How do I express my concerns about functional medicine to my wife?
August 15, 2019 7:04 AM   Subscribe

Is "functional medicine" as woo as it seems? Are there doctors who take this approach but keep it science-based, or is the unproven stuff (acupuncture, essential oils, herbal medicines) part and parcel of the approach? And how can I (or should I) keep my skepticism in check if my wife pursues this line of treatment?

My wife has struggled with generalized depression and fatigue for a few years now. She has been on a couple of different antidepressants (Wellbutrin, Trintellix) during this time, but it's unclear to me how much they have helped. She has also been engaging in group talk therapy, and we recently started going to couples counseling with the same therapist she attends the group session with. Her medication has been prescribed by a psychiatrist who my wife sees every couple of months. As far as I can tell, her current psychiatrist practices what I would consider "conventional medicine".

At a recent session, our therapist recommended a local psychiatrist who practices "functional medicine". I hadn't heard of this approach before, and the web searches I've conducted have been disheartening. Most results seem to be either from practitioners touting the benefits of their approach, or from skeptics who basically think it's alternative medicine in a fancier suit. I have a scientific background myself, and the criticisms leveled by the skeptics seem pretty well-founded to me. So I'm worried that she'll be hooked in by a charlatan who sells her a bunch of nostrums that don't actually help.

At the same time, I want to be supportive and help my wife get well, and I don't want to be unsupportive if she (and our therapist) think this will help. Part of me is wondering whether to just let her proceed with this line of treatment and see if the placebo effect does its thing. But of course, these treatments are not generally covered by our insurance; the psychiatrist recommended by our therapist is out-of-network, perhaps for good reason. So if she/we pursue this, I'm worried that we'll just end up in the same place but with a smaller bank account.

So my questions are:
  • Are there articles out there in the popular press that talk about functional medicine and its efficacy (or lack thereof)? I've gotten the impression that clinical trials of functional-medicine treatments are too much to ask, but if these actually exist I'm all ears.
  • Are there functional medicine practitioners out there who limit themselves to the science-validated stuff (psychotherapy, yoga, meditation, medications that have passed clinical trials, nutrition & exercise)? Or does the "woo" come standard?
  • How do I (or should I) express these concerns without coming off as unsupportive?
[As an aside: I feel guilty for not having gotten more involved in her treatment before this point. Suffice it to say that my focus over the past few years has been on my career (for reasons that I won't get into here), and that this has been a bit of a wake-up call for me. This also means that my description above of my wife's health situation is probably sketchier than it should be.]
posted by anonymous to Human Relations (21 answers total) 10 users marked this as a favorite
 
My sense is not all functional medicine practitioners are created equal, but I see a psychiatrist who loosely bills himself that way, and he is not very "woo" at all. I expected way more woo, actually. At the moment we're working together on a plan that includes both a conservative approach to meds for my ADD and anxiety and more lifestyle-related changes like supplements/dietary changes/exercise/mindfulness/etc. He's probably my favorite doctor ever; I adore the fact that he's not a meds pusher and is really looking at my whole person, including the soul side. I feel like he's invested in helping me make sustainable changes, too. It works for me.
posted by gold bridges at 7:15 AM on August 15 [4 favorites]


Is there a reason you think your wife isn’t capable of sussing this out on her own over time?

Is there a reason your post doesn’t describe what she’s thinking or feeling about this suggestion?

I’m not saying that you shouldn’t weigh in. I am saying that she should weigh in first, and most, and last. So: start with your wife, then decide if you actually need to engage in the intellectual work you’re proposing to do for her here, or if she’s got that covered.
posted by suncages at 7:38 AM on August 15 [29 favorites]


Kudos for getting more involved and changing your attitude to your wife's illness. But this kind of seems a little bit like your guilt talking, trying to cast blame anywhere else but on yourself. Harsh words from an internet stranger, I know, but also the clearest conclusion based on the information you chose to share here. If it is true, then put your own feelings aside and concentrate on helping your spouse.

Functional medicine is overtly scientific in its approach. It is also really nothing more than the ancient medical idea to treat the whole patient instead of focusing on individual specific health problems while ignoring larger system-wide issues. It is what every primary care physician should also be doing whenever you meet with them. By another name, it is the difference (along with a few bone manipulation classes) between MDs (Medical Doctor degree) and DOs (Doctor of Osteopathy degree). Both medical degrees are accepted as physicians by the AMA.

Of course there are probably functional medicine practitioners who are not good, or who are jumping on the bandwagon of popular movement without understanding it. That's human nature. But the philosophy as a whole is differentiated by its rigorous scientific approach. You also asked for FM experts with impeccable scientific focus-- two I like are Robb Wolf and Chris Kresser.

For me the best iteration of functional medicine is where you work with a medical professional who does individual, detailed custom testing of your body's systems-- blood tests most doctors do not understand or routinely order-- and then work with you to explain and interpret the results. They also focus on better integration of diet and physical movement into your health plan, including things like gut biomes that are just beginning to be understood better. The older a doctor is, the less he or she likely knows or cares about nutrition. Even today, in more than 15 years of professional medical education, most doctors get less than 50 hours of training on nutrition. If a functional medicine advocate isn't doing that for you, and is focusing on "woo", then you don't want anything to do with them.

I wish you success in helping your family member. Remember, I am an internet stranger who doesn't really know you, and I could be completely wrong. Do you own research from reputable scientific sources like NSF and PubMed. That is also the advice any good FM practitioner would tell you.
posted by seasparrow at 7:43 AM on August 15 [6 favorites]


I would not assume functional medicine is in itself a red flag.

Here’s a brief story. I see an oncologist for my cancer, but I also made an appointment with a naturopath. He made a number of lifestyle recommendations. When I got home, I looked them up on PubMed, and every single thing he recommended was backed by peer-reviewed research. Now are some naturopaths charlatans that push their own supplements? Absolutely. But I found out lots of helpful things that my oncologist didn’t know or didn’t tell me. Oncologists are trained in providing drugs, and that’s a super complicated and hard thing, but there’s much more to treating cancer. Taking an integrative approach can be empowering. I still have cancer, but I feel great, and I think the integrative approach has a lot to do with that. I also suffered from depression and fatigue for decades, and I no longer take medication for those issues. They just aren’t part of my life now.

With your scientific background, you should be able to research any specific recommendations.
posted by FencingGal at 7:44 AM on August 15 [15 favorites]


"Functional" means different things to different people.

In one sense, it's the integrative medicine approach that FencingGal references. Traditional medicine does a bad job at teaching nutrition; the 50 hours that seasparrow talks about is a massive overstatement; I think my own training in nutrition was a couple hours at best, all focused on nutritional deficiencies like scurvy and pellagra. If that's what you mean by functional medicine, that's fantastic. But at the other end of the spectrum, there is straight-up quackery like people who tell you to stuff jade eggs up your hoo-ha. Quackwatch is a really good resource for sussing out the latter.

I more commonly encounter it as a synonym for what used to be called "conversion disorder," as in functional neurological disorders or functional gut disorders. Relatedly, some doctors use functional to mean "I think this person is crazy" which is SO WRONG but is unfortunately prevalent. (Especially true for women.) Some non-doctors also call themselves functional neurologists, but do not treat what neurologists call functional neurological disorders, instead preferring to massage your scalp, phrenology-style, to relieve your problems (with about as much basis in science as actual phrenology.) That's very different from what you seem to be talking about, but just keep in mind that you might come across that version of "functional" in your reading online.
posted by basalganglia at 8:12 AM on August 15 [7 favorites]


"Functional medicine" is largely unscientific and unproven, with the "individual, detailed custom testing of your body's systems" etc. as a means of extracting money from your wallet with a veneer of respectability. On the other hand, as a complement to more traditional therapy, it is not necessarily harmful. Much like psychics, often "alternative" medicine practitioners really make their livings off of managing to appear attentive and concerned about the patient, which doctors tend to fail miserably at and which genuinely does alleviate at least some distress for a lot of people (and secondarily off authorizing people to care more about and giving practical advice on lifestyle, by which I mean, like, sleep, not incense). I would be very concerned about a seriously ill person who relied solely on "functional medicine," but as a supplement the main concern in most circumstances will probably be the cost.

But, regardless of the truth here--unless your wife is genuinely incapable of managing her own affairs, you have to let this be her decision within whatever framework you two have agreed to regarding significant expenses. And you also need to abide by whatever guidelines she's set for you regarding discussion of treatment decisions. Does she currently invite/expect you to do additional research on her situation? Or are you "butting in" here uninvited, maybe out of guilt from not having paid more attention earlier? Because here's the thing (I speak from professional experience here). If people want to believe bullshit, they will. Busting in with an uninvited critique that implicitly impugns their ability to understand the truth rarely helps, even if it is 100% true and accurate. So I actually think we here at Mefi can't advise you in too much detail, as we don't know how your marriage currently functions. Whatever you do, you can't appear to be doubting her mental capacity or overriding her decisions, except to the extent it involves spending money you two have agreed cannot be spent or some form of treatment that you genuinely believe is a real risk to her health (no drinking bleach!!!). Not only will that hurt her and your marriage, but it won't work.
posted by praemunire at 8:18 AM on August 15 [21 favorites]


cleveland clinic isn't very woo and they have a whole center.

even if it is woo, if it genuinely helps your wife, who cares?
posted by misanthropicsarah at 8:37 AM on August 15 [14 favorites]


Btw several specific acupuncture treatments and herbal medicines have mountains of scientific support, including meta-analyses etc.

It’s not so simple as ‘all herbal medicine is unscientific’. Plenty of it is unsubstantiated woo, but plenty is thoroughly vetted, down to the mechanistic details.

Anyway, talk to the practitioner in question. Their ability to offer evidence-based rationale and scientific resources for their specific methods is far more important than any general indictment or defense for a nebulous buzz word.
posted by SaltySalticid at 8:46 AM on August 15 [6 favorites]


My husband has gone through health fads and spent collective money on things that even he now admits were pretty woo. There's definitely a budget question to have here, and if you're concerned that she's foregoing other possibly more effective treatments.

But otherwise, her health is her health, right? She gets to manage it the way she wants. Vitamins, expensive running shoes, organic produce for fruit you peel, sugar in your Starbucks coffee...one hundred and eighty thousand other choices that adults make about their health every day, some of which cost money and some of which don't. Is this the hill you want to die on in your relationship?
posted by warriorqueen at 9:06 AM on August 15 [1 favorite]


Are there functional medicine practitioners out there who limit themselves to the science-validated stuff (psychotherapy, yoga, meditation, medications that have passed clinical trials, nutrition & exercise)? Or does the "woo" come standard?

That's an interesting list as psychotherapy, yoga, meditation, and nutrition have all have been seen as severely woo in their day. You'll also be interested to know that acupuncture is no longer considered woo for treatment of chronic pain. So after something has been effective long enough, studies start to happen and some of the "woo" does appear to become standard everywhere.

The placebo effect also has a much higher success rate than many prescription drugs, particularly in complex areas like depression and fatigue. You should probably accept it more than reluctantly. If it works, it works.

In any case I would suggest bringing your scientific skepticism to both sides of the table. While there is undoubtedly a lot of crap out there you would be amazed what has been studied and found to have some effect.

Speaking of studies, an extremely useful resource for medical studies is the U.S. Government National Institute of Health. They're the kind of outfit that makes me happy to pay my taxes.
posted by Tell Me No Lies at 9:23 AM on August 15 [9 favorites]


So I'm worried that she'll be hooked in by a charlatan who sells her a bunch of nostrums that don't actually help.

Is there a reason you believe your wife is likely to be taken in by a charlatan, as opposed to simply being willing to try alternative treatments as a way of supplementing her care in the hands of medical professionals?

I mean, I work in scientific publishing, which has recently been rocked by the reproducibility crisis (as in: they often can't), and while I certainly think clinical trials are GREAT, it is also kind of telling that you think they are the ultimate measure of whether or not a treatment works.

Off the top of my head, I can think of several relevant findings from fairly recent studies-- one that found evidence that some doctors decided to "prescribe" homeopathy (the garbage hit a bottle on a book kind) to patients who would otherwise be demanding antibiotics for common colds, and as a result cut down on unnecessary antibiotic prescriptions. One that found many people who practice yoga and tai chi don't even bother mentioning it to their doctors, because they think their doctors will accuse them of believing in "woo", even though the clinical benefits (and risks) of exercise are relevant to their health.

Also, the reason there haven't been clinical studies on many forms of "natural" medicine is because they are considered "unscientific", which is sort of self-defeating. Some folk remedies are bunk, sure. But some have been turned into clinical studies, which turned into proof they are effective-- yet it takes someone who suspects them to be effective to get funding for a clinical trial, and time, and finding measurable results--and with so many clinicians being taught that all folk remedies are bunk, getting all those conditions in place is kind of haphazard at best.

There is also the fact that what one skeptic considers "woo" might be what another considers "holistic medicine" or "discussing social determinants of health" or "spirituality" or "meditation" as opposed to just "windchimes and incense" (which might also be clinically valid, if someone wants to fund a study).

How do I (or should I) express these concerns without coming off as unsupportive?

Since you admit that you are coming off a hiatus of being fairly unsupportive via absence, and since the inherent biases in your question are...present, I would urge you to be cautious with your feedback. Your wife might try some stuff that does nothing, but she is unlikely to do anything that causes harm (as long as no one suggests a jade egg). I would wait until she actually has a functional medicine practitioner before you mention any of this, and you can simply join her in researching the person's practice. If their list of services is full of actively harmful practices, then maybe you ask about the possibility of finding someone else. But if their practice is full of normal alternative medicines that you personally do not find compelling and cost about as much as a night at the movies (as opposed to a used car), then I think the majority of your feedback should be asking your wife what she thinks about it.

If anyone wants to sell her certain types of classes, videos, pyramid schemes, etc, then sure, speak up. But I would only do so after being supportive about lower level stuff. Your wife probably already suspects (or knows) that you think all this stuff is bunk, and is dreading you scoffing at her willingness to try any of it. Telling her that you trust her to be discerning will go a long way.
posted by a fiendish thingy at 9:52 AM on August 15 [8 favorites]


I, too, am wondering why you have such a large role in determining what treatments your wife gets. Surely this is her choice and her decision? Even your phrasing seems to be off, e.g. wondering whether to just LET HER proceed with this line of treatment (capitalization mine)

Considering that you haven't been involved in her illness until now, I would advise you to step way, way back and let her do all the driving. If she asks you for help, e.g. "Honey can you please help me find out if there's any evidence for this treatment?" then come back here and ask this question about that specific treatment. Otherwise, your job is to be supportive of her process and her choices. Full stop. (Maybe there's an exception to be made when you believe the treatment will actively and directly harm her health, but that doesn't seem to be a possibility for anything you listed here.)

Important note: Please don't tell her or imply to her that she is likely to be hoodwinked! Also please don't tell her or imply to her that a treatment that she's interested in trying is likely to be wasteful or expensive! This is her body and *her health*. She doesn't need her formerly-absent SO to suddenly show up and start telling her how much money she is allowed to use up for her treatment.
posted by MiraK at 11:55 AM on August 15 [9 favorites]


even if it is woo, if it genuinely helps your wife, who cares?

I favorited this comment, and I want to share with you why; my SO was raised with eastern medicine, and has encouraged me over the years to try acupuncture, and the horrible herbs. I could never suspend my disbelief enough to wrap my head around these treatments, and consequently they've never worked for me.

Meanwhile, I've seen my chiropractor occasionally for nearly 30 years. I've always come away feeling better, while my SO simply does not believe in chiropractic care, and has never come away with a good experience.

So there is some measure in the efficacy of a treatment that lies within the patient's trust and belief in said treatment. To put it another way, to some degree, the success of a treatment is all in your (the patient's) head.

As long as the treatments don't become too unaffordable, I say let your wife explore various avenues until she figures out what works for her. You trying to talk her / logic her out of something may make her double down, and ultimately prolong her journey back to health. Were I you (and I actually do have a lot of experience in this arena wrt my SO), I'd make supportive noises ("oh, that's good to hear"; "let me know if I can help you with that") and otherwise refrain from comment.

Finally, fwiw, I am active in the mommy world and in the crunchy world, and I have never, not ever, heard anyone refer to essential oils as anything remotely related to "medicine" or "functional medicine". Alternative healthcare maybe, or something along those lines, but not medicine.
posted by vignettist at 12:05 PM on August 15 [2 favorites]


even if it is woo, if it genuinely helps your wife, who cares?
Steve Jobs could probably explain the major objection, except since he delayed real treatment trying woo, he died. But, that kind of sums it up. If you love your spouse, you worry about them falling into an ordinary cognitive trap and dying. Note that I am not addressing the issue of whether this thing is woo or not, just the question raised in the quote.
posted by Gilgamesh's Chauffeur at 2:09 PM on August 15 [6 favorites]


I am as unwoo as it gets -- I literally commented "yoga can suck a dick" the other day, because I personally hate it. But you need to examine your own prejudices here. The choices are not "Wellbutrin or placebo effect." There are peer-reviewed scientific papers you should take the time to find and read.

And also, you know, shit like acupuncture... the 40 minutes you spend face down on a table, doing nothing except maybe crying, may be the only self-care time someone gets in a week or a month. Nobody bats an eyelash when I spend the same time and same money getting a pedicure, you know?
posted by DarlingBri at 2:35 PM on August 15 [8 favorites]


Apologies if this is getting away from the actual question but as someone with epidemiology training and a science journalism background there are tons of peer reviewed studies that are not done very well for various reasons (small n, insufficient power or overpowering, poor data analysis methodology, lack of reproducibility). Not to mention predatory publishers and shoddy journals, which are hard to spot if you’re not familiar with the academic publishing landscape in a given field.

Just because there are one or two or even a small handful of studies you find on PubMed doesn’t really mean much - it’s easy to cherry pick one-off studies when we should be looking at bodies of evidence and scientific consensus around specific findings, particularly nutrition and medicine.

There doesn’t seem to be much research on FM per se but in a casual Google search I noticed several red flags, namely the “unconventional” diagnostic testing. If these tests were genuinely useful for medical treatment why would doctors and other public health researchers “hide” them? If FM practitioners “know” these treatments work than where is the data and publications showing how these biological mechanisms work? Especially when the open science movement has made it very easy and often free to open publish data and findings.

Asking patients to pay (likely out of pocket since insurance typically doesn’t reimburse for unproven medical tests or treatments) for unproven treatments strikes me personally as deeply unethical.

Interesting article that gets more in-depth on the diagnostic testing:
https://sciencebasedmedicine.org/bogus-diagnostic-tests/

That being said, many aspects of FM (the ones that are also often part of regular old conventional medicine) probably could help your wife out in some capacity, but you can go see experts certified in those specific areas! For nutrition look up a registered dietician (nutritionists do not have to complete training or certification the way dieticians do), a personal trainer, a licensed clinical social worker for talk therapy.
posted by forkisbetter at 4:53 PM on August 15 [5 favorites]


So I'm worried that she'll be hooked in by a charlatan who sells her a bunch of nostrums that don't actually help.

you did just say she's already been sold a couple of nostrums by the names of trintellix and wellbutrin that don't actually help her in any way that you're sure you can perceive. her perception is more important, but presumably if she's still seeking help, she hasn't been satisfactorily helped by the approved substances she's tried so far.

it's great to put your faith in tested pharmaceuticals approved by scientists and insurance companies, and I recommend it, right up until the point where they don't actually help. certainly object respectfully if she starts to think about taking something poisonous (or really prohibitively expensive, if she doesn't have her own money to pay for this.) otherwise, don't interfere unless you genuinely suspect delusions, but don't force your hopes up either. because if she were all that susceptible to the placebo effect, those real psychiatric drugs in their imposing official bottles would have done the placebo trick for her already.
posted by queenofbithynia at 6:53 PM on August 15 [6 favorites]


if she were all that susceptible to the placebo effect, those real psychiatric drugs in their imposing official bottles would have done the placebo trick for her already.

This bears repeating.
posted by headnsouth at 9:05 AM on August 16 [2 favorites]


Honestly, for something like depression, woo can be great! Feeling truly heard, listened to, and cared about can be a deep soul changing experience. A lot of people who have physical and mental ailments get help from seeing someone who is "woo" because it's such a validating experience, which is quite rare for a lot of women. As long as she's not seeing someone who would steer her away from conventional medicine for something like cancer, or prescribe dangerous treatments like chelation, I think your best move is to be entirely supportive. If she is finding relief for depression, that is something to get behind.

Have the money conversation if she finds a doctor not covered by insurance. But honestly, many doctors use functional to indicate that they don't treat symptoms in isolation and instead look at the person. They're often paid for by insurance just like any other doctor, because they have the exact same credentials. For example, someone practicing functional medicine might look at how diet and gut health are interacting with mental health, instead of just prescribing pills. (A well supported connection, btw!)

Do you want to be right, or do you want your wife to be happy?
posted by stoneweaver at 5:24 PM on August 16 [1 favorite]


“Being right” vs. “letting your stupid girl wife be happy with her lady science” is a dumb framing device if you, like the OP, are barely familiar at all with the type of care she might receive. If you’re not capable of seeing how the new doctor treats her depression and determining based on the facts if it’s worth the money or not, you’re not as brilliant of a scientific mind as you assume you are.
posted by stoneandstar at 10:28 AM on August 19


At a recent session, our therapist recommended a local psychiatrist who practices "functional medicine"

So your wife wants to see a specialist in XYZ, who was recommended by a health professional she already sees.

Maybe you should look at what this specific specialist in XYZ does, not other people in other places who say they are specialists in XYZ. Your wife is going to see a specific person, not a random sampling of XYZ specialists.
posted by yohko at 2:49 PM on August 22 [1 favorite]


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