Healing Chronic Disease with a Systems Approach and the Genesis of Functional Medicine
Interview with Dr. Jeffrey Bland PHD, FACN, FACB, CNS
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Welcome to Field Notes, an exploration of functional medicine. I’m Rob Downey, a family practice MD and Institute for Functional Medicine certified practitioner. I’m coming to you from Seaworthy Functional Medicine in Homer, Alaska. Seaworthy exists to help people overcome their health challenges and be fully vital. Today, we have the great privilege to have with us Dr. Jeffrey Bland, the father of functional medicine. Good morning, Jeff!
Good morning Rob, thanks so much! I feel like I’m your neighbor. Alaska is one of my favorite places. We’ve spent a lot of time in our boat up there in the summer over the years. It’s great to be connected, so thank you!
Yes, and thanks again for being with us today. I want to thank our listeners for taking some time to listen and learn. There are so many fun things I could talk with you about life in the Northwest, Alaska, and so on, but I’ll have to be disciplined and make sure I stay on target.
I just wanted to share that you’ve had such a huge influence on my life journey in terms of how I care for people, and how I fulfill my Hippocratic oath. I was trying to think of a distillation of how to encapsulate that when I took in my surroundings here in Homer, Alaska this morning. The robins were singing, the sun was shining, and the mountains are covered in snow. It made me think of a line from the Van Morrison song, “I feel wondrous, and lit up inside.”
Beautiful! Wow, thank you for sharing. That’s a perfect image to have this conversation laid on top of. Thank you!
If I fully articulated your bio, then we wouldn’t have any time left for the interview, so I’m only going to hit the highlights. I’ll rely on you to add any critical things our listeners might need. Many of them will know you, and they’ll just be glad that we get to talk.
You’re a PhD biochemist and you worked with the two time Nobel Laureate Linus Pauling. You were a leader in his lab, and he was a lifelong mentor and friend. You are a founder of Bastyr University, the first federally accredited naturopathic medicine college in the United States. Bastyr is where my mentor in natural and functional medicine, Hillery Daily ND LAC, was trained and certified over 25 years ago.
You and your wife Susan founded the Institute for Functional Medicine back in the early 90s, around twenty years ago, and then more recently the Personalized Lifestyle Medicine Institute. You’ve authored 10 books and 120 peer reviewed papers, and we’re just scratching the surface. For today’s purposes, that thumbnail sketch will probably have to be adequate, but there’s so much more. Are there any key things about your bio I should add today before we segue in?
I think that lays out the landscape of what I’ve been working on. The only arithmetic difference is that IFM is now coming into its 30th year this year, not 20, because it will have been from 1990 to 2020.
That’s important! I think for our listeners to get a sense of our connection in terms of how you influenced me, it’s important to share that I attended the Applying Functional Medicine in Clinical Practice conference in Fort Lauderdale in 2006. Both you and David Jones were there, and David Jones led off by saying, “Okay everybody, you’re wearing these glasses that are essentially making you see the world upside down, but you didn’t know that you were wearing these glasses. When you take them off, everything’s going to flip again, but your brain will reorient.”
You then talked about xenohormesis, or the idea that consuming molecules produced by plants under stressed conditions can confer immunity, antiaging, and stress reducing benefits. That really lit up my mind, but I don’t want to put the cart ahead of the horse.
My mentor, Hillery Daily, flew out with me to get this training because she said that I’d be able to help people in the way she helped people. She was Bastyr trained and influenced by functional medicine and had treated an autoimmune case I referred to her with an incredible result. She and I cared for patients together at the point of care in Montana for many years.
Functional Medicine makes you rethink how you care for patients. It’s like taking care of an ecosystem rather than taking care of a machine.
Every night I would say, “Hillary, what’s happening now is that Dr. Bland and Dr. Jones and the Institute for Functional Medicine are completely shattering my concepts in a good way. I’m intoxicated and intimidated because I’m going to have to strip this back and rebuild to see how I care for my patients as a family practice MD. It’s like taking care of an ecosystem rather than taking care of a machine.” Every night during the conference I kept repeating, “This is so interesting and exciting, that’s so interesting, exciting!”
As you educate and illuminate everyone today, I want to share that I have felt this whole time that it was a manifestation of my Hippocratic oath when I realized there was a way to help so many of these folks that the conventional toolbox alone couldn’t help as much. I just had to add the functional medicine. It wasn’t always easy, but it was always imperative. Intellectually to me, it was crystal clear that it was the fullest manifestation of my oath.
Here we are now in 2020 at the 14-year mark for functional medicine for me and 20 plus years as a family practice MD. It’s just great to talk to you today about what I’m doing in Alaska and also what you’re doing with your Big Bold Health products and podcast. I guess that’s where we start.
Intellectually to me, it was crystal clear that adding functional medicine to my toolbox was the fullest manifestation of my Hippocratic oath.
That’s a great introduction! Let me just respond a little bit to the David Jones, Jeff Bland dance and how that relates to functional medicine from my perspective looking back now. David and I have been friends and colleagues since we sat next to one another at a meeting of the Northwest Academy of Preventative Medicine in 1976. David was at that time a young doc from Ashland, Oregon. I was a professor working hard to get my laboratory and my professional life going. We didn’t know each other at all. We have this word ‘serendipity.’ I’m not sure if serendipity is true, but I think sometimes in life we’re drawn together for certain reasons. During the break we start talking and getting to know each other.
As often happens with a new relationship, you try to figure one another out. I’m not sure if it was he or I that first said, “So what do you think of this meeting?” We agreed that there were some good things about the meeting, but that we believed it could be done a lot better. That conversation opened up the opportunity for us to say, “Well, okay, what does that mean it could be better?” We said, “Well, I think this isn’t good, and that’s not good. We could bring more science into this, and we could make it more inclusive. We could get over some of these things that look like they’re built on an old model.”
From that conversation we both said before we left, “We’ll have to continue this conversation. We’re kindred souls!” Over the next year I ultimately became the president of the Northwest Academy of Preventive Medicine. He said, “I’m going to start the Southern Academy of Preventive Medicine in Ashland, Oregon to have Southern Oregon docs involved.” I went down four times a year to Southern Oregon to meet with his group, and he came up four times a year to meet with our group. We started with just one conversation, and then that conversation grew to be a study club that ultimately included around 100 healthcare practitioners between the two places. In that group were people like Jonathan Wright and Joe Pizzorno.
Functional medicine arose out of a chance meeting of two rebellious guys sitting in a meeting saying, “I think we can put together a better meeting than this.” It’s an interesting history that created this opportunity.
I would go through papers and say, “So here’s what’s happening on the frontier of what I’m calling systems biology. And I think this is going to be the pulse that will change the way we think about healthcare.” For whatever reason the timing was right, and we got more and more interest. This grew until my wife said to me, “Jeff, you keep talking about all these wonderful people you’re meeting and ideas that you’re expressing. Now that you’re traveling internationally and provoking conversations, why don’t we just sponsor a get together with some of these thought leaders. We could do a whiteboard discussion and discuss what this all really means.”
That led to the 1989 meeting in Vancouver, British Columbia where we hosted 38 friends and colleagues from around the world from different disciplines to do a whiteboard discussion of what medicine would look like if we remove the barriers of licensure and reimbursement. We talked about what it would look like if it could be best-practice, based on what we’re learning about systems medicine and systems biology. That was the birthing of functional medicine. It really arose out of two renegades, two rebellious guys sitting in a meeting saying, “I think we can put together a better meeting than this.” So I think it’s an interesting history that created this opportunity.
I love that, I love hearing the genesis story. I’ve heard that articulated through my mentor from Bastyr, and thankfully she got the story pretty accurate. Maybe she heard it from you or David over the years, and heard you reflect.
As I now wield the tool that you and an entire community built and conceptualized, it’s so striking to me that its wellspring had this curiosity about, “What would this look like if?” It strikes me that integrity is one of the key operating principles or compass headings that comes out of functional medicine, along with intellectual curiosity and scientific rigor. A lot of these concepts aren’t intuitive to a number of MDs trained in the last 20 years necessarily, given what you described in Disease Delusion as an unintended drift towards a mechanistic approach to health and disease.
When I use the functional medicine tool in my practice now, I find I have the same curiosity at the point of care that you described having back in the mid 1970s along with David. I find myself sitting there with the functional medicine operating system running inside my head. The patient says that they’re tired but not depressed. They’re not anemic. There’s not a one-to-one correlation disease I need to treat with a drug or a procedure, so I am at that point treating only 80% of what needs to be dealt with. Their fatigue has a complex chronic genesis. Then the functional medicine evaluation starts running in my head asking, “What’s this person’s story? What could be happening to the power plants of their cells? Could they have burdens? Could they have inadequate nutrient assimilation through the gut border?”
In case after case after case, I simply ask myself to be capable of wielding the tool when I’m at the point of care. I almost approach it with a sense of the sacred because I’ve seen how many lives it’s changed. It’s just so fascinating to me that if we fast forward the initial conversation between the two of you a few decades, that we’re now at the point of the same truths re-manifesting in multiple domains. People come in and say, “I already know about probiotics, I already know about the gut barrier. I know silent inflammation is part of my depression. What do I do now?” What a span! What a mind-blowing sort of paradigm change just from that beginning.
I’m probably going to be overly simplistic in saying this, but I’ve come to recognize first of all that learning is not linear, it’s episodic. This may come as a consequence of six million miles of travel and being 74 years of age, and trying to understand what I’ve seen and learned and experienced over those years. As Thomas Kuhn said, it has these shifting episodes. You can go along for a long time and you think you know stuff. Then suddenly, boom! You go into this exponential learning moment where you say, “Wow, there’s a lot I didn’t know.” You just pick it up very, very quickly, a whole other reality, a whole other visualization of what you think is reality.
Learning is not linear, it’s episodic. You can go along for a long time and you think you know a lot, then boom! You go into this exponential learning moment. The pace at which our healthcare system is able to incorporate all of the changes in health care lags way behind the knowledge.
For us in the field of health care, the constructs of science that underpin a lot of what medicine is have not been static at all. It’s been extraordinarily dynamic, but the ability of the system in which it’s applied to incorporate that rapid rate of change is not nearly as facile and not nearly as flexible. The system thus lags way behind the knowledge.
The way that people respond to that is to say, “Well, we don’t want to move too quickly because we don’t want to do things that would injure people or put them in harm’s way. We have to make sure that we check every box and go through all the proper evaluation of safety.” No one would disagree that safety is important, but when you’re dealing with chronic illness and the variables have to do with lifestyle, the criteria for decision making I believe are different than if you’re doing chemotherapy with a drug that, at worst, can kill. You have to possess a differential way of assessing how you make decisions. We are unfortunately bridled by the same kind of decision making process no matter what the question is, no matter what the hypothesis is, it’s, “Where is your double-blind placebo-controlled randomized trial?”
Much of the answer to chronic complex disease resides in functional medicine. We need to take a systems approach to discover how genes and environment interact.
When you’re dealing with a multifactorial aspect of people with polygenomic relationships to a complex environment and ask, “How do you do this study?” To tease that apart in a proper way would mean it’s going to be individual and not be population-based health. The answer is it’s impossible. You cannot do all of those things, no matter how much you might want to. If you follow the conventional rules that apply to a different type of question, then you are never going to advance to the answer to where the dominant 80% of our healthcare expenditures lies, which is in the chronic complex noncommunicable disease area. The answer resides in functional medicine or whatever we want to call this. I don’t even want to put a term on it, other than to say that the answer lies in some systems approaches as to how genes and the environment interact to give rise to our function. Our phenotype is a lot more variable than we ever believed. We now recognize that genes are epigenetically linked to experience.
Our phenotype is more variable than was ever believed, and we now recognize that genes are epigenetically linked to experience.
Life experiences can create outcomes such as how we look, act, and feel. It’s very plastic, much more so than we learned from Mendel’s Laws when we were in the eighth grade, and what we learned about crossover frequencies, and dominant and recessive genes. We thought those were the rules of the road, but now we recognize those rules are only partially true. There’s all this other variability that’s laid on top of it, the fine tuning knob that we call epigenomics.
All these things, which are extraordinary new discoveries that have happened only within the last 20 or 30 years, are not incorporated yet in our medicine. The gap thus grows wider. I think that is the dialectic that we find ourselves in right now, and it’s also why functional medicine and this whole field has frontier battles with people that give accreditation and evaluate what is evidence. That’s because they’re working from a set of rules that are actually pretty obsolete in the face of the new things that we understand. If you use old rules to judge new things, you have a challenge.
Sure, there’s a discordance there. I’m struck by so many things you said. One, I feel maybe the most important to attest to is that the dual certification has been so powerful for me as a board certified family practice MD and Institute for Functional Medicine certified practitioner. I spent practicing two years north of the Arctic circle in rural settings, delivering babies, being in the emergency department, using antibiotics, using pressors in the intensive care unit and then using curcumin to down regulate NF Kappa B at the level of the cell in people with ulcerative colitis, and just doing everything under the sun. I am seeing how it all comes together. I realized I’m at about the 15,000 hour mark in functional medicine. I don’t say that as a “gee, ain’t I great.” I say it more as a measure, based on Malcolm Gladwell’s criteria, that I don’t really get to think about the distillate of my understanding until I get past 10,000 hours, so I’m sort of a newbie in that respect.
I don’t find the false dichotomy of conventional medicine versus functional medicine in my practice. Conventional medicine is there and is useful, but it relatively quickly exhausts itself.
I was trying to think of metaphors of who I am in relation to you. I’ve been out there using the tools of conventional and functional medicine and finding out what happens. I’ve been so struck by the safety focus of conventional medicine that is often taken care of relatively quickly. My patients who are tired, I know relatively quickly that they don’t have cancer, they’re not anemic, they’re not clinically depressed and suicidal. We go through that differential diagnosis pretty fast. I’ve done enough medicine over the years that if cancer crops up, or if anemia or clinical depression emerges and that’s the genesis of their fatigue, that those conditions require medication or surgery. We find and treat it.
I don’t find that I’m having to deal with the false dichotomy of this or that. Conventional medicine is there, but it relatively quickly exhausts itself because of what you point to in Disease Delusion that only 20% statistically-ish of what MDs treat is a “one item-one solution,” get the bug-drug combo figured out, get the brain tumor resected kind of problem. The other 80% involves going back through their story, seeing it through the functional medicine lens, the matrix. Functional medicine often helps people get back on track relatively quickly.
I want to share with our listeners a recently published a Journal of the American Medical Association (JAMA) article that cites your work, Jeff. The Cleveland Clinic’s Center for Functional Medicine compared around 1500 of their functional medicine patients with roughly 5000 family health center patients in terms of efficacy of treatment and quality of life. The main purpose of the study was to compare outcomes for patients in functional medicine versus traditional family medicine settings.
Patients were evaluated as to efficacy of treatment based on the National Institutes of Health (NIH) validated tool evaluating quality of life over 12 months. The functional medicine patients had an equal or better quality of life outcomes measure from NIH, which has no agenda at all to further functional medicine. In fact, this study supports the idea that functional medicine may have the ability to improve global health in patients, and concluded that functional medicine may be associated with an improved higher quality of life.
When I heard about this study, I thought, “Well, these are the kinds of studies we need to have more of,” to start talking to the colleagues that want these double-blind placebo-controlled trial data for understandable reasons. The double-blind data again tends to look at a “one item-one fix” solution, whereas the NIH tool for evaluating the Cleveland Clinic’s Center for Functional Medicine patients is in some ways perhaps a better tool, because it can look at a systems biology approach towards an overall outcome. Those are the things that I flashed on while you were sharing. Getting back to the metaphor, I get to be out there actually experiencing what you’re describing.
First of all let me do the obvious, which is to just give you a big applaud and acknowledgement for what you’re doing to bring this model so that people understand that it’s not a replacement for conventional medicine. It’s a compliment to the things that we have learned that are tried and proven, and we don’t want to throw anything out or away. They’re very, very important tools. But then there’s this other new area of exploration that deals with these much more complex chronic problems. We know that symptom suppression doesn’t really treat the problem. The person still continues to get more severe over time until they eventually do end up in the hospital. I think what you’re doing is extraordinarily brilliant! It’s really the manifestation of everything that we were trying to do when we started this idea 30 years ago.
I do want to say something about the Cleveland Clinic study, because as you pointed out I think that it’s very, very important for the Institute for Functional Medicine to do more of this outcome-based work. One of the reasons that work has not been done previously to the extent that we would like is reflective of a great paradigm shift underway now in how you measure outcome in complex patients. As you already indicated, you can’t just take one variable and measure it like you would for blood pressure or cholesterol level, and make that one measurement your outcome observational criteria for efficacy. Only within the last five years has the National Institutes of Health validated the idea that a patient has the ability to self-evaluate how they feel.
Double-blind data tends to look at a “one item-one fix” solution, whereas the NIH PROMIS tool for evaluating patients is perhaps an even better tool, because it is a systems biology approach towards an overall outcome.
That might sound very crazy, because it seems so obvious. For years and years, however, there has been a resistance by medicine and medical science to accept any data that comes from patient response, or so called “patient reported outcome.” We had all this patient reported outcome data that was considered soft or qualitative, meaning that it wasn’t suitable for statistical analysis. It never could reach the level of evidentiary support to be included in a good study, so whatever people felt about the outcome really didn’t matter in terms of the study design.
It was finally pointed out after years and years of debate with biometricians and academics studying this, that oftentimes studies for certain therapies would come out with a positive statistical outcome of p < .05, meaning that statistically speaking the therapy in question showed significant improvement in patients.
When these biometricians and academics actually went and talked to the people that were involved with the therapy, they often said, “I actually didn’t feel better, I felt worse, even though the number changed, and it was significant in terms of a variable against whatever the measurement criterion was. For me personally as a participant in the study who you might’ve said was successful, I didn’t feel I was successful. I felt worse because the unintended adverse side effects were worse than the outcome of the treatment.”
Even though statistics showed significant improvement in certain patients, when the actual patients were interviewed they often stated that they felt the same or worse after therapy.
I think that eventually led a pretty big revolution in what is considered acceptable evidence. In the last three years NIH and the Food and Drug Administration (FDA) for the first time both accept patient reported outcomes in drug registry trials. They use an instrument that was a 100 million dollar NIH initiative called the so-called PROMIS questionnaire. That’s the Patient Reported Outcome Measuring System, PROMIS. The PROMIS questionnaire is now a validated questionnaire that can be used in clinical trials and is in many, many studies. It’s kind of a revolutionary paradigm shifting concept, because now we actually validate the patients and how they feel about an outcome. It’s measurable, quantifiable and forms an important bit of criteria from which decisions can be made. That was the basis of the Cleveland Clinic trial using that PROMIS questionnaire.
I’m so glad how you illuminated that because that kind of data, and validity from the NIH and FDA, that’s the coin of the realm for so many of my colleagues. It’s helpful when I talk about those sources with my colleagues who are medical providers trained in conventional medicine, and I don’t use the word conventional as a pejorative because they have the same background as me. They see me practicing safely, and that’s all they need to coexist with me and feel comfortable with it. When, for example, I switch an inflammatory bowel disease case to meditation and curcumin and wean the corticosteroids, all they need to see in my notes is that I thought about whether or not the person was safe. When we chat or what have you, my colleagues either can be neutral or say, “Oh, that’s interesting, this downregulation of NF Kappa B. I read about it in another area. I just didn’t know that curcumin did it.”
They’re good to go when they hear that the scientific rigorousness has been met, and again a paradigm shift of NIH recognizing the person’s reported outcome matters. It fits so much with what I see at the point of care, in what I find with the functional medicine tool of hearing the person’s story, then engaging the way David Jones has passionately espoused, and forming that therapeutic alliance. Sometimes it almost feels remarkably easy when just hearing the person’s story then illuminates the path forward, because the tool works so well.
I can’t resist mentioning that the only thing that stood out to me about the JAMA outcome we’ve been discussing was that it showed equal efficacy, which is mind-blowing. But the thing that made me go into functional medicine was that I could resolve cases that didn’t respond to conventional treatments.
It sometimes feels remarkably easy when just hearing a patient’s story illuminates the path forward, because the functional medicine tool works so well.
I referred an auto-immunity psoriatic arthritis case to my ND mentor, Hillary Daily, back in 2005. She turned the case around with whole food, bromelain, curcumin and quercetin, probiotics, and some stress management. A number of immunomodulatory drugs had backfired, and the patient reported a terrible quality of life. That’s why they came to the clinic. The much improved outcome was achieved with a handful of supplements and lifestyle changes, and was like 1/100th or 1/1,000th the cost. This is a great time to be practicing!
Yes, Rob, you’re hitting on so many things that light me up and give me goosebumps, that are really important observations. I’ve been asking a question, it’s kind of my recent inquiry question with individuals. I say, “Do you have occasion to either watch television, public media, or to look at print ads in various publications and look at medical advertisements?” Most people in the medical world have some sensitivity to seeing advertisements for drugs or medical therapies. They’ll reply, “Yeah.” And I’ll say, “Well, have you noticed any increase in frequency of specific ads for specific types of drugs?” It’s interesting because most often they won’t acknowledge, or they won’t have recognized that there is some groundswell of increasing numbers of drugs that are actually the same kind of bioactive material. They’re being used against multiple different diseases, all of which relate to immunological hypersensitivity.
You now have drugs for colitis, dermatitis, and arthritis that are all immunosuppressive drugs, and new cancer therapies because that’s the area where the drug company sees the biggest opportunities for treatment. The most rapidly advancing problems that people have is that their immune systems are speaking back. We didn’t just suddenly wake up as “autoimmune” people. In fact, I think the concept of auto-immunity is a fallacious concept. We don’t wake up and become allergic to ourselves. I don’t believe that’s what happens. What happens over time is our body gets transformed into something that is no longer as friendly to us as it once was. There are many biological processes that do this that create debris, damaged cells, or that take our own DNA, cell membranes, or proteins and make them foreign to us. The immune system then does exactly what it should do. It recognizes foreigners and it starts to respond. Unfortunately, we’re the bystander that gets innocently injured.
Many new drugs being offered are immunosuppressive drugs and new cancer therapies, because that’s the area where drug companies see the biggest opportunities for treatment.
When I hear you talk about the experience that you’re having, two things strike me, and I’ll just quickly hopefully summarize. One of our docs in my clinical research facility, Dr. Jack Kornberg, who we dearly loved, unfortunately passed away recently and we’re all very sad. Dr. Jack was a remarkable clinician. He had been a surgeon for 25 years, and was very highly regarded. One of my former students, who was the head of anesthesiology, was in the operating room with Dr. Jack a number of years ago. They were discussing the operation when Dr. Jack said, “There’s something interesting out there that is happening in medicine that I need to learn more about. There’s this other alternative stuff, and I don’t know anything about it.”
Tom replied, “Well, I had a mentor when I was in medical school,Jeff Bland. He’s over there in Gig Harbor, Washington. Maybe you ought to go over and meet him.” So Jack did, he came to an Applying Functional Medicine in Clinical Practice (AFMCP) courses, one of our first classes way back when we first started the Institute for Functional Medicine. He became such a devotee that he and his wife, Peggy, who was a surgical nurse working with him, both gave up their practice and retired from surgery. They became functional medicine husband and wife practitioners. He then became one of the three doctors running our clinical research center. We saw around 1,500 patients a year there on different research projects.
Jack came into my office one morning, and he had the local Tacoma, Washington newspaper in his hand. He threw it down on my desk and he was very upset. He said, “This is ridiculous.” I replied, “What’s ridiculous?” He said, “Read this! Haven’t you read the paper this morning?” I said, “No, I haven’t.” On the front page of the paper was a photograph of two hands. You couldn’t see the face of the person to whom the hands belonged, but could see two hands holding a pile of pharmaceuticals. The story was about this woman who had a unique form of an autoimmune disease called erythromelalgia which causes intense burning sensations in the feet and sometimes hands. It had disabled her so that she had to take this pile of medications. She was taking enough Neurontin, a nerve pain and seizure medication, to basically stop an elephant in full flight.
Dr. Jack said, “We can help this woman.” I asked him, “How do you know that?” Do we know anything about this specific type of autoimmune disease? Have we ever seen anyone in our trials on this?” He sais, “No, we don’t know exactly, but I’m telling you we have an approach that I think could help this person, and we need to take this on. I need to call her and ask her if she wants to come in here and be a member of our studies.” I replied, “Well, I love your advocacy, but this could create some medical legal issues here. So I think we need to be cautious.”
It turns out that her physician, her rheumatologist, was the head of rheumatology at the University of Washington School of Medicine. She was getting high quality care from a traditional rheumatology perspective. Jack was a very convincing guy, a very good people person. With his advocacy, he convinced her rheumatologist to allow us to see her as part of her treatment, because we were doing lifestyle stuff. Her doc said, “Okay, well, that can’t hurt. She’s got a lifestyle, so go ahead.” This was one of the most remarkable experiences that I recall. My office had a window overlooking the parking lot. I could see the patients come in because we had reserved parking for patients coming to our clinic. The first time she came in with her husband, she was virtually immobile. He had to help her, and she was using a walker. You could tell that she was in great, great discomfort. Even on all these medications, her life was really disabled. She was a woman in her late 40s, had four kids, and was unable to leave the house at all.
When Dr. Jack asked what her wishes were, she replied that she had three wishes. Wish number one was to be able to go to the kitchen counter and prepare a meal for her family, because she couldn’t stand long enough to do that. Number two, she wished that she could go into the garden in the spring and plant flowers, because she hadn’t been able to spend much time outside for several years.Number three, she wished that she could go to the mall with her children, and go for a walk in the mall. Those were her three wishes.
It only takes a few of those experiences in your life to transform everything and know that reproducing miracles is what it’s all about.
The reason I bring this example up is that over the course of the months she was coming to visit us using the functional medicine systems approach, she was able to start weaning herself off these medications one at a time with her rheumatologist. This woman who was completely immobile and very disabled gave a gift to Dr. Jack and her nutrition consultant, Dr. Deanna Minich. At the end of eight months of treatment she gave us a photograph of her at the top of Mount Si. It’s a mountain outside of Seattle that’s kind of a rite of passage mountain that people like to climb up. It’s a nice but very demanding trail, because it’s very steep and very long. Here she is at the top of Mount Si holding up a sign that said, “Thank you, Dr. Jack and Deanna.” It only takes a few of those experiences in your life to transform everything you thought of before, and to remind yourself that you might be criticized and people may not understand, but to reproduce miracles is what it’s all about, and to make it available to many others. So that’s kinda my “Ah!”
I’m so grateful to get to participate. I can’t think of any greater privilege. I watched these two astronauts go into the space station, and every time they were interviewed they said how glad and grateful they felt to serve and participate. I thought, “That’s the place to come from–that privilege of participation.” Well, thank you so much again, that just totally lit me up. I’ll be buzzing for days. I may have trouble sleeping!
In terms of the macrocosmic, the microcosmic, as above, so below, I also reflected before talking with you today that you’ve got this Big Bold Health project going. I’ve got, I suppose, what is similar to a Big Bold Health project here in Alaska. Seaworthy Functional Medicine clinic is available to everybody in Alaska including anyone who comes to Alaska for a one-time visit. It would probably be valuable to look at how that’s a manifestation of the concept behind Big Bold Health, so I thought I should share that.
My service area was about 14,000 people a couple of years ago, and included the Homer, Alaska area. We weren’t on social media, and I think our website needed to be more dynamic. Folks that you know who are thought leaders in different areas of functional medicine business, and functional medicine medical law advised me. They asked, “Well okay, Rob, you’ve been doing this a long time, so how do you want to serve next? What’s the next manifestation?” I didn’t realize it would be a cutting edge website and a telemedicine practice where anybody in the state of Alaska could establish care with me. Anybody can come in from Seattle, Cincinnati, Timbuktu, or Two Dot, Montana. They could see me once in Alaska, and then go back to where they live and be an Alaskan patient so that I could serve them over time.
It was all akin to the type of conversation that you had with David, which is, “What’s next? What would this look like if it made the most sense, if it served the most?” In Alaska, if you superimpose the outline of Alaska over the Lower 48, the geographic span of Alaska to the tip of the Aleutians is practically as wide as the whole Lower 48! So for somebody in Nome or Fairbanks, the weather’s going to prevent them getting to me for half of the year, and for the other half it’s often finances or convenience. In order for me to serve them, they need to waive or disclaim that I’m not their primary care doctor, and get cleared by their primary care doctor every two years to see me.
The genesis of Seaworthy Functional Medicine was rooted in, “How can we serve?”
We’ve then met the criteria from mine and our integrative attorney’s perspective that now we’re good to go to serve those folks. It’s just so interesting to me that questions such as, “How do people thrive? How do I serve that? How do I use this tool?” led to the conclusion that we need to be all over Alaska. We need to be educating through blogs and podcasts and social media. The genesis of Seaworthy Functional Medicine was rooted in, “How can we serve?” I wonder if that’s what’s happening for you in Big Bold Health? Are you asking, “How do I, at this point, serve? What’s my next manifestation?”
Rob, in the spirit of reciprocal giving, you just gave a goosebump experience back to me! I just want to say that you are the manifestation of everything that myself, David Jones, and others have been trying to accomplish over these last 40 years since I first met David. I’m really, really in awe and in admiration for what you’re doing. I think it is absolutely just right on spot. There’s so many things that can pull us back away from our dreams at times. The way we would like to see the world can also often lead to disillusionment. Just the other day I was talking to my wife Susan, who is the co-founder of IFM.
I had spent about 20 hours over the weekend burrowed down a rabbit hole to try to understand more about this COVID thing. I walked in late at night that Sunday evening and she said, “Wow, I know you’ve been pretty busy because I haven’t seen you. You look like you’ve been shell shocked.” I replied, “Well, right now I’m in between a very interesting set of contradictory emotions. On one side, I’m exhilarated as to what I’m learning. On the other side, I’m totally disillusioned about what is going on. It’s almost like living in a nether world, living in this complicated environment between exhilaration and disillusionment.”
It works at many levels, it works at societal levels, environmental levels, planetary levels, however you could think of yourself at any one of those levels as being either exhilarated or disillusioned. And I select every day to advocate to be exhilarated because I think the other alternative takes us nowhere. What you just said is exhilarating, but it occurs in the face of things that are often complicated that want to pull us by gravitational attraction into disillusionment. We have to fight against that. When you talk about reaching out, I was reminded that this is part of how we have to fight against disillusionment.
I’m exhilarated as to what I’m learning about COVID. On the other side, I’m totally disillusioned about what is going on. I select every day to advocate to be exhilarated because I think the other alternative takes us nowhere.
Barb Schultz had been one of the nurses in our clinical center and she’s one of my colleagues now and still works with me in Big Bold Health. We’ve worked together for around 30 years since she retired as an intensivist nurse in New York and came out to work with me and got a masters in nutrition at Bastyr.
Barb came in one day back in the days when we saw patients in our clinical research center. She was very disappointed, and that is not her usual attitude at all. She’s usually a very upbeat, optimistic person. She had a patient chart in her hand. I said, “Barb, you look like you’re having a bad day.” She replied, “Yeah, I really am Jeff. I’ve got to fight against this.” I asked her, “What’s going on?” She said, “We’ve seen thousands of patients since I’ve been here, and I’ve personally dealt with many of them. I always take good notes and write the chart notes down in their charts. I always send those chart notes to their attending physician.” It’s just as you were saying, some of your patients have primary care providers and you communicate with them.
Barb said, “So many of the people that are in our studies have remarkable improvement over the course of a study, and some of them are miraculous improvements,” like the one I mentioned with erythromelalgia. She said, “I always make notes and send that information on to the primary care provider in the patient’s chart. I’ve done this for hundreds and hundreds and hundreds of patients.” She said, “Do you want to guess how many people have called or written me back and asked, ‘Gee whiz, that’s interesting. What exactly did you do?’ Just opening up the dialogue?” I answered Barb with, “Okay, obviously this is rhetorical. It doesn’t sound like it’s going to be a good answer!”
Barb said, “It’s happened twice! Twice in the seven years that I’ve been here in this research facility have primary care doctors had enough interest or whatever to call or email me asking what I have done or recommended. That’s very disillusioning for me because I want to think of these people, my colleagues in the profession that I’ve been doing for over 30-40 years, I want to think of them always as advocates who are doing the best they can for their patients. That’s because I know that’s also what they want at heart, but for them to never ask how their own patients who got better were actually treated is very sad.”
Rob, I think that raises all sorts of questions as to why someone like you breaks through, and other people who I’m sure have the same intention in their professional life and this same commitment to patient quality don’t break through. It’s a very big issue that we need to deal with if we’re going to get wider adoption and really make a transition in what is ‘health’ in our system.
I asked my mentor, “If I get trained by IFM, will I understand what you’re doing?” She replied, “Well, if you get the training, you’ll do it.”
During my first two years here in Homer, Alaska, I was admitting patients to the hospital. I think it helped when my colleagues saw me take the time and energy to work through the night. At 3:00 in the morning, the medevac chopper landed on top of the hospital and flew my stroke patient out. I had been sweating the details. I wasn’t bringing any botanicals into the hospital to do that, because it was a transfer stroke case and not a botanicals case. I believe that some of that collegiality has helped because they know I’ve got my chops in conventional medicine. For me, the really striking part was learning so much about the power of our stress/distress pathways. When I was a third-year medical student, my instructors weren’t trying to intimidate me, but I felt as though, “Downey, if you don’t get it right, you’re going to kill somebody.”
I’ve thought back to when I was a second-year medical student. I’m studying all these books and I’m playing hacky sack with my friends over break. Suddenly during the third year it shifts to, “You took this person’s vitals, you took their history this morning. If you get it wrong, you’re going to kill them.” So now there’s this fear imprinting like a gosling following a mother goose, where suddenly it’s like, “This is the beginning of your clinical experience.” I have thought that one thing that’s worth looking at is whether or not we want to imprint new clinicians with the fear that, “if you screw this up, you’re going to kill somebody.” To me the militaristic metaphor is like being a green recruit in combat, I have to look to my platoon leader to avoid taking a bullet to the helmet here.
I’ve grown to believe in having good intent toward everyone, including those I have adversity with, because I think that has made discussions very positive and productive
The fear imprinting was so powerful that it took a long time for me to work it out. I had my Hippocratic oath competing with my fear. Again, I realized that I would have to reconceptualize what I had learned in order to serve my patients. I suppose my hope would be that if we could present conventional medicine as a model, but not the only model, we wouldn’t be fear-imprinting new conventional clinicians. For me there was a carry forward that the participants who weren’t trusted by the conventional medicine community to contribute had really important ideas that were part of the conversation, and needs to be inclusiveness. I’m also glad that I’ve grown to believe in having good intent toward everyone, including those I have adversity with, because I think that has made discussions very positive and productive.
I make a promise to myself all the time, which is that anytime I talk with anyone, I try to talk about what’s good, what matters, and what’s meaningful. And if people are frustrated by what I perceive as false dichotomies between natural medicine and conventional, or what-have-you, I go back to that Dr. Sid Baker adage that functional medicine is just good medicine. It’s just a set of principles that make sense. So it’s been really fun to live it, it’s been a blast. I’ve grown to believe the best thing I can possibly do for my kids is live my beliefs not say them.
I think that there are so many extraordinary truths that come out of opening our ability to see some of these things that were just outside our reach from the way we were trained. They were either on the fringe or they were already stigmatized. Someone said, “Oh, you don’t want to go there, that can take you into dangerous waters, so don’t even ask those questions.” I think once we start cordoning off our ability to explore at the edges of our fields we start sclerosing, or becoming less open to new ideas. I have asked this question, and even wrote an article about this, “What got me into this field?” What got me into this field was not solely the opportunity that I had, which was magic for spending two and a half years with Linus Pauling and even Helen at their institutes in Palo Alto. That was a life changer.
I think that even before that what set me in this intention was that I had been training basic science medical students for 13 years as a professor. I thought some of those students were the most brilliant women and men that were going to change the world and were extraordinarily committed to all sorts of great things. They were growing up, and they were hard workers and dedicated. They were there for service. I thought, “Boy, oh, boy, this is really going to be great to watch them as they grow up and go out into medicine and do their thing!” Over a period of around 20 years I had the chance to meet these individuals who had been in practice for 10 or more years.
The healthcare system in which these young promising individuals were operating squeezed out their most important asset, which is their creative abilities to find solutions that you can never get from a computer in the absence of full sentient capability.
I hope this doesn’t sound too value oriented, but what I came to see in them was that in many cases it was like life was taken out of their eyes. It was as though the flame went dim. I thought to myself, “What happened to these individuals?” I mean, these were really bright, capable, incredibly dedicated individuals. It suddenly looked like the most important thing in our lives, which is our joie de vivre, or élan vital, or whatever you want to call it was stolen from them. I recognized it was the system. It wasn’t them, it was the system that had stolen their creativity, and their sense of exuberance about learning. It was all around protection, self-defense, not getting in trouble, staying on the right side of reimbursement, and filling out the forms right, getting a checkbox, and being a part of a guild that would close around them if they needed support.
The excitement of life and all that other stuff was given over to these other things. I recognized it was not their fault. It was the system in which they were operating that squeezed out their most important asset, which is their creative abilities to use this unique thing we have called our brain in ways that find solutions that you can never think of from a computer in the absence of full sentient capability. That was the greatest theft that I imagined. That was what made me become this advocate.
I’m sitting here feeling so much emotion because the parts that were overwhelmingly emotionally compelling for me today while getting ready to talk to you was that what you care about has become part of the fabric of my life. It’s indiscernible from what I see in the mirror anymore. I do yoga with my wife daily, I ride my bike to work, et cetera. But there was a nadir where the brightness was falling out of my eyes. I looked more like Keith Richards of the Rolling Stones, and less like you. I wasn’t looking so bright, and it was withering. I felt disoriented because I was following my commitment to take care of patients and use the tools that I had learned. But it hadn’t fully emerged into my consciousness that lifestyle was the beginning, it was the cornerstone and foundation of the functional medicine house, which also applied to me.
The tests and supplements did nothing without the cornerstone and foundation built. If I look at the videos I’ve recorded since getting to Alaska, which has been pretty much straight functional medicine for seven years, I’m a little droopy in the video seven years ago. Last year I took a functional medicine business class with Dan Kalish, which was honestly about service. In that class he said, “In a 40-hour week, only 20 hours are for seeing patients, the other 20 is for supporting what you do, and the rest of your time is to take good care of yourself. Do meditation and exercise. Be with your family and go outside to get fresh air.”
There is an abundance for everyone, and there’s a whole career’s worth of people for me to help one by one. There’s also a message to get out.
I realized that, “Oh my gosh, being a living embodiment of the principles is now part of my job.” I felt like the nadir, the irritability, the disillusionment, the overwhelm, the monkey-mind, the anxiety was so profound. I was so scared a year ago. I was scared that our current business partner, South Peninsula Hospital, who we currently have an absolutely lovely relationship with, would not be interested in how we were growing and changing. If they weren’t interested, I knew I would need to go to the bank for a loan, the magnitude of which is going to require me to bring a lot of flowers home every night and do the dishes quite frequently.
The fear, it almost felt like a novel as in, “Oh, this is the crux of this story. This person hits this fear point.” But all of the manifestations and the software is running indicating that there’s abundance. There is enough for everyone, and there’s a whole career’s worth of people for me to help one by one. There’s also a message to get out, so if I get hit by a comet strike tomorrow or in a year, or five years, I want people to get to know what I saw. I want them to see what grew in response to the seed that you and David Jones and everyone else planted so that I get to participate as fully as possible. I realized that I’m sort of a rare creature. I don’t say that in a self-aggrandizing way, but if you look at how many little lab rats make it through the maze and end up with MD training, then IFM experience, some gritty stuff, some setbacks, some poetry and some philosophy all thrown together, it’s pretty rare.
To then pop to the surface at this point, I feel I want what I have witnessed to help people. I want that to have its fullest manifestation. I’m 52, and I feel like I’ve got a lot left, but that’s 52 years done. A lot of people’s best work is in their 30s, 40s, and 50s. I believe that functional medicine allows us to be great in our 60 and 70s. I have to say there were parts of it that were really scary. It’s so striking to me that I had the courage to meditate and eat whole food and ride my bike, because I’d seen my patients get better with it. I felt like, “Oh well, the cobbler’s going to need some shoes now.”
You’re the best teacher, aren’t you, by your examples? You just reminded me of one of my students from many years ago when I was at Evergreen State College on sabbatical and teaching a course in nutritional biochemistry. That was where Applying Functional Medicine in Clinical Practice was born actually. In 1978 Joe Pizzorno and I taught a course called, “Is there a healer in the house?” in which we studied various healing modalities. And I had this very good student in the class who wanted to become a dietician, but he really wanted to do clinical nutrition. I said, “That’s a great profession. That’s a great certification.” He had an opportunity to do an internship with a very noteworthy hospital, and the head of the dietetic services there was a highly recognized published guy in the American Dietetics Association.
This student went for his interview and came back, and he looked very down. I said, “Jeez, did it go poorly?” He replied, “Well, no. At one level, it went actually quite well, I was offered the opportunity to have this internship. At another level, though, it was very disillusioning.” I asked, “Why is that?” He said, “When I went in, I was shown into his office by his receptionist. I went in and he was sitting behind the desk. I had never met him before, and I knew that he was this very well known dietician and nutrition professional. He probably weighed 400 pounds. He had all these Rolaids wrappers sitting around, he was eating a donut, and he was drinking a Coke. When he was introduced to me I didn’t know if I wanted to just turn around and leave, or change my major. Living by principle could be a good teacher!
Wow, you’ve been so generous! People look to you as a thought leader, and I want them to listen to all of your Big Bold Health podcasts. The last question I have to ask you today then is what should people be looking for? What do you want them to know about what you’re doing now, Dr. Bland, as they watch you and your team move forward?
I’m trying to close the loop in the last phase of my career here. Many years ago I set an objective which really has three parts. Number one, to put together a teachable medical curriculum around systems biology and healthcare. That was realized and became functional medicine in partnership with David Jones and the IFM staff and the growth of that. That’s been remarkable, far exceeding anything I would have ever believed. That is a consequence of the extraordinary talents that people have brought into this and made it real.
The second then was to take that model and move it out to create an industry, because I recognize that if you don’t have a supporting industry, if there’s not capital that can flow, great ideas never get fully activated. You need to have other laboratory companies, product companies, evaluative companies, and informatics companies. You need to have a whole community that works together. And so that was really to take it into the Personalized Lifestyle Medicine Institute, which I started in 2013 that broadened the circle to bring in other contributors and participants into this new model.
Third, closing the circle for me was whether I could take this ultimately to the consumer. In the end, changes in culture are really driven by consumers. They’re not driven top down, they’re driven bottom up. If you don’t get an enlightened consumer base, then you’re never going to get to that shift in cultural transition that you really are looking for. I had returned from a meeting, and I was ranting as I often do with my staff on Monday mornings. They’ve been very tolerant of me, knowing that I always come back and have a big monologue.
Many years ago I set an objective which was, part of which was to put together a teachable medical curriculum around systems biology and healthcare. That was realized and became functional medicine. The growth of that has been remarkable, far exceeding anything I would have ever believed.
Trish Eury who has worked with me for over 25 years said, “Jeff, you keep coming back and doing this. You’re a fairly big guy and you’ve got all these bold ideas. I think you need to have a company called Big Bold Health. And I think it ought to be focused on consumers that would benefit from this information that you’ve talked about. It would give you a place to put consumer education and it would tie together your long standing interests in environmental science, planetary health, regenerative agriculture, and personal health into one bucket.” My first job was a dual professorship in environmental science. I was hired during the first Earth Day year, 1970. They wanted to start an environmental science program within the chemistry department, so I was doing environmental science in chemistry. Trish also said, “You ought to call it Big Bold Health.”
Big Bold Health is the last part of my circle of activities here. You can find me on bigboldhealth.com or you can find me on jeffreybland.com or you can find me at plminstitute.org. Any one of those places are the three voices that I’m trying to take into the universe.
It was so great getting to spend time with you today!
Thank you, and likewise. You’re everything that I have been about over these years, and you remind me of the fact that with people like you stewarding the evolution of this field, it will have a great impact on patient care, patient health, and patient outcomes. I’m deeply indebted to what you’re doing, it’s just fantastic!
Have a great day!
You do the same and I can assure you that it’s not going to be a day of disillusion, it’s going to be a day of enlightenment, thanks to you!
Rob Downey, MD
Founder of Seaworthy Functional Medicine