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L0018442 A quack doctor offering a gouty John Bull some medicine whil Credit: Wellcome Library, London. Wellcome Images [email protected] A quack doctor offering a gouty John Bull some medicine whilst conventional doctors are turned away; satirizing British politics. Coloured lithograph attributed to J. Doyle. By: John DoylePublished: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

Functional Medicine:
Pseudoscientific Silliness

ABOVE: A quack doctor offering a gouty John Bull some medicine whilst conventional doctors are turned away; satirizing British politics. Colored lithograph attributed to J. Doyle. See full bibliographic record from Wellcome Images. [CC BY 4.0], via Wikimedia Commons.

Language keeps changing. We used to call questionable remedies “folk medicine,” “fringe medicine,” or “quackery.” In the 1970s, the term “alternative medicine” was coined, an umbrella term for all treatments that were not supported by good enough evidence to have earned them a place in mainstream medicine. Then came “complementary and alternative medicine” (CAM), and later, “integrative medicine.” Now there’s a new kid on the block, “functional medicine” (FM) which is really just the latest flavor of integrative medicine. These are all marketing terms, Trojan horses designed to sneak non-science-based medicine into conventional medical practice. The oft-quoted quip is appropriate here: Do you know what you call alternative medicine with evidence? Medicine.

How is Functional Medicine Different from Conventional Medicine?

Functional medicine was invented by a single individual: Jeffrey Bland. He’s not a medical doctor. He’s a Ph.D. who sells dietary supplements. His supplement companies have been fined repeatedly by the FTC and FDA and have been ordered to stop making medical claims for their products. A number of health care providers have “jumped on the Bland wagon” and claim to be practicing functional medicine.

It’s hard to pin down a definition of FM; each FM provider describes it differently. Dr. Mark Hyman says conventional medicine is dysfunctional, and FM is the opposite. He thinks conventional medicine is as obsolete as phrenology and bloodletting; he also rejects the germ theory of disease. He says diseases don’t exist; they are merely “the downstream symptoms of a mechanism.” The official organization, the Institute for Functional Medicine, says this:

Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine 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.

That sounds good, until you realize that it also describes good conventional medicine. Conventional medicine always addresses the underlying causes of disease: when you have appendicitis, you don’t just get morphine for the pain, you get an appendectomy to remove the cause of the pain. Conventional medicine deals with real underlying causes; FM makes up hypothetical, speculative, or imaginary causes.

Conventional medicine uses a systems-oriented approach when appropriate, but it is not helpful for setting a broken bone. Conventional doctors always engage their patients in a therapeutic partnership; the days of paternalistic medicine are long gone. Conventional doctors have always addressed the whole person. As early as ancient Greece, Hippocrates said it was more important to know which person had the disease than to know which disease the person had. Conventional doctors have to spend time with their patients, since the history is 70% of the diagnostic process. They look at genetic, environmental, and lifestyle factors; the standard medical history has sections for family history and social history, reminding doctors to look at everything that might have an impact on diagnosis or treatment, such as occupation and finances. They routinely ask about things such as tobacco, alcohol, and exercise.

More Medicine

The statement by the Institute for Functional Medicine is far from the only one offered. Alex Rinehart explains that FM is not focused on diagnosis; it sees health as a continuum and it addresses these 7 core imbalances: hormonal and neurotransmitter, oxidation reduction, detoxification, immune and inflammatory, digestive, structural, and mind-body/body-mind imbalances. Elsewhere, a chart shows an iceberg in the ocean: above the water are diseases like diabetes and cancer; below the surface are a long list of “imbalances” along with toxic chemical exposures and “toxic emotions.”

Then there’s the Functional Medicine Tree. The leaves are symptoms, conventional diagnoses, organ systems, and medical specialties. The soil is sleep, exercise, nutrition, stress levels, relationships, and genetics. The roots are antecedents, triggers, mediators, mental, emotional, and spiritual influences, genetic predispositions, experiences, attitudes, and beliefs. The tree trunk consists of the fundamental organizing systems of assimilation, defense and repair, energy, biotransformation and elimination, communication, transport, and structural integrity. In a further illustration, those six trunk factors are grouped around a core of mental, emotional, and spiritual factors. Jeffrey Bland says the five principles of FM are:

  1. Correct the precipitating factor and control oxidative stress.
  2. Get rid of sources of chronic inflammation.
  3. Manage the folate cycle.
  4. Regulate hormones.
  5. Manage insulin and control blood sugar.

FM also espouses principles like the myth that diet and lifestyle will prevent and treat most disease, the concept of ultra-wellness (that we should aim for better than normal), and they treat non-diseases like yeast, adrenal fatigue, “toxicity” requiring detoxification, and leaky gut.

A Case Report in Functional Medicine

Functional medicine practitioners disagree with each other. Nowhere do they actually explain how they could go about applying all these high-sounding principles to an actual patient. But fortunately they have published case reports that give us some insight into the process, and that also give us some insight into their concept of what constitutes evidence. One published case is a doozy. The patient was an 80-year-old woman who had conventional treatment for breast cancer. The surgery probably cured her. Her prognosis was excellent, but they offered her extra insurance in the form of postoperative radiation, which she refused. Two years after surgery she had no signs of recurrence, which is exactly what we would expect.

“Condimentary Medicine,” a term coined by Dr. Richard Rawlins, describes treatments that add spice and flavor but that have no actual effect on the outcome of the treatment. That applies in spades to Functional Medicine (FM).
Real Secrets of Alternative Medicine

So conventional treatment was successful, but FM practitioners got into the act and tried to take the credit for her good outcome. They gave her potentially toxic doses of vitamin C by intravenous injections—a whopping 97 doses! They admit that the use of vitamin C in cancer remains controversial, and that there are only preliminary trials showing it to be “safe and potentially effective in improving quality of life and fatigue.” Seems like thin gruel to justify 97 invasive treatments.

They prescribed a laundry list of dietary supplements: melatonin, digestive enzymes, probiotics, a medical food shake, vitamin D, EPA/DHA, wheat germ extract, oral vitamin C (in addition to the intravenous vitamin C!), and a “standardized herbal inflammation relief supplement.” They put her on a restricted diet: dairy free, gluten free, low glycemic index. They had her exercise by riding a bicycle 10 minutes a day and joining a Qigong class. They put her on a sleep program that consisted only of instructions and a log to record sleep; and they recommended group support, individual counselling, and a part time caregiver/ companion.

And then there were the lab tests! They did 154 of them, mostly nonstandard tests from a lab that is notorious for offering bogus tests—many I had never heard of. Putrefactive single chain fatty acids, urine representativeness index, pancreatic elastase, lignoceric acid, and 150 more. In most cases, the results were within the laboratory reference range; but if they weren’t, how would you know what to do about it, or even if anything needed to be done? They don’t explain how, or even if, they used these test results to guide the patient’s treatment.

The FM practitioners concluded: “This case study highlights the potential benefits of integrative therapy in the comanagement of patients with invasive ductal carcinoma of the breast.” It does no such thing! It shows how they abused this 80-year-old woman for no demonstrable benefit. They left her on her prescription medications and didn’t even attempt to identify the underlying cause of her high blood pressure, gastritis, and thyroid disease, or of her cancer. Did they consider genetics and the environment? Did they correct the 7 core imbalances? Did they address Bland’s 5 foundational principles? Did they use the best evidence-based practices? No, I don’t think they did any of the things they claim to be doing.

Why Functional Medicine is Bogus

The late Wally Sampson characterized FM as “claims cloaked in the language of science, but with the distinguishing characteristics of sectarianism—pluralities of approaches to illness, absence of evidence or efficacy, a unifying concept of illness as a body out of sync with Nature (with the capital N), undecipherable babble and descriptive word salad.” Medical doctor and blogger David Gorski says they take “making it up as you go along” to a whole new level, and that’s not a good thing in medicine.

Skeptic 22.1 (cover)

This article appeared in Skeptic magazine 22.1 (2017).
Buy this issue

Dr. Richard Rawlins, in his excellent book Real Secrets of Alternative Medicine, coined the term “condimentary medicine” to describe treatments that add spice and flavor but that have no actual effect on the outcome of the treatment. That applies in spades to FM. Patients of FM practitioners appreciate all the attention and the personalized treatment, and they say they feel better. Is there a problem with that? I think there is. As cancer researcher David Grimes said, “By clinging to delusion, belief in alternative medicine denigrates the very wonder of science and medicine and the massive strides we as a species have made over the last century or so in understanding the world around us, and how our bodies work.”

Vague claims, testimonials, and case reports do not constitute credible scientific evidence. FM claims that their individualized patient-centered treatment plans are not amenable to clinical trials, but that’s nonsense. It would be a simple matter to randomize patients to two groups, treat one with conventional medicine and the other with FM, and compare the outcomes. To my knowledge, that has never been done. I think I know why. END

About the Author

Dr. Harriet Hall, MD, the SkepDoc, is a retired family physician and Air Force Colonel living in Puyallup, WA. She writes about alternative medicine, pseudoscience, quackery, and critical thinking. She is a contributing editor to both Skeptic and Skeptical Inquirer, an advisor to the Quackwatch website, and an editor of, where she writes an article every Tuesday. She is author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon. Her website is

This article was published on August 16, 2017.


49 responses to “Functional Medicine:
Pseudoscientific Silliness

  1. Richard Farrer says:

    It sounds like functional medicine has just re-invented the idea of balancing humours (blood, yellow bile, black bile and phlegm) which we still recall when describing someone as sanguine, bilious, choleric, melancholic or phlegmatic

    • Benjamin Gonzalez, MD says:

      Yes, it does….when you read only what Dr. Hall has written in a one sided, skewed, heavily biased venue. Functional Medicine in its purest form is good medicine taking into consideration the entire patient physiology and not the specific complaint or system. Pretty much what medicine is supposed to be but is not in our current health care system.

  2. Dr.A.P.Jayaraman says:

    I have had some interactions with naturopaths in India. Mostly patients seeking solace speak the native language of the “path”. Cross language practice is rare. Most paths operate in villages with an attached farm. Lean leafy diet, lots of tree barc infused hot water, applying mud for dermatological problems-vitiligo, psoriasis…, some curious amalgam of breathing exercises and prayer and so on. No two naturopaths agree on diagnosis ,treatment or prognosis. Most of them do not have formal K-12 and college education. They add letters to their name similar to those of modern medicine.Their success stories of auto remission are trumpeted and their invariable failures are unuttered even by those who have coughed up huge sum. It is a subculture and great conversation topic as wellness treatment. The harm they do is incalculable and is an onslaaught on scientific literacy.

  3. Old Nassau says:

    But the superseded “faculty” offers two equally idiotic solutions – “more bread”, “coffee with sugar”. The other two – a better diet and stand him up – might have validity.

  4. Dfmgv says:

    Excellent article, and I’m going to start calling CON MAN TRUMP a “FUNCTIONAL PRESIDENT”

  5. Barbara Harwood says:

    The effectiveness of any treatment is the belief in both the treatment and the person administering it. The mind is the agent that decides what works and what does not. For this reason, placebos and folk medicine seem to work because people believe in them. It also explains why scientific treatments are not 100% effective. Unfortunately, this often means that people will spend huge amounts of money traveling to various places for apparent cures. The fact is that they could heal themselves if they could silence the doubt in their owns minds. This is not to place the blame for the illness o n the patient because there could be many extenuating circumstances. =

  6. BillG says:

    Injections of vitamin-C?
    Here’s my ranking of the biggest and most ubiquitous scams in society:

    3) dietary supplements
    2) chiropractors
    1) and the mother of all scams: religion

  7. Dfg says:

    I tend to think that most false-science is pushed by people who are just convinced and blinded by their beliefs, but at this level, it really looks like FM is pushed by plain escrows whose only goal is to make money.

    The whole process aims at luring non-scientific people and making their products attractive. There are so many signs of it : false studies, appeal to all the popular trends, and even that particular experience on a 80-years old lady : how do you appeal to the most … breast cancer of course, because it is the most common cancer.

    I wouldn’t be surprised if some day they end up in jail for having caused the death of someone.

  8. Gary says:

    Indeed, you can learn things from autopsies.

    Medical science and evidence-based doctors learn from their mistakes. What distinguishes quacks is a quasi-religious reluctance to learn. Britt Hermes’ Naturopathic Diaries cites just a case where her supervising naturopath would have let a child die from naturopathic treatment rathe than admit that it didn’t work and take it to a hospital.

  9. Benjamin Gonzalez says:

    What a sad commentary. As one of my patients stated to me yesterday about your article….”What a curmudgeonly outlook…..” Harriet, you write very well. You write with a chip on your shoulder, with a blind outlook in medicine, with a passion for the lack of progress. You mix valid points with a closed mind. Your appendicitis example right up front misses the entire point. What is truly unfortunate is that you are correct in many ways. J Bland abuses the idea of “functional Medicine” and that term is overused by non medical providers as a way to market their own BS. However, when you say functional medicine is conventional medicine you are way way off track. And a quick comment by me here will not be able to describe why. What your article needs is another look, another article describing the other side…… Harriet, it is obvious you are bored in your retirement…..

  10. Chronic Fatigue Syndrome patient says:

    This article was ignorant and misinformed. Conventional medicine has repeatedly failed my family, while functional medicine practitioners have helped.

    My child came home from college with a serious mental illness that 21 doctors and 9 psychiatric medications did nothing for, resulting in a suicide attempt. Enter functional medicine, where diagnosing and treating celiac, multiple food sensitivities, leaky gut, and severe nutrient deficiencies led to a complete cure with no drugs needed.

    Conventional medicine ignored my estrogen dominance and toxicity until I had cancer in my ovaries and uterus. Then they were ready with surgery and chemotherapy, both of which damaged my body permanently. High dose vitamin C, melatonin, mushrooms, artesunate, and curcumin all have evidence based studies behind them and were a part of my functional medicine treatment plan. My conventional oncologist told me recently he’s very surprised I have not had a recurrence given the seriousness of the presentation where my ovary had ruptured spilling cancer cells throughout my body.

    The chemotherapy triggered chronic fatigue syndrome, which according to Nobel Laureates and several members of the National Academy of Sciences, is a multi organ system autoimmune disease, with dysfunctional immune response, leaky gut, endocrine, neurological, and cardiovascular dysfunction.

    How did conventional medicine treat me? I went to a dozen Seattle doctors, including 3 cancer survivorship clinics, who did nothing for me. I was yelled at, dismissed, fired, and they couldn’t even read the lab results my functional medicine doctor had done, showing a plethora of abnormalities, including high serum ferritin, low immunoglobulins, and evidence of 6 infections. All they offered me was psychotherapy so I could “learn to cope with my fatigue” and the UW Pain Clinic (I’m not in pain.).

    Meanwhile, my functional medicine doctor gave me IV and oral nutrients, immunomodulators, and artesunate (subject of the 2015 Nobel Prize in medicine and chemistry). I’ve since learned that most patients as sick as I am are bedbound or in a wheelchair, while I am ambulatory and work part time. He’s kept me functioning.

    If you look on the CDC website, you’ll see that nutrients are the only treatment, so this was quite appropriate. There are no FDA approved drugs.

    In the end, I went to California to see one of the top MD clinicians in CFS, associated with the latest research, who validated everything my functional medical doctor had done, apologized for all of the ignorant doctors who’d mistreated me and dug more deeply to get to the heart of my immune dysfunction and autoimmunity.

    Arrogant skeptics like the author of this article are what’s wrong with medicine, where people like me and my family members fall through the cracks. I’ve been stunned to find so many intelligent people so narrow minded and uncurious.

    If you care to look, there is a great deal of research supporting what functional medicine doctors do. As a systems analyst, it’s made total sense to me to look at the body as a system of interrelated systems, rather than the conventional medical system which continually injured my parents, drug by drug, intervention by intervention, robbing them of their quality of life and dignity.

    The Cleveland Clinic adopted Functional Medicine about 4 years ago and the clinic has doubled in size since. They saw that the old way of doing things wasn’t as helpful as it could be and were open minded enough to see the promise in functional medicine, which, by all accounts, is quite successful at improving patient outcomes.

    Don’t knock it, it may save your life some day. And don’t you dare take it away from me.

    And, by the way, though functional medicine practitioners have various degrees, I see a naturopathic doctor who is brilliant, curious, and expert at diagnosis through conventional lab testing and prescribing nutrients, hormones, botanicals, and pharmaceutical drugs. Hes helped msnyvpatients that conventional medicine did nothing for, and they are extremely thankful, as am I.

  11. Phil Mott says:

    I agree with the article as a whole, except for the paragraph that says conventional doctors take time, are not paternalistic and work with the patients. They may exist, but I haven’t had a single doctor for whom that is true more than a small degree. Maybe it’s different in the northeast?

    • Jillian says:

      Nope. Same here, Phil.

      Looking right now for a functional/complementary medicine doc bc most primary care doctors have 10-15min per patient for care.

  12. Phil Clarke says:

    Whilst agreeing with most of this article there is an area ignored which needs greater attention and that is the practice of alternative approaches by fully qualified and experienced doctors.

    These reasonably claim that the profession – particularly at institutional level – is very heavily biased against new approaches, confusing prejudice on their part with reasonable caution

    I think here particularly in terms of such practices as “orthomolecular medicine” (awful name) – the field of alternative medicine that tests for allergies sensitivities and nutritional problems and for statistically aberrant vitamin and mineral levels – which it corrects using high dosage supplements

    Much venom has been poured out against honest practitioners seeking to help physically and mentally ill patients using these methods – and arguably with considerable success. Much of what such practitioners claimed decades ago – concerning the use of supplements and adjusting diets is now common practice – often claimed as “recent discoveries” by the “tail-end Charlies” who once reviled and insulted doctors and specialists working in this field – and indeed attacking them to this day.

    It is one thing to attack a medically unqualified person prescribing high dosage supplements etc but quite another to dismiss out of hand medically qualified persons who have had success with new approaches. Medicine cannot advance if you dismiss all new approaches because they do not fit current received wisdom

    The battery of woo-woo and the presence of so many charlatans is purely a result of failures in national health systems at several levels. Too many sufferers feel inadequately serviced by current medical structures

  13. Marvin Doolin, Jr. says:

    Could it be possible that the one of the reasons insurance companies have such control over how much time a doctor can spend with a patient is that young people today must mortgage two-thirds of their working lives to pay for their education? My freshman year, fifty-five years ago, I had a scholarship that paid tuition and fees (still don’t know what that was), and I was able to pay for room and board working two nights a week at a grocery store. By the time my kids went to college in the eighties, two nights’ wages wouldn’t have paid for either room or board. It’s much worse now. When close to half of earnings are going into the pockets of a few hundred people (many of them health insurance executives) who turn around and get tax breaks for nearly everything, everyone else suffers.

  14. John Mitchell says:

    Everybody just relax. “Science advances one funeral at a time”. M. Planck. Harriet’s meager, and anemic opinions will eventually be in the compost bin. Conventional medicine has and will probably continue to hang tightly to archaic ideas soon to be shown incompetent; as many have in the past.

  15. Matt Bille says:

    What we need to reclaim is enough time for a doctor to get to know the patient and the history as thoroughly as both patients and doctors would like. I have a GP who knows my history because he’s known me for 20 years and he used to have the time to sit down and talk. He’s ALWAYS asked about lifestyle and sleep and exercise, those underlying factors that can make many conditions worse. He HATES the fact those now running the practice as part of a larger system schedule him for 15 minutes with a patient. He’s retiring earlier than he planned: I doubt his replacement will ever get to know me nearly as well, but the idea that only CAM practitioners care enough to know the patient is hogwash.

  16. Dr.A.P.Jayaraman says:

    As far as Alternative truth is concerned we know that there is no alternative to truth. So far as Alternative medicine is concerned there is no alternative to science based and science backed modern medicine. Desperate persons resort to desperate remedies and quacks thrive in this region. Anecdotes and storytelling are the medium used to propagate plus a label natural. Alkaloids and heavy metals are ingredients of many herbal remedies and a vast literature assessing their toxicity exists. Rationalists in India are waging a relentless war against unscientific therapeutic claims.

    • Dr Septic Skeptic says:

      Good luck mate, just be careful not to harm too many sacred cows in the culling process.

  17. David Dressler says:

    PS: Re: My comment above, that figure should have been 15%, not 20%. I misquoted. So, the situation is worse than I said.

    Here is the exact quote from Dr. Kerr White on the safety and efficacy of conventional medicine. This quote comes from a book published in 1988. A little over a decade later, Dr. White told me essentially the same thing.

    “Although things are much better than they were a generation ago, it is still the case that only 15% of all contemporary clinical interventions are supported by objective scientific evidence that they do more good than harm. …40-60% of all therapeutic benefits can be attributed to a combination of the placebo and Hawthorne effects…or what most people call ‘love’.” (Medicine and Culture by Lynn Payer (1988), introduction by Dr. Kerr White.) In my interviews, Dr. White updated his statement made in 1988, by saying that medical interventions are (today) probably only about 15% proven to do more good than harm; in other words, they are no more proven now than they were a decade ago.

    • MBDK says:

      David Dressler

      I find it interesting that you use one doctor’s opinion with no empirical evidence to justify your case. Even more interesting is the fact that your quote from him is nonsensical. Specifically, “Although things are much better than they were a generation ago, it is still the case that only 15% of all contemporary clinical interventions are supported by objective scientific evidence that they do more good than harm.”

      How can things be much better, yet still be the same? Such a lack of logic, as well as your endorsement of it, is the foundation of your entire diatribe.

  18. David Dressler says:

    The emotional tone of this article is distinctly “non-scientific”, not what one would read in medical journals or an objective analysis.
    Therefore, one has to be suspicious of some emotional or other agenda. Hardly “skeptical”, more biased.

    One such bias is the statement that functional medical practitioners have a vested interest in the supplement industry, ignoring that conventional medical doctors in the US have a snuggle-relationship with the pharmaceutical companies from the time they are in school to all the years of their practice. So, not mentioning this collusion is an example of not being objective.

    In 1999 and 2000 I did an investigative research project on a Canadian physician regulatory body. They are called “Colleges”, specifically, the “College of Physicians and Surgeons” and their member Association. At the time, the College and Association were stating online that only conventional medicine had scientific proof of safety and efficacy; that physicians should not make referrals (as some had been doing) to CAM (complementary and alternative medical) practices because these professions (although under the government’s regulatory authority and licensed) had no evidence of safety and efficacy and physicians could be subject to legal action if they referred to a CAM practitioner and there was a patient mishap.

    I challenged the College’s and Association’s assertion that only conventional medicine had proof of safety and efficacy by speaking personally with the “father” of evidence-based medicine (EBM), Dr. Kerr White. Dr. White began the EBM movement in the mid-1960s. I asked him what medicine was based on back then. He answered: “Opinion.” Shocked, I asked him what conventional medicine is based on today (1999 and 2000 when I interviewed him). His answer was the same: “Opinion.” Digging for more, I asked him for some numbers. He answered: “Conventional medicine is only 15-20% proven scientifically to do more good than harm.” Shocking.

    That year, over 110,000 people died in the US from correctly applied medical procedures (drugs and surgeries), and the number has risen steadily.

    To be certain, I researched studies that had been done in the US, Canada, and Europe (those published in English). I found Dr. White’s figures were supported, with one exception in Canada where the efficacy of medicine was rated at about 50%.

    Speaking personally, my own experience with conventional medicine is that it does treat symptoms and ignore causes. To use the article’s example: removing an appendix due to appendicitis does treat the cause of the pain, but not the cause of the appendicitis! Fixing a broken leg may remove the cause of the leg pain but does not remove the cause of the fall. Consider non-accidental falls such as osteoporosis and a spontaneous break in the hip bone causing a fall. The cause is what led to osteoporosis, and there are usually multiple causes over a long period of time. The article’s examples are specious.

    It is now known that systemic inflammation is a cause of multiple conditions and diseases, from diabetes to heart disease to early dementia and more. And systemic inflammation is treatable.

    Functional medicine may be in its early stages of acquiring hard evidence, but conventional medicine has had decades to secure an evidence base. That means up to 80% of all medical procedures are of unproven safety and efficacy. Let’s remember that when we swallow that pill or slide under that scalpel.

    • Ron says:

      I agree that there is an emotional tone to the article.

      I thought the examples of appendicitis and broken bone were irrelevant, because I considered them acute and that not much disagreement would exist between a conventional or functional practitioner. However, I think you make a good point that there could be underlying chronic issues that are associated with these issues.

      I think it’s more relevant to discuss the difference between the diagnosis and treatment of chronic diseases (diabetes, heart disease, etc.) between a conventional and functional practitioner. I expect that that is where the main difference will be. I think a more balanced perspective would provide some survey of a group to stay away from cherry picking particular examples that are inappropriately used to generalize (like the Case Study that is mentioned). Without something like this, I feel like the whole argument is just based on name calling, because there’s very little substance to the article on how in general diagnosis and treatment differs between conventional and functional practitioner.

    • Dr Septic Skeptic says:

      David Dressler – thank you for your informative comments,much appreciated.

  19. Mike says:

    I’m not so sure he was rejecting germ theory of disease but possibly saying it didn’t apply to everything. Certainly he could’ve been more specific, but I see FM as being more targeted at the so-called “diseases of civilization” such as obesity, diabetes, etc. Those are the things where lifestyle interventions do play a huge part. Of course some things are caused by a single pathogen and can be treated with a specific drug, and of course sometimes surgeries are necessary. Again, FM seems aimed at the problems that can be solved without drugs or surgery and is why many people seem to tack it onto their conventional medical practice as another layer. The functional medicine textbook is chock-full of references to legitimate published research, much of it dealing with nutritional biochemistry and endocrinology.

    Is he a quack? Doesn’t seem like it to me, certainly has good credentials. Ditto for hundreds of others with great credentials and tons of experience.

    Is there some quackery going on by some claiming the mantle of FM? Perhaps, I’ve seen it myself with a chiropractor claiming to practice FM. But I’ve also been to a more traditional family practice that does IM/FM and received what I considered very good care there. To call the whole thing bogus seems a bit extreme.

    If you only define medicine as drugs and surgery, than I suppose FM is not ‘medicine.’ But if you define it as anything that contributes to the health, wellbeing and flourishing of a person, then nutritional and lifestyle interventions would count also.

    • Dr Septic Skeptic says:

      Mike, Jeffrey Bland was a dedicated, qualified & competent man with an open mind & a generous nature when I studied with him in 1979-80. Haven’t seen him since then, so I’m glad he’s still active. His contribution has been and remains, well founded & well appreciated by those that have “eyes to see”.

      Good health to you,regards from Australia.

  20. Trish says:

    The saddest thing is that the pseudo-medical practitioners have infected much of the public – even people who don’t buy their bogus services – with the belief that most disease is caused by behavior the sick person controls, when in fact very few illnesses are. This belief is sadly consistent with blaming the sick person as somehow having chosen to become sick.

    In a weird way, anti-medical treatments may be a result not of of scientific medicine’s failures as the “alt” practitioners claim, but of medicine’s success. We grow up with few or none of the children we know dying and many diseases used to kill or maim can be prevented, cured or controlled. So when evidence-based medicine can’t address an illness, it can seem like EBM is failing, and there *must* be something that works.

  21. Dr. Ken Karger says:

    Fantastic article. Well written and well founded in actual science. Anecdotal evidence is not evidence at all but merely conjecture and opinion. After 30 years of practice, I can’t begin to name all the quack remedies and opinions I have heard and dealt with. One of my favorite quackeries is a special water filter/ionizer because “regular” water is, supposedly, so poorly absorbed! Geez, if you can sell that, you can sell anything.

  22. Brian says:

    This article is full of misinformation.

    Do you have sources for these things you claim Dr. Hyman thinks? You should let people see his opinions in context.

    Diet and exercise can indeed more effective than medicine for some disease in some people, such as obesity, high blood pressure, depression, etc. Other people with other disease causes absolutely require “conventional” approaches.

    As a retired military doc you were in an environment perfectly suited to conventional medicine. When operating on bullet wounds, there’s no need to change the patient’s lifestyle or get therapy for family violence. Your pilots need to be alert for a mission? Maybe amphetamines are the right thing. Pilots are already active and meet weight and other fitness standards, so no need to look into genetic testing to address their non-existent maladies. Active duty military health is most certainly not representative of the American public’s health.

    BTW, it’s cute that you think conventional physicians have time to take but the most superficial pass over a patient with external requirements (insurance requirements, for example) dictating the amount of time patients are seen.

    • Jillian says:

      Brilliant analysis of this article. Taking ones experience into consideration including the biases that come with one’s particular viewpoint. Having been married to a conventional medicine doc in a major medical area, there seems absolutely a place for conventional medicine to set a broken bone and a place for doctors to take the time to discuss the physical impact of trauma or sleeplessness on anxiety or our crazy American dietary practices. There is a reason why people return from vacations relaxed and happy and oftentimes healthy. A 15 minute rushed appointment is no opportunity to assess a patient’s history–cursory questions about alcohol, smoking and exercise are no match for the care that a conventionally trained Primary Care doc can do with a background in understanding how the inflammatory and immune system can be affected by cortisol from excessive stress or eating foods that “trigger” an autoimmune response. Yes some of this “functional”/”complimentary” medicine may be a bunch of who-ha but if it works to make people feel healthier (and George Vaillant, MD) has shown that people (at least Harvard trained men-ha!) have better health long-term if they are in a good partnership and “content”. So bring on the time and consideration and compassion of a western trained MD anytime for me.

      Finding a doctor with both types of training? Near impossible it seems these days…

    • Richard Rawlins says:

      Don’t confuse what conventional doctors actually do (which may not be very good at times), with the conventional medicine that they are supposed to do, and probably would do if they had the time.
      This excellent article is contrasting ‘functional medicine’ with ‘conventional medicine’, not ‘how conventional doctors perform in practice’.

      I’m not sure if this confusion represents an example of red herring, straw man, or both, but certainly an illogical approach.

      The FMists had better know we are on to them!

    • Dr Septic Skeptic says:

      Brian you are correct on all counts. Good diagnosis.

    • Dr Septic Skeptic says:

      Brian – careful you may dislodge someones plaque & give them a brief view of their own possible “cerebro-macular” degeneration.

  23. Mandi says:

    While I’m sceptical of FM, I had to laugh when I read this: “Conventional doctors always engage their patients in a therapeutic partnership; the days of paternalistic medicine are long gone. Conventional doctors have always addressed the whole person… Conventional doctors have to spend time with their patients, since the history is 70% of the diagnostic process…” Please, please, ask any patient if they feel they are treated like partners in their doctor’s rooms, if they get time, if they get detailed attention… what a laugh! FM and similar concepts are not the solution – but there is something badly wrong with the modern medical model that needs fixing urgently.

    • Rose says:

      I had the same reaction you did – I laughed out loud when I read that paragraph. My daughter has been sick for a year, and we’re still seeking diagnosis & a treatment plan – from conventional doctors. We’re with Kaiser (prominent west coast HMO) and nothing in this paragraph describes what we’ve experienced. Our doctor is scheduled to see a patient every 15 minutes. When she stretched our appt. to 30 minutes during a recent visit, the nurse poked her head in – twice – to hurry her along. How can you possibly do all the things described in this quote during a 15 minute office visit? There is something profoundly dysfunctional about the current medical system. So, fine, functional medicine isn’t the answer, but please don’t insult our intelligence by saying that all conventional medicine “functions” the way it’s described in this article.

      • Trish says:

        What you describe is not a failure of scientific medicine but a result of other factors including:

        – the AMA influencing medical schools to restrict the numbers of doctors graduating to a number too low for our current population (Yale graduated 84 doctors in 2015-16 and 100 in 2014-15. even though they have an enormous endowment)

        – our for-profit insurance system that encourages maximum patients in minimal time and diverts health care dollars to armies of administrators handling the paperwork for the numerous insurance companies each medical practice interacts with (l know Kaiser is a nonprofit, but it competes against for-profit insurers and has highly compensated executives)

        The problems you describe are caused by economic conditions not a flaw in evidence based medicine. And l share your frustration.

      • MBDK says:

        Funny…I have Kaiser (Group Health prior to the merger), and although Group Health was close to what you described about 8-10 years ago, I have noticed a considerable change since. I actually LOVED Group Health the last few years of its existence, and it has only gotten better since Kaiser took it over. I had also been hospitalized a couple of times in San Diego under Kaiser (although Group Health was my insurer), starting around 10 years ago and was given wonderful care. I have since had fantastic care and great staff interactions with more referrals and follow ups than I have actually needed (example: gastric problem cleared up with slight diet change rather than seeing a specialist). I am sorry for you or anyone else that has had lesser experiences, but I just wanted to say that health care can be in line with the author’s description. Also, I have no affiliation or family relations with either Group Health or Kaiser.

  24. James says:

    I recommend the “Science Based Medicine” site.

  25. Keith Croes says:

    I seem to recall that, perhaps in the 1990s, the NIH established an Alternative Medicine division to investigate and report on so-called alternative medical techniques. I believe that the work of that division is responsible for the fact that acupuncture is now accepted and reimbursed by many medical insurance companies. Are there any other alternative medical techniques/approaches that have likewise been studied and have moved into “mainstream” medicine? Thank you to anyone who has information on this.

    • Trish says:

      The office of complementary & alternative medicine was not designed to see if there was something to alternative medicine but to “investigate and validate it” as Sen Tom Harkin (D, Iowa) said in a 2009 speech in which he expressed disappointment that the results of 10 years if the NCCAM was “disproving things rather than seeking out and approving.” (See:

      Though l would say NCCAM has done one thing that benefits “alt” practitioners, that is giving an appearance that there’s something there (or why would we have a federal agency?)

      As for any alternative medicine that has gone mainstream? The one example l can think of is using marijuana for nausea, although the medicinal effects of it have been vastly overblown, including claims that it’s effective treatment for cancer or that rubbing thc-containing oils on the skin treats pain (even if marijuana is ever scientifically proven to have an effect on pain, thc must be decarboxylated with heat and absorbed via mucus membranes or the GI tract to effect the brain, so even if the thc in the oil has been decarboxylated, which many aren’t, applying it to skin is useless)

      As for acupuncture, see the 5/16/2016 Business Insider video: A neurologist explains why acupuncture is useless:

    • MBDK says:

      Regarding acupuncture, I was surprised as I suspect you may be that it actually works – just not as accredited by the normal practitioners. From:
      “I must state up front that those skeptics who say that acupuncture doesn’t work, or that it is not an effective medical treatment for some ailments, are wrong. The evidence from both personal testimony and from scientific studies clearly shows that acupuncture works and is an effective medical treatment for many ailments.”

      However the article continues:
      “The evidence from the scientific studies also shows clearly that sham acupuncture is just as effective as true acupuncture.”

      I endorse the rest of the article to be a very informative and interesting read. Still, this is only one alternative medicine that has been shown to provide a tangible benefit. Also, FYI, I have never been, nor desire to be, subjected to the procedure.

      • Alien Nomad says:

        Unfortunately the evidence you are quoting actially confirms that acupuncture doesn’t work. The placebo effect is well recognised in conventional medicine but unfortunately it is often used as ‘proof’ in alt med claims of success.

        • MBDK says:

          Understood, my Alien friend. I should have been more specific. Still a good, informative read, though.

  26. Evan says:

    Please guide me to citation of M. Hyman’s non-belief in the germ theory of disease.

  27. James T. Lee, MD,PhD,FACS says:

    A good article! I am amazed that a number of my presumably highly intelligent friends here in Minnesota are nonetheless under the “ongoing care” of people proudly “practicing” the FM nonsense.

    Astounding ignorance.

  28. stonecherub says:

    FM? You’re kidding, FM? Everybody knows that FM is a kind of magic. Clearly this guy Bland is FS – a kind of stupid.

    • Dr Septic Skeptic says:

      Clearly you have nothing informative nor intelligent to offer.Don’t punch above your weight you could injure yourself.

  29. bruce says:

    Excellent article. Slapping together these new names for woo are like putting lipstick on a pig.

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