The American Academy of Family Physicians (AAFP) has partially lifted its moratorium on continuing education credit (CME) for courses in so-called “functional medicine,” but only to the extent that these courses give family practice doctors sufficient information to educate interested patients about the topic. “How-to” courses teaching various functional medicine techniques, modalities or applications for implementation in treating patients remain under the CME moratorium.
The AAFP’s decision was announced in in March and later reprinted in the . Unfortunately, it is only by accessing these articles that physicians and the general public will learn the history and current rationale behind the AAFP’s decision: Previous literature reviews did not find sufficient evidence to support the use of functional medicine in family practice and “in some cases, determined the claims being made to be potentially dangerous”. Even then, we are not given a complete history of the AAFP’s review and left in the dark regarding what the research revealed or exactly which claims are “potentially dangerous”. Given the lavish claims made for functional medicine by practitioners and the paucity of research, the AAFP, in my opinion, has a duty to protect the public’s health, safety, and welfare by publishing its findings in full.
Speaking to AAFP News about the decision, the chair of the AAFP’s Commission on Continuing Professional Development (COCPD), Melody Jordahl-Iafrato, MD, explained that, following the AAFP’s third review of the evidence on functional medicine,
given the current lack of evidence, the COCPD does not deem it appropriate to learn how to practice functional medicine or implement related techniques within an AAFP-certified CME activity.
The COCPD acknowledged that while sufficient evidence does not exist, patients still may be utilizing or asking about functional medicine; therefore, it’s important for [AAFP] members to be informed on the concept of functional medicine and what patients might be asking about regarding their health care and treatment options.
While, according to the COCPD chair, this may include some examples of techniques,
a session that teaches how to treat a specific disease – such as neurological or gastrointestinal disease – with functional medicine principles would not be eligible.
In a telling comment, Dr. Jordahl-Iafrato added this remark:
The AAFP Credit System strives to certify CME that is evidence-based, objective and balanced, which means benefits have been proven and all possible risks, side effects and negative outcomes should be acknowledged. Ideally, CME includes fair, balanced consideration of all usual and customary approaches and not only the approach preferred by the CME provider.
In other words, courses teaching physicians how to practice functional medicine do not meet these standards.
According to the AAFP News, the first review of functional medicine, in 2014, was in response CME providers getting inconsistent results when they applied for credit for their functional medicine courses. After a literature review, the AAFP made its initial determination that not only was there insufficient evidence to award CME credit, in some cases claims being made for functional medicine were “potentially dangerous”. Actually, according to, of all organizations, the (IFM), which “certifies” physicians, naturopaths, acupuncturists and chiropractors as functional medicine practitioners, the AAFP “identified some treatments as harmful and dangerous”. Perhaps the IFM was made aware of this conclusion in the AAFP’s response to its application for CME credit for its courses.
Based on this literature review, the AAFP placed a moratorium on functional medicine courses. A similar evidence review in 2016 came to the same conclusion and the moratorium was extended to 2018. In anticipation of that deadline, last year the AAFP issued a call for comment, including a request for evidence on functional medicine’s efficacy and any additional supporting evidence and/or literature. At the time, I expressed confidence that the AAFP would stick to its guns and continue the moratorium. Unfortunately, I was only partly correct.
the information received was objectively reviewed and summarized in a report by a third party and presented to the COCPD. That information, along with several literature reviews and results from the AAFP Member Survey, informed the [COCPD’s] decision to lift the moratorium on functional medicine.
That decision was reviewed by the AAFP’s Board of Directors. The end result is a new question under “AAFP Credit System FAQ” – “?” The answer simply sets forth the new policy in anodyne terms, approving the overview, but not the “how-to,” courses. While it refers to the literature reviews, it does not mention the lack of evidence, or “potentially dangerous” claims, or “harmful and dangerous” treatments.
Predictably, the that the AAFP’s decision “wasn’t the exact outcome we had hoped for” but was “thrilled to see AAFP take a step forward and recognize the merits of Functional Medicine,” which the AAFP most certainly did not. The IFM explained that,
in an effort to provide a better understanding of how our programs were developed, we supplied AAFP with evidence-based literature and clinical feedback demonstrating the efficacy, safety, and effectiveness of Functional Medicine education for all family physicians. In addition, we asked our physician partners to participate in the “call for comment” process.
Putting it a different way, IFM gave the AAFP its very best effort and still came up short.
Support was not unanimous. Although the comments have not been released, the , to its credit, posted its comment calling for a continuation of the moratorium “because there remains much unknown about functional medicine”.
SBM’s evidence review
Fortunately for the public, over the years, SBM has conducted its own evidence review of sorts of functional medicine. As we’ve discussed numerous times, despite patronage from the venerable Cleveland Clinic, whose own genetics experts have called out functional medicine for its dubious use of genetic testing and supplement prescribing, the safety and efficacy of functional medicine, as the AAFP itself determined, has yet to be established. In fact, it’s hard to know exactly what functional medicine is, other than a marketing term, partly because there is no detailed explication of its principles and practices anywhere in the medical literature. For that (if it exists at all), physicians, chiropractors, naturopaths and the like must attend the IFM’s proprietary courses, to the tune of about $15,000, to become “certified” in functional medicine.
Wally Sampson (also here, here, and here), David Gorski, (also here, here, and here), Steve Novella, and (also ) have all taken a crack at trying to fathom functional medicine and have come away wanting for information, although they were able to gather bits and pieces from, for example, published case studies, which they .
From what little information is available, it appears that functional medicine includes conventional practices like healthy lifestyles, good nutrition, enough exercise, adequate sleep, and cessation of habits known to be deleterious to health, all of which are rebranded “functional medicine,” combined with a whole lot of lab testing – both unvalidated tests and conventional testing that is, in Dr. Gorski’s words, “massively misinterpreted and abused.” From these lab results, said genetic and biochemical “root causes” of disease are divined and “personalized treatment” instituted, which seems to involve a lot of dietary supplements, conveniently sold to the patient , assorted other quackery.
Functional Medicine guru Mark Hyman, whose mangling of medical science and anti-vaccination sympathies have been called out before on SBM (also here) and by (also and ) is Chair of the Board of IFM. Naturopath Joseph Pizzorno, is on the Board as well. Pizzorno is co-editor of the naturopathic masterwork, The Encyclopedia of Natural Medicine, which Dr. Hall thoroughly shredded in a recent post. Faculty at past IFM presentations include a cell phone radiation alarmist who warned against keeping your cell phone in your bra (debunked here), a dentist who advocates removing amalgam fillings based on , a chiropractor who spoke on “Ensuring a Safe Detox Program: Applying Oral to Reduce an  Elevated Heavy Metal Burden with Case Studies,” a naturopath whose clinic offers and IV therapy delivering “micronutrients and pharmaceuticals” for, among other things, “support for detoxification” and “heavy metal chelation”, and an MD who authored “a guide to mastering one’s genes to reverse disease.” Unfortunately, most of these courses were approved for CME credit by the ACCME, which is decidedly more tolerant of pseudoscience, having not only accredited IFM as a CME provider, but .
While I’d like to think SBM’s information on functional medicine is persuasive, and that our posts might be consulted by anyone thinking of becoming a functional medicine practitioner or seeing one as a patient, I am far from sanguine that the science-based medicine community alone can stem the tide of pseudoscience being introduced into medical practice by the purveyors of functional medicine. Given the Cleveland Clinic’s and the ACCME’s complicity, it is of utmost concern that no one from within the medical establishment has come forward to oppose the rosily simplistic deceptions coming from the IFM and the Cleveland Clinic’s Center for Functional Medicine. If the AAFP had similar misgivings about a drug or conventional medical practice, I feel certain they would release their research and warn the public. It is a mystery to me why the AAFP is pulling its punches with functional medicine.
Author’s note: On Monday, I emailed the AAFP ([email protected]) asking for the literature reviews and other information on which they based their CME decision. A quick response simply referred me to the new policy and information on CME standards. I replied that this was not the information I needed, adding that I thought “it incumbent upon the AAFP to release its evidence reviews in the interest of the public health, safety and welfare”. There has been no response to that email.