Treat Cause -- Not Just Symptoms -- of Chronic Illness
By Leslie Champlin Chicago
Posted: 10/5/2007, 4:05 p.m. -- Most chronic illnesses develop long before the physician learns about their symptoms. Over time, genetics; years-long lifestyle choices; psychological pressure; exposure to chemicals, other environmental hazards and inappropriate medications; as well as other factors, contribute to the eventual manifestation of the condition.
That's why the acute model of care will fail in treating people with chronic disease. Medications alone may merely mask the symptoms and never treat the actual cause. That's why family physicians should step outside the box of conventional medical wisdom and add the tools of functional medicine to their diagnostic repertoire, said David Jones, M.D., of Ashland, Ore., and Jane Murray, M.D., of Overland Park, Kan.
The pair spoke during "A New Chronic Disease Model: From Organ System Medicine to Systems Biology and a Functional Medicine," an Assembly CME session presented on Oct. 4. Jones is president of the Institute for Functional Medicine, an organization that trains physicians to bring all elements of a patient's life to bear on managing chronic illness. Murray has implemented the system in her practice for 10 years.
"We're at a crossroads in medicine," said Jones. "We haven't yet awakened to the dilemma between acute medical care and chronic medical care."
By teaching medical students to quickly diagnose an illness and provide acute care for its symptoms, medical schools train future physicians for what will be about 20 percent of their practices, he continued. Seventy-eight percent of today's patients present with at least one chronic illness.
"And do you have an office where your patients come in with just one morbidity?" Jones asked. "It's always comorbidities, and they come in with seven prescriptions."
Murray agreed. "As family physicians, we hardly ever see a patient with just a high lipid profile," she said. "They also probably have obesity, hypertension and diabetes."
The solution is systems biology and functional medicine. Using these, the physician looks for the cause of the condition, not the diagnosis.
"Instead of naming a disease, we ask, 'Where does this come from? What are the antecedents and triggers? What keeps it going? What can be done to change the dis-eased balance that the patient is locked into?'" said Jones.
He does so by assessing the patient at several levels: cellular, physiological, organ system, whole body, and mind and spirit. He reviews the patient's family and medical histories. Then he determines how all these and other factors have interacted negatively to put the body out of balance.
Managing the chronic conditions might call for prescriptions for medications that manage symptoms. But more important are prescriptions that include such interventions as dietary change, yoga, mental health counseling or a different job.
"In conventional, acute-care medicine, the goal is to get a fast diagnosis," said Jones. "Problems arise when you apply the acute-care model to long-term problems, because you end up naming the disease. And once you name a disease, it's all over.
Each diagnosis becomes a distinct entity unto itself, and the patient's whole story never has a chance to be heard and understood."
As a result, the illness doesn't resolve because the lifestyle, physiological, psychological, environmental and other causes remain in place.
"Many chronic illnesses result from a dysfunctional mesh of genetics and the human context," said Jones. Lifestyle choices underlie 70 percent of chronic illnesses, he said, "but almost everyone ignores that."
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