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.
2)
https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html
