In the muddle of all these healthcare reforms, a few things have become starkly obvious. The rising cost of healthcare cannot be met with current levels of public funding. This means that as GPs we are going to become more important as gatekeepers, but we are also going to have to focus a lot more on preventive rather than curative medicine.
But what does preventive medicine actually mean? Most of what we were taught at medical school was the acute care approach, and most of us are not adequately trained to apply strategies such as nutrition, diet, and exercise to both treat and prevent these illnesses in our patients. Preventive medicine services, as such, barely exist, and we need them now more than ever.
What is functional medicine?
Learning about the approaches taken in different countries can be very useful and this is where functional medicine comes in. Functional medicine is a system of preventive medicine used in the US, said by some to be ‘the single biggest game changing idea in health care'.
A quarter of participants on functional medicine courses in the US are GPs. Functional medicine is virtually unheard of here in the UK, although internationally more than 100,000 practitioners from 69 countries have been introduced to the principles and practices and faculty from one-fifth of all medical schools in America and physicians from 44 countries have had some training in functional medicine.
So what is functional medicine? Let’s start with what it's not: it is not alternative medicine. It is a stepping stone to a more effective chronic care model that looks at the roots of illness, namely the gene-environment interaction. It recognises that our genes determine our response to environmental factors, and that by changing the environment we change the genetic expression.
|HOW FUNCTIONAL MEDICINE WORKS|
Areas studied in functional medicine
In functional medicine the idea is to responsibly incorporate clinical research related to physiology mechanisms and interactions, case studies and pharmaceuticals into clinical practice. Functional medicine is based on nutrition and biochemistry and looks at amino acids, minerals, vitamins, fatty acids, the ecosystem in the bowel, neuro-biochemistry and our immune system.
It connects physiological symptoms and reminds us that none of the organ systems work in isolation, but that we should always be thinking about how diseases are connected: for example, the insulin resistance of diabetes contributes to the inflammation involved in arthritis.
What do GPs say about functional medicine?
GP Dr Amrti Thakar who has trained in functional medicine says: 'I was already interested in underlying causes of disease having done a biochemistry degree and being a research active GP practice. The functional medicine course would suit GPs wanting to develop a special interest/qualification that could be used for private practice. It is difficult to apply in NHS general practice because of time constraints and limitations in lab testing in local hospitals.
'Nutritional therapists with training in functional medicine may have a role in general practice but again there are constraints as they are not officially regulated so appointing them becomes logistically difficult. However, some of the information especially about nutrition and genetics already has current application.'
What does the training involve?
Certification in functional medicine requires completion of an Applying Functional Medicine in Clinical Practice (AFMCP) course, six individual functional medicine advanced practice modules and successful completion of written examination following completion of AFMCP and APMs.
The five-day AFMCP course is being run in the UK on 30 April 2012 and it is highly practical: by the end of the week it will literally give GPs all the tools necessary to put preventive medicine straight into practice.
For GPs thinking about setting up a preventive medicine service, particularly in the private sector, then training in functional medicine is something to consider. Functional medicine can provide the framework GPs need to make patient-centred diagnoses, look at the concepts of antecedents and triggers and develop treatments using diet, lifestyle, nutrient, phytonutrient, mind/body, and pharmaceutical modalities.
- Dr Arasu is GP in west London