A New Framework: Why We Need Functional Medicine

By Mark Hyman, MD

Over the years, I have shared with many physicians my passion for an emerging healthcare model based on systems medicine — Functional Medicine — that can reduce the global burden of chronic disease, improve patient outcomes, create healthy communities, and avert an economic crisis from escalating healthcare costs.

As Director of the Cleveland Clinic Center for Functional Medicine, it is my hope to deepen your understanding of this medicine of the 21st century and share insights about its science and practice.

Why Functional Medicine?

After 15 years of practicing Functional Medicine and witnessing the extraordinary clinical results from applying this new operating system to chronic disease, I am clear this must be the model for medicine going forward. I want to enlist your help as advocates, activists, and leaders in making this a new paradigm in medicine.

Part of this involves learning about the theory and practice of functional medicine through case studies and review articles that will be the subject of upcoming articles on this ConsultQD physician blog.

The Institute for Functional Medicine’s strategic plan serves as its handbook and blueprint for how we are going to accomplish the expansion, validation and diffusion of functional medicine that is necessary to bring this form of research, medical education and clinical practice to the forefront.

From heart disease to diabetes, from depression to dementia, from attention deficit disorder to autism, from asthma to autoimmune disease, from digestive disorders to cancer, we must take a systemic look at how we treat these. We cannot arrive at the solutions for our healthcare crisis only by improving access to care and medical quality and reducing errors or waste while continuing to apply outdated diagnostic and therapeutic methods.

We cannot arrive at a better healthcare system by doing the same things better. We must make sure medical education, research, practice, and policy to match the current scientific shift from reductionist, organ-based medicine to a more ecological understanding of health and disease based on systems medicine. We cannot otherwise get to the solutions for our healthcare crisis, or solve the problem of chronic disease.

Functional Medicine is the best-kept secret in science and medicine today. That must and can change by implementing initiatives in research, education, collaboration, and policy on a large scale to support and nurture the seed of a viable healthcare system nationally and globally.

The Shifting Tides of Science and Healthcare Policy

Our current model of disease and specialty medicine is breaking down as we begin to understand underlying causes and biological mechanisms at the root of chronic disease. We must reimagine disease to match current discoveries. At Cleveland Clinic, we are doing so much. Stanley Hazen, MD, PhD, Chair of the Department of Cellular and Molecular Medicine, has established beyond question links between the gut microbiome and cardiovascular disease, chronic kidney disease, and other disorders. Charis Eng, MD, PhD, Chair of the Genomics Institute, is investigating how the microbiome may affect head, neck and kidney cancer. Particular colonies of microbiota have been associated with depression, obesity, type 2 diabetes, heart disease, cancer, autoimmune disease, autism, allergy, asthma, fibromyalgia and other conditions.

Perhaps the doctors of the future will need to be “inflammologists” or “microbiome-ologists” skilled at seeking out and optimizing disturbances in human function. Our current framework of disease cannot explain these observations.

We need a new framework based on systems biology that focuses on causes and mechanisms, not symptoms and diseases, that is focused not on organs but on the whole organism and the dynamic patterns emerging from the complex adaptive system that is our human biology. Functional Medicine is not a new specialty or modality – it is a new way of thinking that incorporates these emerging observations into a coherent, clinical model of diagnosis and therapy. It is the medicine of why, not only what.

Rather than stopping our clinical assessment at the ICD-10 diagnosis, that is when thinking begins. Rather than ask the questions what disease? what drug?, we ask the question why? Functional Medicine is the filter through which we can make the big data small, create big insights from the super genome – the genome, microbiome, epigenome, transcriptome, metabolome, nutrigenome, sociogenome and exposome.

Value-Based Care and Functional Medicine

The shift toward value-based health care embedded in the Affordable Care Act forces us to rethink not only how we do medicine – improving efficiencies, reducing medical errors, better care coordination, better health information technology, better financing and payment systems, but also the medicine we do.

We cannot solve our current chronic disease epidemic and stem the burden on our healthcare system without also changing the medicine we do, the “content” or “intel inside,” without addressing the upstream drivers of chronic disease. Unless we apply the disruptive advances in our understanding of disease to clinical medicine, and marrying that to disruptive delivery models that build a healthcare system without walls by addressing health and disease where it originates – in the kitchen, grocery store, school, workplace, community and faith-based community – we cannot avert the coming tsunami of disease and costs.

Perhaps the healthcare system of the future will employ a million community health workers to help address the real drivers of disease – what we eat, how we move, how we deal with stress and the social context in which we live.

I know there are many things competing for your time and interest, but I believe that Functional Medicine is one of the most important ideas of our time — an idea that can help relieve the unnecessary suffering of millions. I encourage you to explore, learn, investigate, question, and become re-enchanted with medicine alongside me, through the doorway of Functional Medicine.