Synopses & Reviews
The functional approach is a philosophical way of looking at how physicians make decisions. Most of the time, physicians are taught to adhere to guidelines and studies, etc. As history shows, many of the things that have been taught to physicians for many years have eventually been shown to be completely wrong. It is very possible to do double-blind, placebo-controlled studies and come to some clear conclusions and yet these conclusions are eventually proven to be wrong. In the area that I deal with, hypothyroidism, the prevailing wisdom, the TSH test tells you yes or no and that nobody needs T3 because T4 converts to T3 remains the correct answers for doctors on multiple-choice exams.
The functional approach in this situation simply says that when someone has an overwhelming clinical picture of hypothyroidism despite normal tests, the only thing that really matters is what happens to that patient on an intelligent therapeutic trial. If multiple symptoms of year's duration disappear and the patient feels better than in years, that is what validates this approach.
The same thing with adding some T3 to the standard T4 treatment. All that matters is if the patient gets better or does not get better. This is widely applicable to all areas of human endeavor, not just medicine. Many doctrines in politics, economics, etc. exist but the only thing that matters is do you get better results by making educated guesses and trying things even if they are not supported by underlying theories.
Kenneth Blanchard, M.D., Ph.D.
About the Author
Kenneth R. Blanchard, PH.D., M.D. is an endocrinologist certified by the American Board of Internal Medicine and the American Board of Endocrinology and Metabolism. Dr. Blanchard practiced general internal medicine until 2000 and now concentrates on thyroid disease and menopausal hormone replacement therapy. He has been in private practice in Newton, Massachusetts since 1976.