The fight over functional medicine


Functional medicine, which at its base is simply the idea of using healthy choices to mitigate risk factors for disease, has gained traction in recent years. Somewhat puzzlingly, it is still met with skepticism and resistance by many in the field. Granted, in some ways it has also become a collection of fringe medicines that may or may not have benefits but are at least suggestive of some impact in treatment. Interestingly enough, the weird conglomeration of practices that have amounted to what is now called functional medicine, in my mind, stem from a failed of our healthcare system. Our current paradigm is rooted in treating the symptoms of disease once patients get sick, and we’ve invested a lot in that system. The entire medical field’s reimbursement system relies on treating patients, meaning that if the system tried to establish care that acts to prevent disease then the system would make less money. Notably, the wages of doctors haven’t gone up, but hospital administrators’ have. So while doctors are treating more patients than ever before (until the pandemic), they aren’t actually making more money1.

The system isn’t invested in wellness, it’s invested in making money off of treating people’s illnesses. That’s not a secret either, the major drivers in American healthcare—investment bankers and insurance conglomerates—are open about it. In a major memo sent out to biotech companies by Goldman Sachs analysts, they flat out say it while talking about why gene therapy treatments might pose a problem2:

“The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies,” analyst Salveen Richter wrote in the note to clients Tuesday. “While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.”

The report cited three potential solutions2:

“Solution 1: Address large markets: Hemophilia is a $9-10bn WW market (hemophilia A, B), growing at ~6-7% annually.”

“Solution 2: Address disorders with high incidence: Spinal muscular atrophy (SMA) affects the cells (neurons) in the spinal cord, impacting the ability to walk, eat, or breathe.”

“Solution 3: Constant innovation and portfolio expansion: There are hundreds of inherited retinal diseases (genetics forms of blindness) … Pace of innovation will also play a role as future programs can offset the declining revenue trajectory of prior assets.”

They’re literally suggesting to focus on diseases specifically based on how much money you can make off of keeping sick people from dying. This practice is widespread. A new treatment for hemophilia, marketed as a one-time cure was marked at $2.8 million, because the average lifetime cost for patients with that severe of a disease pathology is $6.4 million in treatments. The company, Bluebird Bio wanted to make sure they didn’t leave too large of a market share untouched3. They manage to justify this somehow because in their minds they “cut the price in half.” This is the paradigm we deal with. And I think that’s why so many people are opposed to functional medicine—doctors aren’t in charge and business drives decisions. Our healthcare system doesn’t want patients to be healthy. Functional medicine is a shift in optimal living to prevent disease, and it’s slowly gaining hold. Certain aspects of functional medicine are even social-justice oriented, seeking to close disparities in healthcare outcomes in minority groups. They’ve achieved this in certain populations by integrating “health coaches” into care groups to foster and support good health choices4. The potential to attract paradigm shifting approaches to treatment is what makes functional/integrative medicine interesting. However, many treatments ostracized from canonical medical spaces have found their way into the halls of functional medicine, and some still need to be filtered out. They’re drawn to this arena because it has buzz and potential, not because they share a goal, and they may not even work, but I don’t blame legitimate practitioners of functional medicine for this. I think there’s a lot of potential in the public health arena when it comes to functional medicine, it would make adopting universal healthcare a more sustainable system.


Written by Jeremiah Ockunzzi, courtesy of Dr. Bart Rademaker, MD.






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