Functional medicine (FM) quackery dissected in the mainstream media

I’ve frequently written about something that its proponents call “functional medicine” (FM). It’s a “specialty” that’s become very popular among alternative medicine practitioners (e.g., naturopaths love it), as well as medical doctors who have fallen under the spell of “integrative medicine,” in which alternative medicine quackery is “integrated” into conventional medicine. Two questions always see, to come up when I consider FM. The first is: Just what the heck is FM, anyway? It’s a question that has puzzled not only me, but others who were examining implausible health claims years before I became interested in them, even as far back as when I was in college and medical school, people such as the late Wally Sampson, who once asked: Functional medicine (FM), what is it? As you will see (yet again), our puzzlement derives not from any great mystery embodied in FM, but rather in the vagueness of the definitions FM practitioners invoke. My second question is, of course, why is this nonsense so popular? The Cleveland Clinic, for instance, hired FM guru Mark Hyman to start a clinic 4 years ago, and it’s reportedly been “wildly successful.” “Integrative medicine” mavens like John Weeks laud the clinic as “disruptive.” Of course, I agree that it’s disruptive, just not in a good way and certainly not in the way Mr. Weeks means.

Discussing the ins and outs of FM and, in particular, how it’s a form of “make it up as you go along” quackery that combines the worst of both worlds in medicine—the overtesting and overtreatment that can sometimes plague conventional medicine plus the quackery of “integrative medicine”—has been largely a highly niche endeavor, seen mainly in blogs like mine and Science-Based Medicine and a handful of skeptic blogs. So it was surprising to see a large article on FM in a major Irish newspaper, The Independent. It’s by Lynne Sharman and entitled Functional medicine: Is it the future of healthcare or just another wellness trend? Actually, it’s neither, but that’s OK. In any event, Sharman starts with a fairly reasonable history of FM:

Functional Medicine is the alternative medicine Bill Clinton credits with giving him his life back after his 2004 quadruple heart by-pass surgery. Its ideology is embraced by Oprah and regularly features on Gwyneth Paltrow’s Goop.
Developed in 1990 by Dr Jeffrey Bland, who in 1991 set up the Institute of Functional Medicine with his wife Susan, today the field is spearheaded by US best-selling author Dr Mark Hyman, adviser to the Clintons and co-director of the controversial Cleveland Clinic for Functional Medicine.

Dr Hyman, a medical doctor, says FM is “a rigorous system for assessing chronic illness using new advances in systems biology and systems thinking”.

“Functional Medicine is not about a test or a supplement or a particular protocol,” he adds. “It’s really a new paradigm of disease and how it arises and how to restore health. Within it there are many approaches that are effective, it’s not exclusive, it doesn’t exclude traditional medications, it includes all modalities depending on what’s right for that patient.”

Of course, Dr. Hyman is spouting the purest of pure BS about FM. It’s not a “new paradigm.” It’s actually a very old paradigm—old as in “ancient”—tarted up and combined with science-y sounding jargon. What do I mean by ancient? Well, let’s just reconsider the seven “precepts” or “principles” of FM yet again:

• Acknowledging the biochemical individuality of each human being, based on concepts of genetic and environmental uniqueness
• Incorporating a patient-centered rather than a disease-centered approach to treatment
• Seeking a dynamic balance among the internal and external factors in a patient’s body, mind, and spirit
• Addressing the web-like interconnections of internal physiological factors
• Identifying health as a positive vitality—not merely the absence of disease—and emphasizing those factors that encourage a vigorous physiology
• Promoting organ reserve as a means of enhancing the health span, not just the life span, of each patient
• Functional Medicine is a science-using profession

In any post about FM, I feel compelled to remind our readers that the very first principle is, in essence, FM’s “get out of jail free” card for basically anything its practitioners want to do. They can always find ways to justify any form of treatment, be it science-based or quackery, simply by invoking the “biochemical individuality” of the human being whom they are treating. I also like to remind my readers of my retort to this: Yes, human beings are individuals, and each human being is unique. However, we’re not so unique that our bodies don’t all work pretty much the same way. In other words, in terms of biology, physiology, and yes, systems biology, human beings are far more alike than they are different. If that weren’t the case, modern medicine, developed before we had the tools to probe our genetic individuality, wouldn’t work as well as it does. FM fetishizes “biochemical individuality,” not so much because humans are so incredibly different that each one absolutely has to have a markedly different treatment. We’re not. FM fetishizes “individuality” because it distinguishes FM as a brand from science-based medicine and, I suspect, because it makes FM practitioners feel good, like “total” doctors never at a loss for an explanation for a patient’s symptoms or clinical condition, and makes patients feel like special snowflakes whose every bit of “individuality” is being catered to.

As for being a “science-using” profession,” FM uses science the same way a drunk uses a lamp post, not for illumination, but for support. Just look at the way Mark Hyman has mangled autism science and systems biology, and you’ll soon realize that this is true. Also, any specialty that is willing to consider homeopathy as anything other than rank quackery cannot claim to be science-based.

But what’s ancient? Well, let’s look at its focus on “imbalances”:

1. Hormonal and Neurotransmitter Imbalance
2. Oxidation Reduction Imbalances and Mitochondropathy
3. Detoxification and Biotransformational Imbalances
4. Immune and Inflammatory Imbalances
5. Digestive, Absorptive, and Gut Microbiological Imbalances
6. Structural Imbalances from Cellular Membrane Function to the Musculoskeletal System
7. Mind-Body/Body-Mind Imbalances

Does this remind you of anything? How about “imbalances” in the four humors? Or “imbalances” in the Five Elements in traditional Chinese medicine. Basically, FM also fetishizes “balance” in a way that sounds very much like both ancient Asian and European medicine. It’s a philosophy more than a scientific principle. Mark Hyman, of course, is guilty of all these things, as are other prominent FM advocates.

There’s also a variant of the “principles” of FM included in Sharman’s article. (FM practitioners can’t even agree on the basic principles of their “profession.”) It’s similar, but with some differences:

FM has five basic principles. 1. We are all genetically and biochemically unique so it treats the individual, not the disease. 2. It’s science-based. 3. The body is intelligent and has the capacity for self-regulation. 4. The body has the ability to heal and prevent nearly all the diseases of ageing. 5. Health is not just the absence of disease, but a state of immense vitality.

Notice that part about the body being “intelligent”? Doesn’t that sound rather vitalistic to you? Of course, one other part is rather ridiculous, namely #4. If the body truly has the capacity to heal and prevent nearly all the diseases of aging, then why does every single human being eventually die? Or at least, why is it so uncommon to live beyond 100? FM mavens would claim it’s because of the “toxins” and our lifestyle choices, and it’s true that our lifestyle choices can contribute to and exacerbate chronic disease (one of the few things they get right), but it does not follow from that that if we did all the happy magical things FM practitioners suggest that almost none of us would suffer from diseases of aging.

Sharman nails it here:

Its this broad scope that makes FM seemingly applicable to every malady. In practice, this means a FM practitioner could recommend everything from taking pro-biotics to replace gut flora, an antioxidant supplementation to boost mitochondria function, a parasite cleanse, IV vitamin infusions, fish oil to ‘unlock’ autistic children or dietary changes to repair a ‘leaky gut’.

I’ve often said that trying to get a straight, reproducible, understandable definition of FM is like trying to nail Jell-O to the wall. It always manages to slip away, and you really get a feel for this aspect of FM in how Sharman tries to get Hyman to be concrete. She fails, but everyone fails, because there is nothing concrete about FM other than the quackery:

Some other chronic illnesses the field claims to treat include heart disease, type 2 diabetes, irritable bowel syndrome, ulcerative colitis, depression, anxiety and arthritis. However, some in the field are also involved in treating so-called ‘vaccine injuries’ and MS.

“Diseases aren’t necessarily fixed, they’re affected by many factors,” Dr Hyman tells me. “MS is an auto-immune disease, so what’s causing the auto-immune disease? It’s not the same treatment for everybody, I’ve seen all kinds of different reasons, some might have gluten issues, gut issues, others might have a deficiency causing neurological issues, MS is a symptom.”

See what I mean? Multiple sclerosis is autoimmune, but it might be the gluten. It might be the gut. It might be some sort of “deficiency” in nutrients. Or it might be anything else Dr. Hyman might care to pull out of his nether regions to blame for disease.

What I find both particularly amusing and infuriating is the utter lack of self-awareness of FM practitioners. They love to present themselves as so much more knowledgeable about biochemistry and genetics than the average physician, and maybe they are. However, it’s not in a way that helps patients. They might know a lot about the basic science, but they appear to understand little about basic issues in applying laboratory tests to patient care, such as sensitivity, specificity, overdiagnosis, and even basic statistical principles that if you run hundreds of tests at a time approximately 5% will be abnormal in the absence of disease because most normal values are defined as the mean ± two standard deviations. In other words, they seem clueless regarding correcting for multiple comparisons, something any good scientist, epidemiologist, or clinical trialist knows to be essential. I’ve written about examples of this very thing, one time in the context of a particularly egregious “case report.”

So when I read this part of the article about Dr Fionnula McHale, a prominent FM practitioner who has offices in London and Dublin, I laughed out loud:

“The term [Functional Medicine] tends to be bandied around quite a bit. Other things people say, such as ‘functional nutritionist’, can be misleading as a term. Many people are Functional Medicine practitioners but don’t have any real medical background at all… I think regulation is always probably the best way forward.”

As for the issue of drug interactions, she says, “The ideal approach is to work synergistically with acute medical consultants and with the GP to develop the best avenue for the patient.”

Testing and the interpretation of results is also an area of concern for Dr McHale, who makes patients aware when she’s relying on anecdotal evidence rather than proven research.

“There’s an awful lot to it in terms of biochemistry and physiology,” she says. “You do need to have a very solid and well ingrained bio-chemistry background. A solely clinical background doesn’t equip you with the knowledge to read a test.

“Evidence-base is the cornerstone of medicine and that has to be maintained. It becomes problematic in this area because you are looking at personalised medicine and that can be very difficult to evidence-base.”

See what I mean? I pity you non-FM doctors! You have no idea how to read a test. You don’t know biochemistry! Kneel before the awesomeness of FM, you mere GPs! Then I saw that she offers “toxin” testing (including heavy metals) and uses intravenous micronutrient infusions, which are pure quackery without an evidentiary base, and I laughed even louder.

Sharman also mentions an upcoming FM quackfest to be held in Ireland, the third annual Lifestyle and Functional Medical Conference, which will take place in Salthill, Galway on November 3. It’s the usual collection of FM quacks, including a naturopath, just mostly from the UK instead of the usual American collection of FM quacks with whom I’m familiar. What’s disturbing, though, is that one of the speakers is Senator Catherine Noone. Yes, a prominent Irish legislator has agreed to speak at this quackfest and is listed as one of the headliners.

When Senator Noone was called out for being a speaker at this quackfest, she appeared pretty clueless. First, the callout:

Agreed and it would make one wonder why a politician @senatornoone thought it appropriate to speak at this event when government is bringing in anti quackery legislation @drg1985 @campaignforkate

— Eileen OS (@eosull) October 24, 2018

Next, the cluelessness:

What do you mean Eileen – I do not subscribe to ‘quackery’ of any kind. I am fascinated by nutrition and how well one can feel by eating good food. I also fully subscribe to western medicine when necessary.

— Sen Catherine Noone (@senatornoone) October 24, 2018

Here’s the thing. FM is not in any way an authoritative guide to “nutrition.” At best, when it gets nutrition right, it advises less meat, more vegetables, and less processed food. However, at its worst (which is most of the time) FM includes useless micronutrient testing and supplementation, intravenous high dose nutrients, “detoxification,” and a whole lot of other quackery.

David Grimes tried to get through to her:

Senator, I’m a big fan but this event appears to be pseudoscience garbage with a veneer of science to lure the unwary. I could urge you to reconsider, or chat with colleagues like @campaignforkate, or @DrRobertOConnor from Irish cancer soc. Happy to advise if it helps. DRG

— David Robert Grimes (@drg1985) October 24, 2018

Then:

With all due respects, appearing at such an event is an endorsement, and could be argued is contradictory to what you just stated. Not being flippant, but most people are not fully equipped to make such judgements – which is why charlatans prosper, esp. in nutrition field alas

— David Robert Grimes (@drg1985) October 24, 2018

To which Senator Noone replied:

It’s equally good to be informed of what is happening if tha’s the case. The organiser is a friend of mine & I will be speaking about government policy – I can assure you that my quackery radar is high. The idea that nutrition can cure cancer and all those notions are v dangerous

— Sen Catherine Noone (@senatornoone) October 24, 2018

Let’s just say that I don’t think Senator Noone’s quackery radar is high. In any event:

I interact with people with all sorts of views on a regular basis. Rest assured that I will have no qualms making my views known about any non evidenced based theories or crazy ideas that may be espoused – could be an opportunity in that regard.

— Sen Catherine Noone (@senatornoone) October 24, 2018

Senator Noone’s naïvété is rather painful to behold. There’s no way this is an “opportunity.” The speakers at this conference are all true believers, and the vast majority of attendees are likely to be true believers too. It’s highly unlikely that anything science-based Senator Noone says would be likely to say anyone. Her attitude strikes me as a case of someone who has more confidence in her ability to tell quackery from real medicine than is warranted. True, a case can be made for a science advocate to appear at a quackfest like this, but it shouldn’t be an elected official whose appearance provides a patina of respectability to the quackfest. Rather, it would have to be someone utterly fearless and thoroughly knowledgeable about the ins and outs of FM quackery. (I might qualify on the second criterion, but I fear that I fail the first.) In any event, it’s utterly irresponsible for a senator to appear at a quackfest like this, regardless of what she intents to talk about. Let’s just put it this way. The organizer (who’s a friend of Senator Noone) didn’t want her there for her science-based viewpoints. She was recruited because she’s an Irish senator.

It just goes to show, however, just how good FM quacks are at cloaking their “make it up as you go along” quackery about “biochemical individuality” in something that looks to most people (and even some doctors) like science.

Oh, and Senator Noone blocked @gorskon.