Functional medicine is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms. Functional medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, functional medicine supports the unique expression of health and vitality for each individual.

Why Do We Need Functional Medicine?

• Our society is experiencing a sharp increase in the number of people who suffer from complex, chronic diseases, such as diabetes, heart disease, cancer, mental illness, and autoimmune disorders like rheumatoid arthritis.
• The system of medicine practiced by most physicians is oriented toward acute care, the diagnosis and treatment of trauma or illness that is of short duration and in need of urgent care, such as appendicitis or a broken leg. Physicians apply specific, prescribed treatments such as drugs or surgery that aim to treat the immediate problem or symptom.
• Unfortunately, the acute-care approach to medicine lacks the proper methodology and tools for preventing and treating complex, chronic disease. In most cases it does not take into account the unique genetic makeup of each individual or factors such as environmental exposures to toxins and the aspects of today’s lifestyle that have a direct influence on the rise in chronic disease in modern Western society.
• There’s a huge gap between research and the way doctors practice. The gap between emerging research in basic sciences and integration into medical practice is enormous—as long as 50 years—particularly in the area of complex, chronic illness.
• Most physicians are not adequately trained to assess the underlying causes of complex, chronic disease and to apply strategies such as nutrition, diet, and exercise to both treat and prevent these illnesses in their patients.

How is Functional Medicine Different?

Functional medicine involves understanding the origins, prevention, and treatment of complex, chronic disease. Hallmarks of a functional medicine approach include:

• Patient-centered care. The focus of functional medicine is on patient-centered care, promoting health as a positive vitality, beyond just the absence of disease. By listening to the patient and learning his or her story, the practitioner brings the patient into the discovery process and tailors treatments that address the individual’s unique needs.
• An integrative, science-based healthcare approach. Functional medicine practitioners look “upstream” to consider the complex web of interactions in the patient’s history, physiology, and lifestyle that can lead to illness. The unique genetic makeup of each patient is considered, along with both internal (mind, body and spirit) and external (physical and social environment) factors that affect total functioning.
• Integrating best medical practices. Functional medicine integrates traditional Western medical practices with what are sometimes considered “alternative” or “integrative” medicine, creating a focus on prevention through nutrition, diet, and exercise; use of the latest laboratory testing and other diagnostic techniques; and prescribed combinations of drugs and/or botanical medicines, supplements, therapeutic diets, detoxification programs, or stress-management techniques.

Working with a Functional Medicine Practitioner

Functional medicine practitioners promote wellness by focusing on the fundamental underlying factors that influence every patient’s experience of health and disease.

The Functional Medicine Approach to Assessment

The functional medicine practitioner assesses the patient’s fundamental clinical imbalances through careful history taking, physical examination, and laboratory testing. Multiple factors will be considered, including:

• Environmental inputs – The air you breathe and the water you drink, the particular diet you eat, the quality of the food available to you, your level of physical exercise, and toxic exposures or traumasyou have experienced all affect your health.
• Mind-body elements – Psychological, spiritual, and social factors all can have a profound influence on your health. Considering these areas helps the functional medicine practitioner see your health in the context of you as a whole person, not just your physical symptoms.
• Genetic makeup – Although individual genes may make you more susceptible to some diseases, your DNA is not an unchanging blueprint for your life. Emerging research shows that your genes may be influenced by everything in your environment, as well as your experiences, attitudes, and beliefs. That means it is possible to change the way genes are activated and expressed.

Through assessment of these underlying causes and triggers of dysfunction, the functional medicine practitioner is able to understand how key processes are affected. These are the body’s processes that keep you alive. Some occur at the cellular level and involve how cells function, repair, and maintain themselves. These processes are related to larger biological functions, such as:

• how your body rids itself of toxins
• regulation of hormones and neurotransmitters
• immune system function
• inflammatory responses

All of these processes are influenced by both environmental factors and your genetic make-up; when they are disturbed or imbalanced, they lead to symptoms, which can lead to disease if effective interventions are not applied.

A Comprehensive Approach to Treatment

Most imbalances in functionality can be addressed; some can be completely restored to optimum function, and others can be substantially improved.

• Prevention is paramount. Virtually every complex, chronic disease is preceded by long-term disturbances in functionality.
• Changing how the systems function can have a major impact on the patient’s health. The functional medicine practitioner examines a wide array of available interventions and customizes a treatment plan including those with the most impact on underlying functionality.
• Functional medicine expands the clinician’s tool kit. Treatments may include combinations of drugs, botanical medicines, nutritional supplements, therapeutic diets, or detoxification programs. They may also include counseling on lifestyle, exercise, or stress-management techniques.
• The patient becomes a partner. As a patient, you become an active partner with your functional medicine practitioner. This allows you to really be in charge of improving your own health andchanging the outcome of disease.

©2008 The Institute for Functional Medicine

An Economy in Need of Holistic Medicine

CAMBRIDGE, MASSACHUSETTS —

The American economy is having what doctors call an acute episode.

Employment won’t throb. The circulation of capital remains weak. Industry is breathing, but barely. And if we can agree on anything one year into this mess, it is that there is little we can do when the patient arrives already this bad.

That is why the talk now is so often of prevention. Prevent the next crisis through health insurance and a green-energy sector, the American president says. Prevent it by cutting spending and nurturing personal responsibility, American conservatives retort.

But the truth is that politicians, and not just in the United States, are rarely willing to invest in a problem that hasn’t occurred.

Consensus and action are easier to come by after a 9/11 or a Lehman Brothers than before. Problems in the embryonic, soluble phase don’t interest us; and those that do interest us are often too big to solve.

Which is where acupuncture comes in.

Western medical practices have attracted similar criticisms in recent years, for an emphasis on intervening in disease rather than preventing it beforehand and promoting quotidian well-being. But in health, unlike politics, an alternative approach called wellness has emerged, focused on investing in health before it breaks down.

What can wellness tell us about our present economic malady? As it moves from fringe to mainstream — with wellness programs in the health care reform proposals now in Congress, wellness manifestos on the best-seller lists and a U.S. Army wellness program that asks soldiers to introspect and meditate — I asked experts about the approach’s core tenets and how they might be applied to the body politic.

Nip it in the bud. Wellness argues for cultivating health a little every day, not just restoring it during calamities.

We increasingly accept that it is better to monitor a diabetic’s blood sugar with regular clinic visits than to amputate her limbs. We accept that businesses can avoid costly cancer treatments by encouraging workers to stop smoking. But in our political life, we prefer to wait until things reach the emergency room.

We barely regulate financial markets for years, thinking regulation oppressive, until we are compelled to nationalize private firms. We avoid expensive investments and controversial new methods in public education, then pay the price in lower social mobility and vast prison populations. We neglect building roads and bridges and Internet highways, fearing the cost, and then reap the much greater costs of whole regions falling off the economic grid.

“With a lot of social problems, we’re not sure how to prevent it, and therefore we don’t spend money on it, because we always have a lot of other priorities,” said David Cutler, a Harvard economist who has advised both the Clinton and Obama White Houses on health care.

Go to the roots. Western medicine tends to fight symptoms, whether suppressing coughs or flooding the brains of the depressed with serotonin. Wellness is interested in underlying causes. It is inclined to see an infertile woman, for example, as a stressed woman rather than a woman with defunct ovaries, and may suggest that she eat and work differently rather than take ovary-manipulating pills.

In public policy, a symptom bias rules. A housing crisis? Enact a tax credit! Bank failures? Bail them out!

There is nothing wrong with such steps — except for what they leave out, as most economists will tell you.

Even amid all this action, we have virtually ignored the complex weave of issues beneath the issues: meager savings, a debt addiction, a congenitally spendthrift political system, an almost pathological craving for stuff. And, with our topical cures, we should not be surprised to see new symptoms of the old maladies appearing: insurance again being packaged into derivatives, bonuses again soaring on Wall Street.

“We treat symptoms, and we do not look at the causes of the symptoms,” Deepak Chopra, the famed alternative-medicine and wellness guru, said when asked to extend the wellness metaphor to the economy. “We are totally at this moment looking at it in a reductionist manner. The reductionist manner is a bailout. And somehow that’s supposed to solve the problem, whereas the problem occurred because we were thinking reductively.”

Look within.

Wellness sees the causes of and remedies for ailments as lying within us.

Avoid infection by building immunity. Defeat disease by eating foods that help the body heal itself.

With the economy, we look everywhere but within. It’s the fault of greedy Wall Street bankers. It’s Washington’s fault. Bush’s fault. Obama’s fault. Greenspan’s fault. Somebody fix it!

But what about us? Why can’t we acknowledge that it was us who bought all those unaffordable houses, us who listened to that zero-gravity financial “advice,” us who bought and bought and never kept a rainy-day fund? And why, in solving the problem, do we expect the state to create substitute dynamism instead of renewing the culture of decentralized dynamism that made the U.S. economy so vital to begin with?

“Conventional medicine is very unbalanced in placing all its emphasis on external interventions rather than looking to advance that internal capacity to maintain healing,” said Andrew Weil, founder of the Arizona Center for Integrative Medicine and the author of several books on wellness. Likewise with the economy, he said: “Instead of simply identifying external threats and developing weapons and strategies against them, we should instead identify and strengthen immunity and resistance.”

A politics of wellness would transcend party. It would emphasize the up-front investments that Democrats like in order to achieve the long-run fiscal solvency on which Republicans insist. It would fulfill the liberal belief in a positive role for government in maintaining well-being but would honor the conservative conviction that government’s chief role is to help the social organism heal itself. It would acknowledge, with the left, the complex lattice of cultural and institutional influences that govern a society’s well-being, while emphasizing, with the right, the limits of what any external healer can do.

Think wellness in these hard times.

The most urgent problems, after all, may be the ones we haven’t had yet.