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Exploring the Parallel Universe
of Functional Medicine
There are two worlds of medicine today, the con-
ventional disease-centered model and the patient-
centered model that treats each person as a unique
entity with diverse systems of genetic, biologic, so-
cial and environmental inputs. As a board certified,
teaching physician, I know the conventional system
well, but as a ¡°functional¡± medicine practitioner I
feel like I am living in a medical parallel universe.
For over one hundred years ¡°modern¡± medicine has
taught doctors to identify and treat disease. We
learn the skills that lead us to a single diagnosis
amongst all the different possibilities. The patient is
then labeled as having this or that disease and for
every disease there is an approved code, called the
International Classification of Diseases or ICD. Ver-
sion 9 is about to be replaced by version 10 and go
from 13,000 to 68,000 possible codes. If a physician
wants to get paid via insurance they must submit
the proper codes.
ICD coding is useful for the government and the
insurance companies to facilitate billing, assess data,
and measure outcomes, but is one of the biggest
detriments to healthcare today. The entire system
revolves around codifying and classifying of patients
according to the disease or illness they have. This
reductionist mentality trains and rewards physicians
to see patients through the lens of a disease label
instead of a complex and unique person.
The ancient healing arts emphasize restoring har-
mony and balance to the patient¡¯s underlying body
systems. Ironically, modern research combined with
technology is enlightening us, and reminding us, of
this principle. From genetics to the microbiome we
are making huge strides in understanding how spe-
cific disturbances in core systems lead to disease.
Focus on healing underlying systems is the core of
functional medicine. Instead of simply putting our
patient into a disease classification we strive to un-
cover the origin of symptoms or disease so that we
might eliminate the issue altogether.
Advanced testing allows us to gather information un-
heard of just a few years ago, such as genetic muta-
tions, nutrient or hormone deficiencies, metabolic
or immune disturbances, gut dysfunction and food
allergies, toxin accumulations, chronic infections and
more. This information is invaluable in sorting out
root cause, yet so much of it is considered unneces-
sary or experimental and outside covered insurance
benefits.
More Than Just
Testing
Including and
engaging the
patient in the
healing process
is another aspect
of medicine
that is lacking.
In the rushed
world of conven-
tional practice
we hardly have
time to hear the
patient¡¯s story
- there¡¯s no ICD
code for that.
Everyone has a
story, and listen-
ing to that story
is one of the
2015 May
Pg 6 - The Sunshine Express
Health & Nurturing
Improving Food Safety
MIT sensor detects spoiled meat
April 14, 2015: MIT chemists have devised an
inexpensive, portable sensor that can detect
gases emitted by rotting meat, allowing con-
sumers to determine whether the meat in their
grocery store or refrigerator is safe to eat.
The sensor, which consists of chemically modi-
fied carbon nanotubes, could be deployed in
¡®smart packaging¡¯ that would offer much more
accurate safety information than the expiration
date on the package, says Timothy Swager, the
John D. MacArthur Professor of Chemistry at
MIT.
It could also cut down on food waste, he adds.
¡°People are constantly throwing things out that
probably aren¡¯t bad,¡± says Swager, who is the
senior author of a paper describing the new
sensor this week in the journal Angewandte
Chemie.
The paper¡¯s lead author is graduate student
Sophie Liu. Other authors are former lab tech-
nician Alexander Petty and postdoc Graham
Sazama.
The sensor is similar to other carbon nano-
tube devices that Swager¡¯s lab has developed
in recent years, including one that detects the
ripeness of fruit. All of these devices work on
the same principle: Carbon nanotubes can be
chemically modified so that their ability to carry
an electric current changes in the presence of a
particular gas.
In this case, the researchers modified the
carbon nanotubes with metal-containing com-
pounds called metalloporphyrins, which contain
a central metal atom bound to several nitrogen-
containing rings. Hemoglobin, which carries
oxygen in the blood, is a metalloporphyrin with
iron as the central atom.
For this sensor, the researchers used a metal-
loporphyrin with cobalt at its center. Metallo-
porphyrins are very good at binding to nitro-
gen-containing compounds called amines. Of
particular interest to the researchers were the
so-called biogenic amines, such as putrescine
and cadaverine, which are produced by decay-
ing meat.
When the cobalt-containing porphyrin binds to
any of these amines, it increases the electrical
resistance of the carbon nanotube, which can
be easily measured.
¡°We use these porphyrins to fabricate a very
simple device where we apply a potential across
the device and then monitor the current. When
the device encounters amines, which are mark-
ers of decaying meat, the current of the device
will become lower,¡± Liu says.
most important and rewarding processes in human in-
teraction, especially so in medicine. It sets the stage for
healing.
I teach my students that 80% of diagnoses can be
gleaned from the patient¡¯s history. The physical exam
and lab tests are meant to confirm the diagnosis. While
it doesn¡¯t always work this way I think it underscores the
need to listen more, and to understand what patients are
up to, and up against, outside the office.
To truly heal patients we need to think holistically and
we need the time to consider the mind as well as the
body. Addressing attitudes, spirituality, social networks,
and stressors should be part of the workup. For our part
as physicians, the intention to heal and sincerity are
powerful tools as well. Almost one hundred years ago
Harvard physician Francis Peabody wrote, ¡°One of the es-
sential qualities of the clinician is interest in humanity, for
the secret of the care of the patient is in caring for the
patient.¡± Perhaps now more then ever this is needed in
healthcare, for the sake of the patient and the physician.
Areas such as nutrition and exercise get little more atten-
tion than a feel good marketing message in our current
¡®sickcare¡¯ model. Having health coaches, nutritionists and
personal exercise trainers involved in every primary care
clinic would likely do more good than physicians learning
the latest drug protocols and approved formularies for
treating the increasing epidemic of obesity, heart disease
and diabetes.
For thousands of years herbal and nutritional supple-
ments have been an integral part of healing. Despite
what the television commercials and lobbying pressure
from big pharmaceutical companies would suggest, there
Medicine
In Harmony
by Scott Rollins, M.D.
is an abundance of
evidence based re-
search and experience
showing the safety and
efficacy of many natural
treatments. We have a
much larger ¡®toolbox¡¯ of
treatment options than
the local pharmacy can
provide.
Along the same lines, a
lengthy list of comple-
mentary therapies such
as chiropractic, acupunc-
ture, and massage have
proven benefits. Stress
management techniques
including meditation
and biofeedback lower
blood pressure and blood
sugar. Yoga and dance
expand the traditional
ideas of exercise. The
point is that physi-
cians don¡¯t have all the
answers and integrating
other health practitioners
is part of the cure.
The Future of
Healthcare
A welcome paradigm
shift in healthcare is
imminent. While the
conventional system
marches on with the
disease-centric pharma-
ceutical model, a quiet
revolution is happening.
Just recently the pres-
tigious Cleveland Clinic
announced the establish-
ment of its Center for
Functional Medicine. And
meanwhile, an army of
physicians from around
the country has been
discovering the joy and
success of treating pa-
tients under the func-
tional medicine umbrella.
With ever expanding
coding, data collection, documentation bureaucracy,
prior authorization, meaningful use, and so on, there
are days I feel more like an accountant than a physi-
cian. For the sake of the art of medicine and true
healing, the patient-centered world of integrative,
holistic, functional medicine is coming, and hopefully
it won¡¯t long be the alternative.
(Scott Rollins, MD, is Board Certified with the Ameri-
can Board of Family Practice and the American Board
of Anti-Aging and Regenerative Medicine. He special-
izes in Bioidentical Hormone Replacement for men
and women, thyroid and adrenal disorders, fibromy-
algia, weight loss and other complex medical condi-
tions. He is founder and medical director of the Inte-
grative Medicine Center of Western Colorado (www.
imcwc.com) and Bellezza Laser Aesthetics (www.
bellezzalaser.com). Call 970.245.6911 for an appoint-
ment or more information.)