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Where Does Functional Medicine Go From Here? The 2021 AIC in Review

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Guest Bio

James Maskell is a former economist turned serial entrepreneur who founded Functional Forum, the world’s largest integrative medicine conference, with record-setting participation online and growing physician communities around the world. He’s also the founder of the Evolution of Medicine, a community e-commerce platform that provides highly curated and customized resources, tools, products, and services, making it easier and more affordable for conventional doctors to embark on a new way of managing health care. An in-demand speaker, James lectures internationally and has been featured on TEDMED, HuffPost Live, TEDx, and more. He has also contributed to HuffPost, KevinMD, The Doctor Blog, and MindBodyGreen. He serves on the faculty of George Washington University’s Metabolic Medicine Institute and speaks regularly on the integrative medicine conference circuit.

James has spent the past decade sparking debate and encouraging a shift away from conventional western medicine and toward a wellness-centered, functional medicine model—starting with the doctors themselves.

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Transcript:

James Maskell:
That phrase, health medicine, really struck a chord with me, because if we want to talk about the social determinants of health, if we want to talk about all the different topics that are brought together, and where functional medicine is leading the conversation, is how do we create a health system built around health?

Kalea Wattles, ND:
IFM recently wrapped up our 2021 Annual International Conference, which marked 30 years of the Functional Medicine Movement. Since its inception, functional medicine has provided a new paradigm for mitigating chronic illness and restoring health. Keeping with its roots, this year’s conference discussed innovative strategies for addressing prominent issues in health care, such as long-term sequelae of COVID-19 infection, enhancing patient-centered care in a virtual or group environment, and the urgency of health equity in at-risk communities.

In this episode of Pathways to Well-Being, we welcome James Maskell to discuss the key learnings from this three-day online experience and what they mean for the future of functional medicine. James Maskell is a former economist turned serial entrepreneur who founded Functional Forum, the world’s largest integrative medicine conference, with record-setting participation online and growing physician communities around the world. He’s also the founder of the Evolution of Medicine, a community e-commerce platform, which provides highly curated and customized resources, tools, products, and services, making it easier and more affordable for conventional doctors to embark on a new way of managing health care. James has spent the past decade sparking debate and encouraging a shift away from conventional Western medicine and toward a wellness-centered functional medicine model, starting with the doctors themselves. Welcome, James. I’m so happy to have you with us today.

James Maskell:
Excited to be here. Thanks so much for having me.

Kalea Wattles:
This year’s AIC was a really heartfelt, and I would say at times emotional exploration of where we’re at in health care and how functional medicine practitioners are uniquely well-suited to address things like social determinants of health. And as a clinician, there were times where I felt both the weight of responsibility just to do better, but also felt really empowered to interface with my patients in a really nourishing and healing way. So I know it’s really hard to narrow it down—there were so many great speakers—but I thought we could start today’s episode by just sharing a memorable moment from this year’s conference.

James Maskell:
Yeah. I want to share a memorable phrase that I hadn’t really heard before that I felt was like a unifying trend across a number of talks was this concept of health medicine, right? So Amy Mack talked about it in her opening, and it was in some of the other areas too. I’ve always been trying to find a way to unite practitioners, like you’re a naturopathic doctor, there’s people that really align with functional, integrative all these different words, but ultimately, we’re all doing a very similar type of care. That phrase, health medicine, really struck a chord with me, because if we want to talk about the social determinants of health, if we want to talk about all the different topics that are brought together and where functional medicine is leading the conversation, is how do we create a health system built around health? And so for me, that was a highlight to see. Is this a phrase, is this a brand in a certain way that could unite all of these different areas and that we can then look to provide real leadership out to the rest of medicine that is now seeking to reinvent itself with this need to create health but they don’t really understand how to do it?

Kalea Wattles:
Yeah. Health medicine, that’s really well-aligned with what I would say is my most memorable or one of my most memorable experiences, at least from the first day of the conference, was in Amy’s opening talk, how she recounted that origin story of IFM and how Dr. Jeff Bland had this knock on his door in 1977. And on the other side of that door was Dr. Joe Pizzorno. And then Dr. Bland goes on to describe this, I think he termed it, group of friendly revolutionaries, which I loved, who came together and blended—just as you’re speaking about naturopathic medicine, molecular medicine, systems biology—to create what we know now as functional medicine and being a naturopathic doctor and graduating from Bastyr University where Dr. Pizzorno was a founder. It’s really special to hear how intertwined that history is. And I think that really set the scene for us to think about how integrative medicine is so special because it honors so many fields of medicine, and that health medicine catchphrase, I think, is just a really nice way to summarize how we just all want to take care of patients in exciting and innovative ways.

James Maskell:
Yeah, absolutely. Yeah. That was a great starting point. I love hearing the old stories. Obviously, 30 years is a big deal, and it’s nice to be able to do this, because every year for the last five years, we brought the cameras to the AIC, and we’ve had a chance to speak to doctors, meet the community, have people do one-minute tips, some interviews. And so I’m really grateful for this opportunity to summarize what we learned so that all those people around the world that did attend and many that didn’t are able to get a feel for what was a really special event.

Kalea Wattles:
Exactly. I couldn’t agree more, and I will say it is fantastic to see how we’re able to make these connections and cultivate the sense of community even on an online platform. But of course, it would have been so nice to be together, especially when we’re talking about these topics that are very emotionally, socially charged. It’s so nice to be able to have that open dialogue about these topics, and of course, racism, bias, and the responsibility for healthcare workers to engage in these conversations was really highlighted during our conference. And I’d love to chat with you a little bit about why you think this focus is really crucial for the future of patient care.

Podcast HomepageJames Maskell:
Yeah, absolutely. So about three years ago, I realized that this was the next big thing that we had to overcome in functional medicine, right? It’s been the medicine for the very green, the very rich, and the very sick, the very desperate for that long. And if we want to make it out into the rest of medicine, we need to really start thinking about these types of topics, access. And I’ve heard someone say that medicine is not really functional unless it functions for everyone. So when we start to work with parts of the population that have not had access to functional medicine before, it’s really important to be able to really understand where those people are coming from. If we’re the medicine of understanding people’s story, we really need to understand the full story and the full context. And that’s actually something that Gail Christopher said in her opening keynote is that story is such a big part of medicine and particularly functional medicine, because going in and doing the deep dive and understanding where people came from, what their parents are like, what their parents did for a living, what their early years were like, your story as a patient is critical. But a lot of times, it’s not just people’s own life story, it’s the environment that they arrived into. And that can be intergenerational, that can have all kinds of history that they’re coming from. And so ultimately, I think it was a big moment for IFM to lead into this conversation. I’ve become so passionate about group functional medicine, because I believe, and it’s proven out with the outcomes earlier this year in the British Medical Journal from the Cleveland Clinic, that not only are the outcomes better, but the cost is lower. Which now means there’s a legitimate new model to create access to functional medicine operating systems for clinics and for organizations that want to grow and deliver functional medicine. And one of the beauties of the group model is that it does… If you put people of diverse origin and experience into a room together, it’s actually profoundly educational for everyone in the room. And I think as an organization or as a movement, by highlighting people like Dr. Gail Christopher, like Dr. Zimmer, Dr. Carter, we’re able to really understand where we might be missing the mark and how we can all up-level the quality of care that we can provide as we make our way into new territory.

Kalea Wattles:
Yeah. That’s beautifully said. And a couple of things came up for me as I was hearing you speak, which Dr. Gail Christopher, just what an amazing opening to a conference. That has to be one of the most impactful conference opening speeches I’ve ever experienced. And she talked about we’re at this triangle of three different pandemics, which is obviously the COVID-19, but also racism, and then the downstream economic crisis. And I think what you’ve highlighted is that we have to do the medical management piece, obviously with diagnosing, but we really have to understand the lived experience of enduring hardship, enduring racism, that trauma piece, and in a culture that’s really fraught with implicit bias. And we have to understand how that plays out in a patient’s health trajectory. And you already just highlighted the importance of telling the story. And I’ve often thought that functional medicine really shines in this area, because we already have tools like the matrix and the timeline that help us tell that story as we plot out our patient’s lived experience. And I think it’s really important that you highlighted the group visit experience and how that captures folks from a community and builds on that trust and that relationship to really acknowledge how those lived experiences play out in our health.

James Maskell:
Yeah, it’s absolutely critical. And I think that as a community, patients need to experience that, to understand each other and build trust and connection. And then obviously, as a community of practitioners, there’s a long way to go to build that too. And that’s why I’m very much involved in trying to bring practitioners together and communities together of practitioners, because I think that one of the things you see in the group dynamic is that the group dynamic allows people to go places that they couldn’t go by themselves, right? And I think as a functional medicine community, what we’re creating through this input, and then ongoing community and connection and conversation about these topics, we’re allowing doctors and practitioners to go places that they might not go for themselves. Like you could run your own little practice, only deal with white rich people, and never have to deal with this at all. But ultimately, there’s a calling here to go in and really make medicine functional and take this opportunity for what we’re calling this year the evolution of medicine, the reinvention of medicine, right? We’ve had COVID, we’ve seen that the medical system we have is not fit for that purpose. We have an inkling that the functional medicine operating system can solve a number of these critical issues from chronic disease care. But also, some of the things we’re talking about with medicine or otherwise. But one thing I think that Dr. Zimmer said that I was interested in is that just learning about it is not enough. In the same way that just learning about doing healthy behaviors is not enough. It’s in the actual implementation of these ideas into your practice where all the learning happens, and just learning about it doesn’t lead to the outcomes. And so, I think we’re really starting to understand, in functional medicine, we have to focus our efforts on getting people to participate, right? It doesn’t really matter what the protocol is. First things first, let’s get people to participate in their health. And the same thing too with this is it doesn’t really matter what the protocol is for how we’re all going to change our practice and go through a journey of self-discovery to understand how we can remove implicit bias and these things from our practice, but we have to get started into action. And so my hope is that everyone who is watching is now digesting and now is able to start to implement that because this is going to be an ongoing conversation and an ongoing journey for everyone.

Kalea Wattles:
I’ll just add, as you’re talking about this relationship that the patients have with the practitioner, but also that they may have with each other in a group visit setting, is in that opening talk, Dr. Gail Christopher invited us to view health and wellness as something that’s relational. So she said, “Overcoming racial injustice requires that we create this culture where we can depend on each other and then really to value that interdependence.” She said, “In order to end racism, we have to understand how we participate in systemic and structural manifestations, that this work is clearly a matter of life and death.” And so thinking about how the group visit model helps to facilitate this value that we placed on that interdependence, I think it just adds a layer of power to that approach.

James Maskell:
Yeah, absolutely. It’s an interesting journey, and the more and more to see parallels, there’s always been interesting parallels for practitioners that the implementation of participatory medicine with patients and then going a step further and realizing what doctors have to do in order to implement it in that same way. There’s always been a lot of great lessons there, and I think there continues to be great lessons in how we’re all in the process of transforming the way that we see patients and the way that doctors practice medicine. I think one thing Dr. Zimmer said that I liked, she says, “Just recognize that I could be at fault here. This could be me. This could be something that’s for me.” And I think that’s something that was very interesting, because from my own personal experience, I grew up—my first five years in this world were in apartheid South Africa, right? So it was super obvious to me even growing up to 10 years old, there was literally whites-only beaches still in my lifetime. And so being aware of that and in some ways participating in that, but in some ways not participating in that, because my parents were very much against that, and that led us to leave South Africa. And then now to participate in it, I always felt like, “Oh, well, I’m not like that,” because ultimately, I look at my history and I can see apartheid when it’s there and that’s it, but ultimately, there’s a lot. On reflection, there’s a lot. There’s a lot in how I interact with physicians. There’s a lot in how I interact with the community. There’s a lot about how we create safe spaces for doctors to gather together. All of those things have been conversations that I’ve started to realize. And a lot of it I learned from when I was writing the book, The Community Cure, going and sitting in these groups, right? And going into Oakland and seeing 35 people in a room together and seeing the depth of disparities between the different people in the groups. And so I think there’s a lot of soul searching and connection that comes from being in it and recognizing that this is probably for all of us.

Kalea Wattles:
Yeah. Well, thank you for sharing that insight, and I think you highlighted that aspect of Dr. Zimmer’s talk where she talks about having, I think she phrases it, moral courage, where you have to have that bravery to look back and to reflect and to see where your shortcomings are. And in a lot of ways, I think that’s step one when we’re thinking about how we’re going to dismantle these problematic aspects of our society. And it also made me think, just as I’m thinking about clinical takeaways that I had personally, was the talk by Dr. Stephen Porges where he talked about this concept of intimacy and how it actually relates, not just in our close partner relationships, but all of our social exchanges. And for example, he said, “Our body language helps for the people around us to understand if they’re safe.” And he mentioned even simply maintaining eye contact or using facial expressions, these things, of course, are feeding back to those around us, about what he even called predation risk, which I think is really a stunning, startling way to say, “Are there predators around us?” But I think this plays out in the treatment room when we’re with patients and behind the screen and furiously typing, and are we even cultivating that aspect of health care that allows for the therapeutic partnership to thrive so that when we go to those hard spaces, like you mentioned, that that information is able to surface so that we can offer assistance and healing? And just the last thing I’ll say about the group visit model is, what a beautiful way to inform a group of people that their nervous system can rest so that those experiences can surface and there can be a collective healing.

James Maskell:
Exactly. And that gets into some of the polyvagal stuff that I thought was really interesting, just like the science of safety and how do you help people feel safe? And how do you turn on the parasympathetic nervous system consistently? Or how do you get people into those kinds of spaces? Yeah, I think that was really interesting. And I think for many doctors who have for most of their career participated in, for want of a better word, like disease medicine, there’s also a large and looming shadow of that and how that has not been empowering, right? That has not been taking into account everyone’s perspective. That’s been a sort of a drug-dispensing machine, one way or another. And there is some shadow to that that has to be dealt with as doctors start to make a journey into practicing in this new way, that even if you’re practicing health medicine now, you’re still viewed with the credentials of disease medicine and all of the baggage that comes along with the highs and lows of that history.

Kalea Wattles:
Yeah. In Amy’s opening statements at AIC, she said, “We really need to move away from standing alone and appreciate what every practitioner has to offer, what they bring to the table,” because that’s what happened 30 years ago when IFM was founded, right? It was this appreciation for so many different modalities and philosophies. I’d love to hear from you as someone who, from my perspective, is very well connected in the field of functional medicine. How do we start approaching these conversations as allies to find alignment between more of that interventionist model and the functional medicine world?

James Maskell:
Well, I’m biased, because I’m working on this the whole time, but I want to get people in rooms together with—the whole goal of the Functional Forum meetups was always, how do you put people in a room together to actually start to develop real empathy? Because I think that a lot of times there is this gap, and that was also commented on by Mark Hyman and Laurie Hofmann and Joe Pizzorno in one of their sessions too, that there is this gap. And look, the medical delivery of care for type 2 diabetes is pretty stark, right, in its difference between the allopathic approach and the functional medicine approach. And we have to honor that there is a significant difference in those two approaches, but as you said, we need disease medicine, definitely. And it’s an important part of the future of medicine, but ultimately, the growth and the trajectory that I think all of us see in this community is that if we were able to scale up the delivery of health medicine via functional medicine to a whole population, we wouldn’t need as much disease medicine, because there wouldn’t be as much disease. And I think that’s the shining light for me. And I think what’s really happened in this pandemic is I think a lot of doctors have realized that there’s a certain understanding of health creation that needs to be brought in. In fact, I want to actually talk about this, because Dr. Galland talked about this, and I love Dr. Galland. I’ve always thought he was such a great communicator, but he talks about this missing curriculum, right? I just love that phrase, this missing curriculum. There’s—doctors see the world through disease and patients see the world through illness, right? And that ultimately, he created this patient-centered diagnosis model that’s a central part of the functional medicine operating system to try and bring those two worlds together. And so I think there’s potential even in the medicine, right? Learning about functional medicine that can bring those two areas together. But he said something that was really powerful that I love. He said, “The more specialists that a patient has been to where they’re not getting the results, the greater the need of this missing curriculum.” And ultimately, this missing curriculum is functional medicine, right? It’s a lifestyle-first approach. It’s a root-cause approach. It’s learning the story. It’s sitting with people. It’s connecting. It’s turning on the safety signals, because everything else is being lost, and it’s not this drug or it’s that drug. It’s like, “Let’s have a real conversation about what your life is like today.” And as I’ve witnessed doctors over the last 15 years make a journey toward functional medicine and develop some expertise in it, what I hear from them, they say is that at the very beginning, they are very much in the minutia of the labs and the supplements and the drugs and how to work it all out. But as they become more sophisticated, the first conversation they’re having with patients is, “Tell me what’s going on in your life,” because they realized that that is the missing curriculum that is being left behind. And so I love the phrase that he used, “the missing curriculum.” And I think that functional medicine is the missing curriculum of medical school. And ultimately, if you go to the end of Dr. Galland’s talk, he’s like, “Look, we’re even more relevant 30 years in than we ever have been because most people realize that it’s that missing curriculum that made us ridiculously susceptible to COVID in this case.” So that really tied it together for me, and I thought Dr. Galland obviously played a critical role in the creation of this whole thing. And I think the patient-centered diagnosis can be a point of bridging, I guess, between disease medicine and health medicine.

Kalea Wattles:
Well, Dr. Galland’s talk was one of my most favorites at the conference as well, and it must’ve been a very profound statement, because I also wrote down in my notes the quote that you mentioned about disease is what the doctor sees, but illness is what the patient experiences, and those things are not the same, which I think, wow, we really have to sit with that one. That’s very profound. And to your point, at the end of Dr. Galland’s talk, when he said, “Bringing the missing curriculum to health practitioners will continue to be an indispensable function of functional medicine.” Wow. What an invitation over the next 30 years to continue to advance this model. And just when you were speaking, you said, how we do that is to scale up. And I’d love to dive into that a little bit, because I know you’ve done quite a bit of research and work in this area. We’ve talked about some group visits, but there’s also just virtual visits in general or other innovative care models leveraging technology. From your perspective, what are a couple of takeaways for our listeners of what we can start thinking about to really scale up?

James Maskell:
Again, this is the other thing that I spend a lot of time thinking about, but yeah, I mean, look, I think that we need to drastically reduce the friction to engage patients into the missing curriculum. And ultimately, if the only journey for people to get the missing curriculum is to find a doctor that has had to break ranks with their whole profession, go through this other education, completely reinvent their practice, completely reinvent their business model, there’s way too much friction in that. And a certain degree has sort of throttled the growth of the movement, because look what it takes for a doctor to make a journey to now be delivering the missing curriculum. And in the context of technology, are we really delivering that missing curriculum efficiently, given that me sitting across a desk from you in our two-hour first appointment and telling you all about the missing curriculum is an unbelievably inefficient way to deliver that new curriculum? So I’ve been really thinking about, look, even conventional colleagues understand a few things, right? That most of their patients don’t have a lot of immune resilience, right? Most of their patients have experienced a massive increase in social isolation over the last year and a half and need other people to connect, and that most of them are not doing the healthy behaviors every day that would create new resilience. And so what I’ve been really focused on is how can we help those doctors, who just have to know that, prescribe an episode of care that could fulfill that missing curriculum, and not just the curriculum, but actually the structure by which people can implement the curriculum and actually get better without ever having to go through this long journey for practice transformation. Because I see that there is a desire even in major medical institutions now to deliver this missing curriculum, this behavior change structure. They don’t know that it’s called functional medicine necessarily, right? And they may even have reservations about that phraseology. But ultimately, I think it’s part of our journey to—the word that’s used a lot, and I use it a lot because I just think it’s a good way of explaining it, is functional medicine as the operating system. And what I would say is that you don’t often think about… I think that it’s almost time for functional medicine to be delivered in a way where it’s not really all about functional medicine, where it’s just, this is the way that we deliver medicine, and it happens to have that operating system built into it. And so you see that more and more startups and entrepreneurs and other people are coming into the space because they recognize there’s this huge gap in what we could be doing and what’s working versus the way that we’ve been doing it. And I think that more and more of those scalable solutions will have the functional medicine operating system built into it. It just won’t be called functional medicine, because ultimately, there’s still a large education gap that needs to be filled for that terminology.

Kalea Wattles:
Yeah. In the clinic, patients will sometimes ask me, “Well, you’re a naturopathic doctor, so what’s the difference between functional medicine and naturopathic medicine?” And then that gives me this whole opportunity to discuss how the philosophies are actually very well aligned, but that functional medicine or the functional medicine model is really this framework that allows me to solve complex cases. And then I can utilize my naturopathic therapeutics to help patients become well or to seek wellness, seek wholeness. So I also like to think about it as an operating system.

James Maskell:
Can I just add one thing to that? Is that’s the reason why I decided to call the Functional Forum “the Functional Forum” and bet on functional medicine, is because in order to create scale, you need an operating system. And particularly, in order to create effective practitioner teams, you need an operating system. And therefore, when I get asked those kind of questions, I’m like, “Look, the principles are all there.” Naturopathic medicine is a principle-based medicine, right? There’s the six principles, but ultimately, how will a team actually work together in clinical care? When will they know when to refer patients back and forth? How will they prioritize the interventions for the individual that’s right in front of them? Those are things that functional medicine has in spades. And even someone of the depth and breadth of the speaker, I’m just forgetting his name, Lee Hood, right? Lee Hood. Incredible. I can’t tell you that I understood all of his talk, because he’s a very heady character, and he has just incredible knowledge of pathways and systems and engineering applied to medicine. But his idea of P4 Medicine, and I’ve said this a number of times, is actualized today through functional medicine. This is what you would do if you wanted to deliver a medicine that’s P4 executed. So I think even in that talk, what I took away from it, and he said it at the beginning, is that functional medicine providers are well-equipped to deliver this new iteration of medicine that’s built in omics and systems biology or otherwise, but we don’t have to try and work out how do it. There’s a system that we’re all being taught how to do. And if the one central clinician can understand that, then these other functional nutritionists and integrative providers and conventional providers can all work in a team-based structure. And there’s plenty of examples to show that that team-based structure is super-duper efficient for delivery of care and also gets great outcomes.

Kalea Wattles:
Yeah. Very well said. And as we’re thinking about how we build the collaborative care team in the work that we’ve been doing to educate about how functional medicine can support the COVID-19 pandemic, I think we’re seeing a variety of practitioner types who really have something of value to offer to that conversation. We’ve been able to bring them together for a series of offerings that we’ve had here at IFM. But as we’re thinking about functional medicine and COVID-19 specifically, I’d love to talk about how functional medicine is actually well-suited now into the future to support those who have so-called COVID long-haulers. I’ve often thought that functional medicine is such a beautiful model because we already know how to support all of the body systems, right? That’s never been more relevant. So how do you see functional medicine engaging with the future of the ongoing COVID-19 pandemic and long-hauler considerations?

James Maskell:
Yeah. Well look, how many people’s practices in functional medicine have been built around long-haulers from other infections, right? Lyme, Epstein-Barr virus, many practitioners have built a whole following built on their ability to help people with Lyme where all of these specialists couldn’t figure it out because of the missing curriculum, right? And so yes, there’s a history of us understanding this, there’s a history of success in the outcomes. And so I view it as a huge opportunity to do it, but look, the opportunity only really lands if we can prove that the outcomes are there. And this has been something that I’ve been hot on, and now I’m taking it into my own hands, honestly, because I’ve been just desperately disappointed with how it’s gone in the seven years that I’ve been centrally involved here, is look at what a landslide or a moment there is where functional medicine makes it into BMJ or JAMA. It’s huge. But the only reason why that happened is because the Cleveland Clinic got their ducks in a row, thought it through properly, and executed in a way where their data now can inform the rest of the industry. Your average doctor in private practice doesn’t really have the incentive to track their outcomes in that way. There are some examples now of organizations that are doing that, but okay, we all think that we can do a great job at COVID long-hauler syndrome. And I bet we can, and I know that we’ve got all the pieces, but we’ve got to prove it. And we’ve got to prove it by patient-reported outcome measures and pain measures and all the other ways that conventional medicine determines whether their results are good. And if we can use that same system and be able to show that, okay, groups of people with long COVID coming together and learning through a curriculum and building function through their organs and systems and learning how to take care of the bottom of the matrix and starting to understand their stories. We are perfectly positioned to execute on that, and we have so many tools that conventional medicine doesn’t have, and yet in order for us to become the leader, we have to be able to document that this thing works. And I think all of us know that it works, as we’ve seen people who have been everywhere else come to us and get better. But ultimately, that doesn’t really move the needle in the way that an article in JAMA or the British Medical Journal does.

Kalea Wattles:
Yeah. When we think about… There’s those stats that say any intervention from bench to bedside is going to take 10, 15, maybe 20 years, but we just don’t have time to wait 20 years at this point. So seeing all these therapeutics roll out that certainly support the immune component, but now the mitochondrial function, modulating inflammation, supporting the vasculature, ensuring antioxidant capacity, all of that is so exciting. And to see that emerge at such a rapid pace is really a sight to see. And I’m wondering, just since you are so engaged with practitioners that are active in the field, they’re collecting data all the time. We’re all collecting data all the time, just in our daily life in the clinic. How do you suppose that practitioners, just any clinician, should share that information and network and start to collect that data?

James Maskell:
Well, the first thing is to collect the data in a way that other doctors will validate. Like the MSQ, for all its awesomeness, no one cares about that. They don’t even know what it is. The symptoms went down, and so you have to collect data in the right way. And so I’ve been fortunate, actually, to spend a bit of time with Chris D’Adamo, who’s quite connected to IFM, and just really think about, “Okay, what could we measure that would move the needle? And then let’s do that.” Because the truth is, everyone’s got a digital thing now, right? They’ve got an EHR, they’ve got a system. It’s not that difficult to have as part of your onboarding in your practice. Hey, go and fill out these X number of questions that are NIH-validated metrics for PROMIS or there’s even like mental health ones that we’ve been working with that are just a short number of questions that are NIH-validated. I mean, pain is one. So Mylene Huynh in her talk was amazing. And obviously, we’re in such a great place to really help with chronic pain. It’s a bio-psycho-social illness. There are physiological reasons why people experience pain, loneliness. I thought that was a really interesting talk, and it was cool to see pain mapped onto the functional medicine matrix, but we could… Just telling people, asking them what their pain score is between one and ten, that’s a validation measure of pain. And so, why couldn’t we be doing that very easily with some of the technology that we have when patients are coming in with pain, which is a factor when it comes to things like autoimmune disease, for sure, and muscular-skeletal stuff and long COVID and Lyme. So I think it’s about really thinking, like, “Hey, now that I have a technologically evolved practice, where I have an EHR and I have an email automation system and I have an onboarding system, could I just do a little bit of work now to work out how to send patients to something other than the MSQ so that I’d be able to show through 100 patients that my long-haul COVID protocol does work?” And some doctors are forced into it when they’re part of like an ACO, right? An accountable care organization or their data is feeding in somewhere that people have already thought about this. But one of the downsides of the way that functional medicine has grown amongst individual practitioners who care, who have just made this journey, is that we haven’t been good at that. So I expect that to be something that more and more doctors are engaged with, because I’ve seen a lot of organizations now want to hire functional medicine doctors because they realized that they don’t know what the missing curriculum is and they recognize that functional medicine has it.

Kalea Wattles:
Well, I think we can really relate that to the pain talk that you just brought up of addressing the missing curriculum, and then also honoring that the approach is likely multimodal and figuring out how we’re going to track that. Because when we think about the chronification of pain, I think it’s really natural to consider adverse childhood events or poor health, poor nutrition, but as you mentioned, loneliness, things like perceived injustice or…Wow. I don’t think that many of us are thinking about how this can contribute to pain chronification and then also just honoring that the approach to pain is the lifestyle factors, movement, physical medicine, behavioral therapy, maybe acupuncture, energy medicine. That there are so many practitioners that could participate in that collaborative care model to really support pain patients. So I think that was a good lecture to tidy up those topics that you’ve already mentioned about building a collaborative care team and addressing the missing curriculum. That really is going to be the game-changing factor when someone’s already seen so many specialists and they’re still having symptoms.

James Maskell:
Yeah. And one other shout-out I’ll give out that I thought was interesting is wound healing, right? Who would have thought that functional medicine could have an impact in something that’s that acute. We probably even think, “Okay, well, that’s where the disease guys have to be, because we’re doing the health medicine over here.” But even in that, I just got a quick download on that and realized, “Yeah, there’s a lot.” The degree to how the body heals is a function of the internal processes and the health of the body. Who knew, right? But it’s really cool to see functional medicine starting to have a voice in those traditionally acute medicine areas.

Kalea Wattles:
And I think that’s where we see this interface, right? Of, it doesn’t have to be either/or, it can be also/and, and just as you described coming to that conversation in a position of allyship and understanding how everyone can contribute and ultimately the patient benefits, if we’re able to have that conversation and to build that team. As we’re coming to the end of our episode, I want to make sure that we spend a little time talking about the path forward, because that’s why we do the Annual International Conference, right? It’s to collect this information, to download this information and then decide, how can we implement this in patient care moving forward? So now that AIC is behind us, we’re looking ahead to what’s going to happen in the next year or the next 30 years. And I know you’re very engaged and excited about the possibilities in the near future. So, I mean, what do you think? What’s happening next?

James Maskell:
Well, I’ll give everyone a heads up. So each year at the Evolution of Medicine, we have an annual theme, right? So we were very prescient with resilience 2020, obviously, with what went down there. This year, we are all about the reinvention of medicine and really starting to have conversations about the reinvention of clinical care, and also, this summer, mental health, but we’re already set for 2022, and our theme there, which is really growth, right? It’s the growth of the industry, it’s the growth of the ecosystem, it’s the growth of access, but it’s also personal growth, I think, as a conversation. And I think that part of what we were challenged to in this conference is that journey of personal growth. And the impact of a little bit of growth from clinicians on their whole patient base for the whole rest of their career is dramatic. And so if you think about it in those terms, I think there’s a great opportunity in the summer after this conference to reflect and spend some time thinking about how we’re going to reinvent the way that we practice. And then with that reinvention, how can we now grow access to this kind of care? So that’s my thought is that there’s this great opportunity now to prep for this exponential growth in the care that we’re going to see. And Mark Hyman shared in that conversation that he had with Linus Pauling Award Winner Laurie Hofmann and Joe Pizzorno that he saw, I think, these three ideas that he felt were going to drive the growth, right? So one is food is medicine, and I think that people are coming around to that. It’s obvious, it’s been obvious for 30 years, but now it’s irrefutable and super clear that we really need to do that. And that’s coming from up high, it’s coming from farmers, it’s coming from health care. So we’re seeing that really start to be front and center. The second is the delivery system. So we spoke a little bit about that. So, what is this functional medicine like? How do we deliver this missing curriculum in a way that is easy and makes it easy for people to execute on it and is delivered in a way that people are used to getting information, and how is it grounded in our medical relationships? And then there’s this last bit, which is a little bit Lee Hood and a little bit everything else, which is this convergence of

omics and systems, quantified self, big data, and AI, which is not really in the purview of each individual clinician apart from get the data, right? Because we can do all the backend stuff with it already, but if we can actually track outcomes data and have that data in a way that it can feed into some of those systems. The sooner the big data gets access to the outcomes of functional medicine, the sooner it will be clear that this has to be the operating system of medicine, as far as I see it. And there are organizations that are getting that kind of data and have hired functional medicine people historically and are starting to build data sets that show that if you eat like this, you get this kind of outcome, but that’s the next phase. And whether or not Silicon Valley executes on that, or whether or not the functional medicine ecosystem executes on that, or whether those two things just converge and that just becomes the thing, we’ll see, I guess.

Kalea Wattles:
Yeah. It’s wonderful how you’ve described this reinvention of medicine and focus on health medicine, and you already mentioned our Linus Pauling Award Winner Laurie Hofmann, and it was so profound to watch her speech and to hear about her efforts over the last several years, to really engage a larger community for the advancement of functional medicine. And you and I have talked over the course of this episode about how we start to bring practitioners, healthcare providers, into that fold, into that conversation. But in terms of opening the conversation to the larger population, what do you think that means for the functional medicine ecosystem over the next 30 years? Are we going to continue to see our community grow in a perfect ideal scenario to become more of a standard approach?

James Maskell:
My hope is that ultimately, in 30 years, it’s not a functional medicine community, right? That the terminology just gets baked into the way that we actually deliver care, because it’s human, right? Because it’s based in story, it’s empathetic, it’s empowering. And I don’t know. I think there’s going to be a rocky road for the next few years as these ideologies about the future of humanity come into opposition. But I think in the 30-year timeframe, we’re good. In my lifetime, I mean, I’m 40 now. I’m intending to participate. There was actually something they talked about with mentorship and young people and a lot of the IFM senior people becoming senior and looking for this next iteration of who’s going to step into leadership to take the group forward. And I think there’s tons of people inside the IFM and the functional medicine movement generally, and even in academia and in business or otherwise, that are stepping forth to grab the mantle. So I’m very bullish, but I’m always an optimist about it, but I think there’s plenty of signs that we’re headed in the right direction.

Kalea Wattles:
Well, this is the perfect opportunity for me to put a plug in for what you’re referring to, which was a series of legacy videos that IFM recorded where we had a functional medicine pioneer in a variety of topics, and then brought on a newer clinician in that field. And there is this very nourishing transfer of lived experience and all of the clinical takeaways that these clinicians have acquired over their decades of practice. And I think that mentorship piece and that transfer of knowledge and experience is one of the ways that functional medicine will flourish, because our community is so willing to offer the mentorship and the guidance to any clinicians who want to enter this realm.

James Maskell:
Beautiful. Well, I’m excited for this, and I hope that podcasts like this can draw in new people and get them onto a path toward playing whatever role they want, whether it’s leadership or otherwise into taking the movement forward. And I’m grateful for the opportunity to be here on the podcast and to synthesize what went down. And it was really cool to go through and see all the different speakers and leaders and all the different areas that have been brought in and hope this gave everyone at home a taste of what happened, and I really look forward to 2022 in person. And fingers crossed, we’ll all be able to connect in person in Dallas next year and have a great time.

Kalea Wattles:
Well, thank you so much for taking the time to be with us today. I know you’ve devoted much of your time and your energy into advancing the functional medicine model and helping clinicians to scale up, as you said, and really deliver this information in a sustainable way. So really appreciate your time. Thanks for being with us today.

James Maskell:
Thank you.

Kalea Wattles:
To join the conversation on this topic, visit IFM’s pages on Facebook and Instagram. For more information about functional medicine, visit ifm.org.

Show Notes