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Jan 4, 2019

Functional Medicine Vs Conventional Medicine

by Dr. Dan Kalish

What Is Functional Medicine and Conventional Medicine? How are they different?

During my travels around the United States I’ve visited many cities. Atlanta, Denver, San Diego, the list goes on. When speaking with people I meet outside of my profession I find most have never heard of the term “Functional Medicine” and have no idea what is means! I’m so often surrounded by colleagues and patients that this often comes as a surprise, but as of late I’ve had to answer the question what is Function Medicine frequently. Because Functional Medicine contains the word medicine, the obvious conundrum is what is the meaning of  Functional Medicine vs. conventional medicine, What’s the difference, really?

So, what is Functional Medicine and what is Conventional medicine? How are the different? How do they overlap. Does one preclude the other? Is one better than the other for a given condition? Only going back 30 years, Functional Medicine is a relatively new term, first coined by Jeffrey Bland, PhD, to describe what was then a special niche within the over all field of alternative medicine. So this then begs yet another question what is the difference between alternative medicine vs. conventional medicine and how does all that relate to the differences between Functional Medicine vs. conventional medicine.

So let’s start by defining what is conventional medicine. Turns out this is the easy part. Conventional medicine is the treatment of human disease using drugs or surgery. In fact, in the United States at the present time, our laws demand that ONLY conventional medicine be used to treat a known disease. Suggesting that you can “treat” cancer or “treat” heart disease with anything other than a medication or a surgery is against the law. This approach then, of using medications and surgery can only be done by, of course you guessed it, conventional physicians trained in medical schools granting MD degrees.  By definition these folks attended a conventional medical school and are required to follow treatment norms based around what is commonly accepted by their colleagues, medical boards and schools. Conventional medicine examples would include everything from heart surgery to prescribing statins for high cholesterol. From surgery to remove a cancerous growth to chemotherapy. The focus on surgical techniques and the use of prescription medicine makes up the bulk of what we mean by conventional medicine.

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There are a few exceptions to this rule of MD’s being the only ones that can prescribe drugs, for example Osteopathic Medicine, originally a separate and distinct system based around hands on healing work, manipulation of the soft tissue and joints and cranial treatments, was brought into the conventional medicine fold decades ago. Therefore at the present time DO’s or Doctor’s of Osteopathy are licensed to do surgery and prescribe medications. Additionally, are other one off examples like in the state of New Mexico acupuncturists are licensed to prescribe hormones that in other states could only be prescribed by MD’s or DO’s. Plus of course Nurse Practitioners have the ability to prescribe medications under certain circumstances. But the rule stands in general most conventional medicine is delivered by MD’s trained in medical schools.

Alternative Medicine, as the name implies, is an “alternative to” something. It’s an alternative to … conventional medical practices. Falling outside the scope of drugs or surgery alternative or holistic or integrative medicine encompasses a vast array of treatments from special diets to the use of herbs, clinical nutrition using vitamins and so on. The term alternative medicine usually is meant to include acupuncture, chiropractic, naturopathic and homeopathic medicine. All systems of treatment that do not use surgery or prescription drugs. So holistic medicine vs. conventional medicine is easy to distinguish. However, what is being practiced is one thing, who is practicing it is another.

In the 1970’s and 1980’s the term alternative medicine stood for anything outside the mainstream. And going back at least 100 years, a small percentage of alternative medicine was practiced by, ok this is confusing, conventionally trained MD’s! Again, historically most of alternative medicine was practiced by “alternative pracitioners” folks who had chosen an alternative to medical school and were trained in a different setting whether it be chiropractic college, acupuncture school or a naturopathic university.

There has always been tension between these competing groups and the American public has reacted in different ways  to these different professions asserting control over the delivery of care. Naturopaths, homeopaths, MD’s, chiropractors all have historically maintained separate schools and as groups have not gotten along well. In an interesting little spasm of populist revolt every single American doctor was stripped of their license and all medical schools were decertified in the later part of the 1800’s. This backlash against doctors was in response to what the public saw as a fraudulent and abusive use of power. The doctors of that era were busted for a focus on selling what were then called patent medicines that were unsafe and due to a general lack of oversight on standards of care. The conventional medical system in response to this started to develop more carefully regulated systems for training doctors and for approving certain procedures and the use of drugs which came to fruition as our current system in the 1920’s.

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But I diverge, back to our story. When first coined, the term Functional Medicine was used to describe a specific type of alternative medicine. The term spoke to the techniques being used, not to the degree or licensure held by the practitioner. So you could have an MD practicing Functional Medicine next door to a chiropractor practicing Functional Medicine. This adds another layer of confusion to the subject. What made Functional medicine stand out was the relentless focus on complex lab analytics combined with lifestyle changes as foundations for treatment. Lab tests not typically used in a conventional practice such as organic acids testing, amino acid testing, salivary hormones, food allergy testing and nutrient assessments are used by Functional Medicine doctors to determine the source of and extend of problems with the body’s “functioning” prior to the onset of disease or pathology. So for example Functional Medicine would assess the health of your cardiovascular system and use nutritional therapies and diet changes to correct problems prior to the onset of a first heart attack or stroke. Functional Medicine would seek to stabilize blood sugar fluctuations prior to the onset of diabetes and so on.

Now in the last few years there have been a few key changes to the previously long held distinctions between Functional Medicine vs. conventional medicine. Firstly, most of the new doctors coming in to the field to practice Functional Medicine are leaving a conventional medical practice. Therefore most new Functional Medicine doctors were trained originally as conventional MD’s in a conventional medical school. Thirty years ago this was simply not the case. In those days most Functional Medicine practitioners were not MD’s and were never trained in a conventional medical school.

The ranks of Functional Medicine practitioners that are MD’s with conventional training continue to grow because many conventional MD’s are disheartened by the changes they see in conventional practices (see 1800’s popular revolt story above), the over reliance on prescription drugs as the sole treatment option for diseases caused by lifestyle and the large scale abdication of “doctoring” that has taken place in the modern era as insurance companies and HMO’s have dramatically increased patients loads leading to extremely short visit times. The word “doctor” in latin means “teacher” and there is not much teaching about health principles that can occur in a six minute visit as mandated by certain insurance plans. As more and more conventionally trained MD’s want to get back to doctoring or teaching health and inspiring patients to health rather than simply prescribing drugs, the landscape of Functional Medicine has significantly changed. It is to me the best of both worlds to have a doctor that graduated from a conventional medical school and understands the proper use and application of drugs or surgery who is then additionally trained in Functional Medicine, meaning they also understand how important diet, exercise, sleep and stress management art. They also know when a probiotic can “cure” a stomach ache and so can avoid over reliance on medications for every problem they encounter.

Whereas in the past there was often a “Functional Medicine vs. conventional medicine” type attitude among practitioners on both sides, I see that fading more and more as these two treatment modalities start to merge.

So in short. You can find a Functional Medicine doctor that also has conventional training to get the best of both worlds. This group of doctors represents the latest incarnation of Functional Medicine. Or, you can still find Functional Medicine practitioners, like myself, who are expert within the narrow band of Functional Medicine but cannot offer any conventional medical services.

I have to end on a personal note here. For the last year I’ve had the great privilege of joining the Institute For Functional Medicine’s faculty as a leader of their Practice Implementation group. This has put me in the direct orbit of the top Functional Medicine MD’s who are leading this movement and teaching new MD’s the work. It is a huge responsibility and challenge to manage both of these worlds. To be trained in and responsible for conventional medical issues such as diagnosing life threatening illnesses and at the same time to maintain a Functional Medicine approach requires a highly intelligent, properly trained, compassionate and loving human being.  I see the movement of Functional Medicine towards integration with conventional medicine as a positive next step in the evolution of American Medicine.

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Dr. Dan Kalish

Dr. Dan Kalish

Founder of the Kalish Institute
Dan Kalish, DC, IFMCP, is founder of the Kalish Institute, an online practice implementation training program dedicated to building Integrative and Functional Medicine practices through clinical and business courses.