Bill and Hillary Clinton embrace the quackery that is functional medicine

This might look somewhat familiar to people, but I have a good excuse. Yesterday was Easter, and, although by no stretch of the imagination can I be accused of being particularly religious, we still did have family to visit. Add to that the fact that I have a two talks to give today that as of Friday night I hadn't even started working on (OK, two versions of the same talk, which makes it perhaps 1.5 talks), and a little—shall we say?—creative recycling is in order. Even so, if you don't follow the other locales where my written meanderings may be found, it'll still be new to you. It all started while my wife and I were sitting back perusing the newspapers yesterday morning. Reading the trusty iPad version of the New York Times, I saw an older article that just demanded my attention. (In blogging, a week old might as well be a year, if you know what I mean.) So I provided it, figuring better late than never, at least in this case.

The NYT article appeared, appropriately enough, in the Fashion & Style section, not the Health section, and is entitled "He Tells the Clintons How to Lose a Little. Dr. Mark Hyman: Advising the Clintons on Their Health." It's written by Amy Chozick, a reporter I've never heard of, probably because I know the names of most, if not all, of the health reporters for the NYT and national news outlets, but am blissfully unfamiliar with reporters covering the fashion and style beat. Actually, it turns out that Chozick is a political reporter "with a focus on covering Hillary Clinton." If I were a journalist, I'm not sure I'd want to make my name in my chosen career by focusing on covering one person, much less Hillary Clinton, but then I'm not Amy Chozick (obviously). Equally obviously, Chozick's focus isn't on covering health, as her article quickly makes abundantly clear.

The article demonstrates one thing, and that's how good Dr. Mark Hyman is at schmoozing powerful celebrities like the Clintons. In fact, after reading this story, I'm less likely to be supporting Hillary Rodham Clinton for President in 2016, because the article makes it clear that the Clintons are Hyman's friends and that they rely on him for advice with respect to health matters, including, increasingly, health policy. If she's elected, it wouldn't surprise me in the least if Hillary Clinton taps Hyman as a health advisor. For all we know, she might make him Surgeon General or give him a major advisory role in health policy. It all apparently began not long after Bill Clinton had his quadruple bypass surgery ten years ago. Hillary Clinton apparently found Hyman—how, it's not clear—and viewed him as a "30th anniversary present" to her husband designed to keep him healthy after his health scare:

One of the first things Dr. Hyman did was to wean Mr. Clinton off his previously prescribed vegan diet. Despite persistent news media reports that he is vegan, Mr. Clinton does occasionally eat fish and lean protein. “It’s hard being a vegan to eat enough good, quality protein and not have too much starch,” Dr. Hyman said over lunch at the Four Seasons restaurant in New York. “I know a lot of fat vegans.”

Dr. Hyman, who made a name for himself advising the moneyed urbanites who retreat to Canyon Ranch in Lenox, Mass., met Mrs. Clinton at a fund-raiser in New York when she was in the Senate. The two quickly dived into a wonky conversation about childhood obesity and his philosophy of healthful eating. “She then called me and we’ve just become friends,” he said.

If there's anyone who embodies the concept of "integrative medicine," in which pseudoscience and unscientific medicine are "integrated" with science-based medicine and innocuous advice like eating more vegetables and fish, it's Dr. Hyman. As the article points out, he is known for practicing "functional medicine," but what the article does not point out is exactly what "functional medicine" is. Actually, that's not a straightforward question, because what constitutes functional medicine has never been clear to me, although it's clear that a lot of it is pseudoscience. Let's see what Chozick says about it:

His latest book, “The Blood Sugar Solution: 10-Day Detox Diet,” a sequel to his best seller “The Blood Sugar Solution,” provides a 10-day cleanse for quick weight loss, but the splashy promise of pounds shed is mostly a way to get readers to quickly experience the benefits of healthy eating, he said. “Writing books, you kind of have to come up with the way to get people’s attention. I would probably call it something different if I had a choice.”

More broadly, he embraces a wellness philosophy called “functional medicine,” or the practice of addressing the root causes of chronic diseases (from diabetes and arthritis to insomnia and fatigue) through dietary and lifestyle changes, rather than diagnosing them and prescribing traditional medicine to treat the symptoms. Weight loss is a nice side effect, he said.

And:

“He did amazing blood work on me and a lot of other people I know,” Mr. Clinton said, adding that it all started with “a very sophisticated biomedical analysis and he basically gave them their whole lives back.”

I note that "sophisticated" doesn't necessarily equal science-based, as you will see.

What is this "functional medicine" thing, anyway?

I'll get straight to the point (unusual for me, I know). Functional medicine is pure pseudoscience, as the eminent Wally Sampson has explained. It postulates “imbalances” in hormones and neurotransmitters, oxidation-reduction, detoxification and biotransformation, immune function, inflammation, and cell structure. It’s all so vague that these “imbalances” could mean almost anything, and when practitioners of “functional medicine” refer to them, they usually do. Arguably the most famous practitioner of “functional medicine” is Mark Hyman, known for creating “UltraWellness,” the very name of which should tell you pretty much all you need to know about functional medicine. Indeed, it just seems to be a label used to encompass a whole lot of alternative medicine practices being "integrated" with real medicine. As Wally Sampson put it:

Functional Medicine – What is it?

After extensive searching and examination, my answer is still – only the originators of “FM” know. Or, at least one must assume they know, because so far as I can see, I certainly see nothing that distinguishes “FM” from other descriptions of sectarian and “Complementary/Alternative Medicine” practices. A difference may lie in the advocates’ assumptions to have found some “imbalance” of body chemistry or physiology before applying one or more unproved methods or substances. From what I could determine, the “imbalance” or dysfunction is usually either imaginary or at least presumptive. And the general principles are so poorly defined as to allow practioners vast leeway to apply a host of unproven methods.

Indeed, I haven't been able to figure out what, exactly, distinguishes functional medicine itself from quackery, as functional medicine recommends treatments full of supplements, dietary manipulations, and “detoxification.” It's the sort of treatment that practitioners of "autism biomed" quackery, chiropractors, and naturopaths love, in which “imbalances” must be measured through a battery of lab tests and corrected with whatever woo functional medicine practitioners can dream up. That, very likely, is what constituted that battery of "sophisticated" blood work that so impressed the Clintons, rather than any actual science. Of course, when you don't understand medicine or science, any battery of blood tests with levels of lots of blood components with fancy names being tested, accompanied with science-y sounding explanations of what the results all mean, will often seem hugely impressive. Even seriously sophisticated people in other realms will often be taken in. Actually, it's often those very sophisticated people who are most impressed because they think they understand when they don't. The Dunning-Kruger effect and motivated reasoning can indeed affect even people like the Clintons—or maybe especially people like the Clintons. After all, it is the most intelligent people among us who are most skilled at making arguments and (often unconsciously) cherry picking data to support our own arguments, particularly lawyers like Bill and Hillary Clinton. Sadly, functional medicine has even found its way into academic—or, as I like to put it these days, quackademic—medicine.

But, let's get back to the question: What, exactly, is "functional medicine," anyway? I thought it was worth going straight to the source, the Institute for Functional Medicine (the chair of whose board of directors is—surprise! surprise!—Mark Hyman), to find out how much, if at all, functional medicine has changed since the last time I looked into it. If you take a look at the IFM's page What Is Functional Medicine? you'll see quite rapidly that it's a very nice package of woo "integrated" with sensible science-based advice, all tied up with a rhetorical bow of buzzwords common in "complementary and alternative" medicine (CAM) and "integrative medicine," buzzwords and catch phrases such as:

• "Patient-centered care," which is touted as "personalization" of medical care and "listening to patients," in which " functional medicine supports the unique expression of health and vitality for each individual," whatever that means.
• "Understanding the origins, prevention, and treatment of complex, chronic disease," again, whatever that means, given that the functional medicine view of the origins, prevention, and treatment of complex chronic diseases tend to resemble the science-based view of the origins, prevention, and treatment of complex chronic diseases only occasionally, and then only by coincidence or through the co-opting of SBM paradigms as somehow being "alternative" and "functional" (because, you know, alternative and functional are cooler).
• "Integrating best medical practices," which is, of course, the "best of both worlds" fallacy.

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.

It all sounds well and good—on the surface, that is. 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 pointed out five years ago, "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.

Of course, it's a typical massive straw man to claim that, somehow, functional medicine treatments—or whatever "alternative" or "integrative" treatments you care to name—are "individualized," and science-based medicine is not. It's actually rather amusing to contemplate that over the last ten years there has been a large move towards what has been called "personalized medicine," based on genomic profiling and other tests but that the movement has been renamed to "precision" medicine. The reason? To paraphrase the National Research Council report on precision medicine, "precision medicine" refers to tailoring the medical treatment to the individual characteristics of each patient. It does not literally mean the creation of drugs or medical devices that are unique to a patient but rather the ability to "classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment," thus allowing the concentration on those who will benefit, "sparing expense and side effects for those who will not." The NRC also points out that the term "personalized medicine" is also used to convey such a meaning but that the "term is sometimes misinterpreted as implying that unique treatments can be designed for each individual." In other words, "precision medicine" just slices groups of patients with a disease into smaller and smaller categories for purposes of deciding therapy, not to the point where each patient gets a different treatment.

In contrast, as I've described before, in the world of alternative medicine, be it "functional medicine" or whatever, the "individualization of treatments" and a "holistic approach" tend to mean "making it up as you go along" or, basically, whatever the practitioner wants them to mean.

I like to quote Humpty Dumpty from Lewis Carroll's Through The Looking Glass:

"When I use a word," Humpty Dumpty said in rather a scornful tone, "it means just what I choose it to mean — neither more nor less."

"The question is," said Alice, "whether you can make words mean so many different things."

"The question is," said Humpty Dumpty, "which is to be master — that's all."

Functional medicine practitioners are masters of bending language to their wills, just like Humpty Dumpty, and to them "individualized" or "personalized" medicine means whatever they want it to mean, as Wally Sampson has described again and again and again and again. It's a pseudoscientific medical "specialty" that mixes dietary recommendations both reasonable and quackery-laden with the treatment of nonexistent or inadequately-validated "imbalances" in various nutrients and hormones in the body

Perhaps, you think, I paint with too broad a brush. Maybe Dr. Hyman is different. So let's look at what he does.

Dr. Hyman, revisited

If there's one thing I've learned in the world of woo, it's that one of the fastest ways to find out what a practitioner is doing—actually doing—is to head on over to his website. Dr. Hyman actually has at least two. First, there's his own website, which has its own store. Then there's his UltraWellness Center, apparently because "wellness" isn't enough and "ultrawellness" is so much better—so much more "ultra." From the UltraWellness Center website, it didn't take long for me to find a link to the website for Dr. Hyman's latest book The Blood Sugar Solution 10-Day Detox Diet. It's endorsed by Dr. Oz and Dr. Amen, so you know it must be good woo, and on that website there was a link to a quiz to determine whether you need "detoxing." Here it is:

Do You Need to Detox?

1. Do you crave sugar and carbs?
2. Do you have belly fat?
3. Do you have trouble losing weight?
4. Do you have FLC syndrome (Feel Like Crap – fatigue, brain fog, digestive issues, mood problems, allergies, joint pain, skin problems, autoimmune disease)?

If you answered YES to even ONE of the above questions, keep reading.

Yes, apparently if you crave sugar and carbs, have a bit of belly fat, have trouble losing weight, or feel run down, you need detoxification! A naturopath couldn't have said it better! At least 75%, if not much more, of the adult population is likely to answer "yes" to at least one of those questions; so apparently everybody needs "detoxification." And, of course, Dr. Hyman is right there, ready to sell you the supplements you need to detoxify, including his PureLean Pure Pack, PGX Fiber, and Vitamin D3, which, or so Dr. Hyman claims, can do these wonderful things for you:

The 10-Day Detox Diet Basic Kit includes all of the supplementation needed to support healthy blood sugar balance while on the 10 initial days of the program or the basic plan after transition. The unique combination of supplements in this kit is designed to provide a foundation for cellular sensitivity to insulin as well as sustain the metabolism of fats and sugars. This bolsters healthy metabolism, blood sugar balance, cholesterol levels, and more. These supplements should be taken every day for the rest of your life for maximum effect.

So what's in these supplements? The PureLean Pure Pack includes:

• Multivitamins and minerals
• MacularSynergy Complex, which is described as a "proprietary blend of lutein and zeaxanthin—two of the most crucial nutrients for macular function."
• Metabolic GlycoPex, described as a "unique combination of alpha lipoic acid, cinnamon, and l-carnosine provides critical antioxidants and phytonutrients that help improve insulin sensitivity, scavenge free radicals, and support healthy blood sugar levels."
• Metabolic LipidPlex, described as a "special blend of green tea catechins, taurine, and more supports insulin sensitivity, healthy fat burning, and metabolism."
• Alpha Lipoic Acid with GlucoPhenol, described as "useful in supporting healthy nerve function in those with diabetes and pre-diabetes: and a "powerful antioxidant and mitochondrial booster."
• Omega-3 Fats, described as "crucial for healthy cardiovascular, nervous system, and immune function."
• Magnesium
• Taurine, described as a "powerful antioxidant" that "supports healthy cardiovascular, nervous system, skeletal muscular, and retinal function."

Not only is Dr. Hyman a basic supplement hawker, but he sells PGX Fiber, which is widely touted as a fiber that expands in the stomach to produce a feeling of fullness, alleviating hunger pains, the idea being that if you take 2 to 5 g of it before a meal you will eat less. I did a quick PubMed search for the fiber and found a smattering of in vitro studies, rodent studies, and preliminary clinical studies (small pilot studies and a small randomized trial) suggesting that PGX might be useful for such purposes, but nothing particularly compelling. That's better than the evidence base that exists for the average supplement, but nowhere near enough to advocate widespread use of the supplement for "detoxification" and lowering cholesterol and glycemic index of foods. Like most supplement hawkers, Dr. Hyman runs ahead of the evidence. But, hey, if you buy his 10-Day Detox Diet Starter Package, he'll give you a 10% discount on your first order of The Blood Sugar Solution 10-Day Detox Diet supplement support kits. You'll need it, given that the supplements above cost $140 for a four week supply. To ease the anxiety over the price, you might want to buy some of Dr. Hyman's UltraMind (sounds like a supervillain) supplements to calm your mind. Certainly, I was tempted to do just that after reading Dr. Hyman's claim that the laws of thermodynamics "doesn’t apply in living, breathing, digesting systems." That might require a post of its own sometime.

Or maybe I need Dr. Hyman's Thyroid Support Kit or his Essentials Kit for Men, the latter of which he tells me "should be taken every day for the rest of your life for maximum effect." Of course it should. I've always wondered why it's considered so unethical and such a conflict of interest for physicians to sell medications that it's illegal under most circumstances, but to the "integrative medicine" and alternative medicine crowd it's apparently perfectly fine for a physician like Dr. Hyman (or Dr. Joe Mercola or alternative practitioners like naturopaths) to manufacture and sell the very supplements they prescribe to their patients, even going to the point of recommending supplements without pointing out that they own a supplement company. Perhaps Jann Bellamy can help me out with that one. (Stay tuned.)

In any case, we can see the consequences of how Dr. Hyman defines and treats disease in several examples, such as an article in which he touted anecdotal evidence for the "personalized treatment" of dementia, in which he actually had the temerity to paint current medicine as "obsolete," like bloodletting or phrenology, and touts functional medicine as finding the "true cause" of disease. It's rare to see a case of such massive projection outside of the antivaccine movement. Indeed, Dr. Hyman has been known to engage in a bit of germ theory denialism, stating:

We are the same – we need to have a healthy soil or terrain in order to be healthy.

In fact, Louis Pasteur on his deathbed realized this – and it is the terrain, NOT the germ, that is the most important determinant of health.

This explains why giving zinc to malnourished children in the third world can reduce death from infections by over 75% – it doesn’t stop exposure to the bugs, but zinc boosts immunity, helping the children stay healthy.

So by believing in this “germ theory” of disease, medicine has ignored one of the most important scientific ideas of the last century – that our health is determined by the interaction of our genes and our environment.

Anyone who cites the myth that Louis Pasteur somehow "recanted" germ theory on his deathbed is deep into germ theory denialism. Hyman was also attacking a straw man, in that science-based medicine already does take into account the "terrain," which can modify susceptibility to disease, be it infectious disease or other diseases. Much of the rest of what Dr. Hyman teaches when he gives his course of functional medicine includes the usual alt-med claptrap, such as a woo-ish take on inflammation, hormones, gut and digestive health, mind-body interactions, mitochondrial metabolism, and, of course, detoxification, the other One Quackery To Rule Them All (other than homeopathy, of course). Indeed, take a look at the brochure for the Institute for Functional Medicine 2014 course on detox. (Seriously, it's offering a course on detox.) It's chock full of detox pseudoscience, with competencies to be acquired including understanding the "synergistic" effects of toxins, developing "personalized dietary protocols to support detoxification and elimination pathways," and applying "various nutraceuticals, botanicals, pharmaceuticals, and lifestyle interventions to increase mobilization, biotransformation, and elimination of toxic compounds in the body."

I thought I was reading an outline of a naturopathy course.

Such proclivities routinely lead Dr. Hyman to do things like mangle systems biology and cancer research. He's even appeared to ascribe to the antivaccine view that vaccines cause autism, without, of course, explicitly saying that vaccines cause autism—although he does support all sorts of "autism biomed" quackery for autism and recently has been Tweeting support to antivaccine crank Robert F. Kennedy, Jr. He's also been known to criticize science-based medicine as being "for sale" based on a paper that doesn't really provide compelling evidence to support such a conclusion, all the while neglecting to note that he has minimal to no evidence to support the supplements he sells and that he sells the very supplements that he recommends.

Conclusions

These days Dr. Hyman appears to be becoming more and more well-known. For example, Chozick's article mentions that Dr. Hyman has recently appeared on The Dr. Oz Show. I was half-tempted to look up the episode and see what sorts of woo he discussed with Dr. Oz, but this post has already grown long enough. Actually, I did look up the videos (part 1, part 2, part 3). Maybe I'll do a full post on them if I can stand to watch. In any case, apparently he's touting something now that he calls "diabesity," apparently a term that Dr. Francine Kaufman coined in 2008 for a book. It refers to the combination of type II diabetes and obesity, for which he combines reasonable recommendations (avoiding processed sugars) with unsupported recommendations ("detox" from your "addiction" to carbohydrates), opining that "diabesity can be caused by or worsened by many things: inflammation, environmental toxins, gut problems, hormonal imbalances and nutritional deficiencies" and that "customizing the program according to your specific triggers will help you get the best results." Of course.

Unfortunately, Dr. Hyman appears to be one of those "integrative medicine" doctors who's very good at sounding reasonable as he "integrates" pseudoscience and unsupported medical modalities into science-based medicine. He gives the game away by the way he attacks science, touts anecdotal evidence over science, and subscribes to ideas based on prescientific thinking, such as "detoxification" and "imbalances" of hormones, vitamins, and nutrients that could easily be imbalances in the four humors or the five elements. Particularly depressing was this passage from Chozick's article:

These days conversations with the former first couple usually focus on the functional-medicine movement and health policy, Dr. Hyman said. And he has spent time working with the pastor Rick Warren on “The Daniel Plan,” a diet based on community and biblical principles that helped 15,000 of Mr. Warren’s congregants at the Saddleback Church in Lake Forest, Calif., lose a combined 250,000 pounds. “We have the knowledge to relieve needless suffering for millions of people,” Dr. Hyman said. “People like Hillary get it, Bill gets it.”

Before she left the State Department, Mrs. Clinton invited Dr. Hyman to her Washington home to discuss working on health-related issues at the Bill, Hillary & Chelsea Clinton Foundation.

Pastor Rick Warren? A diet based on Biblical principles? And this is the guy who, if Chozick's article is to be believed, seems to be Hillary Clinton's primary advisor on health and medicine? This is disturbing indeed.

If Hillary Clinton is the Democratic Party nominee in 2016, I'm likely to have a real dilemma. Should I vote for her, knowing that she's likely to appoint people like Dr. Hyman to health policy positions? It won't be an easy choice, because, to me, at least none of the current likely Republican candidates with a shot at becoming the nominee is acceptable—and for so many more reasons than just having a health advisor who is the world's most famous practitioner of the woo known as "functional" medicine. Yet, there you have it. Say what you will about Hillary Clinton, before meeting Dr. Hyman, she didn't use to be into what I would consider woo, at least not as far as I can tell. I was half-tempted at the beginning of this post to crack a lame joke about how Hillary Clinton, when she found Dr. Hyman to take care of her husband, wasn't actually trying to keep him around for decades to come at all, but then I thought better of it. The reason is that she clearly does take Dr. Hyman and his functional medicine woo seriously, just as Senator Tom Harkin took a lot of alternative medicine seriously and Representative Dan Burton took the antivaccine view that vaccines cause autism seriously. Does she take him seriously enough to try to take his ideas and implement some of them in her health policy if she ends up being elected President in 2016?

I don't know, but we might find out.