The Semmelweis Reflex, Medical Bilingualism, and treatment of MCI and Early Alzheimer’s Dementia

21 February 2018

I recently attended the Annual Mild Cognitive Impairment Symposium in Miami, where a presentation on the future treatment of dementia focused solely on pharmaceuticals. As a psychopharmacologist, I was familiar with the data. I questioned why the presenter did not include Functional Medicine (FM, a translational medicine approach which converts preclinical research into clinical treatments for chronic diseases) in the future of MCI and AD treatment, since efficacy has been documented in early studies [1,2]. A public dialogue ensued with many neurologists in the audience expressing frustration with the publications, labeling them “opaque and poorly written.”

Since a group of FM clinicians have successfully and repeatedly been able to reverse MCI and early AD using the FM protocol, the dismissal, rather than excitement about this groundbreaking clinical tool seems to be a re-enactment of the Semmelweis’ Reflex [3], in which physicians reject new knowledge when it contradicts an underlying medical paradigm. In the case of Semmelweis, his contention that hand washing reduced the risk of “childbed fever” ten-fold, was ignored for decades, at the cost of many lives.

FM is a unique and rapidly growing field. FM has a somewhat different set of assumptions, language, and processes (e.g., focus of etiology based in systems biology vs. linear and causal reductionism; dynamic vs. static understanding of data; personalized treatments vs. treatments guided by probabilities and statistical means; an insistence on defining underlying etiologies vs. categorizing disease states; Understanding the antecedents, triggers and mediators of disease vs. a focus on the current state of a persons disease, etc.). Additionally FM requires broad knowledge covering gastrointestinal, detoxification, oxidative stress, immune, endocrine, genetic, epigenetic, and lifestyle factors.

Because lives are in the balance, it is incumbent on both the allopathic and FM communities to have a fruitful dialogue. I would argue that since the FM community emerged primarily from the allopathic community, the primary burden for effective communication falls on the FM community; The allopathic community must understand that the FM community is handicapped in its effort to conduct the studies needed since both the pharmaceutical industry and the government are biased in the direction of pharmaceutical research. This is understandable based on the many successes of the pharmaceutical model, with dementia being a notable exception. However, the allopathic community must also fill their professional responsibility: they must learn the new concepts and data that can help their patients. They must tolerate the discomfort that comes with the unfamiliar and become medically bilingual. They must learn the language of Functional Medicine.

Robert Hedaya, MD, ABPN, DLFAPA
Clinical Professor, Georgetown University Hospital
Faculty, Institute for Functional Medicine
Rockville, MD, USA
National Center for Whole Psychiatry

[1] Bredesen DE, Amos EC, Canick J, Ackerley M, Raji C, Fiala M, Ahdidan J (2016) Reversal of cognitive decline in Alzheimer's disease. Aging (Albany NY) 8, 1250-1258.
[2] Bredesen DE (2014) Reversal of cognitive decline: a novel therapeutic program. Aging (Albany NY) 6, 707-717.