The Vision

In the early days of modern civilization, Medicine was not just medicine and Doctors were not just doctors. Not as they are today. Doctors were surgeons, nutritionists, doctors of various specialties. Knowledge was scarce and limited to a few brains, who had the luck and privilege of learning from the great masters. There was no compartmentalisation of medical areas, only one objective: to assess the patient and their illness, try to identify the cause of the clinical picture and treat it, trying to improve and save the patient.

The Physician saw the patient as a complex but unique system, in which all parts would be in balance and that, when facing a "crisis" (in the words of the father of Medicine, Hippocrates), there would be an unbalance that would lead to a cascade of events that would originate the disease. For this reason, the search for the origin of the imbalance was not limited to the place or tissue where the manifestation occurred. Just as an engineer evaluates an engine when he discovers a failure, the Physician tried to find the origin of the problem, wherever it was.

As science has evolved, important advances in biology, biochemistry and biophysics have emerged.

One of the defining moments in the ability to save lives was the emergence of penicillin. It is one of those moments in which there is a before and an after. Before, a lung infection meant certain death if the patient did not have enough defence capacity to fight the agent alone. After, there was a treatment for the disease. One agent, one disease, one treatment, one result.

Medicine began to search for the agents responsible for the disease, so that it could identify the treatment that would produce the necessary result.

The revolution was so gigantic that it led to a paradigm shift. Medicine started to look for the agents responsible for the disease in order to identify the treatment that would produce the necessary result, as happened with Penicillin. The patient moved to the background because, having identified the agent and instituting the appropriate treatment, the individual's characteristics had little influence on the therapeutic result.

Medical research then started to have an objective: to find the treatment that can achieve the most consistent effect in the greatest number of people with the same disease and, in this logic, the same agent. Which drug is able to have an effect on the largest number of patients? The greater the number of patients, which is the largest "n" that can benefit? And, based on this mantra, research exploded and evolved exponentially. New technologies, new approaches and new therapeutic techniques have emerged whose results border on the miraculous. So much so that today it is possible to survive an acute myocardial infarction by placing a stent through an incision in the groin. Despite the differences, the pieces of the reasoning remain the same: an agent (obstruction of an artery), a disease (acute myocardial infarction), a treatment (placement of a stent), an outcome (restoration of circulation). And, like this one, there are hundreds of examples.

However, the paradigm was taken too far. The same reasoning used to diagnose and treat acute clinical situations became the same for chronic situations. This was, and is, a mistake.

Chronic diseases are complex and multi-factorial. They are the manifestation of a disorder of our organism, an extremely complex and interconnected system. Their demonstrations can be very varied and appear, both in timing and location, far removed from their cause. Or, seen from another perspective, the same demonstration of a problem can have very different origins.

Imagine that the engine of your car is leaking oil. Are you expecting that there is only one explanation for this loss? If you're like me, hardly. There could be a whole host of explanations for that signal. Plus, the problem will only be solved by finding the source.

The paradigm "one agent, one disease, one treatment, one outcome" can no longer be applied effectively to this type of chronic and complex clinical situations.

We now have "several agents, several imbalances, several treatments, several results". The question is which agent and which imbalance is present, in order to determine which type of treatment is necessary to achieve which result.

Now imagine that your neighbour's car is also leaking oil. How likely is it that the source and solution of both losses are the same? I would say not much. Maybe your car is new and your neighbor's is not. Or you took a trip. Or you hit a part. Or you both crashed but on different parts. The same demonstration can have different explanations, which leads to different treatments and even different results. 

That's why the most important equation in all of medicine is this: 

n=1. 

The individual, the person. The key to understanding someone's problem lies in who has it, not in other people, who are different, even though they may share the same demonstration that something is not right. To think that different systems can be treated in the same way as if they were the same is probably the biggest mistake we can make.  

Let me give you another example: imagine you arrive in your kitchen and see that there is water on the floor. What is your first instinct? It might be to clean up the water. You would get quick relief from the problem. But it wouldn't solve the issue. I would bet your instinct would be like mine and try to diagnose the cause of the problem. Was it the tap left on? Was it the dishwasher that clogged? Did you leave a jug of water on the sink and your cat threw it on the floor? Or is it a burst pipe? Although the result was practically the same in all situations - water on the floor, the resolution was quite different from case to case - turn off the tap, fix the machine, find a plumber or just look disapprovingly at the cat.

Same symptom, different causes, different solutions. Diagnosing the cause of the problem allows the definition of an investigation or therapeutic plan appropriate to each situation.

It is not astrophysical science; it is what medicine was, it is what medicine should be, it is what functional medicine is.

The definition of Functional Medicine (by the Institute for Functional Medicine) is:

" The Functional Medicine model is an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient's genetic, biochemical, and lifestyle factors and leverages that data to direct personalized treatment plans that lead to improved patient outcomes".

My definition is simpler: it is the result of the fusion of a 3 year old child's curiosity and a detective's incessant search for answers, applied to health. It is the Medicine of Whys, which gets answers by asking questions. The better the questions, the better the answers.

• Why do children have frequent tonsillitis?

• Why is there a decrease in work capacity after 3 years of a new project - company, PhD, position?

• Why can't a young adult lose weight even on a calorie-deficit diet?

• Why do you develop an autoimmune disease?

• Why does an athlete have recurrent injuries despite following all the directions?

• Why does someone suffer from migraines?

When the answer obtained is "because it is normal", there is a strong possibility that it is far from normal.

Everything happens for a reason. Hippocrates stipulated that the disease begins with a "crisis". The trigger, the last straw that makes the glass overflow may be more or less evident. We may not be able to identify it. But it exists. 

• Did the recurring tonsillitis start when the child entered kindergarten or elementary school?

• Is her cognitive ability diminished by burnout and hormonal disturbances?

• Is the inability to lose weight associated with altered gastrointestinal function?

• Did the autoimmune disease appear after a period of increased stress?

• Are recurrent ligament injuries associated with a genetic profile that requires specific nutritional care?

• Does the frequency of migraines stem from a systemic dietary effect?

To be able to confirm or refute hypotheses, all details matter: in them may lie the explanation and the answer to one of the whys raised. The collection of information is the most important moment in this research process. It is done in several ways, starting with the completion of an extensive and comprehensive questionnaire, continuing in the consultation that requires time and attention. It requires time, without interruptions, so that it is possible to give importance to who matters and what matters. For this reason, the initial consultation lasts about 1h: it is the minimum time necessary for a complete clinical evaluation, capable of creating a plan appropriate to the condition.

The initial consultation lasts about 1 hour: this is the minimum time necessary for a complete clinical evaluation, capable of creating a plan appropriate to the condition.

It is not always enough. If the past and present history, if the compilation of signs and symptoms, if putting the known pieces together is not enough for the creation of a logical puzzle and that allows for the definition of an adequate therapeutic plan, it is necessary to expand the investigation, resorting to laboratory tests. In the same way that we can only obtain answers to the questions that are asked, we can also only find what we are looking for. Thus, when appropriate, a complementary investigation plan is elaborated, personalized and adequate to the questions that are unanswered.

Could recurrent tonsillitis be caused by food sensitivities?

• Is the burnout the result of an altered circadian cortisol curve?

• Could the inability to lose weight be in an altered gut microbiome?

• Is autoimmunity triggered by periods of stress in cases of vitamin dysregulation?

• Could recurrent lesions be the result of a genetically altered collagen structure?

• Are migraines a consequence of an inability to decrease systemic toxic load?

It is often necessary to evaluate the gut microbiome, genetic profile, food sensitivities, urinary organic acids or heavy metals to complement the picture and discover the root cause of the problem. 

The investigation plan varies. It depends on the person, the symptoms, the history, the triggering elements. While in some cases answers can be found in more "normal" blood and urine tests, in most situations it is only possible to obtain them through specific and complex laboratory tests. Very often it is necessary to evaluate the intestinal microbiome, genetic profile, food sensitivities, urinary organic acids or heavy metals to complement the picture and discover the fundamental cause of the problem. 

The more information, the more likely we are to get the answers to our questions.

The word "doctor" has its root in the Latin word "doctore", which means to teach.

The Doctor's role is not limited to treating, to prescribing a therapeutic plan and expecting the patient to follow it religiously just because "the doctor said so". Or, at least, it shouldn't. He must be able to explain, to share information in an open and enlightening way. He must be a "coach", he must point out the therapeutic course he considers most correct. He should explain and allow the understanding of the analytical findings. 

During the 30 minutes duration of the second consultation, the results of the tests requested are evaluated and, most importantly, explained, point by point, finding by finding, in Portuguese (and not in "medicinese"), so that the patient can participate in their interpretation, understand the clinical reasoning and, with this, understand where the root of their problem may lie.

A therapeutic plan is then created, personalized and appropriate for each situation. The pieces of the plan can take different forms: drugs, dietary supplements, eating strategies, exercise plans, lifestyle changes. There is no magic recipe or miracle pill. Different people, different systems, different imbalances, different solutions.