Chris Kresser:  Yeah, that’s pretty amazing.  I talked with Mark Hyman a little bit about the Cleveland Clinic Functional Medicine Program.  And just for the listeners, what this is—and James, you might know a little bit more about it than I do—but just from what Mark said, the Cleveland Clinic, for those who don’t know, is a major institution in the field of medical research and pioneering new treatments and approaches to disease from the more mainstream perspective.  They basically invited Mark Hyman to create a functional medicine group within the Cleveland Clinic that is funded and actively looking for strategies. Basically, how to scale functional medicine and make it more viable within the healthcare model that we have.  And that is a really much-needed step because, as I’m sure all the listeners know, right now in functional medicine, everything is paid for out of pocket. Insurance doesn’t cover it.  That really limits the number of people who will be able to take advantage of it.  So getting some mainstream recognition like this for functional medicine is a huge step in terms of making it more accessible and available to the majority of people out there.
Unwritten history is not easy to interpret, and, although much may be learned from a study of the drawings, bony remains, and surgical tools of early humans, it is difficult to reconstruct their mental attitude toward the problems of disease and death. It seems probable that, as soon as they reached the stage of reasoning, they discovered by the process of trial and error which plants might be used as foods, which of them were poisonous, and which of them had some medicinal value. Folk medicine or domestic medicine, consisting largely in the use of vegetable products, or herbs, originated in this fashion and still persists.

When the medicine of ancient Egypt is examined, the picture becomes clearer. The first physician to emerge is Imhotep, chief minister to King Djoser in the 3rd millennium bce, who designed one of the earliest pyramids, the Step Pyramid at Ṣaqqārah, and who was later regarded as the Egyptian god of medicine and identified with the Greek god Asclepius. Surer knowledge comes from the study of Egyptian papyri, especially the Ebers papyrus and Edwin Smith papyrus discovered in the 19th century. The former is a list of remedies, with appropriate spells or incantations, while the latter is a surgical treatise on the treatment of wounds and other injuries.
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During the Renaissance, understanding of anatomy improved, and the microscope was invented. Prior to the 19th century, humorism (also known as humoralism) was thought to explain the cause of disease but it was gradually replaced by the germ theory of disease, leading to effective treatments and even cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Public health measures were developed especially in the 19th century as the rapid growth of cities required systematic sanitary measures. Advanced research centers opened in the early 20th century, often connected with major hospitals. The mid-20th century was characterized by new biological treatments, such as antibiotics. These advancements, along with developments in chemistry, genetics, and radiography led to modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses (from the 1870s) and as physicians (especially after 1970).
Since its founding in 1967, the Medical School’s Program in the History of Medicine has been dedicated to research and teaching in the intellectual, political, cultural, and social history of disease, health care, and medical science. The history of medicine provides students with a historical perspective on the role health, medicine, and disease play in society today. It prepares students to think critically about historical and contemporary health issues.

The University of Padua was founded about 1220 by walkouts from the University of Bologna, and began teaching medicine in 1222. It played a leading role in the identification and treatment of diseases and ailments, specializing in autopsies and the inner workings of the body.[85] Starting in 1595, Padua's famous anatomical theatre drew artists and scientists studying the human body during public dissections. The intensive study of Galen led to critiques of Galen modeled on his own writing, as in the first book of Vesalius's De humani corporis fabrica. Andreas Vesalius held the chair of Surgery and Anatomy (explicator chirurgiae) and in 1543 published his anatomical discoveries in De Humani Corporis Fabrica. He portrayed the human body as an interdependent system of organ groupings. The book triggered great public interest in dissections and caused many other European cities to establish anatomical theatres.[86]
In the Middle Ages monasteries had sanitation. Streams provided clean water. Dirty water was used to clear toilets, which were in a separate room. Monks also had a room called a laver where they washed their hands before meals. However for most people sanitation was non-existent. In castles the toilet was simply a long passage built into the thickness of the walls. Often it emptied into the castle moat. Despite the lack of public health many towns had public bath-houses were you could pay to have a bath.
Late antiquity ushered in a revolution in medical science, and historical records often mention civilian hospitals (although battlefield medicine and wartime triage were recorded well before Imperial Rome). Constantinople stood out as a center of medicine during the Middle Ages, which was aided by its crossroads location, wealth, and accumulated knowledge. copied content from Byzantine medicine; see that page's history for attribution
Chris Kresser:  Mm-hmm.  So let’s talk a little, since we’re on the topic, let’s talk a little bit more about scalability.  We’re actually, you mentioned combining higher-cost services with lower-cost services or personnel for implementation. I’m expanding my own clinic now and we’re getting ready.  I’ve hired an intern here that I’m training, and we’re going to be hiring, probably in the future, some nurse practitioners and physician assistants that can help to implement some of the treatment protocols that I’m designing and researching.  We’re using technology now a lot more efficiently with electronic health records, and handouts and documents that can be delivered through that on specific health conditions that patients have.  So rather than spending time clinically to talk them through these things, we can give them a handout or even direct them to a video or webinar to watch, which is a lot more time-efficient for me, and cost-efficient for them, because they’re not paying me to just tell them something that they could learn by watching a video or a webinar.  So what’s your take on how functional medicine will scale and become available?  And what role does technology play in that?
Chris Kresser:  Yeah, sure.  I’m sure a lot of my listeners know this about me, but for those people who are new to this especially, I think Paleo—and I’ve said this before—is a fantastic starting place, but it’s not a destination.  What I mean by that, is we know that Paleo foods are safe and well tolerated for most of us because we’ve eaten them for such a long period of time.  And by we, I mean human beings.  And they’re the least likely to cause problems, allergies, food intolerances, and issues like that, because human beings have been consuming them for thousands of generations.  But that doesn’t mean that we absolutely need to restrict our diet to those foods, because even though we’re largely the same genetically as we were 10,000 years ago, there have been significant changes.  In fact, as much as 10% of our genome shows evidence of recent selection.  And the pace of genetic change today is occurring at a rate 100 times faster than the average over 6 million years of hominid evolution.  So we’re similar to our Paleolithic ancestors, but we’re different in some important ways.  And those differences actually do affect our tolerance of certain agricultural foods, like full-fat and fermented dairy products, even legumes and grains, some of the newly introduced foods like alcohol and chocolate and coffee.  These are all foods that modern research actually suggests can be beneficial when they are well tolerated, but I call them gray-area foods because our tolerance of them really depends on the individual.  So for one person who is casein intolerant or intolerant to some of the proteins in dairy, eating any dairy is going to be problematic.  But for someone who has no problem with casein or lactose, the sugar in dairy, all of the research on full-fat dairy suggests that it’s beneficial and may reduce the risk of cardiovascular and metabolic disease, and even obesity.  So those are just a few examples of how our diet has changed.  And I think as a healthcare practitioner, my focus is always on the science—what the science shows, and what I see in the clinic in my work with patients.  And I’m generally kind of allergic to extremely rigid, dogmatic approaches, especially when they’re not flexible enough to evolve and adapt with what the changing science tells us.  So that was one of the big focuses of my talk at the summit.
In the Middle Ages monasteries had sanitation. Streams provided clean water. Dirty water was used to clear toilets, which were in a separate room. Monks also had a room called a laver where they washed their hands before meals. However for most people sanitation was non-existent. In castles the toilet was simply a long passage built into the thickness of the walls. Often it emptied into the castle moat. Despite the lack of public health many towns had public bath-houses were you could pay to have a bath.
Ancient Egypt developed a large, varied and fruitful medical tradition. Herodotus described the Egyptians as "the healthiest of all men, next to the Libyans",[18] because of the dry climate and the notable public health system that they possessed. According to him, "the practice of medicine is so specialized among them that each physician is a healer of one disease and no more." Although Egyptian medicine, to a considerable extent, dealt with the supernatural,[19] it eventually developed a practical use in the fields of anatomy, public health, and clinical diagnostics.
^ Jump up to: a b Askitopoulou, H.; Konsolaki, E.; Ramoutsaki, I.; Anastassaki, E. (2002). Surgical cures by sleep induction as the Asclepieion of Epidaurus. The history of anesthesia: proceedings of the Fifth International Symposium, by José Carlos Diz, Avelino Franco, Douglas R. Bacon, J. Rupreht, Julián Alvarez. Elsevier Science B.V., International Congress Series 1242. pp. 11–17. ISBN 978-0444512932.
The physicians drew upon a great store of knowledge in the Peri-Ankh, the Houses of Life; here, students were taught and papyri documenting procedures were stored. Physiotherapy and heat-therapy were used to treat aches and pains, and Ancient Egyptian medicine included repairing and splinting broken bones, as shown by successfully healed skeletons. Priest-doctors also practiced amputation, using linens and antiseptics to reduce the chance of infection and gangrene, and there is some evidence that they employed prosthetics where needed.
She is the co-founder of the American Holistic Medical Association, as well as the co-founder of the Academy of Parapsychology and Medicine. Dr. Gladys shares her experience from medical school in the 1940's during a war to now and how medicine has changed from treating the disease to treating the person. Dr. Galdys talks the talk and she definitely walks the walk. She's a prime example of what we're trying to accomplish with our Journey to 100 project. Journey To 100 is a world-exclusive conference that will explore options for a sustainable approach to healthcare and longevity and begin Guernsey’s quest to become the first country with a life expectancy of 100. 

Chris Kresser:  I think that’s like the biggest change we’re going to see, is the nature of this device will change people’s awareness of health, and that’s incredible to think about.  There are so many people who are interested in tech that aren’t necessarily that interested in health.  But due to their interest in tech, they’re going to become interested in health, just because that’s going to be one of the main implementations of the iWatch.  And as you said, there’s going to be such a big community of people developing software.  And what we notice and pay attention to is what we can change.  If we’re not aware of something, we can’t change it.  And that, to me, is the most exciting factor of this new technology. It’s really going to dramatically increase people’s awareness of things—like how many steps they’re taking, and what kind of food they’re eating, and if they’re tracking that, and their heart rate, and how their heart rate variability might correlate to what type of exercise they should be doing that day.  And it’s not just about those kind of specific things that they’re becoming aware of.  It’s that focusing even on a few specific things like that is inevitably going to expand their awareness around all aspects of their health.  So I think it can really be a revolutionary impact.  And I know, as a clinician too, I’m really looking forward to having additional ways that I can both support my patients, by referring them to apps and things that can make implementing some of the recommendations that I give them easier and more practical.  But if I need to collect data for something, some of these devices are going to make that a lot easier and they’re going to be able to send it back to me in a way that’s very actionable for me as a clinician.  It’s a pretty exciting time to be involved in medicine and particularly the evolution of medicine.
^ England and Wales had nine county and borough asylums in 1827 with an average capacity of a little over 100 patients, but by 1890 there were 66 such asylums containing on average 800 patients each;[182] the total number of patients so confined increased from 1,027 in 1827 to 74,004 in 1900.[183] Similarly, in Germany, between 1852 and 1898 the asylum population increased seven-fold from 11,622 to 74,087 patients during a period when the total population had only grown by ten per cent.[158] In America the asylum population had risen to almost 250,000 on the eve of the First World War.[184]
Chris Kresser:  Yeah, that’s pretty amazing.  I talked with Mark Hyman a little bit about the Cleveland Clinic Functional Medicine Program.  And just for the listeners, what this is—and James, you might know a little bit more about it than I do—but just from what Mark said, the Cleveland Clinic, for those who don’t know, is a major institution in the field of medical research and pioneering new treatments and approaches to disease from the more mainstream perspective.  They basically invited Mark Hyman to create a functional medicine group within the Cleveland Clinic that is funded and actively looking for strategies. Basically, how to scale functional medicine and make it more viable within the healthcare model that we have.  And that is a really much-needed step because, as I’m sure all the listeners know, right now in functional medicine, everything is paid for out of pocket. Insurance doesn’t cover it.  That really limits the number of people who will be able to take advantage of it.  So getting some mainstream recognition like this for functional medicine is a huge step in terms of making it more accessible and available to the majority of people out there.
Apart from the treatment of wounds and broken bones, the folklore of medicine is probably the most ancient aspect of the art of healing, for primitive physicians showed their wisdom by treating the whole person, soul as well as body. Treatments and medicines that produced no physical effects on the body could nevertheless make a patient feel better when both healer and patient believed in their efficacy. This so-called placebo effect is applicable even in modern clinical medicine.
The Department of the History of Medicine is the oldest such academic department in North America. We are dedicated to scholarship in the history of medicine, disease and the health sciences, and their relation to society. The Department seeks to bring historical perspectives to bear on contemporary health issues. Faculty members conduct research on a broad range of topics, time periods, and geographic areas. The Department offers a PhD in the History of Medicine.

Herophilus of Chalcedon, working at the medical school of Alexandria placed intelligence in the brain, and connected the nervous system to motion and sensation. Herophilus also distinguished between veins and arteries, noting that the latter pulse while the former do not. He and his contemporary, Erasistratus of Chios, researched the role of veins and nerves, mapping their courses across the body. Erasistratus connected the increased complexity of the surface of the human brain compared to other animals to its superior intelligence. He sometimes employed experiments to further his research, at one time repeatedly weighing a caged bird, and noting its weight loss between feeding times. In Erasistratus' physiology, air enters the body, is then drawn by the lungs into the heart, where it is transformed into vital spirit, and is then pumped by the arteries throughout the body. Some of this vital spirit reaches the brain, where it is transformed into animal spirit, which is then distributed by the nerves.[50]

The Byzantine Empire's neighbors, the Persian Sassanid Empire, also made their noteworthy contributions mainly with the establishment of the Academy of Gondeshapur, which was "the most important medical center of the ancient world during the 6th and 7th centuries."[64] In addition, Cyril Elgood, British physician and a historian of medicine in Persia, commented that thanks to medical centers like the Academy of Gondeshapur, "to a very large extent, the credit for the whole hospital system must be given to Persia."[65]

The snakeroot plant has traditionally been a tonic in the east to calm patients; it is now used in orthodox medical practice to reduce blood pressure. Doctors in ancient India gave an extract of foxglove to patients with legs swollen by dropsy, an excess of fluid resulting from a weak heart; digitalis, a constituent of foxglove, is now a standard stimulant for the heart. Curare, smeared on the tip of arrows in the Amazonian jungle to paralyze the prey, is an important muscle relaxant in modern surgery.
^ Porter, Roy (1999). The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London: Fontana. p. 493. ISBN 978-0393319804.; Porter, Roy (1992). "Madness and its Institutions". In Wear, Andrew. Medicine in Society: Historical Essays. Cambridge: Cambridge University Press. pp. 277–302. ISBN 978-0521336390.; Suzuki, A. (1991). "Lunacy in seventeenth- and eighteenth-century England: Analysis of Quarter Sessions records Part I". History of Psychiatry. 2 (8): 437–56. doi:10.1177/0957154X9100200807. PMID 11612606.; Suzuki, A. (1992). "Lunacy in seventeenth- and eighteenth-century England: Analysis of Quarter Sessions records Part II". History of Psychiatry. 3 (9): 29–44. doi:10.1177/0957154X9200300903. PMID 11612665.
Addiction medicine Adolescent medicine Anesthesiology Dermatology Disaster medicine Diving medicine Emergency medicine Mass-gathering medicine Family medicine General practice Hospital medicine Intensive-care medicine Medical genetics Neurology Clinical neurophysiology Occupational medicine Ophthalmology Oral medicine Pain management Palliative care Pediatrics Neonatology Physical medicine and rehabilitation (PM&R) Preventive medicine Psychiatry Public health Radiation oncology Reproductive medicine Sexual medicine Sleep medicine Sports medicine Transplantation medicine Tropical medicine Travel medicine Venereology
Trapped in ice near Stadacona (the site of present-day Quebec City) in 1536, Jacques Cartier’s ships weren’t going anywhere. The crews, holed up in a makeshift fort with little access to fresh food, came down with a disease so gruesome that “their mouth became stincking, their gummes so rotten, that all the flesh did fall off, even to the rootes of the teeth, which did also almost all fall out.” They had scurvy, now known to result from a deficiency of vitamin C. Cartier had no idea what to do.
This week on the Evolution of Medicine podcast, we take a look back at a very special presentation from Dr. Leo Galland from our 2014 Evolution of Medicine Summit. Our next Functional Forum is entitled the "Evolution of Primary Care", which will address the most significant way functional medicine can impact medicine as a whole... as an updated operating system for primary care.

From 1917 to 1923, the American Red Cross moved into Europe with a battery of long-term child health projects. It built and operated hospitals and clinics, and organized antituberculosis and antityphus campaigns. A high priority involved child health programs such as clinics, better baby shows, playgrounds, fresh air camps, and courses for women on infant hygiene. Hundreds of U.S. doctors, nurses, and welfare professionals administered these programs, which aimed to reform the health of European youth and to reshape European public health and welfare along American lines.[174]
Two great Alexandrians laid the foundations for the scientific study of anatomy and physiology, Herophilus of Chalcedon and Erasistratus of Ceos.[48] Other Alexandrian surgeons gave us ligature (hemostasis), lithotomy, hernia operations, ophthalmic surgery, plastic surgery, methods of reduction of dislocations and fractures, tracheotomy, and mandrake as an anaesthetic. Some of what we know of them comes from Celsus and Galen of Pergamum.[49]
The sexual revolution included taboo-breaking research in human sexuality such as the 1948 and 1953 Kinsey reports, invention of hormonal contraception, and the normalization of abortion and homosexuality in many countries. Family planning has promoted a demographic transition in most of the world. With threatening sexually transmitted infections, not least HIV, use of barrier contraception has become imperative. The struggle against HIV has improved antiretroviral treatments.
This week on the Evolution of Medicine podcast, we're thrilled to welcome Danny Iny, the founder of Mirasee. Danny is a serial entrepreneur and has been involved in the online education space for more than a decade. We've been working very closely with Danny at the Evolution of Medicine to help us build out our online courses like the Practice Accelerator, the New Patient GPS, and the Membership Practice Builder. 
The Evolution of Medicine provides step-by-step instruction for building a successful "community micropractice," one that engages both the patient and practitioner in a therapeutic partnership focused on the body as a whole rather than isolated symptoms. This invaluable handbook will awaken health professionals to exciting new career possibilities. At the same time, it will alleviate the fear of abandoning a conventional medical system that is bad for doctors, patients, and payers, as well as being ineffectual in the treatment of chronic ailments.
In 1880 Pasteur and a team of coworkers searched for a cure for chicken cholera. Pasteur and his team grew germs in a sterile broth. Pasteur told a coworker to inject chickens with the germ culture. However the man forgot and went on holiday. The germs were left exposed to the air. Finally, when he returned the man injected chickens with the broth. However they did not die. So they were injected with a fresh culture. Still they did not die.
IFNA defines Integrative and Functional Nutrition (IFN) therapy as a leading-edge, evidence-based, and comprehensive approach to patient care that focuses on identifying root causes and system imbalances to significantly improve patient health outcomes. This emerging medical nutrition model combines the very best of modern science, clinical wisdom and critical thinking and is being driven by increasing consumer demand, advancing technology and the changing healthcare landscape.
In preparation for next Monday's Functional Forum, The Evolution of Primary Care, we are thrilled to welcome IFM certified practitioner, Dr. Kara Parker to the Evolution of Medicine podcast this week.  Dr. Parker has been practicing integrative and functional medicine for almost two decades, and practices in Minnesota at the Whittier Clinic. If you are interested in functional or integrative medicine, particularly how to work with the undeserved, this podcast is not one to miss.
When the Roman Empire split into the Western and Eastern Empires, the Western Empire, centered on Rome, went into a deep decline and the art of medicine slowly slipped away, with the physicians becoming pale shadows of their illustrious predecessors and generally causing more harm than good. Western Europe would not appear again in the history of medicine until long after the decline of Islam.
This week on the Evolution of Medicine podcast continues our “Success Leaves Clues” series, “From Matrix to Action” and welcome former Functional Forum guest Dr. Lara Salyer of Health Innate. Dr. Salyer, DO was featured on the Functional Forum this year, is an enthusiastic member of our Practice Accelerator program, and runs a functional medicine practice in rural Wisconsin.
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