Medicine Quackery

The Cleveland Clinic publishes a study touting the benefits of the quackery known as “functional medicine”

The Cleveland Clinic has, unfortunately, embraced the quackery known as “functional medicine.” Now it’s publishing dubious studies touting it.

Here on this blog (and elsewhere), I have been writing about the “integrative medicine” specialty known as “functional medicine” for nearly 15 years. The reason is that so-called “functional medicine” is a form of pseudomedicine that dresses itself up as scientific but at its core is deeply unscientific. Basically, its practitioners don the mantle of “science” by ordering reams of diagnostic tests that are not science-based and whose interpretation is not at all clear, all in order to “treat the cause” of disease. True, functional medicine does also include some very banal, science-based advice (weight loss, healthy diets, exercise, sufficient sleep, and the like), but in addition to “integrating” massive overtesting and overtreatment it also “integrates” quackery like homeopathy, naturopathy, traditional Chinese medicine, and chiropractic into the mix, thus diluting the science-based part to the point where it becomes difficult for the non-skeptic to tell what is and isn’t science-based. Functional medicine is also such a vague and amorphous entity that it led Wally Sampson to ask several years ago just what functional medicine is anyway and to conclude that it’s an “indecipherable babble and descriptive word salad“. As I like to say, functional medicine combines the worst features of conventional medicine (overtesting and overtreatment) with a heaping helping of quackery. Or, to apply Harriet Hall’s famous adage about naturopathy to functional medicine, what is good about functional medicine (emphasis on diet, exercise, and lifestyle) is not unique, and what is unique about functional medicine (the overtesting and quackery) is not good.

Dr. Sampson also noted, as I continue to do, that claiming to treat the “underlying cause” of a condition raises the usual straw man argument that modern medicine does not, which of course is untrue, while also implying that there are “underlying causes” known to functional medicine practitioners and not to regular physicians. Functional medicine also claims to treat chronic diseases that are (according to its advocates) inadequately treated by conventional medicine, thanks to a more “advanced” approach, both in conceptual thinking and in practical management. Of course, when you look critically at what functional medicine actually does in practice, these claims are easily shown to be nonsense. (For an example, just check out a case report that I discussed a three years ago of functional medicine used in treating an elderly woman with a nasty breast cancer.) Unfortunately, thanks to the embrace of functional medicine by the Cleveland Clinic, which in 2014 hired functional medicine guru Dr. Mark Hyman to set up a clinic there, the promotion by practitioners of “integrative medicine,” and stealth advertising in the form of news stories, functional medicine has become somewhat respectable, even though it doesn’t deserve that respect and the American Academy of Family Physicians has pointed out that it includes harmful and dangerous treatments. (Functional medicine includes a lot of diagnoses of “heavy metal toxicity” and often includes “detox” treatments to alleviate that fantasy-based diagnosis.)

It was only a matter of time before the Cleveland Clinic started publishing studies to promote functional medicine, and a couple of weeks ago I saw this one popping up on social media as “evidence” that functional medicine does better than conventional medicine treating chronic illnesses. But does it? Let’s find out if the study matches the advertising claims the Cleveland Clinic posts on social media:

The Cleveland Clinic publishes a study advertisement for functional medicine

So late last week, I started seeing Tweets like this, either retweeted or in the various alternative medicine feeds that I follow (for blogging material):

So let’s take a look first at the Cleveland Clinic’s press release about the study, and then we can dive into the study itself, which you can read because it’s published in JAMA Network Open.

The Cleveland Clinic pressroom exults:

In the first retrospective cohort study of the functional medicine model, Cleveland Clinic researchers found that functional medicine was associated with improvements in health-related quality of life. The study was published today in the Journal of the American Medical Association Network Open. The two-year study examined 1,595 patients treated in Cleveland Clinic’s Center for Functional Medicine and 5,657 patients seen in primary care at a family health center, assessing health-related quality of life using PROMIS®, an NIH-validated questionnaire. PROMIS provides a measure of patients’ global physical and mental health that can be monitored over time, measuring factors like fatigue, physical function, pain, gastrointestinal issues and emotional well-being. The study investigated the association between the functional medicine model of care and health-related quality of life by comparing functional medicine patients with patients seen in a primary care setting. Researchers found that patients seen by the Center for Functional Medicine showed beneficial and sustainable improvements in their PROMIS global physical health.

So, before even delving into the methods section of the study, I can see a lot of issues. The study is retrospective, for one thing, and not randomized. That means that the patients who come to Cleveland Clinic Center for Functional Medicine are likely a very different patient population from the patients who go to the Clinic’s regular primary care clinics. A lot of the tests and interventions used in functional medicine, not being evidence-based, are not covered by health insurance, which means that the patient has to pay out of pocket and, therefore, it’s very likely that the patient population seen at a functional medicine clinic will be more affluent and suburban than patients seen at a regular primary care practice run by the Clinic. In fairness, the authors do address this issue in the paper, but the question is whether they addressed it well enough. Also, spoilers: Some of the differences in populations were not what I would have expected.

Before delving into the paper itself, I feel obligated to briefly recap just what functional medicine actually is.

Functional medicine: WTF is it?

The basic “principles” of functional medicine tend to be mundane and difficult to disagree with; rather, it’s the interpretation of these principles that is problematic and embraces quackery, bad science, and pseudoscience. I’ve seen multiple versions of these “core principles” of functional medicine over the years, but they usually boil down to something like this list:

  • Acknowledging the biochemical individuality of each human being, based on concepts of genetic and environmental uniqueness
  • Incorporating a patient-centered rather than a disease-centered approach to treatment
  • Seeking a dynamic balance among the internal and external factors in a patient’s body, mind, and spirit
  • Addressing the web-like interconnections of internal physiological factors
  • Identifying health as a positive vitality—not merely the absence of disease—and emphasizing those factors that encourage a vigorous physiology
  • Promoting organ resilience as a means of enhancing the health span, not just the life span, of each patient

Much like traditional Chinese medicine and its invocation of “imbalances” in the five elements as a cause of disease or, for that matter, ancient European medicine and its “imbalances in the four humors,” functional medicine is all about “correcting imbalances,” only just far more “science-y” sounding than the imbalances of the aforementioned ancient forms of prescientific medicine. Specifically these imbalances:

To assist clinicians in understanding and applying Functional Medicine, IFM has created a highly innovative way of representing the patient’s signs, symptoms, and common pathways of disease. Adapting, organizing, and integrating into the Functional Medicine Matrix the seven biological systems in which core clinical imbalances are found actually creates an intellectual bridge between the rich basic science literature concerning physiological mechanisms of disease and the clinical studies, clinical diagnoses, and clinical experience acquired during medical training. These core clinical imbalances serve to marry the mechanisms of disease with the manifestations and diagnoses of disease.

  • Assimilation: digestion, absorption, microbiota/GI, respiration
  • Defense and repair: immune, inflammation, infection/microbiota
  • Energy: energy regulation, mitochondrial function
  • Biotransformation and elimination: toxicity, detoxification
  • Transport: cardiovascular and lymphatic systems
  • Communication: endocrine, neurotransmitters, immune messengers
  • Structural integrity: subcellular membranes to musculoskeletal integrity

This set of imbalances and the principles above frequently lead to charts like this, which look profound on the surface but are really quite banal:

Functional medicine chart 1

And this one:

Functional medicine patient intake

The strategy functional medicine claims to use to treat patients sounds very scientific, but in reality are a lot of hot air:

  • Gene-Environment Interaction: Functional Medicine is based on understanding the metabolic processes of each individual at the cellular level. By knowing how each person’s genes and environment interact to create their unique biochemical phenotype, it is possible to design targeted interventions that correct the specific issues that lead to destructive processes such as inflammation and oxidation, which are at the root of many diseases.
  • Upstream Signal Modulation: Functional Medicine interventions seek to influence biochemical pathways “upstream” and prevent the overproduction of damaging end products, rather than blocking the effects of those end products. For example, instead of using drugs that block the last step in the production of inflammatory mediators (NSAIDs, etc.), Functional Medicine treatments seek to prevent the upregulation of those mediators in the first place.
  • Multimodal Treatment Plans: The Functional Medicine approach uses a broad range of interventions to achieve optimal health including diet, nutrition, exercise and movement; stress management; sleep and rest, phytonutrient, nutritional and pharmaceutical supplementation; and various other restorative and reparative therapies. These interventions are all tailored to address the antecedents, triggers, and mediators of disease or dysfunction in each individual patient.
  • Understanding the Patient in Context: Functional Medicine uses a structured process to uncover the significant life events of each patient’s history to gain a better understanding of who they are as an individual. IFM tools (the “Timeline” and the “Matrix” model) are integral to this process for the role they play in organizing clinical data and mediating clinical insights. This approach to the clinical encounter ensures that the patient is heard, engenders the therapeutic relationship, expands therapeutic options, and improves the collaboration between patient and clinician.
  • Systems Biology-Based Approach: Functional Medicine uses systems biology to understand and identify how core imbalances in specific biological systems can manifest in other parts of the body. Rather than an organ systems-based approach, Functional Medicine addresses core physiological processes that cross anatomical boundaries including: assimilation of nutrients, cellular defense and repair, structural integrity, cellular communication and transport mechanisms, energy production, and biotransformation. The “Functional Medicine Matrix” is the clinician’s key tool for understanding these network effects and provides the basis for the design of effective multimodal treatment strategies.
  • Patient-Centered and Directed: Functional Medicine practitioners work with the patient to find the most appropriate and acceptable treatment plan to correct, balance, and optimize the fundamental underlying issues in the realms of mind, body, and spirit. Beginning with a detailed and personalized history, the patient is welcomed into the process of exploring their story and the potential causes of their health issues. Patients and providers work together to determine the diagnostic process, set achievable health goals, and design an appropriate therapeutic approach.

Of course, there is nothing in the principles above that conventional science-based medicine doesn’t advocate or do. The main difference is that SBM demands adequate evidence and doesn’t embrace quackery. For instance, the whole bit about “gene-environment” interaction serves as an excuse for functional medicine to make all sorts of fake diagnoses, such as heavy metal toxicity (requiring “detox” such as chelation therapy, naturally), chronic Lyme disease, and chronic candida infections. Meanwhile, the emphasis on “biochemical individuality” and systems biology (which functional medicine practitioners frequently mangle beyond recognition) serves as an excuse for functional medicine practitioners to make stuff up as they go along and prescribe all sorts of supplements to “correct” supposed “deficiencies” in micronutrients, after having ordered dozens (or even hundreds) of unnecessary lab tests to find such “deficiencies.” Indeed, as a physician, I find it rather offensive that functional medicine mavens claim that conventional medicine doesn’t consider the patient in context or physiology that transcends simple organ systems. I went to medical school 30 years ago, and was taught those things then. I was also taught that you shouldn’t make stuff up or use treatments that don’t have good evidence supporting them.

On to the Cleveland Clinic’s functional medicine study

Not surprisingly for a study that’s more propaganda than science, the introduction includes this gem of functional medicine propaganda:

The functional medicine model of care provides an operating system that works to reverse illness, promote health, and optimize function by addressing underlying causes, symptoms, and functional imbalances in interconnected biological networks.10 These imbalances may impair principal biological functions (assimilation, defense and repair, energy production, biotransformation, communication, transport, and structural integrity) that result from gene-environment interactions, including lifestyle, environmental toxins, and the microbiome. Functional medicine removes triggers for illness and provides inputs to restore and optimize health. Functional medicine also addresses social determinants, including the psychological, emotional, and spiritual aspects of health and disease.11 A foundation of functional medicine is the use of food as medicine to prevent, treat, and reverse chronic disease. The functional medicine model of care may have the ability to improve patient’s health-related quality of life (HRQoL), including physical function and well-being. Therefore, the purpose of the present study was to investigate the association between the functional medicine model of care and HRQoL by comparing functional medicine with care received in a family medicine setting.

I really hate when a medical model of care is likened to a computer operating system. It’s so trite. Be that as it may, though, all the functional medicine tropes are right there in the introduction to the study, for all to see.

The study itself is a fairly straightforward retrospective cohort study, which means that the investigators looked at existing data in the Cleveland Clinic database to compare a cohort of patients seen in its functional medicine clinic with a cohort of patients seen in its primary care clinics for various outcomes, in this case, changes in the cohorts’ Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) scores at 6 and 12 months after their first visit. The PROMIS Global Health scale consists of ten questions that measure physical, mental, and social health, and it provides a measure of overall health:

Higher scores indicate a better health-related quality of life. PROMIS GH comprises 10 items and produces 2 summary scores: Global Physical Health (GPH) and Global Mental Health (GMH). The GPH measure includes 4 items on physical health, physical functioning, pain intensity, and fatigue, whereas, the GMH comprises 4 items on overall quality of life, mental health, satisfaction with social activities, and emotional problems. PROMIS physical function measures are sensitive enough to detect longitudinal changes due to targeted clinical interventions and able to distinguish among diverse chronic diseases.17,18 Summary scores are centered on the 2000 US Census with respect to age, sex, educational level, and race/ethnicity and are transformed to a T-score with a mean (SD) of 50 (10).14 Changes of 5 points suggest a meaningful or clinically important change; higher scores indicate a better HRQoL [health-related quality of life].

The overall study encompassed 7,252 patients (1,595 from the functional medicine center and 5,657 from the family medicine center), of which 4,780 (65.9%) were women. The mean age was 54.1 years. Corrections were made for socioeconomic status, race, etc. Interestingly, income was simply estimated by the median income reported in the 2010 census for the ZIP code where each patient resided. After propensity score matching, there were 398 patients in each group.

The results were…underwhelming, the very definition of a statistically significant but almost certainly clinically insignificant change. Just check out the chart below, remembering that a change of less than 5 points in these particular scales is not a meaningful difference.

Basically, at 6 months, the functional medicine cohort had an improvement in their PROMIS GPH scores from 46.18 at baseline to 47.77 (P <  .001). The PROMIS GPH mean (SD) change at 6 months was also significantly greater than that seen in patients treated at the family medicine group. At 12 months, functional medicine patients showed improvement in PROMIS GPH similar to that observed at 6 months; however, comparisons with the family medicine cohort were not significant. True, more patients seen at the Center for Functional Medicine (30.9%) improved their PROMIS GPH scores by 5 or more points than those seen at the Family Health Center (22.1%), but how meaningful is that really?.

Now look at this chart, which is particularly damning:

Interestingly, the median income of the functional medicine cohort was actually lower than that of the family medicine cohort, although the functional medicine cohort younger, whiter, more married, and less healthy at baseline, with a higher prevalence of hypertension and diabetes. More tellingly, the functional medicine cohort started out with a whole lot more functional medicine diagnoses, such as autoimmune diseases (functional medicine loves to diagnose nonexistent autoimmune diseases), mitochondrial disorders, “gut” issues, infections, and allergies. To me this indicates a whole lot of things being treated in the functional medicine clinic that almost certainly don’t require treatment and a whole lot of fake functional medicine diagnoses, like chronic Lyme.

I’ll give the authors some credit for acknowledging potential confounders:

Second, patients seen in the Center for Functional Medicine may be different from those seeking primary care in a family health center. Our attempt to circumvent this bias was to PS match patients from each center based on certain variables; however, there may be unmeasured confounders associated with the reported outcomes. For example, patients who request to be seen at the Center for Functional Medicine may be more motivated to make a nutrition-, lifestyle-, or behavior-related change in their life. Success with such change is associated with patient activation measures relating to engagement and self-management opportunities. Higher patient activation is also associated with individuals who perceive that they have an unmet need as it relates to their medical care. Patients seeking functional medicine may have exhausted all available opportunities in conventional medicine to manage or mitigate their chronic disease and perceive functional medicine as their only recourse. Therefore, patients seen in the functional medicine setting may be more engaged and adherent to treatment recommendations.

In which case, the answer to improve outcomes would be to figure out ways to engage patients more in their own care while using science-based medicine, not to add overtesting, overtreatment, and quackery to the mix and to justify it by saying that it motivates patients to live a healthier lifestyle. Similarly, the authors note that functional medicine doctors spend much more time with patients, with an initial consult running 60-75 minutes. Again, if that’s what it takes to help patients, then the answer isn’t functional medicine and all the quackery that it entails, but rather to find a way to pay for primary care physicians to be able to spend more time with each patient. The Cleveland Clinic requires each of its functional medicine clinic patients to consult with a registered dietitian and health coach, in addition to a clinician, as part of their initial visit. That’s not a bad idea and could potentially be adopted by conventional primary care practices (well, maybe not the health coach, as insurance probably wouldn’t pay for that), again with no association with quackery required.

None of this stops the Cleveland Clinic from saying:

“This is a first-of-its-kind study to evaluate the impact of functional medicine model of care on patients’ health-related quality of life. In the past, evidence to support the model has been primarily anecdotal, published as case reports or based on specific, targeted interventions used as part of the functional medicine approach, such as nutritional changes,” said Michelle Beidelschies, Ph.D., director of Research and Education for the Cleveland Clinic Center for Functional Medicine and the lead author of the study. “Functional medicine practitioners have suggested that their patients are improving with a systems-based approach to chronic disease. Now, they have evidence that their approach is associated with improved quality of life.”

I must emphasize that this study doesn’t show improved health outcomes due to functional medicine. Its primary outcomes were scores on subjective scales, not any measured hard outcome, such as blood pressure control, incidence of complications (i.e., strokes in patients with hypertension or blindness or loss of limbs in diabetics). Worse, it didn’t even really show what the very scales used consider to be a meaningful or significant improvement in health-related quality of life. It’s basically a whole lot of nothing, far more PR than anything else, and I expect that this study will be used to market functional medicine and try to convince conventional doctors that functional medicine has merit.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

33 replies on “The Cleveland Clinic publishes a study touting the benefits of the quackery known as “functional medicine””

This is so frustratingly disappointing. I heard nothing but good things about the Cleveland Clinic for so long, and then this obsession with quackery took over. Are they still ranking high in quality of care?

obsession with over all health care …i would think …call it all what u may .ah ok ..happy bob from oz..cheers.8

The only thing surprising about those figures is that the income is actually lower in the Functional Group: perhaps it’s aspirational care. Basically white middle aged women in suburbia- the target audience for marketing this stuff.

Interestingly, my gentleman had ( amazingly quick, incredibly successful) hip replacement in a very posh hospital in an overly affluent town: his surgeon was young, brilliant and SB although he recommended iron and vitamin C supplements prior to surgery ( probably not a terrible idea) BUT when I looked up the hospital ( which shall remain nameless) it does have Integrative Care and Functional Medicine as well
A 90 minute consultation is 450 USD and follow-ups are 175-225. You can call and discuss insurance it says.
They offer “mindfulness-based stress reduction” and nutrition ( even via phone) with an RD focusing on whole foods, supplements and mind-body approaches. There are two MDs both female, one is a yoga instructor.

It pains me to admit ( but I will) that women frequently find this type of offering desirable: as they do- unfortunately- with other woo- categories: the websites I survey ( woo and anti-vax) appear to tailor their message ( and images) to women : youth, health and beauty are key concepts alongside natural care for women and children. One of the idiots I survey claims that his average follower is a 37 year old college educated woman.
It disturbs me greatly. Women have sought out independence and free thought but then fall into a chasm of pseudoscientific BS artistry and predatory, mercenary copy writing.

College/university education is no guarantee of a training in critical thinking, assessing evidence, even the most basic of statistical knowledge.

Many, if not all, of the regular or semi-regular, commenters here do have something of a training in such things.

The arts, humanities etc graduates of my acquaintance far less so, engaging in a lot of argument from authority, rhetorical flourishes and the like. ‘Twas even worse sharing a house with law students for whom that was even worse, with winning an argument was far more important than the factual content and, y’know, actual evidence.

Thus “college educated” doesn’t necessarily have much relevance here. In fact, it could give an over-inflated sense of capability – if only there were some convenient term for such a thing…

Oh, I know. I’m just bemoaning the fact.

I always suspect that amongst the so-called-educated** woo-entranced there is great importance placed upon being ‘edgy’ or a ‘rebel’ ( contra authorities) despite the fact that they closely mimic their leaders’/ each others’ views rather than sources hopefully outside of personal opinion like, you know, data and research. Often, they follow a cult of personality yay-saying their current guru. Virtually all of the anti-vax mothers I read laud their own university education as well as their ‘independent research’ ( i.e. searching the internet for attractive alt med ideas).

It’s pathetic. It’s worse because- proverbially at least- women more than men make medical decisions for children.
(To be fair, many men have some wacky ideas too.)

** although getting a degree generally forces students into taking at least a little science.

Yeah, I know you know: it is more of a whimper of despair.

I have been somewhat pained over the years by, for example, English graduates trying to lecture me about medical or scientific matters when I know they’ve not been near the actual study of science since they were 16.

You make a key point about the mercenary copy writing. So much of the supplement and self-care industry marketing copy consists of recycled jargon and analytics driven keywords. I find it endlessly ironic how you will see the word “sheeple” tossed around by a group that buys into marketing copy hook line and sinker.

Selling products that require no testing or vetting gives allows companies like Mercola to cast a wide net. They have perfected the use of structure-function word salads.

The best supplement manufacturers have large marketing departments and offshore support that allows them to generate a vast amount of bright and shiny content on a daily basis.

What I find even more surprising is that the CBD industry doesn’t even agree to abide by the minimal standards imposed on the supplement industry, and blatantly violate the law by making sweeping and demonstrably unproven health claims.

I’m confused. Doesn’t table 1 show that the Family Medicine patients have more hypertension (50.9% vs 19.2%) and diabetes (34.1% vs 17.9%) than the functional medicine patients?

If I’m reading that right then it makes the comparison between groups even less meaningful.

That’s what I get when I don’t hit the Post Comment button for a few hours. 😉

It seems the best spin on this is that only the choir will be interested–I hope.

Here’s something I found surprising in the cohort characteristic chart above: The percentages of people with diabetes or hypertension in the family health center column is MUCH larger than the percentage in the functional medicine column.
As you say, in spite of the fact that the family medicine cohort is dealing with much more serious illness than the functional medicine cohort, their PROMIS scores are clinically equivalent. The family medicine center must be doing amazing work to keep their seriously ill patients as happy as a bunch of hypochondriacs being treated with their preferred dosage of nonsense.

At the Cleveland Clinic Functional Medicine Center we have as our long term objective to provide lifelong care to you, your family and all aspects of your lives. The daily interactions among the people, animals and possessions you are closest to affects your health and theirs. We are focused on treated the whole you.

In keeping with this we are happy to announce the opening in early 2020 of the clinic’s Family Alternative Car Care Clinic. When you come in your appointment with the professionals in the Functional Medicine Center why don’t you drop off your car as well. After all, since the in depth consulting we do can take several hours of your busy schedule it’s important to use that time to maximum benefit.

It’s easy! Just past the ticket booth in the underground parking lot follow the F.A.C.C.C. signs to the drive in reception area. There you and your car will be checked in. Our booking system will automatically schedule your arrival one hour before your medical appointment to allow our automobile technicians to interview you to discover the vehicle’s history and usage patterns.

Although vehicles of the same model and year may look alike there are subtle differences – no, we don’t mean the color: beauty is more than skin deep with cars as well. We pay particular attention to these differences, some of which are in data gathered from the manufacturers and others learned from our experienced technical clinicians. How you use your vehicle can have a profound effect and that is the purpose of our interview. Update interviews will be brief in subsequent visits.

How you drive matters. We practice what we call the Rule of 4: a car has 4 sides, 4 wheels, 4 cylinders (or twice 4), possibly 4×4 drive train and related elements of symmetry. Yet few consider that the passenger compartment also follows the Rule of 4. There are front and rear seats and in turn these are divided left and right, sometimes with a drive shaft hump in rear wheel drive vehicles. Often the passenger compartment is not symmetrically populated and this stresses the engineered balance of the whole vehicle. If the car is mostly used for commutes by the driver alone there could be problems brewing that you could not imagine.

Engine oil is so ubiquitous the ordinary consumer will choose whatever is cheapest. Certainly they are all formulated to meet rigorous industry standards and they won’t fail in use. However the oil is under a lots of stress and use, whether idling or hauling a vacationing family on the highway.

Our diagnostics measure polymer chain length before putting the oil and when we drain it. We look for toxic contaminants and signs of chemical changes. The filter is autopsied to see what mix of dirt you are encountering in the gas you buy and the roads you travel. There are many reasons the oil turns dark.

From this we can choose a blend of oils to best suit your needs to create a unique multi-grade lubricant. We may choose 5W from one brand and 30W from another, or even mix a custom proportion of 10W from select lots.

Air filters tell their own story. Your neighborhood mechanic will replace it if it’s dirty without bothering to ask how it got so dirty and what kind of dirt is that anyway. We biopsy the dirt to discover whether the dirt is asphalt dust, airborne pollutants, insects, soil or even leaf litter. Based on how you drive your car we can recommend or custom build an air filter to match.

We keep a record of vehicle use and the many diagnostics we perform so that we can quickly identify and track problem areas. We quickly discover what worked or didn’t work during previous maintenance and suggest improvements.

Don’t wait for something to go wrong. Bring your vehicle in for regular well car visits. There are signs of defects that may pass beneath your notice during the daily commute. We’ll find those invisible problems and recommend corrective action. You may want to fill up while you’re here to benefit from our custom cultured gasoline mixtures with added ethanol from a variety of plants (not just corn!) through our network of trusted farm partners.

Oh, and talk to one of our specialists about your warranty while you wait!

Sorry. Couldn’t resist. Probably should have. Resisted that is.

Damn! My car has 6 cylinders.

Is there anything you can do to help me? Is it still safe to drive? Do I need a cylinder-ectomy? Or cylinder enhancement?

I recommend surgery (the cylinderectomy you mention) to excise the extra 2 cylinders to restore mechanical harmony. They’re the automotive equivalent of wisdom teeth. However if you have a classic Jaguar with 12 cylinders you may be doomed.

With 12 cylinders, you have 3 times 4, so I don’t see much problems. Or should one add 4 extra cylinders?

Heavens no! There is nothing harmonious about prime numbers. I know, I studied number theory for one semester until coming to my senses.

I saw a functional medicine patient in the family practice office of my preceptor last summer. Her “functional medicine” nurse practioner (it shames me to say) referred her back to my preceptor (her PCP) to order things the NP couldn’t order (probably because she wasn’t recognized by the local hospital systems).

She had a thick file of lab paperwork this quack had already ordered. Her basic complaint boiled down to fatigue and generalized pain. My thought was she had fibro.

Her fasting glucose stuck out to me, that and her B12 level. Her Glucose was 98 and the quack recommended a sugar supplement. A sugar supplement!

I almost broke a tooth grinding my teeth.

I noticed that in the blurb for functional medicine nervous system is not amongst list of systems and immune system is split into parts (not very holistic).
Bacteria actually have gene environment interaction, in a form of operons. For instance, lactose operon starts to make enzymes when lactose is present and glucose is not. Genetic organization of humans is quite different.

First I must apologize for commenting so late, I have too much disinformation on the internet to combat. So I could not get here sooner.

I dont know where to begin, but you are a surgeon and/or scientist?

Because Im afraid this post is going to age badly, very, very badly.
Might I inform you of the Duning-Kruger Effect
In other words ppl are sometimes unaware of what they dont know.

I see quite alot of wrong assumptions made in this post here.

Conventional medicine is based on science.
Nope, sad to say, its alot less scientific than you think, in fact surgeons may be the most antiscientific group of conventional doctors
Statin fraud, billions involved
Quackery cannot heal ppl.
Wrong again, might I inform you of the placebo effect
Functional medicine is not value for money
Wrong again, in fact, the reason why functional medicine will go mainstream is because it recognizes that most incurable chronic diseases left are the result of toxic lifestyles, the core of functional medicine is changing lifestyles and this is why it will become conventional medicine in due time. BTW, lifestyle interventions are not patentable, thus much cheaper than other modalities. Also conventional medicine has like zero focus on lifestyle. Saying the same one sentence in 10 secs like “eat more fiber, exercise more” to every patient, because you only have 15 min per patient is not providing lifestyle advice.

Thus, this post will age very, very badly. It also misses the core of science. Science is not about rigorous validation of hypotheses with expensive RCTs. Its about being openminded and entertaining new ideas. How else do you think science advances, if not with experiments? Rigorous validation with RCTs comes afterward, if somebody is willing to pay for it.

Funny, but I’ve been writing posts about the pseudoscience in functional medicine for well over a decade now, and my earlier posts have aged just fine.

“Wrong again, in fact, the reason why functional medicine will go mainstream is because it recognizes that most incurable chronic diseases left are the result of toxic lifestyles, the core of functional medicine is changing lifestyles and this is why it will become conventional medicine in due time.”

Oh, do tell me what “toxic” lifestyle causes obstructive hypertrophic cardiomyopathy, Tay Sacks Disease, type 1 diabetes and cystic fibrosis. Be sure to provide scientific citations, not news articles nor wikipedia.

You may enjoy these:

Srry Chris, look like I owed you some science

Why conventional medicine is largely not scientific
I hope you dont need more links, after all no matter how much scientific facts I supply, you will not be convinced. That wastes both our times.

As for what I meant with most diseases, obviously I meant that most sick ppl nowadays suffer from toxic lifestyles, not a lack of patented chemicals. (Youre right that I wasnt precise in my grammar, Im a layman afterall)
As my favorite MD Mark Hyman tells me: food is medicine or food is poison. Thats why real doctors write cookbooks: food reverses incurable diseases.

Also looks like I triggered a third psychological effect here. PPL rather be wrong together, than right by oneself. Its lonely at the summit as Mercola can probably admit.

You might be interested in the flaw I discovered in the theory of evolution. No, Im not a creationist. It connects to what you say about genetic diseases.
– Why are there so much less sufferers from genetic diseases then lifestyle diseases?
– Why is processed food so toxic and unprocessed food so healthy?
Why does every organism have junk dna?
When you connect the dots, its so obvious. Read this about junk DNA. As I said, new trends and developments, stay openminded…
The only conclusion one can make is that the code of life is not the purely genome, in fact genome is only up to 20% the code of life (exact number is speculation) the other 80% should be the structured water mercola talks about and the other parts of DNA, which must be mostly influenced by lifestyles. Furthermore, cancer must not be caused by mutations in genes, nor does evolution occur through mutations in genes. Think about it, evolutionists still cant explain how the eye evolved, because they dont fully understand the code of life. Neither do I, but I understand what it isnt. While we cant replace this theory yet, just like with physics or functional medicine going mainstream, its only a matter of time…We got all the time in the world, well, as long as the 5G apocalypse doesnt happen.

Your Atlantic article is about executive who self diagnosed stable angina and wrote himself aspirin. Seriously, you should ask second opinion if you do that.
Do Google Scholar search about statins. You will found lots of clinical trials. Besides, theory behind them is attractive: if problem is cholesterol inside your blood vessels, removing it may be useful. Lifestyle change do not change this, because all foods contain it, and ones containing lot are nutritious. (Though avoiding excesses is useful.)
Every medication has placebo effect, you do not need to go functional to get it. That is why a real medicine must be better than placebo.
“Almost all of chronic diseases are caused by toxic lifestyles” is very vague. And functional medicine is not about lifestyles, it is about selling tests and supplements. That is why Cleveland Clinic does it.
About aging of post: to be Galileo, you must right. You are not. Galileo is actually inventor of the scientific method, he did rigorously test falling bodies.
Science is about rigorous testing of hypothesis. Being open minded to everything is hippie faith.

Unfortunately, Im so busy debunking flawed science, I could only now spare the time.

Sadly Aarno, I see evidence of Duning Kruger in your reply, no offense.
But dont despair, for I will hand you the tools to become an above average scientist.

You see science is about human psychology more, than scientific facts (like politics, my theory also neatly explains Trump) Might I introduce you to a second psychological effect
because its what you will soon experience when I introduce you to an irrefutable scientific fact that contradicts your pre-existing belief
Instead of rejecting your wrong pre-existing belief, you will reject my true fact. Emotion is stronger than science.
But this knowledge about human psychology allows even a mediocre scientist who is not very good with facts to become above-average that can become more impactful than Einstein. Use this to your advantage, its not your loss, but your gain. And you are not alone.

For example, recently I discovered that the Big Bang never happened, black holes dont exist, dark energy, dark matter and expansion of the universe also doesnt exist, I also learned that the theory of relativity has been debunked, and lastly that gravity waves have never been measured. Yet do you think the physicists I debate with accept that Einstein was wrong and that Im smarter than Einstein? (gravity is faster than the speed of light) Ofcourse not. They are rather comfortable in the swamp of flawed science Einstein left behind. Thats why dark matter and dark energy dont make any sense to them. Buts its gonna take a while before they clean the slate and start over.

Might I invite you to read the following book to understand how science really works
Yes, functional medicine is a legitimate scientific revolution

BTW Orac, why dont you ever write about the dangerous lack of RCTs involving 5g (0 RCTs)? Arent you a huge fan of “RCT science”? Looks like while 5g will age very badly, and functional medicine will fare much better.

So, in summary a good scientist is: openminded so as to jump on new science revolutions, humble because its too easy to be proven wrong, understands human psychology of others and themselves, and loves being proven long so as to become a lifelong learner.

You have now been observed and your wave function has collapsed. Regrettably the (vanishingly low probability) universe in which you are correct is gone forever.

Q-Ball (layman): That is the most amazing collection of gibberish I’ve read all week. Like, that’s a fully 0.75 TimeCube, well done.

Here’s a cookie and a glass of milk, now off for a walk in the park!

I live in the same zip code as the CC, which includes wealthy doctors and fabulously wealthy administrators as well as the area destroyed by riots in the 1960s and never rebuilt. Impoverished folks living near the clinic are assigned a higher median income number than those in poverty a zip code away who lack wealthy neighbors. I submit that the seemingly affluent general clinic patients probably just have wealthy neighbors.

Now THAT’s highly interesting information. I did my residency at UH; so I’m familiar with the area, but I haven’t lived there in >20 years.

What’s even worse is that the Cleveland Clinic is selling alternative medicine quck prodcuts right on its groun ds, through chique Wellness Shops.
“Our local stores provide approved products from pedometers to chia seeds, including vitamins & supplements, skin care, sports & fitness, healthy eating, gifts & relaxation, books, DVDs and personal health.”

Doors the store still sell homeopathy? A couple of years ago the Clinic said it was going to get rid of the homeopathic remedies in its store.

No homeopathy or outright woo. Some questioanle items, though, including as I recall aromatherapy.

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