Jeffrey Bland, PhD: What is Evidence-Based Functional Medicine in the 21st Century?

As part of Integrative Medicine, a Clinician’s Journal 100th-issue anniversary, Jeffrey S. Bland, Ph.D., reviews the current status of evidence-based functional medicine. In the abstract he writes:

“The 21st century has already demonstrated itself to be an era of change for medicine and science. There is a new openness—to ideas, to a shift in perspectives, to a redefinition of evidence and the many ways it can be gathered. New interest in real-world data, patient-experience information has also become an increasingly important contributor to the evaluation of treatment effectiveness. It is a fertile time on many fronts, including an expanded reach for a systems biology formalism and the Functional Medicine movement.”

In this essay, Dr. Bland delves into the shifting importance of personalized medicine, or n=1 studies, as equally vital to the advancement of medical science as randomized placebo-controlled trials (RCT). “The RCT model is, indeed, a useful tool for a variety of reasons, but—like most icons—it is neither perfect nor infallible,” he writes. He asks the million-dollar question: “Are we are presently using the right type of evidence to validate the effectiveness of some specific therapies.”

Citing research by Nicholas Schork, Ph.D., who is affiliated with the J. Craig Venter Institute, the University of California at San Diego, and the Translational Genomics Institute, Dr. Bland outlines why the RCT model seldom offers practitioners useful options for therapeutic success.

In this essay you will learn about:

  1. New trial models that could statistically evaluate physical, metabolic, cognitive, and behavioral functions.
  2. Functional assessments in combination with new biometrics and bioinformatics tools, including new directions for publications like the New England Journal of Medicine. These include prospective-cohort studies, retrospective-cohort studies, pragmatic and large-observational trials, nested-case reports, and N-of-1 studies.
  3. What can be learned from precision cancer treatments?
  4. The benefits of multi-person N-of-1 trials with clearly defined objectives, functional variables, reasons for stratifying the cohorts, and specific intervention rationale.
  5. Nested-case report as a source of valuable evidence.

“The 21st century has already demonstrated itself to be an era of change for medicine and science. There is a new openness—to ideas, to a shift in perspectives, to a redefinition of evidence and the many ways it can be gathered. It is a fertile time on many fronts, including an expanded reach for a systems biology formalism and the Functional Medicine movement.” ~ Jeffrey S. Bland, PhD

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