I frequently write about a type of medicine known as “functional medicine.” In brief, I’m not a fan. The reason is simple. What practitioners call funtional medicine involves massive overtesting and “make it up as you go along” overtreatment that is not based on evidence but has become very popular, with concierge practices popping up everywhere and academic medical centers like the Cleveland Clinic going all-in for this form of quackery. Functional medicine sounds appealing on the surface, with its claims of respecting the “biochemical individuality” of every patient, but in reality involves running a lot of unnecessary tests, chasing dozens of laboratory abnormalities, and mixing in quackery like homeopathy and acupuncture. Unfortunately, that popularity is fueled also by credulous news stories like this one, which I came across recently. Even though it’s a month old, I think it’s worth discussing the case of Jackie Lithgow and his treatment by functional medicine practitioner Chris Turnpaugh through the lens of this news report by the Harrisburg, PA CBS affiliate WHP CBS 21, Piecing the puzzle together: How alternative medicine helped save Jackie Lithgow’s life.
Here’s the video:
It’s the story of Jackie Lithgow, a college student who on February 23, 2014 was, quite literally, in the wrong place at the wrong time. While at a party, a fight broke out and Jackie tried to break it up. He was hit from behind, fell to the ground, and cracked his skull open, suffering a major traumatic brain injury. His story was described thusly:
Jackie’s parents rushed to the hospital.
“We just sat there and looked at each other, this can’t be happening,” Jim said.
Jackie was in critical condition.
“So when we got there, they had a bolt in his head to try to relieve pressure. The doctor said, ‘Listen, if it gets worse we have to take at least take one piece of his skull off.'”
Then came a 15 day coma and setback after setback.
“The process, it was long,” said Jim. “The roller coaster ride was tough but we had so much support.”
From intense physical therapy to speech therapy. Jackie fought to be Jackie again.
“I really took it to heart to show other people who were following my journey,” he said.
Months after that horrific night, Jackie was making progress but still far from himself.
Unfortunately, this is not an atypical course after a major traumatic brain injury. Recovery is slow. Sometimes it gets to the point where a near-complete functional recovery, but that can take months to years. Sometimes there is little or no progress. Sometimes, there is progress to a point, and then a plateau. Either way, traumatic brain injury is a horrible thing, something that can rob a young person of who he is and leave his life shattered.
Note how the story has progressed thus far. Jackie Lithgow suffered a major traumatic brain injury, but was making slow but steady progress with intense physical therapy, speech therapy, and occupational therapy. You can see from the video that he has made a remarkable recovery, speaking normally and fluently. Conventional therapy was working, although it’s entirely understandable how frustrating it was to Jackie and his family and how slow the progress was, with ups and downs, improvements interspersed with setbacks. I can only imagine what it was like. So it’s not surprising that the parents would look for other options. Unfortunately, the other option they found was a functional medicine practitioner named Chris Turnpaugh. The firt thing I noticed is that Turnpaugh is not a doctor, despite being repeatedly referred to as one in the news report. He’s a chiropractor who describes himself thusly:
Dr. Chris Turnpaugh is a skilled practitioner whose primary focus is on finding and addressing the root cause of disease. He has extensive experience in supporting patients who are dealing with the most difficult, chronic, autoimmune and neurological health conditions. Patients from around the country seek out his expertise to restore their health. Since opening his practice in 1999, he has worked with local hospitals and national laboratories to implement testing protocols leading to further breakthroughs in the treatment of complicated cases.
Dr. Turnpaugh’s vast knowledge of functional medicine and functional neurology, coupled with more than 16 years in practice, has earned him a reputation of being well-respected by his peers and other medical professionals. In 2013, he was invited to join the board of the International Association of Functional Neurology and Rehabilitation. His application of functional medicine as it relates to the neuroendocrine system is a unique clinical approach to non-pharmacological treatments.
If there’s one thing I’ve noticed about functional medicine, it’s that quacks like chiropractors are drawn to it. Naturopaths, in particular, love it. In this case, Turnpaugh has “DACNB” after his name. I didn’t recall having ever seen that after a chiropractor’s name; so a quick Googling was in order. DACNB stands for Diplomate of the American Chiropractic Neurology Board. Yes, there is apparently such a thing as chiropractic neurology, which should be as horrifying to you as it is to me. Be that as it may, there are also a lot of MDs who are attracted to functional medicine as well. Indeed, the guru of functional medicine, Dr. Mark Hyman, is an MD.
Why would quacks be so attracted to functional medicine? Just consider the seven precepts of functional medicine:
- 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
There are different lists describing the principles of functional medicine, but they all more or less say the same thing in different ways. There is a fetishization of the “biochemical individuality” of each person, which plays well among quacks. the very first principle is, in essence, functional medicine’s “get out of jail free” card for basically anything its practitioners want to do. They can always find reasons, science-based or not, 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 the first principle is simple: Yes, human beings are individuals, and each human being is unique. However, we’re not so unique that our bodies don’t all work very similarly. 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. Functional medicine 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. Functional medicine fetishizes “individuality” because it distinguishes functional medicine as a brand distinct from science-based medicine and, I suspect, because it makes functional medicine 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”, I like to say that functional medicine uses science the same way a drunk uses a lamp post – not for illumination, but for support.
But back to Chris Turnpaugh and Jackie Lithgow’s anecdote. I will give the reporter a little credit. Functional medicine was not portrayed as the one thing that saved Jackie’ life, the headline notwithstanding, although if all you read were the headline and the first part of the story you might easily get that impression. Rather, credit was given to the years of physical, occupational, and speech therapy, with Turnpaugh and functional medicine being represented as the “final piece of the puzzle” that healed him. Actually, I suppose that’s pretty bad too, as Turnpaugh is described as “last piece of the puzzle of care to make a leap.”
The anecdote continues:
Dr. Turnpaugh specializes in Functional Neurology, which helps fire up parts of the brain. As he says, it begins with nourishing the brain.
“Does the brain have the proper raw materials if you will, the fuel to even work correctly? And in Jackie’s case it didn’t have the right fuel,” says Dr. Turnpaugh.
That factor is determined after a number of blood tests.
“Different standard lab tests, which are reflective of not disease states but insufficiency states, and that’s the grey area where functional medicine thrives,” Dr. Turnpaugh says.
This is what we we call inadvertently revealing a truth in a way that Turnpaugh probably didn’t intend. Basically, functional neurology is a “subspecialty” of functional medicine that is every bit as non-evidence-based as functional medicine—worse, even, as functional neurology is very closely aligned with chiropractic practice. In essence, functional neurology is based on the belief that reversible lesions in the nervous system are the cause of a multitude of conditions and that specific clusters of neurons can be positively affected by chiropractic manipulative therapy and by many other stimuli. It’s an unholy union between functional medicine and chiropractic.
As I’ve discussed before, functional medicine practitioners love to run batteries of tests, many of which are standard but a lot of which are not; they are the “grey area” that Turnpaugh referred to. For instance, I once described a case report describing how functional medicine was used as an adjunct to breast cancer treatment in 80 year old woman. Dozens of lab tests were ordered, and batteries of supplements used to treat her, including high dose intravenous vitamin C. The end result was no demonstrable added benefit, with the sole exception being the functional medicine recommendations that were entirely within the purview of conventional medicine, exercise, a personal care giver, counseling, and her sleep log. As I like to say, there are some things that functional medicine gets right, but these are no different than the things every primary care doctor should be getting right, namely emphasizing healthy lifestyles, good nutrition, sufficient exercise, adequate sleep, and cessation of habits known to be harmful to health (e.g., smoking). Again, these are nothing that any good primary care doctor wouldn’t take care of, no massive overtesting or quackery needed.
Make no mistake, Chris Turnpaugh offers a lot of quackery, too. including:
- Cranial Sacral Therapy
- Decompression Therapy
- Frequency Specific Micro current
- Functional Neurology
- Holistic Pediatrics
- Hyperbaric Oxygen Therapy
- IV Nutrition Therapy
These tests worked as a guideline to determine what Jackie needed to help the healing process.
“Something simple like tumeric or curcumin, resveratrol, giving some sub straights for the mitochondria.”
These are just a few of the supplements that Lithgow took while working towards his recovery. In just days after adding functional medicine into the mix, Jackie began to make progress at physical therapy.
Dr. Turnpaugh says , “His occupational, speech, and physical therapists all said, ‘I don’t know what you’re doing, but we’re able to get breakthroughs now that we weren’t able to before.”
Although it is possible that whatever Turnpaugh did might have made a difference, it is, of course, incredibly unlikely that tumeric or curcumin, resveratrol had anything to do with Lithgow starting to do better at occupational, speech, and physical therapy. What we’re probably dealing with is probably a bit of confirmation bias. You do something new, hoping that it will help you, and—surprise!—you end up perceiving and then remembering that it did.
There was more woo, of course:
Along with supplements and different compounds, Jackie had to switch his diet dropping certain foods that inflame the brain.
Jackie says he cut out gluten and sticks to a low sugar diet, “because sugar inflames the brain and there’s many different things he told me to get better faster.”
The pieces of the puzzle were coming together.
“When you do this type stuff long enough you’re going to see some quote on quote miracles happen,” says Turnpaugh.
It’s more like: If you do something like what Turnpaugh is doing, eventually you’ll see some people show remarkable improvement because the clinical course after a traumatic brain injury can be widely variable. By random chance, even if you were using homeopathy, you can expect to see the occasional patient make a dramatic recovery even though you’re giving them nothing but magic water. You’ll also tend to forget about all the patients who didn’t get better that fast, because that’s the nature of confirmation bias. We remember things that support our preexisting beliefs and biases and tend to forget things that do not. Every human being does this. The difference between skeptics and everyone else is that skeptics realize that confirmation bias is built into human nature and try to compensate for it.
I’m happy that Jackie Lithgow is now doing so well. It’s been a long road, five years since his injury, and he’s finally getting back to something resembling a normal life, although he’ll never be the same again. Victims of such serious traumatic brain injury almost never are. However, functional medicine almost certainly had nothing to do with his improvement. True, his family does give credit where credit is due, namely to the team of doctors and nurses, as well as the occupational, speech, and physical therapists who worked with him for years. Unfortunately, they elevate a functional medicine quack chiropractor named Chris Turnpaugh by portraying him as the “missing piece” that Jackie Lithgow needed to make a major breakthrough. Overall, the news report reads like a commercial for Chris Turnpaugh’s functional medicine practice. Maybe it was. After all, WHP CBS 21 is owned by the Sinclair Broadcast Group.