Ellie Campbell DO Campbell integrative Family Medicine
Revolution Practice, LLC
CMT Conference Oct 2018
1) History and Definition of Integrative and Functional Medicine
2) Root Cause Resolution and the role of antecedents, triggers and
mediators
3) Tools for the exam room: the functional medicine matrix and timeline
4) Putting it all together! Concierge medicine and Functional Medicine :
an opportunity for improved patient outcome and revenue
5) The Scholarship Program in concierge care
6) Resources to learn, implement and share functional medicine
2 © Ellie Campbell 2018
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By comparison, AUSTRALIA spent 9.422% of GDP and ranks
#3 for men and # 7 for women in life expectancy and CANADA
10.45 % #8 for men and #10 for women
USA
life expectancy #31
Is it ETHICAL to continue to practice in
a broken system that spends too much
money and gets such poor outcomes
compared to the rest of the world???
Or is it time for a
PARADIGM REVOLUTION?
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The IF the primary driver of chronic disease is the complicated interaction between
genes, activities of daily living (lifestyle), and the environment, DRIVEN BY INFLAMMATION THEN our allopathic paradigm addresses these very poorly.
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Integrative medicine -A holistic medical discipline which takes into account
• the lifestyle habits of a patient.
• treat the whole person rather than just the disease.
• mind, body, and soul of a patient are taken into consideration to promote healing and well-being.
Integrative medicine is a combination of modern healthcare
practices for Dx/Tx, often including acupuncture, yoga, massage, nutrition, exercise, structural therapies
. Foundational belief that poor lifestyle choices are the root cause of many modern chronic diseases, and that drugs and surgery are not the solution.
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Functional medicine is a systems biology–based approach to health care that focuses on identifying and addressing the root cause of disease.
It embraces much of the philosophy of Integrative medicine as described above
BUT ALSO
Views the body as one integrated system, not a collection of independent organs divided up by medical specialties. It treats the whole patient, not just the symptoms.
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Marries current progress in
basic medical sciences
with clinical medicine to address
the growing problems associated with
chronic disease.
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Roger Williams PhD (B5 and Folic Acid)
Linus Pauling PhD (how atoms become molecules)
Weston Price DDS (anthropologist)
Jeffrey Bland PhD • Institute For Functional Medicine in 1991
Mark Hyman MD
Josh Axe DC (online…your patients read
him!)
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Mission of IFM • educate
and • provide clinical support for the implementation of
functional medicine across disciplines within the
healthcare sector.
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Whaddya Have? that you need to get rid of
Whaddya need? that you are missing,
in order to get better
Whaddya GOT?? Whaddya NEED??
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A framework and paradigm to address the underlying causes of chronic disease using a systems approach to root cause resolution.
We don’t ask WHAT your diagnosis is, we ask WHY you have symptoms
We look for antecedents, triggers and mediators
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environment, lifestyle, diet, activity patterns, psycho-social-spiritual factors, and stress.
These lifestyle choices and environmental exposures can push us toward (or away from) disease by turning on—or off—certain genes
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In 90 DAYS of TLC !! 48
GENES up-regulated and 453
down-regulated after the
intervention. Ornish 2008
IF EPIGENETICS ARE CONTROLLED BY
ENVIRONMENTAL TOXICANTS ALLERGY AND SENSITIVTY INFECTION DIET AND LIFESTYLE
SHOULDN’T MEDICAL DOCTORS AND
PRACTITIONERS BE ADDRESSING THEM???
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1. An understanding of the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness;
2. Incorporating a patient-centered rather than a disease-centered approach to treatment;
3. Seeking a dynamic balance among the internal and external body, mind, and spirit;
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4. Addressing the web-like interconnections of internal
physiological factors;
5. Identifying health as a positive vitality - not merely the absence of disease- and emphasizing those factors that encourage the enhancement of a vigorous physiology;
6. Promoting organ reserve as the means to enhance the health span, not just the life span, of each patient
7. Functional Medicine is a science based profession
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Assimilation: digestion, absorption, microbiota/GI, respiration Defense and repair: immune, inflammation, infection/microbiota Energy: energy regulation, mitochondrial function Biotransformation and elimination: toxicity, detoxification Transport: cardiovascular and lymphatic systems Communication: endocrine, neurotransmitters, immune messengers Structural integrity: subcellular membranes to musculoskeletal integrity
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Where does the SYMPTOM come from? ie what are the antecedents and triggers
What keeps is GOING? • ie what are the mediators
And what can be done to CHANGE a
dis-eased homeostatic BALANCE point
the patient is locked into? • ie what are the underlying points of leverage
where the intervention can be most effective?
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Simply addressing Chief Complaint
and History of Present Illness to arrive at a DIAGNOSIS
RATHER: a comprehensive story filtered through the lens of antecedents, triggers and mediators to understand key imbalances
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The most important precept to remember
about Functional Medicine is that restoring
balance—in the patient’s environmental
inputs and in the body’s fundamental
physiological processes—
is the key to restoring health.
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Phytonutrients and supplements (incl EO and homeopathic remedies)
Meditation Diet Vitamin and Mineral therapy (oral and IV) Manipulative therapies Acupuncture and TCM/Ayurveda Surgery Drugs Exercise including yoga and Tai Chi Counseling Oxidative and regenerative therapies Detoxification strategies (including chelation)
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G= Gather Information
O= Organization Information
T= Tell the Complete Story Back to
the Patient
O= Order and Prioritize
I= Initiate Treatment
T= Track Outcomes
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Factors the predispose to acute
or chronic illness
Discrete events or entities that
provoke disease or symptoms
Contribute to the
manifestation of disease
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TRADITIONAL ALLOPATHIC MODEL:
Chief Complaint: 54 y/0 WM Substernal Chest pain, DOE HPI: 3 months duration, worse with exercise,
relieved by rest. Underlying obesity, HTN and hyperlipidemia
TREATMENT: stress test +/- echo and CXR, give handout on BMI risk and lower CHOLESTEROL with statin, aspirin, +/- ACE-I, NTG;
come back when you need PCI /CABG
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Review the Matrix and Time line
Test genetics: ApoE, KIF6, Haptoglobin, Cyp450, MTHFR
Test underlying root causes:
Vit D deficiency, OSA, IGT, dyslipoproteinemia, grief,
dental disease and meridians, inflammatory markers,
toxicants esp. heavy metals
TREATMENT: TLC!!! Therapeutic lifestyle changes,
begin GF diet, targeted supplementation, dental
consult, chelation therapy, emotional support,
coaching and counseling. Meds for now, wean off as
possible © Ellie Campbell 2018
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Post MI >50 y/o; Creat <2.0 Overall 26% reduction combined endpoint (death, MI,
CVA, revasc, angina hosp) p=0.0002 NNT 6.5
DIABETICS: blew them away
Overall 51% reduction combined endpoint (death, MI, CVA, coron revasc, angina hosp) p<0.001 5 yr NNT 5.5
43% Reduction in MORTALITY p=0.011 5 yr NNT 12
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TACT2 trial recruiting [email protected] $37 million award 2016
TACT (Trial to Assess Chelation) 2013 Dr Gervasio (Tony) Lamas Post MI >50 y/o; Creat <2.0
Overall 26% reduction combined endpoint
(death, MI, CVA, revasc, angina hosp) p=0.0002 NNT 6.5
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Framing Root Causes as ATM:
USING our PARADIGM OF
ANTECEDENTS TRIGGERS MEDIATORS
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IMPROVE CLINICAL OUTCOMES
(GET BETTER RESULTS, NO CVA/MIs)
INCREASE REVENUE TO THE PRACTICE • Opportunity for testing non-covered labs
• Opportunity for testing US with CIMT (non-covered)
• Opportunity for retailing supplements
• Opportunity for home sleep apnea testing
• Opportunity for pathogenic oral flora testing
• Consider creating “all inclusive packages”
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VIRTUALLY ALL OF MY PATIENTS GET GENE TESTED
• MTHFR
• APO E
SELECTED PATIENTS ALSO GET TESTED
• CYP 1A2
• CYP 2C19
• KIF6 (Kinesin family member 6)
• 9P21
• 4q25, Hp, IL-1,IL-6, IL-17A, ETC ETC ETC
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AMERICAN BODIES ARE ON
FIRE WITH INFLAMMATION
IN FACT INFLAMMATION IS
PROBABLY ALL 3: • ANTECEDENT
• TRIGGER
• MEDIATOR
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Risk of
Disease
Low
Risk Moderate
Risk
Presence
of Disease
High
Risk
Disease
Activity
Oxidation Disease initiation/
Plaque growth
Plaque maturation/
Vulnerable plaque
Acute coronary syndrome
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Learn how to determine whether active arterial plaquing exists • using vascular US
• and CIMT testing
The carotid arteries are a window to the
view systemic atherosclerosis
NB: CIMT is NOT done by mobile US screenings or even by most radiology departments!
Need special tech.
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Size matters –test for size/number • Whereas LDL itself is NOT correlated to CVD risk ,
lipoprotein particle size and particle number are
correlated
sdLDL is BAD
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Lipoprotein(a) is a really bad actor
Test for Lipo(a) !!!!
• DIRECTLY CAUSES MI
• Drives CV risk despite statin therapy
• Inhibits fibrinolysis
• Is decreased slightly by niacin
• (future role for PCSK9 inhibitors)
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ORAL HEALTH MATTERS MORE THAN EVER
Since 2014, GOOGLE SCHOLAR articles
“oral flora cardio”= 689; “dental cardiac” =15,800;
“oral microbiome CVD”= 2670; “periapical abscess coronary disease”= 1,200
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Do Not Smoke BMI <25 TC <200 mg/dL BP <120/80 FBG <100 mg/dL EXERCISE:
• 150 min. moderate
• or 75 min vigorous exercise PER WEEK
(=only 11 min per day!!) Diet 4 of 5 (DASH diet)
• 4.5 cups/d of fruit and veggies • ≥ 2- 3.5 oz fish/week • ≤ 3 -12 oz sugar sweetened beverages/week • ≥ 3 -1 oz servings of fiber rich whole grains/day • ≤ 1500 mg salt/day
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Time for a paradigm shift in our care model
Our crisis management approach is no
longer sustainable. It is time for primary care
to shift from lumenology to arteriology.
PCPs think cardiologists are
managing prevention and
cardiologist thinks PCPS are!! We must ALL put more resources in to
prevention BECAUSE IT WORKS!!!
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ROOT CAUSE RESOLUTION
WHADDYA GOT?
WHADDYA NEED?
ANTECEDENTS
TRIGGERS
MEDIATORS
TIMELINE and MATRIX
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TO CONTINUE TO PRACTICE IN A BROKEN PARADIGM
TO SUPPORT A MODEL THAT IS DRIVING DOCTORS TO BURNOUT, BANKRUPTY OR SUICIDE
TO SUPPORT THE PHARMA MACHINE THAT IS SUPPORTING THE EDUCATION OF FUTURE PHYSICIANS
THAT THE CURRENT SYSTEM DOES NOT GET PATIENTS BETTER OR PREVENT DISEASE?
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Wouldn’t you rather have tools and
a system to change and improve
your patients symptoms and
reduce their risk of chronic
inflammatory disease????
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IFM www.functionalmedicine.org ICIM www.icimed.com AAEM www.aaemonline.org AMMG https://www.agemed.org ACAM www.acam.com A4M www.A4M.com ABIHM--->ABIM http://www.aihm.org
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Introduction to Functional Medicine
AMA Accreditation Statement
The Institute for Functional Medicine
designates this enduring material for a
maximum of 1.5 AMA PRA Category 1
Credits™.
https://www.ifm.org/learning-
center/introduction-functional-medicine/
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http://www.functionalmedicineuniversity.co
m/public/department151.cfm
Founder:
Ronald Grisanti D.C.,D.A.B.C.O.,
D.A.C.B.N.,M.S., CFMP
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https://www.functionalmedicine.org/afmcp/ho
me/
Applying Functional Medicine in clinical practice
1-2X a year CME
March 04-09 2019 Chicago
34.5 hours of CME $3,500
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Functional Forum ON LINE first Monday of every month –hold a meet up group
Lecture to your community: become the expert in your space
Share your message: put your business card in wellness books at the library or bookstore
“Accidentally” leave your website on the screen at the Apple store
Host a Walk with a Doc or Shop with a Doc event
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CAMPBELL FAMILY MEDICINE CUMMING GA
2005 CASH–ONLY PRACTICE
Charge by the hour…3 years failure
2008 CONVERTED TO SOLO, CASH ONLY
MEMBERSHIP BASED CONCIERGE MODEL 3FT/ 3PT STAFF
Chris Ewin MD 1:2:1 MD
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200 ACTIVE CASES @ $250/month
WORK IN OFFICE 3.5 DAYS/WEEK
(time for family, travel, lecturing, teaching, networking, volunteering)
GROSS REVENUE $750,000+
TITHE: 5% CASH 5% SERVICE
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FREE IS VALUELESS
BASED ON HABITAT FOR HUMANITY
SWEAT EQUITY
15 HOURS OF COMMUNITY SERVICE
=3 MONTHS OF MEMBERSHIP RIGHTS
$50/HOUR EQUIVALENT
CARE WITH DIGNITY
WIN/WIN/WIN
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THE ANTIDOTE TO PHYSICIAN
BURNOUT
THE SOLUTION FOR THE
BROKEN SYSTEM
A SUCCESSFUL NEW
PARADIGM © Ellie Campbell 2018
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AFTER 12 YEARS, many mistakes and many successes,
I BELIVE THAT FUNCTIONAL MEDICINE
PRACTICED IN A CONCIERGE MEDICAL MODEL
CAN SAVE DOCTORS AND OTHER PROVIDERS
SAVE THE PATIENT’S
LIVES AND LIVLIHOODS
SAVE MONEY
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8 HOUR NON-CME BUSINESS DEVELOPMENT COURSE
HOW TO ATTRACT PATIENTS • INCLUDING FREE MARKETING STRATEGIES
HOW TO DESIGN A CASH PRACTICE • CONCIERGE, MEMBERSHIP, PROGRAMS
COACHING ROLE-PLAY EXERCISES • TO CONVERT PROSPECTS TO PATIENTS
• TO ENGAGE PATIENT WELLNESS BEHAVIOR
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