IFM's 21st Century Medicine: Co-authors Jones/Hoffman, plus Jim Whedon, DC and Kara Fitzgerald, ND
Written by John Weeks
21st Century Medicine: Co-Authors Jones/Hoffmann, plus Jim Whedon, DC and Kara Fitzgerald, ND Respond to the Review of IFM's Exceptional White Paper
Summary: If there is one must-read document on health reform to come out of the broader integrative practice community this year I would repeat, as I said in my earlier review, that it is 21st Century Medicine from the Institute for Functional Medicine. Sit down for an evening and let yourself learn. These additional perspectives, from NIH fellow and Dartmouth health services researcher James Whedon, DC and from Kara Fitzgerald, ND of Metametrix Institute offer useful insights from two disciplines that were not directly treated in the text. Co-authors David Jones, MD and Laurie Hoffmann, MPH share more on functional medicine's relationships with these other disciplines as well as efforts to penetrate medical schools. Larry Dossey, MD, also offers a supportive perspective.
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Institute for Functional Medicine
The Integrator article Health Reform: IFM Declares the Value of Functional Medicine in Exceptional White Paper on 21st Century Medicine, August 8, 2009, shares my experience that this download-able document is immensely valuable in placing the work of integrative practice inside of the broader health reform discussion. I hope more of you will access the PDF file and read it. It's comforting to see the overlaps and parallels between what we are doing and key trends in conventional thinking about reform of clinical practice.
The article stimulated two letters from readers which strongly agreed with the value of the IFM work, while sharing additional perspectives on its use value. These were from Dartmouth health services researcher James Whedon, DC and Kara Fitzgerald, ND from the Metametrix Institute. These are printed below as first and last entries around notes of additional clarity on the strategy of the Institute for Functional Medicine (IFM) from two members of the co-author team, David Jones, MD and Laurie Hoffman, MPH. I also share a perspective of Explore executive editor Larry Dossey, MD.
James Whedon, DC
1. Dartmouth health services researcher James Whedon, DC
Jim Whedon, DC is located at perhaps the most influential health services research shop in the US: Dartmouth University, base of John Wennberg, MD, MPH. The summer 2009 issue of Dartmouth Magazinereports that Whedon, "an instructor in health policy and clinical practice, received the
Bernard Osher Foundation/National Institutes of Health Complementary
and Alternative Medicine Practitioner Research Career Development Award." Whedon focuses in on my comments about naturopathic medicine and other "CAM" health systems not being included in the IFM book.
"In 21st Century Medicine, Jones et al have articulated a
vision of how Integrative Medicine can fit into and contribute to healthcare
reform. They go beyond the hot political
issues of cost, access and disparities in utilization to address the real core
issues: conventional medicine neglects primary prevention, has failed to stem
the ballooning burden of chronic disease and now faces impending crises in
primary and geriatric care as a result.
The paper is a timely and important contribution.
I agree that Functional Medicine looks a
whole lot like Naturopathic Medicine in new clothes. But I don't see this as
co-opting that is not what the IFM people that I know are about. To quote the white paper, p 41:
"There is a danger that integrative medicine
physicians will extend their practices beyond the scope of their education. Completing a program in integrative medicine does not
turn an MD or a DO into a trained chiropractor, acupuncturist, naturopathic
physician or other such practitioner. It is important that those who wish to
fully practice an alternative discipline seek comprehensive training from
accredited institutions, just as those who wish to practice as medical doctors
must do."
And these from (IFM's) The Textbook of Functional Medicine, p 28:
"Functional medicine is discipline neutral. The field is
accessible to any health practitioner who has a fairly standard western medical
science background. There are significant advantages to this 'neutrality',
particularly as the nation's healthcare system becomes more and more open and
adaptive to integrative care concepts..."
"...functional medicine helps create a bridge
between conventional and alternative practitioners and approaches..."
"...This common meeting ground will enhance the
delivery of care and contribute to the development of respectful and productive
professional relationships among healthcare providers."
"The political reality is that conventional medicine is
the 500 lb gorilla in the room, and healthcare reform is going to be framed in
medical terms. The IFM white paper
provides us with a vision of how that can happen in the way that brings
everyone to the table. I believe and
hope that this is indeed the future of medicine."
Jim Whedon, DC
Health Services Research
Dartmouth Institute for Health Policy & Clinical
Practice Trauma Program
Dartmouth-Hitchcock Medical Center
Lebanon, NH 03766
Comment: I wasn't actually thinking co-optation, and I thank Whedon for pointing out these sections from the IFM's Textbook. Part of the white paper's value is that it is discipline neutral and therefore an interdisciplinary platform.
David Jones, MD
2. IFM lead author David Jones, MD on the philosophical underpinnings
IFM president David Jones, MD begins his comments with gratitude for the review and then offers additional insight into his perspective on the treatment of other integrative systems of care.
"I
have read your work for many years with great interest. Your incisive
remarks about our document touch me.
"When the paper was completed to this
point (we intend in the next few months to add a final chapter containing two
very robust case studies that demonstrate the methodology), I felt that it
represented 35 years of clinical practice and 24/7—365 days of wondering about
what was right in medicine and what was so seriously wrong about it that it
seemed a betrayal of intent. We needed to understand it to help
change it, and those musings eventuated in this paper. Having Sheila (Quinn) as
main editor and co-writer again (we co-edited the Textbook of Functional
Medicine) was god-sent as was the piercing eye of Laurie Hofmann who kept us
focused throughout. Again, I greatly appreciate the time and thoughtful
thinking that has gone into your review.
If you scratch the
surface of most functional medicine oriented practitioners you will find that
they have studied and often practiced one or the other
of these “whole systems —whole person” methodologies.
"You
asked in your editorial about naturopathic medicine, as well of acupuncture and
Oriental medicine and broad-scope chiropractic in reference to the different
solutions that have been proposed. My response is that if you scratch the
surface of most functional medicine oriented practitioners you will find that
they have earlier in their careers studied and often practiced one or the other
of these “whole systems—whole person” methodologies. They were pushed in
that direction because of a lack that that they perceived in their conventional
training. What was missing for them in conventional medicine was a
coherent foundational philosophy that mapped forward to the clinician’s dilemma
of how to solve complex, chronic illnesses.
These whole-system methods had foundational principles
that theorized how the dysfunctions, but fail to deeply
embrace the precision of the scientific method nor integrate them into daily
practice.
"As you know, conventional
medicine’s philosophy is not very comprehensive: 'Come see when you are
broken and we will assess the most broken of your organ systems and use
pharmaco-surgical measures to treat your broken-ness.' There is no
breadth or depth to this philosophy, no foundational notions of how the system
wobbles into brokenness; conventional medicine’s philosophy is sadly
barren. However for these practitioners, the traditional whole system
methodologies (as mentioned above) were also unsatisfactory but for the
contrary reason. These whole-system methods had foundational principles
that theorized how the system wobbles into dysfunction, but fail to deeply
embrace the precision of the scientific method nor integrate them into daily
practice.
"At
IFM, we consciously integrated the traditional principles (I once did an
exercise with a group of traditional practitioners where we mapped their core
principles to the functional medicine principles and except for the principle
of vitalism, the mapping was exact) WITH the rich and robust
understandings that have been gifted to the healing arts from the biological
sciences. Along with that integration we developed a method for clinical
applications of assessment and therapeutics that guide the clinician’s appropriate
use of most of the established methodologies both conventional and traditional.
"I
hope this helps with some of your questions. I would welcome further
dialogue that emerges from your reading/thinking about a 21st
century model for healthcare."
Sincerely, David Jones, MD, President
Institute for Functional Medicine
3. Co-author Laurie Hoffmann, MPH: Need more time to talk about pilots in med schools
I then followed up Jones' comments with two questions: Is the pilot project referenced in the white paper going to
happen (where several IM medical schools actually put a FM model into
their training programs)? And I asked what the feedback
about the white paper has been from physicians, academic medical folks, non-MD
professionals, and politicians?
Jones referred me to Laurie Hoffmann, MPH, his co-author and "our executive director and network maven (ala Malcolm Gladwell's definition in Tipping Point)." Jones added, in the hand-off, that "we have pilot projects in
early stages going with a number of medical schools and have had a number of
reviews of the white paper that Laurie can share." Here is Hoffman, who is herself a 20+ year veteran of work in natural health care and medicine3.
"Thank you for the excellent review/summary of IFM's 21st
Century Medicine white paper in the Integrator blog.
"Regarding your two
questions: I think by year-end we'll have an update that we can really talk
about and will then be appropriate to publish regarding functional medicine in
medical schools. There are several medical schools and residency programs (in
addition to graduate nutrition programs, osteopathic medical programs, and
naturopathic programs) that are introducing functional medicine into their
curricula. I would not say they are putting the functional medicine
"model" into their programs yet; what seems to be consistent across
these varied programs is initially an elective course that provides
the opportunity for students, faculty, and administrators to evaluate the
merits and interest. Thus far, there has been very positive feedback - so much
so that the elective courses and seminars are being expanded.
Can't make names of schools public yet
"We're not ready
to make public the names of the schools and programs we're working with just
yet. We don't want to jeopardize the pilot projects or the faculty who have
stuck their necks out to introduce functional medicine to their students and
colleagues. Again, we should have an update by year-end.
"In terms of your second question about receptivity and
feedback from the white paper, we have just completed the drafting
of a comprehensive dissemination plan to include academicians, clinical
faculty, clinicians, policymakers and elected officials, health and medical
websites and blogs, professional associations, etc. If there is anyone
specifically that you'd like us to send the white paper to, please let me know.
"In terms of reviews, we've just begun to solicit them. Joe
Pizzorno just completed a review that will be published in an upcoming issue of
IM and the foreword by (Victor) Sierpina & (Adam) Perlman certainly serves as a review. In
addition, here is a review from Larry Dossey." (See below.)
LaurieHoffmann, MPH Executive Director, IFM
Larry Dossey, MD
4. A Note from Larry Dossey, MD, on 21st Century Medicine
Here is the quote Hoffman shared, from author and editor Larry Dossey, MD:
"I know of no document that so clearly, succinctly, and
compellingly charts a path forward into twenty-first century medicine as this.
Dr. David Jones and the IFM staff have their fingers firmly on the pulse
of medical science and healing. This document should command the attention not
only of physicians and other healthcare professionals, but also of anyone in a
leadership position in the evolving landscape of healthcare in America."
Larry Dossey, MD, Executive Editor] Explore:
The Journal of Science and Healing
Kara Fitzgerald, ND
5. Kara Fitzgerald, ND: Teaching the IFM "matrix" to ND students
Kara Fitzgerald, ND agrees that this paper is a "goldmine." She then offers information about experience she had in teaching from the IFM "matrix" to students in naturopathic medical schools. Fitzgerald's blog on the Metametrix Institute site is here.
"Nice
review of the 21st Century Medicine white paper. The document is a
goldmine. An amazing piece of lifework created by the IFM. It's inspiring and
will be something I reference and forward to others for years to come, I am
sure.
"I
thought about naturopathic medicine during my read as well (for obvious
reasons). And I was glad that it was mentioned, albeit briefly. We are ideally
suited to step in and participate in the solution to the chronic disease
crisis, and we are steeped in the concepts taught at IFM. That said, I think
NDs could gain much from the structure IFM employs, including the Matrix.
"I
presented earlier this year on systems medicine, the IFM Matrix and functional
laboratory testing at grand rounds at a number of the US ND medical schools.
The students seemed genuinely interested in the IFM structure, as it’s very
helpful for capturing and organizing complex data into meaningful and
clinically usable ways. I would like to see it taught or more widely available
in our schools as well as conventional medical schools. Fortunately, according
to 21 Century Medicine, it does look like that’s happening.