I’ve written a fair amount about “functional medicine.” After all, the Cleveland Clinic has embraced it, hiring one of the godfathers of functional medicine, Mark Hyman, in 2014 to set up a clinic. Unfortunately, reportedly that clinic has been wildly successful, and the Cleveland Clinic has been good at sneaking credulous laudatory stories into Ohio media about patients experiencing the “miracle” of functional medicine. That the Cleveland Clinic did this around the same time that the antivaccine book that Robert F. Kennedy, Jr. had co-authored with Dr. Hyman was released and he appeared on The Dr. Oz Show to promote it. Unfortunately, the illusions that functional medicine sells appear to be popular. I just saw an article advertising a functional medicine concierge practice, Parsley Health, founded by Dr. Robin Berzin. The story’s headline asks if “holistic primary care” is the “future of medicine.” All I can say is that I hope not:
The doctor doesn’t quite make house calls, but this “Uber for blood” guy was the first indication that this was going to be an entirely different checkup. My Parsley Health experience started with a kindly bloodwork technician coming to me to draw a sample, pack it in his duffle bag, and drive away to the lab. The whole thing took less than five minutes—all while I was still in pajamas.
Later, I booked an in-office doctor’s visit online via a streamlined site that was more a Slack/ClassPass hybrid than any MyChart health portal. The only real work? An online medical questionnaire, covering everything from what type of birth my mother had (vaginal or C-section) to whether I ever had an eating disorder. The dozens of personal questions went far beyond the medical norm: Are you happy? Would you describe your childhood as secure? Are you satisfied with your sex life?
Once I arrived in the doctor’s office inside an L.A.-area WeWork, my appointment ran for 1.5 hours. A doctor, with my blood results already in hand, explored the physical and emotional issues affecting my well-being beyond the numbers. That can run the gamut from potential food allergies and environmental toxins to insomnia and stress.
You can recognize that this “holistic” practice is heavily into nonsense because of the mentions of certain buzzwords that give it away, buzzwords such as “food allergies” and “environmental toxins.” The article, as you might expect, is littered with such buzzwords and catchphrases, along with others like “holistic”; a Parsley doctor “doesn’t just prescribe drugs”; focusing on the “root causes of disease” (whatever that means); and that Parsley does a better job at treating chronic disease. In other words, these are the same claims that pretty much all “complementary and alternative medicine” (CAM) and “integrative medicine” advocates trot out when trying to claim that their embrace of pseudoscience and unproven treatments is better than conventional medicine.
But don’t call Parsley founder Dr. Robin Berzin a practitioner of “integrative medicine.” No, she insists on being called a functional medicine doctor:
“Functional medicine is not Eastern medicine, it’s not integrative medicine,” stresses Berzin. “It’s just taking best practices for conventional medicine but focusing on the root causes of disease.” For example, she adds, “You’re not an insomniac lying awake at night because of an Ambien deficiency.”
Actually, this is disingenuous. Functional medicine itself might not be “Eastern medicine” or traditional Chinese medicine, but it sure as hell is a form of “integrative medicine,” because if there’s one thing functional medicine does a lot of, it’s “integrating” the unproven and quackery with conventional medicine. Indeed, I’ve often characterized functional medicine as the “worst of both worlds” because it combines the massive overtesting and overtreatment to which conventional medicine can sometimes be prone with—you guessed it!—quackery. That includes homeopathy, traditional Chinese medicine, and, above all, a boatload of supplements. I once discussed a functional medicine case report describing the care of an 80 year old woman with locally advanced breast cancer. The care involved the assessment of well over 100 minerals, metabolites, hormones, and the like in the blood and the addition of a whole bunch of supplements.The results take up more than two pages of the case report, and include amino acid levels, “gut immunology” markers, secondary bile acids, parasite tests, pancreatic enzyme levels, heavy metal levels, and, of course, the most beloved lab tests of FM practitioners and autism quacks, oxidative stress markers like glutathione and coenzyme Q10. She got huge doses of intravenous vitamin C three times a week plus 18-24 g of oral vitamin C every day.
In the end, I concluded that there were probably a couple of things the functional medicine doctors did that added anything to her care other than the surgery, chemotherapy, and radiation: exercise, a personal care giver, counseling, and perhaps the sleep log she was asked to keep. For everything else, there’s no evidence that it added anything to her care at all, other than expense, inconvenience, and additional risk above and beyond the risks that she already faced due to the harshness of her conventional treatment and her advanced age. This is the same as it usually is with functional medicine. The things functional medicine co-opts, like diet, exercise, weight loss, and improvements in sleep are primarily responsible for good outcomes, while the shotgun testing and quackery get all the credit.
That’s not all, though. You should see a particular functional medicine protocol that claims to treat Alzheimer’s disease. Known as the MEND™ protocol for Alzheimer’s disease, it claims to slow the cognitive decline due to Alzheimer’s disease by simultaneously treating “the dozens of pathology drivers of age-related cognitive decline,” including “metabolic issues, toxicity, inflammation, and mitochondrial damage,” which sounds exactly like functional medicine. That’s why I’ve referred to the MEND™ protocol as functional medicine on steroids, because, whether the scientists at Muses Labs know it or not, that’s exactly what functional medicine does: Measure a lot of markers that basic science and/or epidemiological studies have tentatively linked to various diseases without regard to whether these markers have been shown to have a causative role in these diseases, and then try to fix their abnormal levels. In doing so, functional medicine ignores an adage I’ve been taught since I was a resident: Treat the patient, not the lab values.
Whenever I discuss functional medicine, I like to try to remind my readers just what the heck functional medicine is. I always have a hard time explaining it; so I usually end up going to the source, the Institute for Functional Medicine, which quickly reveals that functional medicine is a lot of nonsense mixed with some sensible advice. Functional medicine claims to be guided by six core principles:
- An understanding of the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness;
- Awareness of the evidence that supports a patient-centered rather than a disease-centered approach to treatment;
- Search for a dynamic balance among the internal and external body, mind, and spirit;
- Familiarity with the web-like interconnections of internal physiological factors;
- Identification of health as a positive vitality not merely the absence of disease emphasizing those factors that encourage the enhancement of a vigorous physiology;
- Promotion of organ reserve as the means to enhance the health span, not just the life span, of each patient.
The above list is the sort of thing that sounds reasonable on the surface but doesn’t stand up to close scrutiny. I could (and would) point out that the “understanding of the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness” seems custom-made to cater to the belief among some of the woo-prone that they are special snowflakes, so utterly unique that treatment must be tailored to their finest uniqueness. Alternatively, as Wally Sampson once pointed out, “biochemical individuality” is an expression invented by Dr. Roger Williams of the University of Texas 50 years ago to justify administering massive doses of vitamins and other supplements in order to achieve “optimum health.” Linus Pauling, proving that Nobel Laureates can be taken in by pseudoscience, adapted the concept, along with other treatments involving massive doses of vitamins, into the idea of “orthomolecular medicine,” a type of medicine that seems to have at its very core the concepts that all disease is due to some sort of vitamin or nutrient deficiency (or “imbalance”) and that, if some vitamins are good, massive amounts more are even better. It’s no wonder that functional medicine frequently goes hand-in-hand with orthomolecular medicine. Unfortunately, functional medicine has some famous believers, such as Bill and Hillary Clinton—and Bernie Sanders.
Oh, and did I mention that all the doctors at Parsley are certified by the Institute for Functional Medicine?
Here’s a video of Dr. Berzin explaining her practice:
In it, you’ll hear Dr. Berzin talking about genomics (functional medicine docs love to abuse systems biology), the microbiome, stress pathways, all the usual stuff that functional medicine doctors think that they understand but make abundantly clear that they do not through the ways that they approach patient care, which is basically to measure every marker they can think of, whether relevant or not, whether validated or not, and then to try to correct the lab values.
In any event, when you get past all the holistic buzzwords and standard rhetoric about “disruption,” what you’re left with here is a fairly standard concierge practice, or, if you would prefer, a concierge functional medicine practice run by Dr. Robin Berzin. It’s a practice that’s expanded to three cities already, San Francisco, Los Angeles, and New York. Guess who’s backing it as well? Come on, guess:
This past April, the startup announced a $10 million round of Series A funding, led by FirstMark Capital, with additional investments from Amplo, Trail Mix Ventures, Combine, and The Chernin Group. Individuals included Mark Hyman, MD, director of the Cleveland Clinic Center for Functional Medicine, and Warby Parker cofounder Dave Gilboa.
Moving forward, Parsley Health intends to open more clinics across the country, as well as beef up its online content platform. The biggest challenge, says Berzin, is educating the public about the benefits of functional health.
Mark Hyman? Surprise, surprise!
I did say, however, that this functional medicine practice started by Dr. Robin Berzin is a concierge practice:
That, and convincing people to adopt an alternative payment model. Most consumers aren’t too well versed in options beyond health insurance–or just depending on the emergency room.
“You have to educate people about how they’re already spending their money in ways that they’re not aware of themselves . . . they are already spending hundreds if not thousands of dollars on unnecessary medications, unnecessary specialists, and ‘healers,’” says Berzin.
With Parsley Health, membership equates to a little under $5 a day. That’s a small price, says Berzin, for preventable health strategies that encompass all of one’s physical and emotional well-being. These are doctors who won’t ever say, “‘We have 15 minutes with you. Here’s your prescription for drugs. Off you go.’”
But what does this mean? If you wander over to the Parsley Health website, you’ll find two plans and a service. The first service costs $500 and includes a 75 minute doctor visit, 45 minute coaching session, and “basic biomarker testing,” access to an online portal, among other things. The “basic biomarker testing” claims to look at “inflammation, nutrient status, heart health and more”; in other words, the usual functional medicine “throw everything at the wall and see what sticks” approach. This plan goes for three months.
Next up is the “Complete Care” plan, which is $150 a month and includes so much more, including, of course, something Parsley calls “advanced bimarker testing,” which includes a “curated testing program” that includes “microbiome, genomics, toxin, heavy metal, hormone, nutrient and immune analyses as indicated.” (Pro tip: Any time someone proposes testing you for heavy metal levels in the absence of an exposure or symptoms, they’re quacking. Ditto testing you for “toxins” in the absence of a clear indication.” (Heck, Parsley even brags that you can get over 1,000 biomarkers tested, which, let me remind you, makes it very likely that they’ll find at least a few dozen “abnormal” labs if the cutoff for abnormal is more than two standard deviations away from the mean, as is usually the case.) Going up to the $250/month “premium care” plan just gets you more visits and access to “priority visits” within 48 hours of calling, which hardly sounds very “priority” to me given that my doctor’s practice can often see patients the same or the next day when necessary.
Then there’s this:
Yes, you saw that right. Dr. Berzin was retweeting antivaccine and antifluoridation nonsense. Elsewhere, she talks about how she tested high in mercury before getting pregnant and therefore did a “heavy metal detox” before trying to have a baby:
She also parrots a whole lot of antivaccine nonsense at around the 1:00 mark while claiming that she’s “not antivaccine.” For instance, she talks about comparing the 1980 CDC recommended vaccine schedule to the current one and being appalled that children receive “10X” more vaccines now, all while invoking big pharma and the profit motive as the reason. Of course, she’s unhappy over the birth dose of hepatitis B vaccine. Overall, she comes across as what I’d call “soft antivax,” of the “too many too soon” variety, saying she’s planning on following a “delayed vaccination schedule.” She does also invoke hygiene and public health as being more important. She even heaps disdain on pediatric practices that brag about close to 100% vaccination rates and promises that the pediatric practice Parsley will be starting (actually, has already started—this interview is from 2017) won’t vaccinate everyone. She even invokes thimerosal and implies she’s sympathetic to the “toxins gambit.” All the while, she tries to portray herself as being the “moderate” and “reasonable” one, as compared to all those radical pro-vaccine doctors. This is, of course, bullshit.
Of course, practices like Parsley Health have to be made more appealing and glitzy by adding the latest bells and whistles. Don’t get me wrong. I like some of the technology Parsley has applied, such as:
Apart from the in-depth diagnosis and treatment model, Parsley also differs in its emphasis on technology. The entire booking process is done online, with doctor’s notes, medical records, and health coach messages available on an easy-to-navigate dashboard.
“Everyone is busy,” says Berzin of Parsley’s 100% open notes policy. “You shouldn’t beg us to fax you something. All your data should be online so that you can view it 24/7 and download it yourself. We believe you own your data.”
Additionally, Parsley built data tracking into its system to assess and compare outcomes–a method rarely found in general primary care. Before each visit, patients fill out a survey that helps the medical team monitor progress and outcomes. Over the course of a year, Parsley’s digital system then adds thousands of data points to a patient’s charts, which enable them to change course should a method or treatment show little improvement.
Well, not everything. This latter tracking feature sounds to me custom-designed to track mainly subjective symptoms, which are most prone to placebo effects. Also, what good are thousands of data points if you don’t know what to do with them or don’t have the tools to make sense of them?
If there’s one thing this article drove home yet again, it’s that one reason why woo is flourishing these days is because those selling unproven treatment methods are so much better at marketing than conventional doctors are. They have the patient portals that go beyond what most other practices and hospitals have. They make their clinics look like spas that cater to a patient’s every whim. Add to that something like functional medicine, a specialty that tells each patient that he or she is so biologically unique that the treatment must be equally unique (whether that’s true or not), and it’s a message most people won’t be able to resist because they won’t see the emptiness at its core.