With seven decades of living comes a unique ability: the power to recognize that some days unfold with a deeply embedded stamp of significance. On October 25, 2019, I believe the world shifted for the Functional Medicine community. Every day, I read the medical literature. On that specific day, I was able to read a study about the clinical effectiveness of the Functional Medicine model that was published in a top-tier and highly respected medical journal, JAMA Network Open. This experience was almost surreal to me, because it marked the achievement of an aspiration that I had held for more than 40 years. I feel tremendous pride and genuine gratitude for the many people who were involved in the publication of this important work, “Association of the Functional Medicine Model of Care with Patient-Reported Health-Related Quality-of-Life Outcomes.”
This large-scale retrospective study of 7252 patients compared the outcomes of those receiving care at the Cleveland Clinic’s Center for Functional Medicine (CFM) with those receiving standard care from one of the Cleveland Clinic’s family health centers (FHC). It employed PROMIS questionnaires for Global Physical Health (GPH) and Global Mental Health (GMH) developed and validated by the National Institutes of Health to detect treatment effects over time on physical, mental, emotional, and social functions, overall health, and quality of life. After 6 months of care, participants receiving FM treatment demonstrated significantly greater improvements in GPH and GMH than those receiving standard treatment, and FM patients with data at 12-month as well as 6-month time points also showed significantly greater increases in their GPH scores (indicating improvement) at 12 months compared to FHC patients. According to the Cleveland Clinic’s press release announcing the study, in about 31% of CFM patients, GPH scores increased by 5 or more points—a clinically meaningful degree of change that is noticeable to patients in their daily lives. CFM patients were also more likely to raise their GMH scores by 5 or more points compared to FHC patients. CFM patients see a health coach and a dietitian as well as a primary care clinician, and the CFM emphasizes patient engagement and self-care as part of a partnership approach to enhancing health and function.
The Functional Medicine ‘operating system’ is based on optimizing function in order to promote well-being and reverse illness by considering behavioral and lifestyle inputs, including crucial factors not definitively addressed by conventional treatment like sleep, exercise, eating habits and nutrient intakes, stressors, social relationships, genomics, digestive and metabolic functions, the microbiome, and the exposome. This study supports the concept that Functional Medicine represents a comprehensive system of care and the application of network biology to the practice of precision, personalized, lifestyle medicine.
Not unexpectedly, criticism of the study emerged almost immediately. Among the most vocal complaints are assertions that the study was not placebo controlled and was only 12 months in duration. With due respect given to these concerns, this study does demonstrate that the Functional Medicine model is a safe and effective treatment option for the management of a broad array of complex health issues that represent an ongoing challenge for primary care providers. A door is now open, and controlled studies that prospectively evaluate the benefits of the Functional Medicine model will be a welcome next step in the evolution of this important work.
As I reflect on the impact of this study, I have come to feel that its contribution to the advancement of global, patient-centered healthcare cannot be overstated. I admire and have a profound respect for the principal investigators, as well as the countless clinicians and biomedical scientists who have dedicated their professional lives to the development of this model of care. This article is essential reading for anyone who is searching for solutions to the challenges associated with managing the rising prevalence of chronic disease. October 25th, 2019 is a date that is now etched into the personal timeline of inflection points that I carry with me through life. Things will never be the same, and I look forward with great anticipation to what lies ahead.
Biography
Jeffrey S. Bland, PhD, FACN, FACB, is the president and founder of the Personalized Lifestyle Medicine Institute in Seattle, Washington. He has been an internationally recognized leader in nutrition medicine for more than 25 years. Dr Bland is the cofounder of the Institute for Functional Medicine (IFM) and is chairman emeritus of IFM’s Board of Directors. He is the author of the 2014 book The Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life.