Evidence based medicine in functional medicine

First Do No Harm

We rely on evidence-based-medicine (EBM) to determine "safe" and "effective" treatments for our patients.  This is ideal for:

  • Pharmaceutical drugs that are potent and carry many side effects/risks 
  • Herbal medicines and supplements that are utilized in high doses or continuous dosing
  • Physical medical interventions, such as IV treatments and surgeries.

Basically, when using any pill or procedure, it all comes down to:

"First do no harm"

 

Over my years working in functional medicine, I've come to realize that there is a plethora of EBM that we do not use in conventional medicine.  I'd venture to say that maybe only 5% of the studies in circulation are used to determine medical treatments in our U.S.-based medical system.  New studies are coming out every day - it's overwhelming!  And it is a losing battle to try to back up everything....it is smart to read the research, but too often we become limited by it.

That being said, I used to get very stressed trying to back up ALL my treatment recommendations (including vitamins) with studies in reputable journals.  Despite the thousands of hours of training, my confidence wavers - especially when a patient (or colleague) doubts my treatment decisions.  I know that no one - NO ONE - can be an expert in all areas of medicine.  We are still human, after all.  So much information that we took as dogma in our medical education is now debunked - if we are stubborn and believe that the information we learn in school will always be true, we are greatly affecting the outcomes of our patient's health.  We don't need to know everything - just the right information for the particular patient you are treating.

One day I realized that my efforts were mostly because I felt the need to defend functional medicine, particularly with colleagues.  But when I would discuss studies I use in treatment, my colleagues in mainstream medicine would brush them off, saying "that's nice, but it's not what the [insert major organization] says".  Using this rebuttal is the "easy" way to practice medicine, since we unfortunately just don't have the time/energy to be be a skeptic or be thoroughly informed.  The harsh reality is that it's easier to stay "within the box", and continue to treat chronic diseases in the current (failing) model.  

Don't get me wrong, I still follow the guidelines for medications and supplements - especially when "off label".  But now, I feel less inclined to seek studies on everything, especially when it pertains to food and lifestyle.

When you start to utilize functional medicine, you become an innovator.  EBM gets knocked out of it's high place in the hierarchy of medical practice.  I believe the "unlearning" of using EBM for every treatment is one of the biggest challenges for practitioners trained in the allopathic model.  Andrea Nakayama calls this the "Evidence Trap".  It's good to be evidence-informed, but we tend to become evidence enslaved.  We've become so reliant on one-sided evidence for treatment that we're losing the "personalization" of practicing medicine.  We're losing our clinical intuition.  Fear is certainly an aspect of this, but I advise pracititioners who are working in functional medicine to be savvy in pharmaceutical drugs that are utilized in treatment, but with all other methods of treatment ask yourself:

  1. What are the true risks and potential benefits?  
  2. How do these potentially affect the biochemistry of the human body?

 

Functional Medicine-Based Thinking vs Mainstream Medicine-Based Thinking

Instead of operating within the confines of a closed box, functional medicine practitioners honor the fact that studies don't reflect healing of individuals.  How can healing occur in a petri dish or in a controlled study?  No study can accurately reflect the complexity of any individual.  Healing is more than a single treatment.  People are complex, and when you really consider the goals of medical treatment, a patient only cares about the outcomes of a treatment and how we can help them achieve these outcomes.

If you want to practice functional medicine, you have to look outside the box and honor the individuality and complexity of all patients.  It takes courage to question the authorities in our profession!

Takeaways:

  • First do no harm
  • Be evidence informed (use the scientific evidence to be aware of the risks of drugs and medications/supplements), but don't become enslaved by it
  • We don't need to know everything - just the right information for each unique individual we help
  • Honor the fact that studies don't reflect healing of individuals
  • There are very few studies in lifestyle medicine (nutrition, exercise, etc) that can effectively be used as "evidence" in clinical practice
  • Studies don't reflect healing
  • Accept that when you join the functional medicine practitioner community, you are courageous and an innovator.  You will be challenged, but focus on the patient outcomes.

Wishing everyone great health, happiness, and a life at ease.

Meg

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