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Functional medicine (FM) quackery dissected in the mainstream media

Functional medicine (FM) is “make it up as you go along” quackery that combines the “worst of both worlds,” namely the overtesting and overtreatment that can plague conventional medicine plus the quackery “integrated” into “integrative medicine.” It’s rare to see a mainstream outlet get it right about FM, but an Irish journalist pulls it off.

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:

Next, the cluelessness:

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:

Then:

To which Senator Noone replied:

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

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.

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]

45 replies on “Functional medicine (FM) quackery dissected in the mainstream media”

Can it be that FM practitioners embrace the woo-ful idea that a person may appear to be healthy BUT…….
there are usually sub-clinical levels of disease, less optimal states of nutrition and lower functioning in general SO we’d better test the hell out of them and see if anything looks amiss.

Micronutrients is one clue.
Of course they probably sell lots of supplements as well.

And oh, if everyone is so absolutely individual how can we tell if they are off a bit? Maybe they’re just that way naturally?
“I’m not lower by 2% in vitamin D, it’s my NATURE!”

re Bill Clinton:
I wonder if because he was in such a state of physical danger/ instability, if he and other patients like him are especially emotionally vulnerable to FM’s dictates ?

Denice didn’t ask the question so why reply to her? Just desperate to get a comment near the top? Dr. Poland isn’t a quack thus no reason to discuss him thus far. I have no doubt he cringes at the misuse of his research by anti-vaxxers like you and Toni Bark.

Orac writes,

You don’t know biochemistry!

MJD says,

Functional Medicine and its emphasis on “biochemical individuality” is, in my opinion, a catalyst for “Functional Vaccines”. “Functional Vaccines” will be a groundbreaking effort in vaccine safety wherein each patient’s biochemical profile (eg., cytokine profile, white blood cell count, etc…) will be analyzed prior to vaccination. In the future, such efforts will enhance the health and wellness screening process prior to vaccination.

In summary, an offspring of “Functional Medicine” (i.e., Functional Vaccines) will be a vaccine-safety measure that improves consumer confidence through test-before-you-vaccinate!

MJD,

How specifically would a cytokine profile or a WBC affect say a pneumococcal vaccination in your proposed system? Which cytokines at what levels would concern you? What WBC would you be happy with? Would you review the differential?

@ Len Tukwilla,

Thank you for the questions. I’m in temporary shock at the moment in that most responses to my comments are laced with insolence and occasional profanity (e.g., Narad). I recommend that you attempt to find the answers to these interesting questions.

MJD,

“I recommend that you attempt to find the answers to these interesting questions.”

That’s why I asked you! Or are you proposing a “groundbreaking effort in vaccine safety” about which you’re unable to answer basic questions?

:>I’m in temporary shock at the moment in that most responses to my comments are laced with insolence and occasional profanity (e.g., Narad).

Bite me, you pretentious hemorrhoid.

I sense another $200 booklet in the pipeline, also with no reviews or recommendations over the subsequent ten years. It seems no one really cares what “MJD says”. 😉

BillyJoe writes,

I sense another $200 booklet in the pipeline, also with no reviews or recommendations over the subsequent ten years.

MJD’s latest “booklet” effort is as follows:

Note: All the exemplary ladies discussed below were provaccine. I’m sure there will be no reviews or recommendations even though there are vaccine miracles described therein.

Missionary women of the 19th and 20th centuries are no strangers to the ecstasies, horrors, and humor of the human condition. June M. Dunn, RN-MSN was a 20th-century missionary in Haiti, Honduras, Guam, Russia, Saigon, Saipan, and Thailand. June’s American family upbringing, science-based healthcare training, and humanistic effort allowed her to be an exemplary teacher and caregiver to the poverty-stricken. Her recollections offer inspiring, frightening, and sometimes comical aspects of missionary work. Select quotations and hymns give meaning to the spiritual and emotional impact of her calling. Personal photographs and paintings beautifully illustrate a life well spent. In the final chapters, chronicled are five not-to-be-forgotten missionary women: Charlotte Moon; Mary Slessor; Amy Carmichael; Gladys Aylward; and Mother Teresa. These six women and their missionary achievements are a testament to living for His glory in self-sacrifice and heroism.

@ Orac,

I’d be honored to write a RI guest post for a fee of $25,000, and donate the money to a Christian missionary. Please advise.

Do you mean the mother Teresa who thought other people grew character through suffering even when it was their final illness, but who took herself off to a hospital for relief comfort in her final days.

Michael

I’d be honored to write a RI guest post for a fee of $25,000

Why do you keep this nonsense up? It’s as annoying as when you first appeared in the comments
sections years ago to spam promos for your book.

Don’t you have anything better to do with your time?

Are you capable of taking constructive criticism? Please stop posting comments that suggest the emotionally maturity of a grade school child.

US best-selling author Dr Mark Hyman, adviser to the Clintons

Any mook can call himself “Adviser to the Clintons” and journamalists will repeat it, without asking key questions like “Do the Clintons heed the advice?” And “Do they actually receive it?”

I don’t know how much Hyman had to do with it, but Bill lost a lot of weight and drastically improved his numbers by switching to (mostly) low-fat vegan. I suppose if something Hyman says helps people make those sorts of changes, then Hyman has at least that going for him.

Actually Mr Mook DID advise Hilary.

I think Orac has shown somewhere @ RI that H & B admitted following Hyman.

hmmmm last two big posts too much for me ..looked like a pillow fight on going ,weather warming up here in oz think ill head up the west coast to my beach shack @ wedge island & check the surf …the rest of u take a step back & recharge no vaxanators up here .. cheers from oz happy bob..

In my (to quote Fitzgerald) younger and more vulnerable years I looked very hard for the “root cause” (UGH) of my anxiety. I think I heard every nonsense FM explanation under the sun and had thousands of dollars worth of meaningless tests which I strongly suspect are not reproducible, or if they are, are not measuring anything important. These people just seem to migrate from one sciency sounding trope to another — inflammation, gut dysbiosis, adrenal fatigue, heavy metal toxicity, pyroluria, subclinical hypothyroidism, candida, leaky blood-brain barrier (seems to be catching on of late), and on and on and on (oh yeah how could I forget chronic Lyme). Why institutions like the Cleveland Clinic legitimize it are beyond me. Money, I guess.

I’m sure Ms. Noone’s quackery radar is high. It’s so high that quackery just flies (waddles?) under it.

Also, if there are micronutrients, then what’s a macronutrient?

Vitamins and minerals: iron, potassium, sodium, calcium, magnesium and so on.

We need each of those things for our biochemistry to work. 🙂

Why FM / CAM / integrative/medicine ?

-because you can do things simply not possible in maimstream medicine,
-for a much lower cost
-with more flexibility, more naturally (compatibly)
-with a better quality of life
-perhaps with a much longer life (if you can better achieve the durable tail of survival, -ers)
-perhaps with a faster, good result

That’s the way it works for us.

Patients may have a broader range of experiences. We are amongst the more eclectic shoppers and probably avoid some pitfalls.

Extra blood tests for us mean better sensitivity to initial problems, response, side effects (e.g. chemo) and recurrence. More opportunities can be better addressed per test cycle.

In my experience FM is just an umbrella term. Go to 5 FM doctors you’ll get 5 different analyses and 5 different supplement regimes (most of which you can buy at the little store in the office). Eventually, I realized that the field had nothing to offer me. Now that doesn’t make mainstream medicine any better, of course, but the shortcomings of mainstream medicine do not make FM better.

In my experience FM is just an umbrella term.
I tend to agree.

Do your homework and choose well. DIY most of it and save your money for the hard stuff. I view all doctors as fractional sources of useful information, skills and accomplished tasks.

most of which you can buy at the little store in the office
I judge them partly by what they stock but do better online

…but the shortcomings of mainstream medicine do not make FM better.
The shortcomings of mainstream medicine make FM possible, and some of it, necessary

Do your homework and choose well. DIY most of it and save your money for the hard stuff. I view all doctors as fractional sources of useful information, skills and accomplished tasks.

So confuse your G–gle degree for others’ MDs and since no MD is to be trusted, pretend you know more than they do. Makes perfect sense.

SM, your view of Science is so institutionalized, it is like a prisoner who has been in prison so long, they can no longer function in the real world.

I do use doctors’ skills where applicable. There are several parts required for a de novo outsider to exceed standard of care results with reasonable confidence. For me, one part was several units of directed work effort. Unit ~ 1000 papers + 10,000 abstracts. This can allow an intelligent person some far more specialized views than a doctor on various points and problems.

SM, your view of Science is so institutionalized, it is like a prisoner who has been in prison so long, they can no longer function in the real world.

Oh please; spare me the pompous attempt at oneupsmanship. There is a difference between being one’s own advocate and pretending that you know as much or more than physicians do. I would imagine that you provoke eyerolls but your FM MDs are wringing their hands with glee over your gullibility.

“I would imagine that you provoke eyerolls but your FM MDs are wringing their hands with glee over your gullibility.”

The FM MDs must see prn as a walking wallet.

There is nothing about functional medicine that has been shown to improve patient outcomes. It is tailored to rubes like you who equate touchy-feely and extensive testing with a better experience.

Extensive and EXPENSIVE. Read the Yelp reviews of Genova Diagnostics, home of “NutrEval” and countless other nonstandard tests. Been there done that nothing at all to show for it. As many diagnoses as I have seen FM doctors.

There is nothing about functional medicine that has been shown to improve patient outcomes.
That’s a very politicized situation in a dysfunctional industry.

It is tailored to rubes like you…
showing your lack of perception, and a deficiency of 9s…

who equate touchy-feely
I never buy touchy feely stuff beyond the surgeon…

and extensive testing with a better experience.
…and extensive testing with a better result. My reference is a bunch patients who all died horrible, expensive deaths, sooner than later.

Oh, I do have data Chris, lots of data. Just not the sacrificial crowd kind you want. And it gets a fair amount of respect from various doctors and oncologists now, as a one off achievement.

Our discussion is that you confuse existence with redundancy in proof of technique and broad application.

For some of you, there would be no proof that Man can, or went, to the Moon. Apollo was too small a study… If offered various photos, ‘fakery’ might be the reply. And I wouldn’t be surprised to hear someone here tell Harrison Schmidt that the moon is green cheese.

*Oh, I do have data Chris, lots of data. Just not the sacrificial crowd kind you want. *

You mean verifiable and reproducible?

I can’t comment on every FM/alt med test out there but I would be shocked if there is any meaningful information at all to be gleaned from so-called neurotransmitter testing, or urine organic acids (mine were tested twice in a short period and were night and day different), or hair tissue mineral analysis, or provoked heavy metal testing.

prn

maimstream

Was this intentional?

I can’t decide if I find it funny, or just lame — and I happen to love wordplay and bad puns.

Of course. With regular chemo, often that isn’t a joke. The first line chemo treatment for colorectal cancer, Folfox, often has debilitating and then disabling neuropathies, as the cycle count goes beyond 8-9 cycles.

Some years ago, I was trashed by an antibiotic later removed from market.

And your peer reviewed PubMed indexed evidence of this is what?

Seriously, your random ramblings without any verifiable evidence are just like vaporware. A total of nothing.

If an antibiotic was removed from the market means science is working to remove things that do not work, or cause more harm than benefit. This is why we now use the IPV to prevent polio than the OPV.

And yet folks like you still adhere to unproven stuff that has never shown to work and has actually caused real harm. Real medicine corrects its mistakes, do your supplement suppliers correct their mistakes?

@ Box of Salt:

So far, not one of us has got through to MJD:
no one agrees with him or seems interested in his books.
He doesn’t seem capable of benefitting from feedback from readers or learning SB information that contradicts his idee fixe. Orac said he wouldn’t grant him a post; still, he persists.

Is it possible that he is a bot? And one that isn’t transformed by new conditions ( which would make it appear more human)

re “maimstream” – sound like something from Bolen or Jake

Wasn’t there a heavy metal musician named Malmsteen? Maybe that’s what they’are thinking of.

I asked one of my docs whether she could tell me what functional medicine really was about two years ago. She rolled her eyes. Pretty much whatever you want it to be. There are a lot of people out there who fall for this fringe stuff. Voice of reason, thank goodness.

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