At Bodhi, We Change Lives!

How do we that? We focus on the causes of disease rather than just the symptoms.

In an inspirational and supportive environment, we incorporate all appropriate science-based, integrated medical services, the highest quality natural health products along with aesthetics to bring you TRUE Health, inside and out.

Our patient-centered care is aimed at early detection, prevention, treatment and reversal of chronic disease and age-related decline. Our physicians design individualized treatment plans to restore physiological, psychological, and structural balance.

Importance of Improving Management of Complex, Chronic Disease

Despite the fact that non-generic factors that are modifiable - including diet, overweight, inactivity, and environmental exposures such as smoking-account for 70-90% of mortality in the U.S., physician education, training, and reimbursement are most often focused on treating disease using drugs and surgery rather than comprehensive patient-centered treatments focused on the individual.

For example, as reported in a study published in the British Medical Journal, clinical questions in primary care can be categorized into a limited number of generic types and frequency. The four most common question types were:

• What is the drug of choice for condition x?
• What is the cause of symptom x?
• What test is indicated in situation x?
• What is the dose of drug x?

This shortsighted approach to health care should give us all cause for serious concern, because it is perpetuating a system that is far too costly and increasingly ineffective for the prevention and management of chronic diseases whose root causes are to be found in a much more complex perspective on patients’ lives.

A Critical Problem

The gap between emerging research in basic sciences and integration of new knowledge into clinical practice is often astonishingly large—particularly in the area of complex, chronic illness. This is one of the reasons that today’s healthcare providers are not adequately trained to manage the increasing burden of complex, chronic disease.

The 20th century took on—and, to a great extent mastered—the challenges of providing health care for acute conditions (injury and life-threatening illness). Knowledge and technology grew apace, and so did costs; measures no one thought possible 100 years ago have become readily available.

Organ transplants, re-attachment of severed limbs, life-support systems, new drugs, infection control procedures, laparoscopic explorations and surgeries—the list is extensive. But at the same time that our healthcare system was becoming dependent on advances in acute care, other influences were superseding acute conditions as the greatest threats to American health:

• increasingly stressful and sedentary lifestyles,
• industrial pollution of air, water, and earth
• leading to devitalized (and sometimes dangerous) food,
• overconsumption (rising rates of obesity) but undernutrition,
• and fragmented family and community ties

These influences have helped to create an overwhelming burden of chronic disease that we do not yet train our healthcare providers to treat or prevent effectively, among other contributing factors.

Disease prevention has too often been conceptualized as immunization and early diagnosis, an approach that is far too limited. Effective prevention of chronic disease today requires understanding individual genetic vulnerabilities (20–30% of chronic disease risk) and the effect of lifestyle upon those individual variations (70–80% of the risk).

Physicians highly trained primarily in conventional diagnosis and treatment (drugs, surgery, radiation) are not well qualified to apply prevention-focused interventions such as nutrition, diet, and exercise to help patients minimize their risk of suffering from one or more of the major chronic diseases in America (heart disease, diabetes, autoimmune disease, mental illness, and cancer).

In addition to prevention strategies, many complex, chronic diseases are very responsive to dietary and various lifestyle interventions. But clinicians without these skills are literally at the mercy of the pharmaceutical industry.

Doctors are taught about drugs by agents of the pharmaceutical industry, which works hard to persuade them to select the newest and most expensive medications — even in the absence of scientific evidence that they are any better than older, less costly ones, even in the presence of evidence that many non-drug interventions are therapeutically effective and significantly less expensive.

Increasing Economic Burden

The American healthcare system is predicated on a huge myth—that the more a society spends on health care, the better the health of its population will be. We justify having—by far—the costliest healthcare system in the world by deluding ourselves that we therefore also have the best health in the world. However, our romance with ever newer and more expensive drugs, technology, and surgeries has not achieved what we have been led to expect.

Consider just a few of the many significant statistics available on this subject:

• National health expenditures increased 69% between 1990 and 2000, to a per capita cost of $4,637,
• which is 68.5% higher than our closest competitor (Germany) and more than 2½ times as much as the UK;
• increased at a rate 4–5 times that of inflation in most years of that decade (a time of relatively low inflation in other industries)
• were disproportionately affected by the cost of prescription drugs, which were responsible for 21% of the cost increases in Year 2000, while representing only 9% of total spending; and
• are expected to rise to $3.1 trillion over the next 10 years (from a level of $1.4 trillion in 2001).

What does the American public get for this exorbitant price tag?

• A nation with 43.6 million uninsured in 2002 (while every other westernized nation provides basic coverage to all its citizens).
• An excessively high serious medical error rate (highest among U.S., Canada, the UK, Australia and New Zealand), including (in 1994) 160,000 deaths from adverse drug reactions (ADRs).
• An unacceptable portion (45%) of Americans failing to receive “indicated care” including, notably, preventive care.
• A healthcare system that is thought by many to be “in imminent danger of collapse.”

Add to this volatile mix, the projection that one-third of the people born in the year 2000 will eventually have diabetes —perhaps the most costly of the chronic diseases when all its comorbidities and secondary complications are considered—and we believe that no further evidence is necessary to justify a sea change in our approach to health care.

There will be many ideas about the best changes to consider, but this textbook is being written, in part, to ensure that all those who are interested in the assessment, prevention, and treatment of chronic disease know what functional medicine has to offer.

There are, of course, other powerful societal drivers for the problems described above. Among them are the demand for fast and easy, high-fat, high-sugar foods; the demand for expensive testing (such as CAT scans or MRIs) and expensive drugs; the increasingly sedentary nature of most jobs (tied to a desk) and personal lifestyles (centered around television and other passive entertainment experiences).

It is important that all sectors share the responsibility for empowering healthful choices—the individual and his/her family, the workplace, the residential and civic communities, the marketplace, and the healthcare system.

Functional Medicine and the Chronic Care Model

In the inaugural issue of the Annals of Family Medicine, the lead editorial focused on the need for a new paradigm for the primary care disciplines. The present intellectual framework taught in our medical education system fails to address the web-like interactions of multiple comorbidities for chronically ill patients.

The power of organ-system medicine and the scientific research based on this model have brought us to the doorstep of the 21st century where, despite huge advances in disease detection, pharmacology, and surgical interventions, we are ill-equipped for the century’s greatest challenge—an aging population with ever-increasing rates of (largely preventable, often reversible) chronic disease. The dominance of the existing heuristic (rule of thumb and experience) and reductionist model has fragmented medical care into specialty and sub-specialty care, which drives costs upward and conflicts with the need for a comprehensive, integrated approach to chronically ill patients with multiple comorbidities.

In Grumbach’s insightful editorial, Chronic Illness, Comorbidities, and the Need for Medical Generalism, he opens: “It is said that when students enter medical school, they care about the whole person, and by the time they graduate, all they care about is the hole in the person. Current medical education inculcates many of the dominant values of modern medicine, reductionism, specialization, mechanistic models of disease and faith in a definitive cure.”

He suggests that the dominant paradigm now being taught is most applicable in the context of acute illness (e.g., trauma and infection). However, the dominant illnesses of the 21st century are and will be the chronic diseases (e.g., diabetes, heart disease, arthritis, and dementia, among others). In this context, the reductionist model fails to address (what he believes is) the most germane issue: “Cure is rarely possible, but improved functional status with amelioration of symptoms of pain and dysfunction and longer life (health span) through a thorough understanding of secondary prevention is possible.” The intellectual framework and filter taught and then used by primary care practitioners will, from here on, be called the intellectual matrix.

Why Functional Medicine?

Carving up patients on the basis of individual conditions and sending them to the diabetes program on Monday, the cardiac program on Tuesday, the arthritis program on Wednesday, and the depression program on Thursday. What is needed is a model of care that addresses the whole person and integrates care for the person’s entire constellation of comorbidities.

This generalist approach does not deny the value of specialty care, which can offer expertise and unique services to the care of patients with chronic illness. But the generalist approach affirms a central role for the primary care clinician as the coordinator and integrator of specialty care and other referral services, working in partnership with the patient and other health care personnel to optimize overall physical functioning, mental health, and well-being.

Functional medicine is not a unique and separate body of knowledge, but it does represent a different way of applying the scientific and clinical information that emerges from the research literature and from the clinical practices of many disciplines. Functional medicine emphasizes a definable and teachable process of integrating multiple knowledge bases within a pragmatic intellectual matrix that focuses on functionality at several levels as the key to health.

Functional medicine uses the patient’s story as an essential tool for integrating diagnosis, signs and symptoms, and evidence of clinical imbalances into a comprehensive approach to improve both the patient’s environmental inputs and his or her physiological function. It is a clinician’s discipline, and it directly addresses the need to transform the practice of primary care.

Functional medicine can substantially improve the existing Chronic Care Model, which comprises six basic elements to foster productive interactions between patients and providers:

• Patient self-management support;
• Delivery system design (team-based delivery of care);
• Decision support (consistent with scientific evidence and patient preferences);
• Clinical information system (organizes individual patients and patient populations to receive appropriate levels of care);
• Organizational support; and
• Community support.

Learn More about how We Change Lives using a Functional Medicine approach at Bodhi:

• Conditions We Treat
• What to Expect from Your Treatment

Schedule your consultation by calling 888.271.8877 today!