Quackademic medicine: “Wildly successful” at the Cleveland Clinic? [Respectful Insolence]

It’s no secret that my odds of ever landing a job at the Cleveland Clinic are probably slim and none, at least if anyone there ever Googles my name, particularly if they Google it with the words “Cleveland Clinic” added. The reason, of course, is that I’ve been very critical of the Cleveland Clinic’s wholesale embrace of what can only be described as pure quackery. I first noticed this a long time ago when I perused the Cleveland Clinic Foundation’s (CCF) integrative medicine page, in particular its farcical acceptance of the magical mystical reiki master definition of reiki. It got worse when the Cleveland Clinic did something it seemed to view as incredibly innovative, namely when it opened a traditional Chinese medicine herbal medicine clinic in 2-14, staffed by a bona fide naturoquack naturopath. The CCF’s embrace of quackery then reached its zenith later that same year when it hired “functional medicine” guru and antivaccine collaborator with Robert F. Kennedy, Jr. to open a functional medicine clinic.

Unfortunately, if a recent report is to be believed, this last endeavor has been a swimming success:

The Cleveland Clinic’s Center for Functional Medicine (CFM) will be doubling its physical size and patient care capacities in the coming year, to meet what medical director, Dr. Patrick Hanaway, characterizes as “unbelievable pent up demand for this kind of care.”

Since opening in late 2014, CFM practitioners have handled nearly 5,300 total appointments, quickly reaching maximum capacity. People seeking care at CFM in 2015 came from 36 states, and 12 countries.

The center now has a waiting list of over 1,100 individuals.

“This has grown much faster and much more profoundly than we expected,” says Dr. Hanaway, CFM’s medical director and co-founder. “We have a great number of people who want to receive services from us, and the demand far outstrips our current resources and capacities.”

Hanaway says the center has secured a financial and administrative commitment from Cleveland Clinic to build a new center that would more than double the physical size of the existing clinic, and to extend the functional medicine model into several community-based sites located off the main Cleveland Clinic campus.

In other words, functional medicine at CCF is invading and metastasizing.

Longtime regular readers have seen what I’ve written about functional medicine before and therefore understand why I’m not particularly a fan of it and in particular why I’m not a big fan of Mark Hyman. For one thing, he mangles autism science in so many ways that it’s depressing to read. For another thing, he embraces Alzheimer’s disease quackery. For yet another thing, he willfully misinterprets the scientific literature to justify his woo. He also mangles systems biology in the service of justifying his “functional medicine.” Finally, he seems to value anecdotes above rigorous clinical studies. I could go on, but perhaps I should discuss just what “functional medicine” is first.

The problem with so-called “functional medicine” is that it’s pretty darned hard to define. I suspect that this is not entirely unintentional. Being too specific constrains freedom, of course. Perhaps the most definitive discussion of what “functional medicine” is came from the late great Wally Sampson, who did an entire entire series on it, starting with Functional Medicine (FM) What Is It? It’s a good question. In fact, it’s the best question when it comes to functional medicine, given that its definitions tend to be so vague as to border on being meaningless. If you don’t believe me, check out Wally Sampson’s followup posts, Functional Medicine II, Functional Medicine III, and Functional Medicine IV.

Personally, when I want to look at the ridiculousness that is “functional medicine,” I like to go straight to the source, namely Mark Hyman himself. For example, there is a post entitled Why Diseases Don’t Exist and What Really Makes You Sick!

Check it out:

Functional Medicine is an ecological view of the body where all the networks of our biology intersect and interact in a dynamic process. When out of balance, this process creates disease, and when in balance, it creates health. Functional Medicine takes all the component parts of science, all the puzzle pieces, all the data about how we get sick and what makes us well and reorganizes it in story that makes sense, a story that has the capacity to solve our health care crisis nearly overnight if it was understood and applied widely.

Medicine is the youngest science. There is no theory of medicine, no organizing principles that helps us navigate the territory of chronic disease. Functional medicine is that breakthrough theory, the biggest breakthrough idea in medicine since the discovery of the microbe and antibiotics. It is a cataclysmic shift in our view of biology.

There are moments of awakening in science that are not incremental but transformational: Columbus proving the earth was round, not flat; Galileo showing us the earth was not the center of the universe; Darwin explaining that species evolved and didn’t arise fixed in their current form; Einstein shattering our notions of time and space. Functional medicine is a paradigm shift of equal magnitude and significance.

Whoa.

No, I mean double whoa.

This is some serious stupid. For instance, Columbus didn’t prove the earth was round. It was known that the earth was round at least since the time of the ancient Greeks, and heliocentric models dated back just as far. As for there being no “theory of medicine” and “no organizing principles that help us naviaate the territory of chronic disease,” so what? Hyman assumes that there must be such a principal, but his assuming that doesn’t make it so.

If you want to get an idea of just how quacky “functional medicine” can be, take a look at this article by Hyman, entitled Why Diseases Don’t Exist and What Really Makes You Sick!:

The true cause of depression may be a leaky gut caused by gluten that activates the immune system, producing antibodies against the thyroid leading to low thyroid function and depression. It may 10 years of an acid-blocking drug for reflux that led to vitamin B12 deficiency, or a gene called MTFHR that leads to folate deficiency, or inadequate sunlight caused vitamin D deficiency. It may be a diet high in tuna that has caused mercury toxicity, or a diet low in fish that has caused an omega-3 deficiency, or a high-sugar diet that has caused pre-diabetes. It may be the use of antibiotics that have altered the gut flora, which have in turn altered brain chemistry. It may be a life trauma or stress.

Each of these factors – dietary, environmental, lifestyle — creates a different imbalance, yet all cause depression. Thus knowing the name of a disease tells us nothing about the true cause, not does it leads us the right treatment.

Notice how evidence-free Hyman’s assertions are. Mercury “toxicity” causing depression? Where’s the evidence? “Leaky gut caused by gluten” causing toxicity? Again, where’s the evidence? MTFHR leads to a folate deficiency that leads to depression? Again, where’s the evidence? Alterations in gut flora due to antibiotics have altered your brain chemistry? Again, where’s the evidence? There is none, at least no convincing evidence.

Basically, in this particular article, Hyman is praising a book by another functional medicine guru, Jeffrey Bland, whom he praises as the “father of functional medicine,” and laying down howlers like:

Disease appears real and fixed, just as the earth seems flat, and time and space seem linear and solid.

You got that, you unimaginative old doctors, you? You’re the past! Functional medicine is the future! At least, so Hyman is arguing in his not-so-subtle and grandiose fashion. Of course, during Columbus’ time the earth didn’t even really seem that flat, as it was widely accepted that the earth was a sphere dating back to the ancient Greeks (as I’ve mentioned before). As for his invocations of Einstein and Darwin, there’s a difference there between Einstein and Darwin compared to Hyman’s “functional medicine.” They convinced the scientific community the old-fashioned scientific way: With data and evidence. Then their theories were found to have a great deal of predictive power, with evidence accumulating in the decades after the theory of evolution and the theory of relativity were first published. Heck, Einstein’s theory just received another boost last month with the report describing gravitational waves.

Hyman bemoans the lack of a general “theory” of medicine equivalent to these, but there is no real reason why one would expect such a theory to exist. There does exist the germ theory of disease, but that only really describes infectious diseases, diseases for which the cause is more easily identifiable. It might be that one day there is some sort of theory of chronic disease, but if such a theory is developed it will come from scientists and physician-scientists, not self-promoting “visionaries” like Mark Hyman, who can’t even really describe what “functional medicine” is. Get a load of his attempt:

Functional Medicine is not simply about improving diet, or getting more exercise or managing stress or even reducing exposure to environmental toxins, all of which are critical foundations for creating a healthy human. It is a personalized method of getting to the roots of symptoms and restoring balance. Above all, this is the science of creating health. When we do that, disease goes away a side effect.

How the “personalized medicine” of “functional medicine” is any different from what homeopaths do when they “personalize” your homeopathic treatment is unclear. How the “personalized method” of “functional medicine” is any different from what naturopaths do when they make it up as they go along and come up with a plan to “detoxify” you and give you various supplements is any different is not determinable. What is determinable is that Hyman practices anecdote-based, not science-based medicine. He proudly recounts the anecdote of a girl with psoriasis that had been refractory to conventional treatment that he supposedly cured by putting on a gluten-free diet. (Of course! What else?)

Basically, there is what Grant Ritchie once called a “major unstated premise” to functional medicine, namely:

When it is claimed that FM “…addresses the underlying causes of disease,” or “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,” the unstated premise is that “regular” doctors don’t do any of these things; they must be only symptom-oriented, not preventive in their outlook, and don’t take all of a patient’s personal, medical, and social factors into consideration before arriving at an invidualized course of action. This, of course, is false, and is what any good physician will do. I know mine does, and he does not identify as a Functional Medicine physician. This dubious technique is employed by most if not all CAM providers in an attempt to set themselves apart from the crowd.

Basically, functional medicine is a lovely new buzzword to describe a form of “integrative medicine” (i.e., “integrating” quackery into medicine) that sounds progressive and cutting edge, and that’s the way it’s sold, as you can tell from Hyman’s own words and countless other examples of him and other functional medicine mavens hyping their woo on their websites, in books, and in videos. If you believe the hype, functional medicine is a “new paradigm” that “empowers” the patient. It’s very big on “biochemical individuality,” which in the hands of functional medicine doctors means lots and lots of lab tests (e.g., hormone level panels0 in which “imbalance” can be found to be corrected. How does one know what tests to order or how to correct these “biochemical imbalances”? It’s not always clear. Indeed, that’s the very issue that lead Wally Sampson back in the day to ask just what the hell functional medicine is. Sadly, he went to his grave without an answer, and certainly I still don’t have one.

Meanwhile, apparently although the CCF administration has bought into functional medicine completely, there is still resistance:

Not everyone in Cleveland is a fan of the functional medicine paradigm. Curran says there is still considerable resistance toward functional medicine in many sectors of the Cleveland Clinic system. She attributes that to “a lack of understanding among certain physician specialists.”

No, I rather suspect that the resistance to functional medicine comes from physicians who, as I do, understand all too well that the emperor has no clothes. Still, that’s just a problem for functional medicine evangelists to overcome with propaganda “education”:

In response, CFM is embarking on an ambitious education program aimed at introducing the core concepts of functional medicine to the widest possible spectrum of specialists.

“One idea is to have an open forum, so that other doctors can meet with our functional medicine doctors, and have open discussions. We will try to get the naysayers to show up, and let them know they can come with their concerns and questions.”

Curran says the CFM team is collaborating with the Lerner College of Medicine—the medical school established in 2002 by the Cleveland Clinic and Case Western Reserve—to weave a nutrition education thread into the school’s core curriculum. Students at Lerner will now get nutrition-focused didactics as well as case studies throughout the 5 years of their training.

And that, my friends, is how quackademic medicine co-opts the valid science of nutrition and turns it into woo.

Interestingly, despite its massive growth, the functional medicine clinic at the CCF is not yet profitable, although it is cost-neutral. The main reason, it would appear, is that because functional medicine is not its own specialty and its visits can only be billed to insurance companies as internal medicine office visits. Indeed, I tend to view functional medicine as basically “integrative internal medicine,” where a whole lot of quackery is “integrated” into standard internal medicine practices.

Sadly, if you believe the CCF experience, the “bait and switch” that is functional medicine is the wave of the future. Given how thoroughly quackademic medicine has infiltrated many medical schools, i can’t even necessarily say categorically that this isn’t correct.