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Jan 14, 2016

How Was Functional Medicine Developed?

John weeks PhD wrote an interesting article on how Functional Medicine was developed in his Integrator blog and in the January 5, 2016 Huffington Post article in which I wanted to share.

Chronicles of Health Creation: The Naturopathic Profession's Impact on Integrative and Functional Medicine

I was called by a consultant to an institute associated with the American Association of Naturopathic Physicians to participate as an outside expert in a strategic process.
I spent the 1983-1993 years working in an intense period of the profession's re-emergence. I have since closely observed its multiple contributions to the subsequent rise of the functional medicine and integrative medicine movements.
The profession has focused on setting and earning recognition of standards for the naturopathic brand of integrative medicine. Despite opposition from the American Medical Association and its affiliates, since 1978 the profession has re-bounded from just a few hundred practitioners, licensing in 6 just states, and a single college. Now, while still a vanguard, the profession boasts 8 federally-recognized colleges, roughly 5,000 practitioners and legal practice rights in 20 U.S. jurisdictions.

The consultant's question: How should the Institute set its course to best advance the profession in the next phase?
My answer grew from dual awareness of the field's small size and its extraordinary influence on the evolution of the "new medicine."
My answer came quickly. I urged that the profession focus on its broad, health-fomenting mission rather than to cling to its narrow guild interests as a profession.  Mightn't the naturopathic guild, paradoxically, benefit from a very non-guild-like, energetic strategy?
First, evidence of the contributions.
1. NDs are Core Educators at the Institute of Functional Medicine
The functional form of integrative medicine, embraced at the Cleveland Clinic, has had naturopathic physicians at its center since its beginning. Naturopathic physicians are the organization's co-directors of medical education. Sheila Quinn, ND (Hon), the editor of the Textbook of Functional Medicine, earned her integrative chops as a co-founder of a naturopathic college, now Bastyr University, and as executive director of the naturopathic professional organization. Bastyr's founding president Joseph Pizzorno, ND - essentially a co-founder of the Institute -- has served as the Institute's chair and remains on the executive team.
Author Mark Hyman, MD, the functional medicine organization's current chair, states frankly: "The origins of functional medicine stretch back into the history of naturopathic medicine -- on the idea that health is not the absence of disease, but the creation of vitality and abundant health. Many of the principles of naturopathic medicine -- the body as self-organizing, self-healing dynamic system, the concepts of detoxification, and digestive health, and food as medicine are all now embedded within Functional Medicine."
2. Academy of Integrative Health and Medicine: NDs as Director of Education and Associate Fellowship Director

When two MD-based holistic and integrative organizations merged in 2013 to form an interprofessional "big tent" organization, the Academy of Integrative Health and Medicine, the founders selected naturopathic physicians to serve as the first directors of education and of certification, Tabatha Parker, ND, and Seroya Crouch, ND, respectively. Parker led the organization's robust 2015 conference and Crouch is teaming with Tieraona Low Dog, MD as associate director of the organization's pioneering 
interprofessional fellowship in integrative medicine.

3. Society of Integrative Oncology: NDs as President and Immediate Past President
The guiding organization for opening oncology to integrative practices is the Society for Integrative Oncology. It's immediate past president is University of Michigan family medicine associate professor Suzanna Zick, ND, MPH. Her predecessor, Columbia assistant professor Heather Greenlee, ND, PhD, guided the Society to its crowning achievement: Clinical Practice Guidelines for integrative treatment of breast cancer.

4. Naturopathic Leadership in Whole System Research, Integrative PCMHs, Policy and Academic Consortia
Naturopathic contributions to the new medicine does not end here. Naturopathic researchers are pioneering whole practice research strategies. Naturopathic clinical leaders are leading the demonstration of integrative patient-centered medical homes. Leaders in the profession's re-emergence were core contributors in forming the most significant interprofessional collaborations for the field: the Integrative Health Policy Consortium and the Academic Consortium for Complementary and Alternative Health Care.
The integrative model carried by the naturopathic physicians has led integrative medicine leader Tracy Gaudet, MD, the present director of the VA Office of Patient-Centered Care and Cultural Transformation to declare that "naturopathic physicians are a huge part of the solution -- [they] always have been."
Gaudet is right. These are foundational, standards-based contributions across the education-practice-research-policy continuum. Another observer now with the RAND Corporation, aware of the field's flyweight size, famously commented that"naturopathic doctors are fighting above their weight class."
Even with the profession's recent growth, the fact remains that the sheer lack of numbers means that the vast majority of people will never in any foreseeable future receive care from naturopathic doctors.
So, what, in this context, is the best answer strategic direction for the maximum contribution from the naturopathic profession?
4. Naturopathic Leadership in Whole System Research, Integrative PCMHs, Policy and Academic Consortia
Naturopathic contributions to the new medicine does not end here. Naturopathic researchers are pioneering whole practice research strategies. Naturopathic clinical leaders are leading the demonstration of integrative patient-centered medical homes. Leaders in the profession's re-emergence were core contributors in forming the most significant interprofessional collaborations for the field: the Integrative Health Policy Consortium and the Academic Consortium for Complementary and Alternative Health Care.
The integrative model carried by the naturopathic physicians has led integrative medicine leader Tracy Gaudet, MD, the present director of the VA Office of Patient-Centered Care and Cultural Transformation to declare that "naturopathic physicians are a huge part of the solution -- [they] always have been."
Gaudet is right. These are foundational, standards-based contributions across the education-practice-research-policy continuum. Another observer now with the RAND Corporation, aware of the field's flyweight size, famously commented that"naturopathic doctors are fighting above their weight class."
Even with the profession's recent growth, the fact remains that the sheer lack of numbers means that the vast majority of people will never in any foreseeable future receive care from naturopathic doctors.
So, what, in this context, is the best answer strategic direction for the maximum contribution from the naturopathic profession?

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My answer: Magnify the potential of the profession to influence other professionals. Let go of concern for credit. Don't focus on requiring anyone to become a naturopathic physician.
Instead, promote adoption of naturopathic principles far and wide in clinical care of other health professionals. Apply the docere principle -- to teach -- to exporting the naturopathic therapeutic order (pictured above) into the clinical methods of other professions. Expand on what the profession is already doing in integrative and functional medicine. Teach people in other professional domains to problem solve with naturopathic principles.
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In 2010 The Lancet Report on Education of Health Professionals for the 21st Century urged radical shifts that are deeply consonant with naturopathic principles. Among these: attention to the determinants of health, focus on primary care, behavioral change, community health, and public health. The report urges that health professionals be educated as leaders who are, above all, "change agents."
Present evidence suggests that the naturopathic profession is proving itself a change agent of the first order. The values and philosophy, birthed of the standards, are now infused into practices of thousands who may have little awareness of these origins. That's mission work.
Following this line, the question for the naturopathic profession and for anyone who seeks to advance health-focused clinical models is clearly something like this: What are the initiatives and social investment that can multiply the profession's change agency work while also attracting allies that will advance the profession's guild requirements?
For many naturopathic doctors, burdened by MD-levels of student loan debt and a still wildly inequitable payment and inclusion practices, to strategically focus on anything other than a narrow guild strategy may seem utter lunacy.
I don't think so. Just the opposite. Go with the energy. Go with the mission. You? Got any ideas?

by John Weeks PHD