Functional medicine: An overview
Although functional medicine is not formally recognised in the NHS, it is gaining a wide following from patients and healthcare professionals who believe the approach has value. So, what is functional medicine, and why is it attracting interest?
Functional medicine is described as an individualised, patient-centred approach in which patients and practitioners work together to address the root causes of disease. This requires a holistic understanding of the patient’s genetic, biochemical and lifestyle factors to direct personalised treatment.
When and where was the functional medicine concept born?
The origins of the functional medicine concept are detailed in ‘The Natural Roots of Functional Medicine’, an article by the cofounder of the Institute for Functional Medicine (IFM). The movement began in 1989, in Victoria, British Columbia, Canada, at a meeting of a diverse group of professionals interested in the management of complex chronic disease through a systems biology approach.
The IFM was founded in 1991 to provide post-graduate medical education courses and drive research in the field. Since then, the functional medicine model has been adopted by other organisations and healthcare clinics, particularly in the USA and UK.
Functional or conventional medicine?
Proponents of functional medicine argue that the conventional model of care relies too heavily on treating symptoms of complex diseases, often ignoring the origin of the dysfunction that leads to those symptoms. Functional medicine is more concerned with addressing the underlying processes that lead to dysfunctions, in order to optimise wellness.
The model targets the management of many chronic health conditions, including arthritis, depression, Type 2 diabetes, cardiovascular disease, irritable bowel syndrome and chronic fatigue syndrome. In functional medicine, practitioners must take time to listen to patient stories and investigate the individual and environmental factors that influence long-term health. Personalised lifestyle interventions are introduced based on information from these investigations and the evolving fields of systems biology and genomics.
Functional medicine also has its critics, who maintain that its fundamental features also apply to conventional medicine – i.e. a therapeutic partnership between patient and doctor, assessment of medical history, investigating and addressing the underlying causes of disease when appropriate. Notably, functional medicine is not officially recognised in the UK and the American Academy of Family Physicians refused to award continuing medical education credit for courses teaching how to implement functional medicine, on the basis of insufficient evidence to support its claimed benefits.
Why are patients seeking functional medicine practitioners?
The functional medicine approach is gaining popularity with GPs and patients alike. With many primary care staff experiencing high levels of stress, compounded by the challenges of the pandemic, some may be looking for an alternative, more satisfying way to practice. Others may be attracted to a system of medicine that targets support for the rising numbers of patients with chronic diseases that are complex to manage in 10-minute consultations.
There are plenty of patients willing to try a new approach. Patients often seek out functional medicine practitioners after learning about the concept through social media, TV programmes, as well as word of mouth. They may be in search of new solutions for a chronic condition, perhaps due to dissatisfaction with their current treatment.
How is functional medicine incorporated into clinical practice?
Many functional medicine practitioners receive training through well-publicised IFM courses, and within the UK, most offer their services in private clinics. Yet some GPs are finding ways to integrate aspects of the approach into their NHS practice. The Prescribing Lifestyle Medicine course, accredited by the Royal College of GPs, provides education about the underlying causes of common symptoms and about science-based lifestyle interventions, including their application into the standard primary care system.
GMC guidance must be followed when incorporating functional medicine into clinical practice. In 2019, the BMJ reported the suspension of a functional medicine specialist, who worked in private practice, for persistently overdiagnosing thyroid problems and prescribing drugs that were not clinically indicated.
Advice for sensitively introducing aspects of functional medicine into NHS practice includes allowing time to listen to the patient story, applying national guidelines and up-to-date evidence, taking care not to exceed budget constraints, and encouraging patients to use tools to educate themselves with easy-to-access resources. Importantly, GPs should not promote their own private services to their patients within the NHS.
If you need medico-legal support for your practice in functional medicine, please contact us for advice at Medical Defense Society.