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Functional Medicine Data Fallacies

Brett Sparks, August 16, 2016

I have been thinking about the disconnect I’ve encountered with functional medicine. There seems to be plenty of physicians interested in functional medicine, but as popular as functional medicine is, there doesn’t seem to be that many available functional medicine positions or that many physicians practicing functional medicine. I think this is representative of functional medicine’s position as an emerging technology. Like solar power, there is little doubt that functional medicine could hold a significant competitive advantage in the market place, but the jury is still out on how to successfully deliver these benefits to the general population.

It is helpful to remember that functional medicine is an emerging technology when presented with some of the data being used to support different approaches to functional medicine. With little direct data available about the practice of functional medicine, vendors and consultants can present data that is more supportive of their approach than representative of functional medicine. Here are some common mistakes made when evaluating data regarding functional medicine practices.

Apples-to-Oranges

With a very limited track record, it is hard to find functional medicine practices, markets or opportunities to compare. With apples-to-apples comparisons unavailable, apples-to-oranges comparisons are being made comparing all functional medicine practices to other practice approaches. I see functional medicine compared to concierge medicine, cash practices and corporate wellness models, even though functional medicine can be drastically different in each of these models. It is comforting to rely upon the data for each of these models to forecast what to expect with functional medicine, (e.g., “Concierge practices are projected to grow 15% in the next five years!”), but these apples-to-oranges comparisons are of limited value.

Converting a traditional practice to functional medicine, for instance, often results in the loss of 80-90% of the practice base. Treating functional medicine like concierge medicine leads one to believe that converting a traditional practice to functional medicine would have similar results, but I would disagree. Converting patients to concierge medicine requires convincing patients to change the compensation structure for medical care, while converting patients to functional medicine requires much, much more.

Functional medicine practices not only change the financial arrangement with patients, they also require patients to change the type of medicine they are seeking, the treatment modalities they are embracing and, most often, the lifestyles they are leading. And all of this requires financial commitment from the patient beyond just paying the provider an equitable rate. Of the 10-20% of the practice that is willing to pay more to continue at the practice, how many patients will be willing to pay even more for supplements, specialty testing and ancillary services such as message therapy, energy work, etc?

Source Bias

Another common mistake I see with data related to the practice of functional medicine is source bias. I bet most readers would be skeptical if I told them that practices using practice consultants with MBAs in Health Care Management were 90% more successful than practices using other consultants. (And they would be right to be skeptical; I just made up that “data.”)

The statement does invite skepticism. First, the statement paints an overwhelmingly rosy benefit to hiring a consultant with an MBA in Health Care Management, (MBA HCM). That alone should invite suspicion, as supported by the old adage, “If it sounds too good to be true, it probably is.” A second, even more alarming point is that the source of that data—me—has an obvious bias because I am a consultant with an MBA HCM.

Source bias is a significant cause for concern because of the inherent conflict of interest. It is one thing to be an ardent supporter of something. It is entirely different to be an ardent supporter of something I have a vested interest in promoting without disclosing my interest. When physicians hear data about the success of functional medicine practices, they should definitely consider the source. If the source’s interests are financially aligned with the success of functional medicine, there may be source bias.

This doesn’t mean that the supplement vendor encouraging you to redesign your practice is wrong. It does mean that you should balance their support of functional medicine—and any data they use to make their case—against some common sense and other data. And while you could hire a consultant with an MBA HCM, I would be careful about trusting that guy too much.

“Aggressive Marketing”

Speaking of common sense, it is also helpful in spotting one of the most common issues with data used to promote the practice of functional medicine: Aggressive marketing. I feel like I’m being kind because “aggressive marketing” could also be called “lies.” I hesitate to be that judgmental because the question of intent is involved.

With apples-to-oranges, there is the possibility that the source believes that the oranges are really more like apples than oranges, i.e. that the comparison is appropriate. With source bias, there is also the possibility that the source believes the data provided to support their interests. With aggressive marketing, the facts have been stretched so far as to challenge reality.

As an example, consider entities that speak of a “long history” practicing functional medicine that have only 18 months of experience. Is that a long history? I would consider this a case of aggressive marketing. Even more egregious are claims that are just factually incorrect rather than relying on a liberal interpretation of some word or phrase.

I often find that those promoting this aggressive marketing are quoting material that has been given to them. They aren’t intentionally misrepresenting the truth—they just don’t know the truth. I’ve had vendors who told me that they “actively support functional medicine” be clueless to the needs of my wife’s functional medicine practice even though her practice is pretty standard in its approach to functional medicine. Do I think that these vendors lied to me? No. I think these vendors fell victim to aggressive marketing, where they hopped on the functional medicine bandwagon in word only, waiting for the bandwagon to pick up steam before figuring out how to actually work with functional medicine offices.

Please don’t think that I believe that functional medicine practices can’t be successful. I know that functional medicine practices can be successful. Rather, I caution against believing that functional medicine practices will be successful based on faulty data or the wrong premise. The truth is that as an emerging technology, supporting functional medicine requires more faith in the potential of functional medicine than data analysis. There are cases to be made for good business plans, but the lack of solid functional medicine practice data means that every plan has risk—and that risk is often greater than those pushing the plan would have you believe.

©2016, Brett Sparks, e3Business.