Long wait times. Symptom-managing treatments with side effects. A one-size-fits-all approach. An absence of nutrition education in medical school. The sinking feeling of a predatory financial system that seeps into healthcare and dentistry. These are among many issues Americans have with modern conventional medicine.
That's not to mention agricultural practices (pesticides, GMOs, tilling, monocropping) and city planning practices (fast food chains and walking- and bike-unfriendly neighborhoods), adding to the public health crisis of obesity, type 2 diabetes, metabolic syndrome, and cardiovascular disease.
Before the gut-brain connection became established in mainstream culture with names like Dr. Andrew Huberman, Dr. Rhonda Patrick, Dr. Berg, and Dr. Stephen Gundry, I remember as a teenager with acne reading an article written by a doctor that flatly dismissed a gut-brain link as pseudoscience. Many of us grew up drinking multiple glasses of milk daily to support growth, popping antibiotics for recurrent ear infections, pursuing 5 servings of bread and pasta per day, and eating pesticide-laden, low-nutritional fast food. Neuroimmunology research has established gluten, sugar, and dairy as causative agents of inflammation.
Understanding the critical interactions between the gut microbiota, the immune system, and the central nervous system, rather than spraying pesticides on our internal lawn and growing a monoculture, many of us are now on a journey to rebuild the shifts created by a commercial society filled with toxins and toxicants.
It's time for a probiotic revolution.
Holistic healthcare of the future
To move towards a comprehensive, functional medicine approach, holistic healthcare will have to accept its shortfalls and move towards a more efficient, effective, safer, and less expensive system. That will involve several key considerations:
Main problems with modern healthcare
The current Western medical paradigm has been heavily shaped by industrialization. Some major problems with healthcare include:
1. Reactive and episodic
Health is not a one-off deal but a continual pursuit. Patients typically present to the doctor with a bothersome symptom such as pain, and they are promptly prescribed medication without much thought. Instead, healthcare should be proactive, preventive, and emphasize lifestyle interventions.
The opioid epidemic, antibiotic overuse, and other medical practices have contributed to chronic disease. 17% of Americans take 3 or more prescriptions. These are often last-generation, expensive, quick fixes that manage symptoms, have unpleasant side effects, and don't functionally target the disease drivers or health promoters. Functional, personalized, precision molecular medicines are needed.
3. Medical error
Doctors and other HCPs often work over 8-hour shifts, with 12- or even 16-hour shifts being common practice among nurses. Fatigue and stress increase the likelihood of mistakes and decrease patient satisfaction (Stimpfel, 2012). Working shifts longer than 13 hours can triple the chance of medical error (Lockley, 2007).
According to some sources, medical error is the third leading cause of death in the U.S. (Makary, 2016). One study estimated that in the U.S., 210,000-440,000 deaths per year are due to medical error (James, 2013). Medical error can include errors in diagnosis, treatment strategy, or prevention. To have any hope of treating and preventing illnesses, we need to advance our causal models of the human body and uphold ethical occupational health standards for the healthcare workforce.
Doctors often have busy schedules, leaving little time for patient interactions. This can cause them to not listen as attentively, ask the right questions, or take their patients' concerns seriously. This is problematic because the patient is more familiar with their body and has more information and investment in their health than a third-party observer. The reality is, when interaction is minimized to a mere 5-10 minutes, the relationship doesn't have much room to grow. This rift can increase patient non-compliance or cause patients to switch healthcare providers.
5. Inefficient centralized data sharing
Although there is a massive amount of data, we still lack implementation of reliable, user-friendly data centralization platforms. Electronic medical records (EMRs) often don't have enough of the "right kind" of data that matters to the patient. Doctors don't have access to lifestyle data, and patients sometimes have poor access to their own medical records. When lifestyle data from health trackers like FitBit is sent to medical professionals, that data becomes HIPAA-protected, creating a gray area with regards to data integration and privacy.
In addition, even though you're entitled to access to your own medical records, some patients are charged for access to or copies of their own medical records. In New Jersey, for example, it is legal for health care providers to charge up to $200 for hard copies of one's medical record, which can make it more difficult to switch doctors.
Now that we have identified some current limitations of the medical industry, let's talk about opportunities for growth in healthcare.
Future Directions of Functional Medicine
Some promising avenues of medicine include:
1. AI and machine learning in diagnostics
Artificial intelligence (AI) could manage mountains of data, even unstructured ones like brain scans and voice recordings. If you can teach a computer pairings between charts and disease states, you can quickly pin down possible diagnoses based on imaging such as MRI, PET, CT, angiography, x-rays, next-gen dental digital imaging, or DEXA bone density scans, bloodwork, and other biometric data.
2. Multi-omic sequencing for personalized disease prevention and disease-modifying lead generation
Information on mutations that affect absorption (e.g. in certain intestinal cell transporters) could allow doctors to advise patients on dietary or nutraceutical interventions. Sequencing could also identify genetic risk factors and help personalize lifestyle interventions. Genome, proteome, metabolome, and microbiome sequencing methods like RNA-seq and GeoMX digital spatial profiling can reveal the role of environmental factors in molecular and cellular function. Sequencing methods are becoming increasingly cheaper and more efficient.
3. Biologics and nutraceuticals
Plants, fungi, prebiotics, probiotics, postbiotics, and synbiotics will be key xenobiotic components of nutraceuticals. These therapeutics will be enhanced with R&D in science and biotechnology. Biotechnology solutions require skill in manufacturing, packaging, processing, and delivery. Training in biology, biomedical engineering, physics, and chemistry are in great demand. Areas of growing interest include biomaterials, 3D printing, formulations, and synthesis of biodegradable polymers, micelles, and nanoparticles to enhance absorption and therapeutic value.
4. Minimally-invasive surgery and advanced medical devices
Surgical techniques are improving, and as a result, surgical scars are shrinking. Nanotechnology allows the ingestion of tiny monitoring devices that can assist in diagnostics and surgical interventions. Medical innovations and scientific findings are cutting down on unnecessary procedures, and the risks and benefits are being more thoroughly analyzed and conveyed. AI is also being used in robotic surgery to minimize potential complications and postoperative pain. This shift towards decreased invasiveness will continue as surgical techniques advance.
On a related note, new technologies like Dia-Vit, GlucoWise, and sugarBEAT allow patients with diabetes to accurately track their blood glucose level without the painful finger prick. Products are undergoing testing, and the ones out on the market may still be expensive.
5. Expanded healthcare ecosystem to include functional medicine practitioners board-certified in nutrition
Allied health professions include medical doctors (MD), osteopathic doctors (DO), dentists (DDS), chiropractors (DC), naturopathic doctors (ND), physician assistants (PA), nurses (RN or NP), and physical therapists (PT). The healthcare ecosystem is expanding to fill unmet needs, including psychologists (PsyD), research scientists (PhD or MS), board-certified functional nutrition coaches, dietitians (RD), nutritionists, personal trainers, massage therapists, and acupuncturists.
Important partners for these healthcare practitioners may include hospitals, clinics, health insurance companies, funding sources like government agencies, venture capital, and nonprofit research foundations, manufacturers (for pharmaceuticals and nutraceuticals), contract research organizations (CROs), diagnostic data science companies (such as genetic or microbiome sequencing, hormone tests, telomere analysis, or bloodwork), fitness gyms, and wellness spas.
6. Informative, user-friendly digital interface
Healthcare providers, researchers, and patients need to articulate their needs and identify what's missing from current technology. IT experts need to understand the needs of users and come up with and implement creative solutions.
Patients want something consistent that will allow them to quickly and conveniently log lifestyle factors such as diet, exercise, sleep, water intake, health conditions, and menstrual cycles. Wearable health devices, such as FitBit or Apple Watch, already offer this technology. The next step is more advanced monitoring, such as skin cortisol levels, and widespread integration. If wearable health devices are synced with electronic medical records, the data could be assembled into a more comprehensive picture of patient health. Data could also be used, with patient consent, to make new findings that could directly benefit the patient and other people.
Health insurance companies could also incentivize preventive lifestyle behaviors through fitness trackers, offering lower rates for individuals as their biometric data indicates more exercise, better sleep, or otherwise increasing health. This would have to be done with care to promote patient privacy while also not becoming discriminatory.
Overall, medical technology is advancing in the direction of patient and consumer demand--that is, towards more holistic modalities that also maintain efficacy.
As our scientific understanding of the human body becomes higher-resolution, healthcare is becoming more proactive, preventive, lifestyle-oriented, functional, personalized, precise, and accurate.
Therapeutic time-to-market is decreasing due to advancements in multiomics technology and high-throughput tissue- and cell type-specific patient data analytics. Nutraceuticals are becoming more bioavailable and easily absorbed with facilitated localization to target tissues to have the desired functional therapeutic effect due to discoveries in biomedical sciences, biomedical engineering, and formulation science.
Healthcare is taking on a more personal approach, with healthcare practitioners spending more time with patients going over their diagnostic data. Vibrational technologies employing electromagnetic (light) and sound frequencies are being used as innovative cancer treatments, with lower side effects and toxicity to the patient than chemotherapy and radiation. Surgery is becoming less invasive and less necessary.
Healthcare practice is expanding as an ecosystem of professionals all with investment in patient and consumer health. Overall, all these changes are expected to advance public health for the better.