接Part.1 

The Origin of Functional Medicine and the Institute for Functional Medicine

功能医学的起源和功能医学研究院

By 1988, HealthComm was well established as a leadership organization in nutritional medicine education and development. My wife, Susan Bland, suggested that we bring together some of the remarkable people I had met through the years—innovators and leaders—to discuss our vision for the future and objectives for collaborative efforts. We convened a meeting in 1989 in Victoria, British Columbia, Canada. A group of key opinion leaders from different backgrounds, and with different perspectives and expertise, were invited to discuss and freely exchange ideas about what the “best practices” of health care in the future might look like. Sponsored by HealthComm, the attendee list was as follows:

• Sid Baker, MD

• Stephen Barrie, ND, PhD

• Jeffrey Bland, PhD

• Susan Bland, MA

• J. Alexander Bralley, PhD

• Leo Galland, MD

• David Jones, MD

• Jeff Katke

• Martin Lee, PhD

• Hakeem Lewis, ND

• Peter Madill, MD

• Wayne Matson, PhD

• Darrell Medcalf, PhD

• Jean Munro, MD (England)

• Stephen Paul, PhD

• Joseph Pizzorno, ND

• Graham Reedy, MD

• Scott Ridgen, MD

到1988年，HealthComm已经成为营养医学教育和发展方面的领导组织。我的妻子苏珊-布兰德（Susan Bland）建议我们把我多年来遇到的一些杰出的创新者和领导者召集起来，讨论我们对未来的展望和合作的目标。我们于1989年在加拿大不列颠哥伦比亚省的维多利亚市召开了一次一群来自不同背景、具有不同观点的主要意见领袖的会议。我们邀请了一批来自不同背景、具有不同观点和专长的关键意见领袖，自由讨论和交流关于未来医疗服务的 "最佳实践 "的想法。会议由HealthComm赞助，出席者名单如下：

• Sid Baker, MD

• Stephen Barrie, ND, PhD

• Jeffrey Bland, PhD

• Susan Bland, MA

• J. Alexander Bralley, PhD

• Leo Galland, MD

• David Jones, MD

• Jeff Katke

• Martin Lee, PhD

• Hakeem Lewis, ND

• Peter Madill, MD

• Wayne Matson, PhD

• Darrell Medcalf, PhD

• Jean Munro, MD (England)

• Stephen Paul, PhD

• Joseph Pizzorno, ND

• Graham Reedy, MD

• Scott Ridgen, MD

 

From the discussion among this diverse group of experts, the concept of functional medicine as a systems biology approach to health care was born. Systems biology was just emerging as a conceptual way of thinking about the complex interactions in biology and molecular medicine that give rise to function; once established, innovators such as Lee Hood, MD, PhD, would go on to be acknowledged as pioneers in this field.⁷ Among our group, there was considerable discussion as to whether functional medicine was an appropriate term; this description was already in use in geriatric medicine and also in reference to psychosomatic illness.^8,9 It was the consensus of the group that the use of the term functional in medicine was starting to change in the late 1980s, especially due to the development of important new technologies and approaches, such as functional MRI and functional cardiology. Our assembled group also believed that functional medicine would honor the molecular medicine concept of Linus Pauling and its connection to system biology¹⁰ as well as the roots of science-based natural medicine.¹¹ All these years later, the word functional now applies to states of health that span physiological, physical, cognitive, and emotional issues in health care; the accumulated loss of function across those 4 functional domains defines the early signs of what is later diagnosed as pathological disease.¹²

在这群不同专家的讨论中，功能医学作为一种系统生物学的保健方法的概念诞生了。作为刚刚兴起的学科，系统生物学是一种思考生物学和分子医学中产生功能的复杂相互作用的概念性方法；一旦确立，Lee Hood博士等创新者将被公认为该领域的先驱。⁷ 在我们的小组中，对功能医学是否是一个合适的术语进行了相当多的讨论，这一描述已经在老年医学中使用，也被用来指代心身疾病。^8,9 小组的共识是，功能医学一词的使用在80年代末开始发生变化，特别是由于重要的新技术和方法的发展，如功能磁共振和功能性心脏病学。我们的小组还认为，功能医学将尊重莱纳斯-鲍林的分子医学概念及其与系统生物学的联系，¹⁰ 以及以科学为基础的自然医学的根基。¹¹ 这么多年过去了，功能一词现在适用于健康保健中跨越生理、身体、认知和情感问题的健康状态；这四个功能领域的功能损失的累积定义了后来被诊断为病理疾病的早期迹象。¹²

 

Nearly 2 decades after our summit in British Columbia, a colleague discovered a stunning article in the medical literature: an editorial published in Lancet in 1871 by Sir Willoughby F. Wade, MD, professor of medicine at Queens College in Birmingham, England, titled “Clinical Lecture on Functional Medicine.” Professor Wade wrote the following words: “Whenever we come to treat a case, to prescribe drugs or particular diets, rest or action, we should first of all consider what function of the body it is that is improperly performed.”¹³ As a copy of this article was emailed and shared digitally in a future world that the distinguished Professor Wade most likely never envisioned, my colleagues and I came to recognize that functional medicine is a concept that makes sense in any era when the right questions are being asked. We’ll never know what kind of reception Professor Wade’s lecture received when he presented it in March of 1870, but given the silence that followed for more than 100 years, one can assume he was a unique thinker in a time that preferred conformity to innovation. For a truly successful application of functional medicine to take place—one with widespread impact and clinical success—the science of systems biology and molecular medicine, in combination with a focus on patient-centered health care, represents the right soil for the concept to take root and thrive.

距在不列颠哥伦比亚省举行峰会近20年后，一位同事在医学文献中发现了一篇令人震惊的文章：英国伯明翰皇后学院医学教授、医学博士威洛比-F-韦德爵士1871年发表在《柳叶刀》上的一篇社论，题为 "功能医学临床讲座"，韦德教授写下了以下的话：“每当我们来治疗一个病例，开出药物或特殊的饮食、休息或行动时，我们首先应该考虑的是身体的什么功能被不适当地执行了”。¹³我们永远不会知道韦德教授在1870年3月发表演讲时受到了怎样的欢迎，但考虑到随后100多年的沉默，在那个喜欢顺从而不喜欢创新的时代，我们可以认为他是一个独特的思想家。结合以病人为中心的医疗保健，才是真正成功地应用功能医学产生广泛的影响并取得临床成功一概念扎根和发展的正确土壤。

 

Natural Medicine Education and the Connection to Functional Medicine

自然医学教育及与功能医学的联系

In 2016, journalist John Weeks, who is well known for his in-depth reporting on topics related to natural medicine, wrote a column about the early leadership within the naturopathic profession and the later emergence of functional medicine.¹⁴ In this review, he acknowledged the modern rebirthing of a science-based and described the significant role this era played in the development of both integrative and functional medicine. What I have written here today is an insider’s view of key events that transpired during that period and the very real people we should honor and credit as we reflect on this history. For me, it all started with a knock on my door. I opened it to find a friendly and smiling group of quiet revolutionaries, and I hold each one in the highest regard to this day. Their work led to the first graduates of distinction from the National College of Naturopathic Medicine in Portland and John Bastyr College of Naturopathic Medicine in Seattle. Later, the movement spread, and I had the opportunity to work with the founders of the Canadian College of Naturopathic Medicine in Toronto on the development of their science-based curriculum. Later still came the Southwest College of Naturopathic Medicine in Scottsdale, Arizona, and Bridgeport University College of Naturopathic Medicine in Connecticut.

2016年，以深入报道自然医学相关话题而闻名的记者约翰-威克斯(John Weeks)撰写了一篇专栏，介绍了自然疗法行业的早期领导力以及后来功能医学的出现。¹⁴ 在这篇评论中，他承认在20世纪70年代末和80年代初，以科学为基础的自然疗法行业在现代重新崛起，并描述了这个时代在整合医学和功能医学的发展中所发挥的重要作用。我今天在这里写的是对那段时期发生的关键事件的内部看法，以及我们在回顾这段历史时应该尊敬和赞扬的真实人物。对我来说，这一切都始于对门的敲击，我打开门，发现一群友好的、面带微笑的安静的革命者，直到今天，我还对每一个人给予最崇高的评价。他们的工作使波特兰的国家自然医学学院和西雅图的约翰-巴斯蒂尔自然医学学院产生了第一批优秀的毕业生。后来，这一运动蔓延开来，我有机会与多伦多的加拿大自然疗法医学院的创始人一起工作，开发他们基于科学的课程。后来，亚利桑那州斯科茨代尔的西南自然医学学院和康涅狄格州的布里奇波特大学自然医学学院也成立了。

 

With my wife, Susan Bland, I founded the Institute for Functional Medicine in 1991. The forward-looking dialogue that began with natural medicine has never stopped: How do we balance science with experience, the individual with the average, the diagnosis with the prognosis, the intervention with the intention, the technology with the intuition, and the genes with the environment? More than 100 000 licensed health care practitioners have participated in education programs offered through the Institute for Functional Medicine during the past 26 years. Millions of patients have experienced the functional medicine approach to the clinical implementation of systems biology, as well as personalized prevention and treatment during this period.¹⁵ In 2014, the Cleveland Clinic Center for Functional Medicine was established; hundreds of patientsare now seen annually and the success of the functional medicine operating system is being closely measured.¹⁶ For me, this has been a remarkable 40-year journey, and it was the convergence of 3 paths—natural medicine, molecular medicine, and systems biology, viewed through the lens of patient-centered care—that elucidated not only the case for the development of the functional medicine concept, but also the need for it as a logical step as an operating system for the transformation of health care. Personalized lifestyle health care, a dynamic field that will introduce even more people to the value of functional medicine applications, is a success story that is just beginning to be fully revealed.^17,18 A new year has just turned, and therefore the journey—for all of us—continues. The past is important to me and I like to honor the history and lineage that brought us to this time and place, but like so many others, I also look forward with great anticipation to the emergence of a new era of discovery, progress, and empowerment.

我和我的妻子苏珊-布兰德在1991年创立了功能医学研究院。对自然医学开始的前瞻性对话从未停止: 我们如何平衡科学与经验、个体与平均、诊断与预后、干预与意图、技术与直觉、基因与环境？在过去的26年中，有超过10万名有执照的医疗工作者参加了功能医学研究院提供的教育课程培训。在此期间，数以百万计的患者体验了功能医学在临床上实施系统生物学的方法，以及个性化的预防和治疗。¹⁵ 2014年，克利夫兰诊所功能医学中心成立；现在每年有数百名患者就诊，功能医学操作系统的成功被密切衡量。¹⁶ 对我来说，这是一段不平凡的40年旅程，正是这3条道路的融合--自然医学、分子医学和系统生物学，通过以病人为中心的照护视角来看，不仅阐明了发展功能医学概念的理由，而且还阐明了它作为医疗保健转型的操作系统的逻辑需求。个性化的生活方式保健是一个充满活力的领域，它将向更多的人介绍功能医学的应用价值，这是一个刚刚开始充分展现的成功故事。^17,18 新的一年刚刚过去，然而，我们所有人的旅程还在继续，过去对我来说很重要，我喜欢尊重把我们带到这个时间和地点的历史和脉络，但像其他许多人一样，我也非常期待一个新的发现、进步和赋权的时代的出现。

 

References

参考文献

1. Niki E, Traber MG. A history of vitamin E. Ann Nutr Metab. 2012;61(3):207-212.

2. Bland J, Canfield W, Kennedy T, et al. Effect of tocopherol on photooxidation rate of human erythrocyte membrane in vitro. Physiol Chem Phys. 1978;10(2):145-152.

3. Bland J, Madden P, Herbert EJ. Effect of alpha-tocopherol on the rate of photohemolysis of human erythrocytes. Physiol Chem Phys. 1975;7(1):69-85.

4. Krause H. A review of the history of naturopathy. J Natl Malar Soc. 1946;2:18.

5. Huemer, Richard P. The Roots of Molecular Medicine. A Tribute to Linus Pauling. New York, NY: W. H. Freeman and Company; 1983.

6. Cameron E, Bland J, Marcuson R. Divergent effects of omega-6 and omega-3 fatty acids on mammary tumor development in C3H/Heston mice treated with DMBA. Nutr Res. 1989;9(4):383-393.

7. Editorial Staff. Interview with Leroy Hood. Bioanalysis. 2013;5(12):1475-1478.

8. Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: One or many? Lancet. 1999;354(9182):936-939.

9. Jeffcoate WJ. Chronic fatigue syndrome and functional hypoadrenia: Fighting vainly the old ennui. Lancet. 1999;353(9151):424-425.

10. Pauling L, Itano HA. Sickle cell anemia a molecular disease. Science. 1949;110(2865):543-438.

11. Pizzorno JE. Naturopathic medicine—a 10-year perspective (from a 35-year view). Altern Ther Health Med. 2005;11(2):24-26.

12. Bland J. Functional medicine: An operating system for integrative medicine. Integr Med (Encinitas). 2015;14(5):18-20.

13. Wade WF. Clinical lecture on functional medicine. Lancet. July 1871;1:1.

14. Weeks J. The Leadership of the naturopathic profession in the emergence of integrative and functional medicine…plus more. Integr Med (Encinitas). 2016;15(2):16-18.

15. Hyman M. A look at the Institute for Functional Medicine with David Jones, MD. Altern Ther Health Med. 2008;14(1):10-11.

16. Weeks J. Tipping point? Cleveland Clinic announces partnership with Hyman/Hanaway and the Institute for Functional Medicine … plus more. Integr Med (Encinitas). 2014;13(6):12-15.

17. Hyman MA, Ornish D, Roizen M. Lifestyle medicine: Treating the causes of disease. Altern Ther Health Med. 2009;15(6):12-14.

18. Bland JS, Minich DM, Eck BM. A systems medicine approach: Translating emerging science into individualized wellness. Adv Med. 2017;2017:1718957.

 

译者简介

往期回顾

译作分享|美国功能医学之父Jeffrey Bland博士谈《年龄是慢病的可改变风险因素》

译作分享|美国功能医学之父Jeffrey Bland博士谈《功能医学的过去、现在和未来》

 

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