (there have been a few) has so much as asked me how I am or what my life is like–even though I’ve tried to actually converse with them. And, no, these things don’t rise to the level of needing to schedule mental health appointments in another building, but they are things that media often tell you to “talk to your doctor” about. This is true even in an initial visit, which is not as time-constrained as the average 10 minute session.

Nothing is going to make me turn to woo, but I am a major skeptic–most people are not.

in the last ten years, not one of my PCP’s (there have been a few) has so much as asked me how I am or what my life is like

Man, even my specialists do that sort of thing. Then again, I might be in obviously worse psychological shape.

I think I may have had the same PCP for nigh unto a decade, as well. Enough with residents, give me the MCO.

That’s really unfortunate. My PCP and usually spend the first half of the appointment “chatting”. I always tell her that she asks me about all the tough things in my life THEN takes my blood pressure so, it’s no wonder it’s a little high. When I was unemployed and about to run out of health insurance, we talked about everything I needed to do before it happened and how she would be able to help me once I didn’t have insurance. I know her mother goes to the same orthopedist as I do and that our fathers died around the same time. I know she didn’t have pets growing up. She knows I have a cat (and doesn’t approve). She gave me advice on teaching English to people in China when I was doing that online as a stopgap job (she’s half Chinese). Part of it is, like Narad, I’ve had the same doctor for more than a decade.

I mean, I chat with my doctor plenty, but that’s because I have to see her quarterly for prescription refills, and that takes all of 2 minutes, so there’s plenty of time to chat and still have me leave early. Then again, I’m a pretty easy patient and I do have to see my doc more than most people.

At the same time I try not to ask too many personal questions about my doc, because I like some professional distance.

I kind of wish my shrink, who is basically just writing scripts, spent more time on whether a different antidpressant is warranted rather than baseball. I think I might be one of his “lighter” patients, as it’s a low-income hospital clinic.

I hear you. Been there. Unfortunately, our experiences are just going to be seen as :”anecdotal” and garner replies like megsaint’s from commenters who’ve had long-term personal relationships with their PCPs. Oh hell, I’ll add to the anecdotes. After the rushed impersonal PCP I had where I used to live failed to address my repeated complaints of a worsening chronic cough with anything but a 2-week scrip for anti-histamines and another appointment in 3 months (huh?), I decided to get on the waiting list for the doc that had been recommended by a colleague when i first started my job there, but hadn’t been accepting new patients. It took months for there to be an opening. In the interim, after doggedly pursuing my cough issue through a chain of shrugging specialists (‘OK, who else can you refer me to? Really, I insist’) I discovered that PCP had missed what should have been an obvious diagnosis of a life-threatening condition, based on what should have been in my chart, which either had fallen through the cracks or he just didn’t cross-check (I’m pretty sure the info was in there somewhere.) Anyway, when I finally get in with the new PCP, she’s awesome. Of course, since she actually asks good questions and listens (no just social chit-chat, really…) she’s chronically behind her medical-group dictated appointment schedule, sometimes more than 90 minutes by mid-afternoon. So a couple years later, they force her out…

There may or not be systematic studies of what kinds of insurance or med-group imposed time constraints exist on primary care, or of what effects these may have on outcomes. But I think it would be disingenuous to deny that much of primary care has been ‘Taylorized’ – meaning ‘work put on a dehumanizing stop-watch speed-up, and based in a supposedly “efficient” set of mechanical rote procedures)**.Between 10 and 15 minutes are the figures regularly cited. This has been going on for awhile, with the predictable result that the ranks of PCPs have been refilled with folks who fit in with the system, while those who might struggle against it fall away for one reason or another.

Channel surfing on the car radio last week, I chanced upon some professor from Stanford discussing a study that showed women MDs had significantly better outcomes than men across the conditions studied (which IIRC included ER treatments). The prof attributed this to the fact that women docs are better listeners. I don’t know if that was a conclusion of the study, or just his interpretation. My guess was more the latter, as he specifically went on to argue that women PCPs had better outcomes than men by virtue of establishing the sort of patient relationships that resulted in better compliance with whatever treatment regime was prescribed. Now, this no doubt appealed to my own conformation biases informed by my own experiences, but I think it’s a provocative concept worthy of further exploration if nothing else. If more of a human connection does indeed yield better outcomes, I’d resist any gender essentialism and argue that male MDs could be trained and encouraged to equal their female colleagues in this sort of communication, if given the time and incentive, and that we should do that on it’s own direct merits, with an indirect benefit that it might help reduce the number of dissatisfied patients turning to either pure woo or woo-inflected IM, FM yada, yada, yada.

** There’s actually an entry on Taylorism as pseudoscience at RationalWiki. The definitive critique of Taylorism is Harry Braverman’s Labor and Monopoly Capital, which, despite it’s rather imposing academic-sounding title, is a very accessible and engaging read.

I think western cultural certainly expects women to be better listeners and rewards them for being quite and listening (especially if the speaker is male). Women could certainly turn that life long habit to good use in a profession where listening is useful. But, I agree that men can learn how to listen, too. 😉

I saw my primary care doctor last week about a sinus infection. He asked me a lot of good questions, paid attention, and even gave me advice on my job search (apparently the local university sometimes hires people who do what I do). It was almost a pleasure to see him. No woo whatsoever!

About marketing:

isn’t that fundamental to woo? Figure out what people want and then promise delivery.
If patients find physicians not friendly enough and spending little time, then fix that and charge a concierge monthly fee.

Perhaps the impersonality that our commenter finds reflects time pressure and the high costs of running a medical office. Not all physicians are good at juggling interpersonal interaction and being efficient at their work. Altie practitioners have more time because they charge above the basic costs. Parsley tacks on an additional 150 a month.

( I wonder why it’s called Parsley? Is it green, decorative and superfluous like the herb?)

The advertising for this company seems to cater to common trends in altie thought that appeal to a certain population: I’ll venture younger, female, suburban, perhaps bohemian bourgeoisie, with disposable income ..
thus, the spa-like appearance of the salon… er.. office.

I think that the marketers have captured a particular niche that may be similar to what certain SoCal vaccine averse doctors have established for children. It would be interesting to track locations of this firm based on demographics such as income level and ethnicity. I immediately thought of 2 nearby towns where it might thrive: where homes prices are even more outlandish than the area’s average ( which is merely ridiculous).

Don’t be critical of parsley. Try tabouli, a wonderful salad with lots of chopped parsley in it. Parsley provides vitamins and antioxidants the way they ought to be taken, in your food, not as pills.

In my younger days, parsley was used as a garnish on certain meat dishes (particularly but not exclusively steak) and, at least in American cuisine in those days, not meant to be eaten. I usually don’t dine in restaurants that serve that kind of food, so I don’t know if that is still the practice, but that is what Denice meant. I’m not surprised that in other cuisines you might be expected to eat parsley.

My Kaiser Permanente Medicare Supplement plan is $105/mo. So $150/mo is a lot less than expected to see if the PCPs are doing office visits that last over and hour. I think I need more info on what a “concierge practice” is and isn’t, and how it fits in with health insurance, and I wish Orac had detailed that financial stuff. Would I be right in guessing then that Parsley does not include anything other than its expanded primary care service, and a patient would still need a health plan for hospitalization, Rx, etc etc etc., so the cost is absolutely an additional $150?

Which poses the question of exactly what Parsley’s business plan is. I don’t think it’s necessarily limited to your presumption of skimming off the well-healed ‘worried well’. Orac did not mention where the article he saw was published. It’s the business mag Fast Company. In one of his pull quotes the author wrote, “Most consumers aren’t too well versed in options beyond health insurance–or just depending on the emergency room.” Now, if that last bit came from Parsley, and I’d guess it did… well, who just depends on the ER? Not just younger, female, suburban, boho, haute boozhies with disposable income .. Berzin is quoted:

You have to educate people about how they’re already spending their money in ways that they’re not aware of themselves . . . they are already spending hundreds if not thousands of dollars on unnecessary medications, unnecessary specialists, and ‘healers,’

Note the two poles of “unnecessary’ as both conventional care AND woo (that ‘healers’ in irony quotes). That’s not a pitch at just some value-added service. It’s an “an alternative payment mode” (my emphasis). As in ‘instead of”. Seems to me then the business model includes pulling in patients who will spend ‘x’ amount of limited healthcare budgets on Parsley instead of a conventional plan – at least petit bourgeois if not plebe. Which suggests, I think, that part of the Parsley business plan for growth is articulated to the sort of bargain-basement grossly-weak coverage that is springing up as the GOP continues to undermine the AHA.

What risks are Parsley patients going to have if their other coverage does not include good access and/or coverage for those “unnecessary” meds and specialists?

I think Orac fails to properly credit that “healers” crack, and the fact Brezin emphasized “not Eastern medicine, not integrative medicine, just taking best practices for conventional medicine but focusing on the root causes of disease”. That’s not a defense, it’s a pitch. It’s positioning Parsley as “not quackery”, and to whatever extent there may be some crossover between some FM –> IM –> homeopathy, TCM, etc. etc. I think Parsley is smart enough not to go there. If you want to build a mainstream brand, get all that big-time capital investment behind you, you stay away from anything widely delegitimated, controversial, etc. Beside, the narrative justification of that woo is the opposite of what Parsley is pitching, witness that Fast Company is where this story appeared. TCM, homeopathy, yada yada claim validity through long tradition, while Parsley is all about ‘New!’ and ‘Cutting Edge!’ cleverly framed ‘holistically’ in the combo of high-tech online interface and ‘digital’ record system that “adds thousands of data points to a patient’s charts” on one hand and all the latest medical sciency buzzwords – microbiome, genomics, “over 1,000 biomarkers tested” – on the other.

It’s important to note, I would argue, that the Parsley version of FM seems to restrict it’s dubious practices to excesses in legitimate categories: supplements and medical tests. Unlike homeopathy, chiropractic or other familiar forms of woo you can’t argue against the whole enchilada, you have to get down into the weeds to show how this supplement or that test is useless, and that gets even trickier when we’re just talking about quantity. Vitamin C is good stuff, right?

The things functional medicine co-opts, like diet, exercise, weight loss, and improvements in sleep are primarily responsible for good outcomes, while the shotgun testing and quackery get all the credit.

I have to argue that in grappling with Parsley we should consider that this sort of FM doesn’t merely “co-opt” lifestyle counseling, but may well do it better than than time-pressed conventional PCPs focused on danger signs like BP, cholesteral, etc. If folks are getting a 75 minute doctor visit AND a 45 minute coaching session, even if only half of that time is devoted to skilled sympathetic, support of the lifestyle stuff (vs. the supplement and testing crapola), it wouldn’t be surprising if that produced better compliance and thus better results, maybe a lot better. Obviously, when Berzin says “These are doctors who won’t ever say, ‘We have 15 minutes with you. Here’s your prescription for drugs. Off you go.’,” that resonates with even skeptics like brainmatterz, who have tried to engage their PCPs in life discussions to no avail.

I can’t help up ask why we, as healthcare ‘consumers’ seem to face a Hobson’s choice between, on one hand, conventional care that doesn’t listen and can’t take the time to go beyond just dispensing the right advice on ‘lifestyle’ health matters to do the personal work required to help patients actually change ingrained behaviors, and on the other, practitioners who listen, engage, encourage productively, but either pile on garbage or offer nothing but garbage. Why isn’t mainstream care better on these matters? Why is there an apparent need to justify this stuff by claims of either magic or some ‘scientific breakthrough’ newly unlocked secret that amounts to magic?

The growth of both outright quackery and the sort of.. (what to call it… ) ‘quasi-quackery'(?) of Parsley are complex phenomena without a single simple cause (‘overdetermined’ in Althusserian theory-speak). But I remain convinced systemic problems in the delivery (not the science) of conventional medicine are a big part of it. To that end, I’ll suggest that Orac’s scorched-earth Insolence obscures important aspects of what’s going on here. What comes to my mind is instead is one of the fundamental principles of Birmingham School Cultural Studies (exemplified by the writing of the late great scholar Stuart Hall) – that popular culture is “a site of struggle”.

What Hall meant is that ‘the popular’ (and in this case we could be talking about a rising trend among healthcare consumers as well as a hit film or TV show) is rarely if ever an inflection of one socio-political force (cf. classic Marxian ‘dominant ideology’) but contested terrain defined by the presence of opposing forces simultaneously – not that any individual reader sees the contradictions or points of articulation. “The popular’ then, is “polysemic”, ‘meaning more than one thing at once’ – especially accommodating to fitting in with different and contradictory confirmation biases. Hall was a lefty, not a non-judgemental liberal-pluralist, so there’s a clear sense that the struggles being contested within cultural phenomena are ‘good’ vs. ‘bad’ in one way or another. The prescription then is to pay due attention to both aspects, to both highlight and critique the bad, but also to recognize the good, not just throw it out with the bathwater.

So, what I see as the struggle at the site of IM, FM etc. is a ‘good’ force of desire for reform in healthcare delivery, in a more humanistic and less mechanistic direction for want of better terms, and a ‘bad’ force of cynical exploitation, greed, and con-artist level false promise. To reframe one of Orac’s favorite metaphors, the fact magic carpets don’t fly is no excuse for not fixing the airplane, and unless we address the faults of the airplane, more people are going to be drawn to the magic carpets.

According to the Fabulous Furry Freak Brothers,specifically Phineas, “parsley, administered orally in large amounts, is a POWERFUL APHRODISIAC!” I can’t vouch for it, having neither a desire to consume mass quantities of parsley nor a need for an aphrodisiac.
Parsley also, apparently, was the key to solving a horrific crime. As Sherlock Holmes relates, “You will remember, Watson, how the dreadful business of the Abernetty family was first brought to my notice by the depth which the parsley had sunk into the butter upon a hot day.”

Having eaten several salads where parsley was the main ingredient, it didn’t seem to have any impact on me. I love parsley, but I imagine most people would find a salad of parsley off-putting. My grandmother made them because it was something that she could still taste.

I’m a little worried about my external body, though I’m comfortable with my internal one. Should I be rubbing parsley on it?

I have a chronic disease, which is why I see a specialist regularly and my GP every three months. At my last visit, the nurse practitioner and I took care of everything on my list– refilling the prescription they’re not allowed to do automatically by phone, checking that the antibiotics had cured my pneumonia, and a follow-up on cortisone and PT for joint pain–with time for a non-medical discussion of non-natural hair colors (since I noticed hers). It’s possible we went slightly over 15 minutes, before she sent me down the hall to get my blood drawn.

The nurse practitioner I usually see is warm and friendly, and either genuinely likes me or is a very good actor.

This isn’t a concierge anything, it’s $location Family Practice, and is covered by my health insurance (with, yes, a copay, because this is the United States).

I looked at their website:
– it has a store ( important sign of woo)
– take a peek at the images of potential patients/ hotties
– notice the locations and “events”

Denice, your mention of “hotties” caused me to check the site too. While I did see a hottie or two, I noticed that they offer “health care for individuals” and “health care for companies”. While the Supremes ruled that corporations have First Amendment rights and Mitt Romney has informed us that “corporations are people, my friend”, I think this is taking it a little too far.

Concierge: “Who d’ya want? Nobody gets in the building unless I know who they want. I’m the concierge. My husband used to be the concierge, but he’s dead. Now I’m the concierge.”

That reminds me that the concierge service at the Seattle W hotel was a complete fail when it came to getting a hair dryer or something for my boss at the time, even though they touted this “service” as being able to get one anything legal. The Lakeshore W in Chicago ended my relationship; they just have louvers between the bathroom and the bedroom. It’s a remodeled Motel 6 or something in what is supposed to be a premium brand.

Really low lighting in the public areas, though. Hip.

Eric, you must know by now that I relish any opportunity to scoff at alt med so old-timey-meal presentation it is
HOWEVER, natural health/ vegetable worshippers regard parsley as a natural chelator, de-toxifier and panacea that is nearly as ubiquitous in green drinks and herbal pharmacopeia as is kale.
And sure, tabouli is fine. I was amazed that the local Syrian gathering place/ restaurant offers both the salad and green drinks.

With Parsley Health, membership equates to a little under $5 a day.

That’s about £1400 a year, which as a UK citizen is about three-fifths of what I pay in total taxes towards the NHS in a year, and I’m in the top 20% of taxpayers. I think it’s fair to say that my blanket coverage is somewhat better than the integrative bollocks that Parsley Health offer. Those who gloriously expound the Parsley model can console themselves that they never have to negotiate the socialist death panels which I am forced to justify my existence to every time I get a toothache.

“not going to vaccinate everyone”? I hope the pediatric waiting room is separate because that sounds like a whooping cough outbreak waiting to happen.

What if I don’t want to talk to my doctor for an hour? What if I’m in pretty good health with no reason to suspect any changes to my health? Or what if you’re going in for pink eye? Like, it’s pink eye, you treat it with simple medication, it’s (generally) not anything weird or complicated. Do they make you sit around and chat with a hideous eye infection?

Do they make you sit around and chat with a hideous eye infection?

If the hideous eye infection is in a chatty mood, why not?

Anti-vaccine quack = Berzin = shouldn’t have a medical license and as a pediatrician I especially detest her BS.
Any physician that labels her/himself a CEO while practicing should be suspect for putting monetary gain over patients.

A minor setback for Gwyneth’s goop Empire, which has reached a settlement for a relatively paltry (paltrowy?) amount with the Orange County (CA) DA’s office over unsubstantiated claims:

“Goop advertised that the Jade and Rose Quartz eggs could balance hormones, regulate menstrual cycles, prevent uterine prolapse, and increase bladder control,” the Orange County District Attorney’s office said.

Inner Judge Flower Essence Blend also drew the Task Force’s attention. Prosecutors say goop advertised the product as a dietary supplement that “could help prevent depression.” The blend of essential oils costs $22 and is currently sold out on the site. Users are advised to apply drops on the tongue every five to 15 minutes, add it to “spring water” to sip on, or apply it externally to “acupuncture or marma points,” according to the goop website.

As of Wednesday afternoon, the site described the Essence Blend as “a purifying organic floral blend that assists in the clearing of guilt, shame, self-criticism and blame” that can “help prevent ‘shame spirals’ downward toward depressive states.”

When asked about the current claims, Napa County prosecutor Katy Yount told ABC she was told the product was no longer being sold. After checking with goop’s lawyer, she later wrote in an email, “She told me that there is no live webpage for the essence product, only a cached page. They do not currently sell that product.”

Under the terms of the settlement, goop did not admit wrongdoing, but agreed not to make any claims regarding its products “without possessing competent and reliable scientific evidence, and from manufacturing or selling any misbranded, unapproved, or falsely-advertised medical devices,” the Orange County District Attorney’s Office wrote.”

https://abcnews.go.com/US/gwyneth-paltrows-goop-settles-vaginal-eggs-claims/story?id=57618571

So much for “the strictly guarded secret of Chinese royalty”. 🙁

RIers who bought these products last year are now eligible for refunds.

The BBC had a story on that, which I saw yesterday. The amount mentioned was $145k. That would be a drop in the bucket for a big corporation, and probably less than deserved, but for an operation like Paltrow’s it is still a hit to the bottom line. Especially since the settlement presumably stipulates that she can’t sell those products in any other jurisdiction.

I like the fact that many counties – some of them hotbeds of woo- decided to get involved.
-btw- 1. Katy Yount – is she of the Yountville Younts? It’s a ritzy town in Napa, home of the French Laundry restaurant and mucho dinero
2. “paltrowy”- so excellent

The ten counties that brought the suit: Alameda, Marin, Monterey, Napa, Orange, Santa Clara, Santa Cruz, Shasta, Solano, and Sonoma.

The Santa Clara district attorney, Jeff Rosen, said: “The health and money of Santa Clara County residents should never be put at risk by misleading advertising. We will vigilantly protect consumers against companies that promise health benefits without the support of good science … or any science.”
Under the settlement Goop is banned from making any claims regarding the efficacy of its products without reliable scientific evidence.

Refunds are available only for products purchased in California between January and August of 2017. It’s not a big settlement, but it’s nice to see something done to stem the tide of woo.

I’m curious to hear you expand on the basic blood panel, and why you think it constitutes a “throw everything at the wall and see what sticks” approach. Screening for nutrient status, and heart health seems like it could result in the ability to focus a person’s treatment, rather than constituting a shotgun approach. If a person has risk factors for heart disease, they can more adaquitly provided care an interventions to address this risks. I see a lot of issues with alternative medicines, but this particular approach I’m not seeing an issue with. Curious what your perspective is.

There are very few useful screening tests because the requirements are difficult to meet. These include (oversimplifying and incomplete): the test needs to be sensitive, specific, able to detect a problem that can be treated or managed, needs to be cost-effective and safe for the patient to undergo (including followup tests to confirm a positive screening result). Very few tests end up fulfilling these requirements. Screening tests sound really good, but with a few exceptions, are worse than useless.

It is useless to screen for iron or B12 levels unless the patient is demonstrating symptoms of an anemia. The results will be normal, and you’ve paid for a test that will give you useless information.

A basic blood panel . . . I’m not sure what you mean by that. My doctor does a comprehensive metabolic panel and a complete blood count on me every year. That consists of the basic electrolytes (sodium, potassium, chloride, calcium, magnesium, anion gap), glucose, kidney panel (BUN, creatinine, GFR), liver panel, RBC count, WBC count plus differential (values for different types of WBCs plus the measurements of RBCs).

Because of my age, he gets a lipid panel once a year as well.

Nothing else is needed unless I have specific symptoms. When I had unexplained fatigue, my doctor got a thyroid study. When it came back normal, he did’t do further studies. He looked elsewhere for the problem.

Not every condition in health care is explained by a blood test. Some conditions are not explained by them at all. That’s why the complete history and physical is so important; 85% of the time you get your diagnosis from that.

All that extra testing does is pad the doctor’s bottom line, and there are doctors who support their practices that way. In functional medicine, it’s the whole model.

No, you’re pimping your vanity book in a particularly idiotic fashion. You don’t know shit about that which has recently been rechristened as “AI,” much less its actual history, as I’ve noted before. If you mean “big data” (which would still be utterly imbecilic in this context), which you doubtlessly don’t have a fucking clue about either, then use the correct term. It’s as though you’re in some sort of self-competition to invent the dumbest fucking comment imaginable.

Or somebody we know could create a bot like the Th1TH2 one to respond to MJD and we can then all see if we can tell which is which. That would determine something if we couldn’t.
Hint.

The saddest thing about SBM switching to Disqus is that her comment about toddlers know better than to go from the “safe” sidewalk to the “dirty” grass where tetanus lurked has disappeared.

I don’t miss Thingy, I just miss the access to her idiotic comments.

Me: Kaiser ‘Senior Advantage.’ Cost: assign Medicare payouts to Kaiser plus about $100/month. Most copays $35 including PCP visits. Annual physicals have no copay. Prescription meds have a low copay.

I schedule routine non emergency PCP visits online. One time I totally forgot my appointment. My bad. I apologized when I saw her after rescheduling. “Not a problem as I was running late – I was happy to get almost back on schedule.”

My only ‘emergency’ doctor visit came the only time I came down with laryngitis. I described my symptoms as sore throat and not being able to make vowel sounds. Phone call got me a same (late in the) day visit. “It’s viral. Take OTC meds for sore throat. Come back if it gets worse or doesn’t start to get better in 4 or 5 days.”

Cost: assign Medicare payouts to Kaiser plus about $100/month. Most copays $35 including PCP visits.

Thank goodness for Medicaid. I don’t pay a dime, not that I have many.

Same with my oldest kid with multiple medical issues who keeps needing medical care. Go figure.

Not long ago he had gall bladder surgery. It is usually an out-patient procedure but it was determined he had to have in an actual hospital due to his heart condition. It was approved.

I learned that my son is a very polite autistic man. In the recovery room he always thanked the nurses for helping him and also getting him another jello cup. They loved him.

Screw AoA and their attitude towards lovely people like my oldest kid. A young man who helped an elderly woman with the door as they both left the echocardiogram clinic.

Now I just have to convince my dad to vote Democratic in the Florida gubernatorial race. And white-knuckle things for two more weeks before I go visit him.

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