When the head of the world-renowned Cleveland Clinic approached Dr. Mark Hyman about creating a department that would employ the doctor’s specialty of “functional medicine,” Hyman was typically blunt.
“If I create a program there, it would cut the number of angioplasties and bypasses in half, and reduce hospital admissions,” he told clinic CEO Toby Cosgrove.
And if slicing the number of cardiac procedures at the country’s top heart hospital wasn’t alarming enough, Hyman warned that he would strive to take functional medicine to its ultimate end by teaching patients to care for themselves so they could avoid the hospital altogether.
“Hire me and I’ll do what I can to put you out of business,” Hyman recalled of their meeting 22 months ago.
That was just what Cosgrove, a 74-year-old cardiac surgeon who earned a Bronze Star in Vietnam, wanted to hear. And he hired Hyman.
“Toby was looking for innovation and he sees the future of medicine,” Hyman said of the man who heads the nonprofit clinic that has been a leader for nearly a century in improving medical care.
In the United States, people spent more than $2.7 trillion annually on health care in 2011, more than 80 percent of which — $2.16 trillion — was spent on chronic diseases like heart disease, diabetes and obesity, according to the Centers for Disease Control and Prevention. And for the most part, chronic conditions are managed with medications and procedures but not cured. Functional medicine doctors like Hyman take a different approach. Instead of soothing the symptoms, they try to identify and eradicate the root cause of the problem through a holistic approach in treatment.
“We must consider new approaches to understanding and treating diseases,” Cosgrove said. In his book, "The Cleveland Clinic Way," he writes that chronic diseases “are now so prevalent and so costly that they’re threatening to destroy America’s broader economic health.”
A patient’s eye view
The Center for Functional Medicine opened Sept. 23 with a staff of four physicians, a nutritionist, a health coach and a radically different schedule for patients than most medical offices. Leading the team is Hyman, a 54-year-old family physician and pioneer in functional medicine who founded the UltraWellness Center in Lenox, Massachusetts.
When a patient makes an appointment, before seeing a doctor, she will complete a lengthy questionnaire the doctor will read and review before the initial visit. When the patient does come into the center, she will spend 60-90 minutes with the physician and another 45 minutes with a nutritionist.
At that point, the physician, nutritionist and health coach will work with the patient to devise a care plan that includes dietary advice.
“We take a team approach and we believe that food is medicine,” Hyman said.
The patient starts on the plan and follows up with a health coach.
The time commitment is greater for the health care professionals and the timeline may be slower for the patient than filling a prescription at the pharmacy. Yet, the strategy, Hyman said, is more straight-forward and the effects longer lasting.
“We want to create (better) function in a body by restoring balance,” he said.
When the body can balance itself, symptoms disappear and medication becomes unnecessary. To get there, the team will create a plan that could include some combination of healthy foods, exercise and sleep while removing junk food, stress, alcohol, tobacco and anything else that tends to throw a body out of balance.
The center’s health care professionals, with decades of study and dozens of academic degrees between them, work toward a singular goal: getting good stuff into the body and bad stuff out.
“Like Einstein said, make things as simple as you can and no simpler,” Hyman said.
A second Renaissance
While the practice of functional medicine sounds simple — good stuff in, bad stuff out — it also simplifies the experience for the many patients who already have many doctors. Take for example a patient who sees one doctor for high blood pressure, another for migraines and a third for that annoying skin condition. Often, the patient is responsible for keeping track of which doctor is advising what.
At the Center for Functional Medicine, the medical team takes the role of coordinating care and sidesteps the common practice of dividing the patient by body part: heart doctors looking at the heart, brain doctors looking at the brain and a skin doctor looking at the outside.
“The diagnosis and treatment model is different,” Hyman said. “Say a patient comes in with psoriasis. The root cause might be something the patient’s eating.”
In the standard model, the patient would likely see a dermatologist, not a gastroenterologist. Then the skin doctor might prescribe topical creams or lotions that sooth the skin without curing the condition. A functional medicine team would strive to prescribe a cure: a different diet, in this instance.
As physicians learn more about the body, more cures become available for what could be considered incurable, chronic conditions.
“In the last 40 years, a lot of progress has been made in defining the mechanism that creates disease,” said Dr. Jeffrey Bland, who is considered the father of functional medicine. Bland, coauthor with Hyman of "The Disease Delusion," started the Institute for Functional Medicine in 1991 and is incredibly bullish on the future of health.
The origins of disease, Bland said, can be found “in the interrelationship between environment and lifestyle and how those interact with a person’s genetic disposition.”
A person’s genes may make him susceptible to certain conditions and then the decisions he makes — choices about food, exercise, and workplace — can push him closer to or further away from developing symptoms. With functional medicine, doctors look at the whole picture and devise a plan to move someone away from symptoms.
“It’s different from the model that says, ‘here’s a pill for every ill,’ ” Bland said. “It’s a systems approach to biology.”
And “the pill for every ill model,” which started with the discovery of penicillin in the 1920s, paved the way for numerous medical breakthroughs. But in this era, with rising rates of chronic disease and soaring health care costs, the model may be past its prime.
“At the turn of the last century, we started to understand the origins of infectious diseases,” Bland said, adding that we are sitting in a similarly exciting moment in time. “We’re going to witness an unbelievable shift around noncommunicable diseases.”
Historically, medical experts have belonged to a small and exclusive club. As they made new discoveries in health care, the information traveled slowly, even to other doctors. “It takes an average of 13 years for a health care innovation to be established as a mainstream standard of care,” Cosgrove writes in "The Cleveland Clinic Way."
In Bland’s forecast, the speed is about to ramp up. Functional medicine doctors are deciphering the links between environment and lifestyle choices and noncommunicable diseases, like diabetes, asthma and heart disease. And because lifestyle choices are a piece of the problem, functional medicine doctors can share information and advise patients on actions that patients can take themselves. No prescription needed. Simultaneously, the information can be shared widely, by patients and doctors alike. “The Internet democratizes information,” Bland said.
Cleveland clinic effect
The Cleveland Clinic employs more than 3,000 doctors and 40,000 other caregivers who handle 5.5 million patient visits each year. Started in 1921 by four physicians who were inspired by the Mayo Clinic in Minnesota, the Cleveland Clinic has long been on the leading edge of medical progress. The first blood transfusions were done at the hospital in the 1920s. Coronary angioplasty — a nonsurgical procedure to open narrowed heart arteries — started there in the 1950s. And in 2007, the hospital became the first to have a chief wellness officer.
All these things are now commonplace at hospitals around the country.
Functional medicine may be next. In several states, individual doctors have been training with functional medicine proponents like Bland and starting small practices. Hyman and others like him have been using the diagnostic and treatment models, although not in a large enough setting to study its effectiveness.
The Cleveland Clinic is the first large institution to offer the functional medicine model to its patients.
“All eyes will be on this clinic,” Bland said. “It will send a message to other regions of the country and the world.”
Within the Cleveland Clinic, other doctors are already asking to learn more and collaborate with the functional medicine staff. And calls from people wanting to schedule appointments have flooded in from across the country and Canada.
After plenty of dysfunction in America’s healthcare system, Cosgrove is betting the future will be functional.
Jody Berger is an author, journalist and health coach in Denver, Colorado. She can be contacted through www.jody-berger.com; Twitter: @jodyberger.
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