During a recent discussion with a colleague, I asked, "What's the difference between integrative health, integrative medicine and functional medicine?" His hesitant reply was very illuminating. I realized there's quite a bit of confusion in our community surrounding these terms.
"Medicine" to "Health"
Let's begin with integrative medicine. It evolved from the moniker "complementary and alternative medicine" when those in the CAM community wanted to simplify the title and emphasize the interprofessional aspect of the model of care.
Physicians didn't care for the term alternative medicine because of the notion patients would discard conventional medicine for alternative treatment. Massage therapists, nutritionists, acupuncturists, naturopaths and chiropractors didn't embrace inclusion of the term medicine since prescribing pharmaceutical drugs is outside their collective scopes of practice.
Health promotion and disease prevention (emphasized in the Affordable Care Act) is the primary focus of integrative health providers. National organization titles have progressively shifted from "medicine" to "health" in the past decade (e.g., Academic Collaborative of Integrative Health), some of which kept both terms (Academy of Integrative Health & Medicine; and Academic Consortium of Integrative Medicine and Health). Others retained the term complementary, like the NIH National Center for Complementary and Integrative Health (NCCIH).
Similarities and Differences
The Oxford English Dictionary defines integrative as "Combining two or more things to form an effective unit or system," which is pretty accurate in this context. The Integrative Health Policy Consortium defines integrative health as "a collaborative, comprehensive, person-centered approach to health creation and disease care that addresses all factors impacting health, including social determinants, and embraces all evidence-informed disciplines, both conventional and complementary, in order to achieve optimal well-being."
The Institute for Functional Medicine (IFM), on the other hand, defines functional medicine as "an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient's genetic, biochemical, and lifestyle factors and leverages that data to direct personalized treatment plans that lead to improved patient outcomes."
Notice that the two definitions are quite similar, but integrative health specifically calls out disciplines (conventional and complementary), whereas the functional medicine definition emphasizes identifying the underlying cause of disease.
Functional medicine also tends to "connect the dots" from the patient's medical history, "functional" lab work and genetic testing to patient symptoms in a more holistic way than conventional specialists (who are only checking liver enzymes, for example). Gut health and toxic load also play a central role to those who practice functional medicine. The primary providers of functional medicine include MDs, DOs and NDs (naturopathic physicians).
An integrative health model requires a multidisciplinary team, allowing patients to actively participate in their care plans. It offers an array of distinct health professions and recognized whole-world systems of practice, each with specific principles, systems of practice and care, and unique therapies and materia medica. Team care is shared among a full range of health professionals from these varied systems, bringing myriad options and possibilities to the patient.
Practitioners also employ subtle energy techniques, physical manipulation, movements like tai chi and chi gong, and cognitive behavioral therapy, with social determinants of health in mind.
Both integrative health and functional medicine models are patient-centered, holistic, cost-effective, evidence-based, treat the patient vs. the disease, are safe, and recommend lifestyle modification.
|Requires a multi-disciplinary team of healthcare professionals
May address subtle energy, biofield, or spiritual aspects of health condition
Evaluates social determinants of health
Several training options (AIHM, UCLA East West Integrative Medicine Fellowship, UCSF Osher Center, Andrew Weil, etc.); no standardized certification program
|Can be performed solo, one-on-one with patient
Evaluates lifestyle, genetic, and environmental determinants to health and well-being (personalized medicine)
Relies on systems science
Has a well-defined model for diagnosis and treatment, and has a phased educational program through IFM, with rigorous testing for certification
I reached out to John Weeks, publisher of The Integrator Blog, who offered a historical view of functional medicine:
"Functional Medicine was officially formed and brilliantly named in 1991 by Jeff Bland, a PhD in biomedicine, who was (among other things) a student of Linus Pauling, a consultant to many natural products firms, and a founding board member 13 years earlier at what was the John Bastyr College of Naturopathic Medicine, where the founding president, Joe Pizzorno, ND, was on Bland's first board and is currently the chair of the Institute for Functional Medicine. The naturopathic influence has been strong – with many of its core staff of educators hired out of Bastyr and its Textbook of Functional Medicine led by a co-founder of Bastyr. Under Bland, the focus was on biochemical pathways and the way natural products can shape them. Under David Jones' later leadership, IFM broadened to a wider lifestyle and bio-psycho-social model. The organization has strategically not chosen to participate directly and openly in coalitions and collaborations with integrative and naturopathic and other natural health consortia. I suspect this is to keep an identity of 'Functional Medicine' as separate from the baggage that the other fields can have for some mainstream medical professionals. This helped launch FM into its prominence via the Cleveland Clinic Center, where its outcomes are being researched. The lack of an ongoing research infrastructure and engagement that is specifically examining outcomes – both clinical and cost – of functional medicine practices is presently an issue for the field."
Pathways to Health
A good analogy is that conventional medicine is like a vending machine with prepackaged snacks based on your specific craving and a numbered button you press; functional medicine could be seen as a balanced "made to order" meal of organic food, taking into account the person's nutritional deficiencies and dietary history; and integrative health would be a buffet of natural foods, with a disco ball for generous movement, and a server who can lend a concerned ear and positive recommendations on future meals and lifestyle modification.
Is one better than the other? No. There are several pathways to health, and both models serve to provide the information and tools to get you there.
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