Functional Medicine is a system that addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership.
It talks about cures rather than just management and embraces all that is evidence-based in integrative medicine and other complementary medicine modalities.
It is an evolution in health practice 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 and its method of delivery embraces all of the buzz words (patient-centred care, patient homes etc)

* Functional Medicine offers a powerful new operating system and clinical model for assessment, treatment, and prevention of chronic disease to replace the outdated and ineffective acute-care models carried forward from the 20th century.

* Functional Medicine incorporates the latest in genetic science, systems biology, and understanding of how environmental and lifestyle factors influence the emergence and progression of disease.

* Functional Medicine enables physicians and other health professionals to practice proactive, predictive, personalized medicine and empowers patients to take an active role in their own health.

* Functional Medicine is a personalised, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working in collaboration to address the underlying causes of disease.

In one sense, when the adoption of functional medicine occurs with qualified health practitioners, it is recognition that the care delivered by many people involved in complementary health care delivery may actually have got it right.
Getting science-based qualified people from a range of disciplines expands the research and application of Functional Medicine.
Critics often confuse their messages to consumers because of their different agendas.
Global Pharma’s try to eradicate all the positive associations of Functional Medicine by creating dubious research studies and having their front organisations act as foot soldiers in the delivery of this type of research.
The Internet is full of reports of massive fines levied on Pharma’s because of this Medifraud, and it always makes for depressive reading.
However, patients and governments are waking up and rejecting this ineffective and inappropriate model of health in a time where people are living longer and experiencing one or more lifestyle illnesses.
The cost of footing the drug bill and eventual hospital bills is now too high to be acceptable.

One dramatic step forward for Functional Medicine has occurred with the top US hospital, the Cleveland Clinic, setting up a department of Functional Medicine.
At last, a centre that can review existing research and conduct its own, by blending it with its own patient programs, including the ability for the patient to self-manage.
It also represents a unique opportunity for pharmacists to support these types of programs, returning to a model of care they once practiced.
As reported in the US newspaper The Desert Star:

When the head of the world-renowned Cleveland Clinic approached Dr. Mark Hyman about creating a department that would employ the doctor’s specialty of “functional medicine,” Hyman was typically blunt.

“If I create a program there, it would cut the number of angioplasties and bypasses in half, and reduce hospital admissions,” he told clinic CEO Toby Cosgrove.

And if slicing the number of cardiac procedures at the country’s top heart hospital wasn’t alarming enough, Hyman warned that he would strive to take functional medicine to its ultimate end by teaching patients to care for themselves so they could avoid the hospital altogether.

“Hire me and I’ll do what I can to put you out of business,” Hyman recalled of their meeting 22 months ago.

That was just what Cosgrove, a 74-year-old cardiac surgeon who earned a Bronze Star in Vietnam, wanted to hear.
And he hired Hyman.

The Cleveland Clinic is the first academic medical centre in the country to embrace Functional Medicine, which focuses on the underlying causes of illness, instead of symptom management.

It employs more than 3,000 doctors and 40,000 other caregivers who handle 5.5 million patient visits each year.
The start was in 1921 by four physicians who were inspired by the Mayo Clinic in Minnesota, the Cleveland Clinic has long been on the leading edge of medical progress. The first blood transfusions were done at the hospital in the 1920s. Coronary angioplasty — a nonsurgical procedure to open narrowed heart arteries — started there in the 1950s. And in 2007, the hospital became the first to have a chief wellness officer.

All these things are now commonplace at hospitals around the country.

Functional medicine may be next.

The Cleveland Clinic is the first large institution to offer the functional medicine model to its patients.
One Functional Medicine Practitioner commented:

“All eyes will be on this clinic and it will send a message to other regions of the country and the world.”

Within the Cleveland Clinic, other doctors are already asking to learn more and collaborate with the functional medicine staff. And calls from people wanting to schedule appointments have flooded in from across the country and Canada.

After plenty of dysfunction in America’s healthcare system, Cleveland Clinic is betting the future will be functional – and that the US will finally get its woefully poor health care system to world best standard.

Patients who make appointments at the centre complete an in-depth questionnaire that the doctor will review prior to the initial visit. During that visit, the patient will spend 60 to 90 minutes with the doctor and then another 45 minutes with a nutritionist. The team then works with the patient to create a care plan that includes dietary advice.

The medical team at the centre coordinates the care of patients who in the past may have had many doctors to treat them for various conditions. The team creates a plan to help balance the body so symptoms disappear and eliminates the need for medication. A patient’s care plan may involve a combination of healthy foods, exercise, sleep and removing junk food, alcohol or tobacco that may throw a body out of balance.

Australia does have a range of similar health practitioners found under the umbrella of the Australasian Integrated Medicine Association (AIMA) and involves medical doctors and a range of complementary medicine health practitioners.
The following is taken from their website:

The term Integrative Medicine (IM) refers to the blending of conventional and natural/complementary medicines and/or therapies along with lifestyle interventions and a holistic approach – taking into account the physical, psychological, social and spiritual wellbeing of the person – with the aim of using the most appropriate, safe and evidence-based modality(ies) available.

(AIMA joint working party/RACGP : ‘Best Practice’ document) 

Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health and healing.
Developed and Adopted by The Consortium, May 2004 Edited May 2009 and November 2009.

Whilst some pharmacists are members of this association it does not seem to be pharmacist-friendly or democratic, and is controlled by medical doctors.
At an earlier date pharmacy had a world class College of Clinical Nutrition, which to pharmacy’s loss, was dismantled by the PGA leaving pharmacists without a suitable educational resource of its own.
This is just one of many gaps in the pharmacy landscape in Australia that has to be repaired.
While the practice of functional medicine sounds simple — good stuff in, bad stuff out — it also simplifies the experience for the many patients who already have many doctors. Take for example a patient who sees one doctor for high blood pressure, another for migraines and a third for that annoying skin condition. Often, the patient is responsible for keeping track of which doctor is advising what.

At the Centre for Functional Medicine, the medical team takes the role of coordinating care and sidesteps the common practice of dividing the patient by body part: heart doctors looking at the heart, brain doctors looking at the brain and a skin doctor looking at the outside.

The diagnosis and treatment model is different. A patient may come in with psoriasis, but the root cause might be something the patient’s eating – and that is what is treated.

In the standard model, the patient would likely see a dermatologist, not a gastroenterologist. Then the skin doctor might prescribe topical creams or lotions that sooth the skin without curing the condition. A functional medicine team would strive to prescribe a cure: a different diet, in this instance.

As practitioners learn more about the body, more cures become available for what could be considered incurable, chronic conditions.

The origins of disease can be found in the interrelationship between environment and lifestyle and how those interact with a person’s genetic disposition.

A person’s genes may make him susceptible to certain conditions and then the decisions he makes — choices about food, exercise, and workplace — can push him closer to or further away from developing symptoms.
With Functional Medicine, practitioners look at the whole picture and devise a plan to move someone away from symptoms.

And “the pill for every ill model,” which started with the discovery of penicillin in the 1920s, paved the way for numerous medical breakthroughs. But in this era, with rising rates of chronic disease and soaring health care costs, the model may be past its prime.

At the turn of the last century, we started to understand the origins of infectious diseases but we are going to witness an unbelievable shift around non-communicable diseases from this point onwards.

Historically, medical experts have belonged to a small and exclusive club. As they made new discoveries in health care, the information travelled slowly, even to other doctors.
It takes an average of 13 years for a health care innovation to be established as a mainstream standard of care.

Communication speed is about to ramp up.
Functional medicine practitioners are deciphering the links between environment and lifestyle choices and non-communicable diseases, like diabetes, asthma and heart disease.
And because lifestyle choices are a piece of the problem, Functional Medicine practitioners can share information and advise patients on actions that patients can take themselves.
No prescription needed – and here is a long-term implication for pharmacists and the need to become Functional Medicine practitioners with their own skill set.
The full cost of poor pharmacy leadership decisions of past decades are now fast coming home to roost.

Both patients and practitioners will share new information via the Internet and that will be the new disruptive model for health.

With a healthcare spend of $140 Billion a year in Australia and half of this on preventable disease, there is an urgent need to use health dollars more effectively.

 A landmark research report, released this week by The Australian Self Medication Industry (ASMI) shows how targeted use of complementary medicines can help reduce healthcare costs and improve productivity.

 The study, ‘Targeted Use of Complementary Medicines: Potential Health Outcomes and Cost Savings in Australia,’ was commissioned by ASMI and conducted by economic research firm Frost and Sullivan.
It reveals that when specific complementary medicines are used by at- risk target populations, there are potential health improvements for individuals, lower health costs from reduced hospitalisations and improved productivity from reduced work absences.

 The study focused on six complementary medicines, across four chronic disease conditions – osteoporosis, cardiovascular disease (CVD), age-related macular degeneration and depression. Using data from a range of published peer reviewed studies on complementary medicines, including RCTs and large cohort groups, the results identify gains across all four disease conditions.

 With the widespread use of complementary medicines (70% of Australians used one or more in a year) AIMA believes the report provides valuable information on both potential health system gains and individual gains

The biggest gains identified in the study are in the area of osteoporosis and osteopenia – conditions which resulted in approximately 140,822 fractures in 2012 and affect some 1.8 million people at a cost of approximately $3 billion per annum.

 Potential healthcare costs savings and productivity gains were calculated if all women over 50 with osteoporosis were to take calcium and vitamin D at a preventive dose to reduce the risk of osteoporosis-attributed bone fractures.

 Frost and Sullivan found the relative risk of an individual in the target population experiencing an osteoporosis-attributed fracture is reduced by 19.7% given the use of calcium and vitamin D at preventive intake levels. This translates to a potential of 36,783 avoidable osteoporosis-attributed fractures in 2015 given 100 per cent utilisation of calcium and vitamin D by the high risk population.

 The report estimated that between 2015 and 2020 average annual hospitalisation costs of $922 million can be potentially saved and average annual productivity gains of $900 million can be realised for the same period if all women aged over 50 who were diagnosed with osteoporosis or osteopenia take a preventive dose of calcium and vitamin D.

 More than a half of the potential total benefits would go to the individual and over 42 per cent of potential total benefits can be realised by Federal and State governments. The average annual benefit/cost ratio between 2015 and 2020 is $22.34 for every dollar spent on this complementary medicine regimen.

 The report also explored the burden of cardiovascular disease (CVD) on Australians and the potential health and economic benefits that can be realised if an omega-3 fatty acid regimen was used by all Australians aged 55 and over who are diagnosed with CVD.

It was estimated that the relative risk of hospitalisation due to a CVD event can be reduced by 4.9 per cent and 6,894 average annual medical events avoided between 2015 -2020 if all Australians aged over 55 with CVD were to take omega-3 fatty acids at a preventive level. The average annual benefit cost ratio from 2015 to 2020 would be $8.49 for every dollar spent on the omega-3 fatty acids, with 60 per cent of the savings going to individual consumers. 

The impacts of St John’s wort for major depression and lutein and zeaxanthin for age-related macular degeneration were also analysed.

The relative probability of an individual with moderate major depression in the target population not experiencing a successful diagnosis transition is reduced by 24% given the use of St. John’s wort at preventive intake levels. This translates to a potential of 39,845additional successful diagnosis transitions in 2015 given 100% utilisation of St. John’s wort complementary medicines among the target population. The net economic benefit is estimated at $255.7 million.

Finally, the net economic benefit of lutein and zeaxanthin use among the target population, can amount to $32.8 million in 2015, with 1,068 AMD related hospital events avoided.

The report has been favourably received from many areas of the health industry.

For the hardcore band of Skeptics committed to denigrating Functional Medicine and its offshoots, the turning point may have now been reached with Cleveland Clinic becoming the centre for information, best practice and clinical excellence providing the evidence backing to counter the often destructive claims from this cohort.

One thing is certain, and that is if pharmacy does not hurriedly reorganise itself now, the Functional Medicine type of health model is going to further destroy the heartland of pharmacy.
Yet it also has the capacity for pharmacists to create a prosperity not experienced for a long time primarily because it releases the profession from the grasp of government and managed care.
Make sure whatever happens is in the positive!