Summary: Anyone who wants to see how integrative practice fits into the best currents of actual clinical reform in conventional medicine will want to download or purchase 21st Century Medicine: A New Model for Medical Education and Practice. This savvy 142 page white paper from the Institute for Functional Medicine (IFM) provides excellent short synopses of prospective health care, personalized medicine, systems biology, evidence-based medicine, integrative medicine, the chronic care model, and to a lesser extent, the primary care medical home. The text and graphics clearly lay out points of overlap and alignment in these movements toward reform that is not merely of payment structures and delivery mechanisms. In their effort to quilt functional medicine into the fabric of conventional initiatives, the IFM author team of David Jones, MD, Laurie Hoffman, MPH and Sheila Quinn has provided a service for all the integrative practice fields. Take a look at this exceptional foray into influencing the healthcare reform debate and see how your experience/field fits, or doesn’t. Let’s discuss this one.
The healthcare reform debate in the United States is frequently judged, if not utterly derided, inside the integrative practice and wellness communities as being little more than adjusting deck chairs on the Titanic. This cynical perspective is that little is being advanced to actually change clinical medicine from its present disease-oriented reactivity toward a focus on health and wellness. If we don’t make huge investments in such shifts, how will costs ever be reduced? How will we create the “wellness society” some Congressional leaders are espousing?
For this reason, a recent white paper from the Institute for
Functional Medicine (IFM) is particularly welcome. This savvy 142 page white paper, available here in PDF, is entitled 21st Century Medicine:
A New Model for Medical Education and Practice.
The authors make the case
for functional medicine not
singing to the choir, but by
neatly quilting functional
into the fabric of the
best currents in clinical reform
The service Gig Harbor, Washington-based IFM provides is two-fold. First, it is a pleasure to see one of the fields associated with integrative practice moving from criticism to ambitiously take on the task of declaring its affirmative value in such a compelling fashion. The IFM team of David Jones, MD, Laurie Hoffman, MPH, and Sheila Quinn (an Integrator editorial adviser) steps up to the bar. They make the case for functional medicine not by singing to the choir, but by neatly quilting functional medicine into the fabric of the best currents in clinical reform among conventional leaders.
This brings us to the second value of this document, perhaps its main value for the primary Integrator audience. The author team presents functional medicine inside a respectful awareness that the integrative practice community is not alone in crying for reform that goes beyond payment and delivery structures. The authors jump directly into medicine’s deeper dialogues about reforming education and practice. They position functional medicine in the
context of these distinct movements in medicine:
the chronic care model (CCM), and to a lesser extent
- the primary care medical home.
The synopses of each are a useful Cliff’s Notes look at the potential receptor sites, in conventional thinking, for integrative practice, and not just for conventional medicine but for all disciplines. Well-laid out charts
show points of agreement and distinction in the different models. In the excellent 3rd chapter, “Emerging Models,” and in appendices, the team spells out their views on strengths and shortcomings of each of these clinical movements. I suspect most readers will find this an intriguing journey, if something of a pin-ball ride, bouncing toward nesting in, and among, these diverse frameworks.
Notably, the IFM writers
as a journeyman-like
Here is one of my own experiences. One of the movements in medicine into which the authors chose to locate functional medicine was that toward “evidence-based medicine” (EBM). As a politico-medical tool, EBM has become something of a sledgehammer in the hands of antagonists to all things complementary and alternative. As in: We’re evidence-based, you are not. But look at the standing definition of EBM, as articulated not by political flame-throwers of EBM but by EBM’s founding clinical proponents: “… integrating individual clinical expertise with
the best available external clinical evidence from systematic research.” So-defined,
EBM is not, in fact, evidence-based; rather, it is clearly a more humble evidence-informed medicine. The polarization disappears. Most in the integrative practice community would be quite comfortable with this. Notably, the IFM writers position functional
medicine as a journeyman-like “science-using profession.” Other examples of moments of such clarity and connectivity abound in this document.
The ultimate intent of IFM and the authors is
to support uptake of functional medicine into medical education and clinical practice. They make their case in
closing chapters entitled “The Clinician’s Dilemma” and “Functional Medicine: A
21st Century Model of Patient Care and Medical Education.” These continue in a vein in which most in integrative practice will see themselves, while also respecting the rich context of medical thinking over the last 20 years of this very era in which integrative practice is maturing. As one small instance, under “Constructing the (Integrative Medicine) Model” (page 67), we see this description of the whole system components: “Combining the principles, environmental inputs, fundamental physiological processes, and core clinical imbalances creates a new information-gathering-and-sorting architecture for clinical practice.” A search for “antecedents, triggers and mediators” (all well described in the text) must be included in the patient intake as “personalized medical care without this expanded investigation will fall short.” Functional medicine is presented as more deeply grounding the movement toward “personalized medicine.”
The ultimate intent is
uptake of functional medicine into
medical education and clinical practice.
At least 17 the (medical) schools in
The authors conclude with
a note that “at least 17 of the (medical) schools with membership in the
Consortium of Academic Health Centers for Integrative Medicine have sent
attendees for training with IFM.” (The Consortium’s chair, Integrator adviser Victor Sierpina, MD,
and chair-elect, Adam Perlman, MD, MPH, provide the document’s forward.) IFM’s other
medical related initiatives are also briefly noted, showing they have other feet in the door.
The document is written with political intent, that is, to gain power for functional medicine, and functional medicine ideas, in the universe of medical education, clinical thinking and the reform of health care. As such, I am struck by two political choices in the structure and editing of the document. One is that the substantial clinical use of natural products, perhaps the dominant tool in many functional medicine-oriented practices, and certainly a core of IFM’s clinical teaching, is side-stepped and even downplayed. This may be wise, given what a hot-button these products can be for conventional practitioners.
I highly recommend this booklet as an
essential health reform reader and as
a device for locating integrative
among the language and constructs
of these other clinical reform models.
Second, I wondered, though not for long as you will see, that another clinical movement that has been ascending in Western medicine over the last couple decades was nowhere mentioned. This is a movement that: combines training in Western medical sciences with a whole person approach; is informed by science; has created a clear model of whole practice medical instruction and gained US Department of Education-recognition for such; is deeply personalized and respects “antecedents, triggers and mediators” in the interview process; and that has had adherents deeply embedded in the Institute for Functional Medicine leadership for years. This movement, boasting some 4500 licensed doctors in North America today, is the modern naturopathic medical profession. Of course, unlike the other trends, naturopathic medicine was not born inside conventional practice. And given the field’s ability to stir up antagonism, singling it out and highlighting it, from a political perspective, would likely have ripped apart many of the stitches with which the IFM authors so skillfully sewed functional medicine into the best patterns conventional clinical thought.
Still, it would be interesting to see a similar graphic comparison of the fit of naturopathic medicine, as well of acupuncture and Oriental medicine and broad-scope chiropractic fit with these other models.
This book has already proved a useful reference document for me since I laid my hands on it a few weeks ago. I highly recommend this down-load, or purchase,
as an essential health reform reader, and as a device for locating integrative
practice among the language and constructs of these other reform models. Take a look at this exceptional foray into
influencing the healthcare reform debate and see how your
experience/field fits, or doesn’t. Let’s discuss this one.
Note: The IFM white paper is available for purchase or
free download from the IFM website. Click here.
for inclusion in a future Your Comments Forum.