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In Response to 'The Biggest Medical Discovery of Our Lifetimes'

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In response to Dr. Mark Hyman's blog "The Biggest Medical Discovery of Our Lifetimes: Finding the Cure for Chronic Disease."

After a busy morning clinic, I eat lunch reading through my Flipboard app on my phone and find a blog by Dr. Hyman titled, "The Biggest Medical Discovery of Our Lifetimes." I read with great anticipation what that discovery might be -- HIV medications, cardiac stenting, cancer-related and disease-modifying therapies, proton beam radiation, stem cells, vaccination theory, or any other host of amazing medical discoveries. However, I was dismayed to find that his blog read more like a marketing pitch for the Institute of Functional Medicine than a genuine survey of groundbreaking scientific work already being done in medicine. In fact, he acquiesces that his "single biggest medical advance of our lifetimes" is something "most people have never heard of." In his blog, Dr. Hyman criticizes conventional medicine as compartmentalized and narrow in focus, with only the ability to suppress symptoms and nothing else. He advocates for a doctor like himself, one who practices functional medicine. This branch is a departure from evidence-based and research-proven health care. It is a dangerous assertion that functional medicine treats the patient as a whole whereas conventional medicine does not.

As a recent medical school graduate, practicing resident physician, and a business school graduate with a concentration in health administration, I may be closer to the didactic approach our nation's medical schools follow than Dr. Hyman. There has been progress in medical school education, but the core teaching still revolves around the differential diagnosis. The differential diagnosis is elegant and practical at the same time. It is our careful approach to a patient's set of complaints and symptoms, their physical exam findings, laboratory and imaging data, that allows us to synthesize it all into a set of diagnostic possibilities. That set of possibilities is further refined by an understanding of epidemiologic data and research-based evidence -- two arms that continue to advance with the adoption of electronic medical records. It is a holistic process founded in an old principle of problem solving -- Occam's razor.

Medicine isn't the only field to apply the theory of Sir William of Ockham. Law, mathematics, psychology and almost every scientific field employs this idea that the fewest assumptions lead to the most probable solution -- and in medicine we explain it as "the fewest causes accounting for all symptoms." Dr. Hyman's grand statement that functional medicine's future is "looking at patterns and connecting everything together" is predated. Sir, with all respect due to you, physicians have been doing this for centuries. Every day, most likely at 7 a.m. or noon, there are probably well over 100,000 residents, medical students, fellows, and attending physicians across the country participating in their round table-like discussions with differential diagnosis at the center of it all. These conferences exercise our ability and skill to arrive at well-reasoned diagnoses, as well as to consider appropriate alternative diagnoses. This is what comprises the physician's workup of a disease. There are no "Band-Aids for symptoms" in this approach and the medical community would find that to be an unfair reduction.

I have now experienced more than a handful of academic medical institutions intimately and met young and old physicians from all over the country where our training was similarly focused in this holistic approach. Dr. Hyman's allegations lie in stark contrast to our education, and his proposition that he has something new to offer patients is untrue. Medicine is very much an investigative science. To reduce the practice of differential diagnosis to "name it, blame it, tame it" is simply doing a disservice to the field. His example that depression is not a "Prozac deficiency" perpetuates the antagonist view that physicians are pill pushers. Attributing that practice of a few physicians to the whole medical community weakens our well-intentioned efforts as experts in our areas. Patients continue to place an immense amount of trust in their physicians as we evolve towards a more patient-centered approach, and Dr. Hyman's article unfaithfully undermines that foundation.

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