Full Transcript Functional Medicine at Cleveland Clinic 0:00 How would you rate the degree to which these functional medicine ideas are permeating into the core of the Cleveland Clinic, 0:07 which is the cardiology program? 0:08 I don't know if I can rate that yet. 0:11 It's still a work in progress. 0:12 There's enthusiasm for it, and I'm not going to say that everyone's enthusiastic. 0:17 You know, it's hard to change, especially when the change has been so hardwired for 10, 15 years and reputations have been made from it. 0:26 But we're just practicing good medicine. 0:29 And patients come to us because they have questions, they are concerned. 0:33 And what they've been told is not consistent with what their reader. 0:37 Yeah. 0:38 So we take the time to explain the biology to them. 0:42 Some of my patients still end up taking pharmaceuticals as part of their health care goal. 0:47 But I tell them the truth about all the literature. 0:50 Lifestyle is still the most important thing. 0:52 Sleep is paramount. 0:53 Stress management is key. 0:55 Connections, doing things for others, all those things. 0:58 And is that kind of care in the Cleveland Clinic Center for Functional Medicine, or is the kind care further afar and making it into the other parts of 1:07 other care? 1:07 It's making into other part. 1:09 Our women's health program is growing. 1:11 We have a lot of strong relationships with GI, geriatrics, pediatrists. 1:17 we have functional medicine psychiatrist as part of our program. 1:21 Funcial medicine OBGYN specialist. 1:25 So we believe in collaboration. 1:27 Yeah, we're not trying to show that one way is better than the other. 1:30 Just find a way to take care of patients to the best of our ability. 1:33 Yeah. 1:34 Hello and welcome back to The Evolution of Medicine podcast. 1:36 We are here at the Institute for Functional Medicine's annual international conference. 1:41 And we are speaking to leaders and innovators, people who have been spreading the message here, at this conference, and I'm super excited to have back 1:49 on the podcast, Dr. 1:51 James Carter. 1:52 If you have been following along for a long time, you know that Dr Carter has a pretty significant role at the Cleveland Clinic. 1:58 We're going to talk about that, but also did an incredible lecture today on cardiology and the evolution of cardiologist, 2:04 which we're gonna talk a lot as well. 2:05 So, Doc, welcome back to the show. 2:06 Thank you very much. 2:07 Thanks for inviting me back. 2:09 Remind for the audience, your journey to get here and, the role that you had at Cleveland clinic. 2:13 Well, I started out as an interventional cardiologist and spent most of my time out in private practice and community-based practice, 2:21 then went back to academics in 2017, went to a major university, and then I was recruited to Cleveland Clinic to direct the Center for Functional Medicine. 2:31 Nice. 2:31 Since we last spoke, I was promoted to an additional role as vice chair of clinical services for the department of wellness and preventive medicine. 2:41 Yeah. 2:42 So our functional medicine program is within the wellness department. 2:47 Well, look, I want to jump into, uh, i'd love to learn what's happened since, cause I know always things are happening, but I wanna just dive straight 2:53 into your lecture because I'd be speaking to a number of clinicians who were there and they were like, kind of like finally, 2:58 this is being talked about as a topic because i know the evolution of cardiology has a lot of factors to it. 3:04 So can you share a little bit about sort of the main thrust of talk and, um, how you see this sort, of evolution in cardiologist? 3:14 Thank you for engaging me about this. 3:16 It was nice to get that type of feedback. 3:20 People came to me after the presentation and expressed the same thing. 3:24 And so I've been reflecting on what resonated.
Cardiology, Inflammation, and Deeper Risk Assessment 3:28 I think what really moved people was the emphasis on the humanity of the work. 3:37 how it's all about our own personal narratives and our stories. 3:42 And importantly, those stories affect our biology and showing that integration of social context intersecting with biologic vulnerability and biological promise. 4:00 is what functional medicine can address. 4:02 So I tried to show that from the perspective of patients who are coming in, they have a story to tell. 4:08 Some was not listening to the story, so they put them on a treatment that actually doesn't make sense for what they actually have presented with. 4:15 That's what you're saying, yeah. 4:17 Yeah, I love that. 4:18 Well, tell us a little bit about, you know, obviously Cleveland Clinic is known for its cardiology. 4:22 That's sort of like the fundamental piece. 4:24 And what I understood from the talk is that there are elements of what's important to a healthy heart that have been sort And that there's a sort of a 4:39 re-reckoning in the field of cardiology about what causes heart disease. 4:43 And I'd love for you to share some of what you shared, because I think that. 4:47 There's number of people in this community who, when they've come to functional cardiologist have been made aware of different set of factors that affect biology. 4:57 You know, biology and story being one, but also like when you get down into the biochemistry, there are some unusual factors, 5:05 should we say. 5:06 Well, the important thing is that everyone's trying to do the best they can to help the patients and for a lot of reasons, 5:15 a lots of cardiology care has been simplified. 5:21 for the purpose of finding a way to reach as many people as possible to guidelines and risk calculators. 5:31 Even though the evidence doesn't really show that that's effective, the incidence and prevalence of cardiovascular disease across the globe continues to rise, 5:40 continues be a burden. 5:42 And the reason for that is because we're not treating all of the risk. 5:48 And my presentation used papers and scientific articles that were peer reviewed from major cardiology journals and major internal medicine journals. 6:03 So Journal of American College of Cardiology, Lancet, and Journal American Medical Association. 6:09 And I was able to show that we've known for a long time that inflammation is more important than lipids. 6:17 We have evidence for that from 1990s. 6:22 And you called it a re-rekening. 6:26 That's an interesting word I'll think about. 6:29 But now an understanding that, we have to look at more than just LDL cholesterol because there's still this residual risk. 6:38 If we only look at LDL, the highlight would be that even in people who have been on statins to lower their LDl, if they have measures of inflammation present, 6:49 their risk remains high for cardiac events. 6:52 What are some of the key biomarkers that you might look out to go a little bit deeper into the actual risk related to inflammation? 6:59 Well, even before the biomarkers, I think it's important to be present for patients to listen to their context of living. 7:07 Yeah, was not trained to do that. 7:09 I was trained do go into the clinical space with a set of questions. 7:13 It was very important understand what people are doing, what they're exposed to, because there's risk from that, there just from environmental exposures, 7:21 from stress, um, From lack of green space, all those things. 7:25 And there is a lot of data on that Then beyond that, to understand the biology is imaging to see if there's signs of plaque in any way you can to show 7:37 whether there is atherosclerosis and that depends on what's available to you. 7:41 And then going beyond a fasting lipid profile, which is an inadequate measure of risk. 7:47 It's just something that I just don't understand why anyone would think the data shows that because it doesn't. 7:55 And there's much more to it than a fasting lipid profile, digging into particle number, particle size, but most importantly, 8:04 signs of inflammation. 8:06 Are they eating a pro-inflammatory diet?
Community Engagement and Group Visits 8:09 And do they have inflammatory markers elevated? 8:13 Do they signs have impaired gut health when you talk to them? 8:16 Are there markers of impaired good health in your laboratory testing? 8:20 Yeah, super interesting. 8:22 So I know one of the things that I interviewed someone at the Cleveland Clinic about, I can't remember the timing or the details, 8:30 is one the ways to sort of engage, particularly like African American men early on was to go out and do these group visits, 8:37 right, in these different areas as a way to engage maybe earlier than you might engage to actually come in and be with a doctor in a normal system. 8:45 How was that? 8:46 process going and do you feel like that is still a way to get in a little bit earlier to those populations? 8:52 It's absolutely still away. 8:54 We even have a poster presented this week showing that we did a pastors program. 9:03 And a shared medical appointment and leaned into the concept that pastors in churches are committed to health promotion and teaching them about health 9:15 so that they could teach better was the concepts. 9:17 So we did two pilots of that. 9:20 We still have shared medical appointments as part of our practice and there's an excitement about a teaching kitchen that's opening soon. 9:30 It will be open the end of this year. 9:32 And it's at one of ours community centers located in a diverse neighborhood. 9:40 And we're going to use that as another way to engage and connect with people, understand their cultural beliefs, their preferences, 9:49 teach them about nutrition, show them how they can make some substitutions that will maintain their joy of eating and won't be dismissive of their culture. 10:01 That's awesome. 10:02 How would you rate the degree to which these functional medicine ideas are permeating into the core of the Cleveland Clinic, 10:10 which is the cardiology program? 10:12 So I just want to take a minute to talk about the incredible mission partners that we have here at The Evolution of Medicine that have made this possible. 10:19 So first and foremost, I want thank So Fullscript has been an amazing partner for 10 years. 10:25 We only pick partners that can help us achieve our vision and help you achieve your practice vision. 10:31 And FullScript have been incredible partner a decade, but their new offering journeys, this is why we called it the Evolution of Medicine Journeys, 10:38 is allowing practitioners to combine the relationships that they have with the newest technology to sell direct to consumer lab testing and use it as a 10:48 funnel to bring into your practise and it's a game changer for the whole industry. 10:51 So go to goevomed.com slash journeys. 10:54 and you can get started on building the journeys for your practice an optimal way into your practise. 10:59 We're gonna have some conversations about it. 11:01 This is a game changer. 11:02 Next, Genova. 11:03 Genoa have been fans of the evolution of medicine for a long time. 11:07 we're big fans with them and they now have a lot more specialty testing. 11:11 They have lot of more tools and it's a key part of understanding the body ecologically. 11:17 So go to goeohomed.com slash Genova to find out more. 11:20 Come on over here and I wanna show you about the other mission partners. 11:24 If you've been following us for a while, you know that these are organizations that we trust, that add a lot of value. 11:29 Freedom Practice Coaching. 11:32 I have been supported by them since the beginning. 11:35 And so many of the issues that practitioners face in building a successful practice, scaling a success practice come down to having the right support with 11:44 people who have being there and done that. 11:46 Go to goevomed.com slash FPC. 11:50 Big boost marketing. 11:52 Uli and his team are the best in the business when it comes to really understanding how to market your functional medicine practice. 11:57 Go to goevomed.com slash big boost and see how they can help you. 12:03 And then what you're going to be hearing a lot about is the formation of clinical networks. 12:08 And ultimately, True Neura is our first effort at that, which is to build an integrated clinical network combining independent practices from across the 12:17 country into a network that can reverse cognitive decline.
Growth of Functional Medicine Across Specialties 12:20 And if you go to goevomed.com slash TrueNeura, you can get a demo. 12:25 You can see what it means to be part of an Integrated Clinical Network. 12:29 That's mentorship, that's software, and that is making it easier for you to get incredible outcomes in a disease state where there are no other options. 12:37 So thanks to our mission partners. 12:39 Let's get back to the content. 12:44 I don't know. 12:45 I dunno if I could rate that. 12:46 Yeah. 12:46 He's still a work in progress. 12:49 There's enthusiasm for it. 12:51 And I'm not going to say that everyone's enthusiastic. 12:54 Um, you know, it's hard to change and especially when the change has been so hardwired for 10, 15 years and reputations have been made from it, 13:06 um, but it just, we're just practicing good medicine and, uh, patients come to us because they have questions. 13:13 They have concerns. 13:14 And what they've been told is not consistent with what their reader. 13:19 And so we take the time to explain the biology to them. 13:24 Some of my patients still end up taking pharmaceuticals as part of their healthcare goal. 13:30 But I tell them the truth about all of the literature. 13:33 Lifestyle is still the most important thing. 13:36 Sleep is paramount. 13:37 Stress management is key. 13:40 Connections, doing things for others, all those things. 13:44 Is that kind of care in the Cleveland Clinic Center for Functional Medicine or is that care further afar and making it into the other parts of other care? 13:54 It's making into other part. 13:57 Our women's health program is growing. 14:00 We have a lot of strong relationships with GI, geriatrics, pediatrists. 14:06 Uh, we have functional medicine psychiatrists as part of our program. 14:11 Uh we, have a functional, medicine OB GYN, uh, specialist. 14:16 So we believe in collaboration. 14:19 Yeah. 14:19 We're not trying to show that one way is better than the other, just find a way to take care of patients to the best of their ability. 14:27 I've spent the last year or so really involved in the sort of the world of dementia and Alzheimer's. 14:35 And it's been amazing for me to learn from so many incredible functional medicine clinicians who are showcasing the relationship of a vascular system to 14:45 the brain and how everything's connected. 14:46 You know, it is interesting that it, in a certain way, you can't just permeate one organization or one specialty because the whole point is the interconnection 14:57 of everything. 14:58 So I'd imagine if that is both a blessing and a curse in institutional change. 15:04 It's an opportunity. 15:05 Yeah. 15:07 It's an opportunity and we work very closely with other specialties because of that. 15:11 And we have brain health programs in our department. 15:14 We have shared medical appointments for brain-health and that's really been taking off. 15:20 So we are trying the best we can to pull it all together. 15:25 Uh, we think it's a necessary, We think, it is an imperative and were dedicated to it. 15:31 And we're dedicated to doing it within our model of care so that we can reach as many people as possible. 15:38 It doesn't mean I have anything against those who are doing for people who have the money to spend every month or in these packages, 15:46 but we are trying to reach everyone. 15:49 Amazing. 15:50 So as you look forward now, you've got this enhanced role. 15:55 You have the functional medicine delivery, the group visits, all these other pieces. 15:59 What are your hopes and dreams for what is possible in the future of your tenure at the Cleveland Clinic? 16:07 My hope is that people would listen to your podcast and say they want to come and work within our program and practice good medicine and take care of many 16:19 people as possible. 16:21 If we get that, that could be MDs, DOs advanced practice providers, all different types, physical therapists, chiropractors, 16:32 acupuncturists. 16:34 Whoever is dedicated to that type of model to try and see that through. 16:38 Usually they have a personal story. 16:40 They have, a father or brother or cousin or mother who needs care in an insurance pay model.
Brain Health and Institutional Change 16:49 And they want to help grow that concept so that we can spread that word. 16:55 Once we show it in a big place like Cleveland Clinic, everyone could follow. 17:02 Is there a tension between sort of leading the revolution in terms of functional medicine coming into institutions and wanting to do that versus, 17:11 you know, executing on the commitment of the Cleveland Clinic to the population of Cleveland? 17:16 Like, is there tension there or is it all part of same thing? 17:19 Part of thing. 17:19 Okay. 17:20 The values of Cleveland Clinic are aligned with our values. 17:26 We believe very strongly that we can shape the future by working together as a team and leading with kindness and care. 17:40 So if we do those three things, we will reach our goals. 17:44 And those are the same things we believe in in functional medicine. 17:47 So we feel pretty aligned with the Cleveland Clinic values. 17:51 Amazing. 17:53 Well, I want to tell you a funny story because I had an interaction this year that you'll like exactly in the context of what you just shared. 17:59 So I get an email one day and it's from a recruiter and they say, Hey, there's a position. 18:05 We think you'd be a good fit for it. 18:06 Are you interested in finding out more? 18:08 So, yes, let's see what this is. 18:12 And all I can say is that it is the email that I've received that. 18:16 I felt the most validated in my whole career. 18:18 It was like, we're from the Cleveland clinic. 18:21 Um, We saw that you visited the cleveland clinic center for functional medicine. 18:27 We see the work you've done in evolution of medicine and new health and all these kinds of things. 18:32 And it was, like reading someone has been paying attention to my. 18:34 Whole career and is, it, is it validating all the things that i've. 18:38 Done and there's this role coming up at. 18:41 the Cleveland Clinic for like the center of like digital innovation and we think you'd be perfect for it. 18:46 Here's the salary rage. 18:47 This is what it is. 18:48 And I'm like, oh my God, look at this. 18:50 I look the bottom and I see this recruiter guy and look him up and like this is a real guy. 18:55 go back and forth and we have this conversation. 18:57 And then it hits me. 19:00 I look at it and I'm like, this is coming from a Gmail account. 19:03 Like, I think this way. 19:05 Oh, no! 19:06 And I've been essentially AI scammed. 19:08 Now, what I don't know is how they were ever planning to make money from this. 19:12 It wasn't like they said, hey, well, send us $5,000. You're in for this thing. 19:16 But I was saying to my wife, like hey what do you think? 19:19 Should we move to Cleveland? 19:22 I don't even know what the point of the scam was, but I guess there's enough information out on me in the world that I got this email. 19:30 I thought you'd get a kick out of it. 19:34 It was a funny moment to imagine. 19:36 Started like that and I went to bed just imagining, I'm not going to fly to Cleveland once a month or whatever. 19:43 I think it has been actually an amazing thread through the evolution of medicine. 19:48 Dr. 19:48 Hyman announced the project in 2014 on the first proper episode of my show. 19:53 We went and toured there when the center was up and now obviously keeping up to date with it through being on a project and seeing you at the IFM. 20:04 If practitioners are interested and inspired to go and do it, If I give my own endorsement, like my feeling is that at this moment of the functional medicine 20:14 revolution at the Cleveland Clinic, a five year stint at The Cleveland clinic center for functional Medicine as a physician or otherwise would set you 20:21 up for an incredible career because ultimately what you see is the seeds. 20:25 of what's happening now blossoms into something amazing. 20:28 And I think that that's an amazing place to be. 20:29 So I, think if I was a early stage physician wanting to learn the clinical stuff and have credibility for the rest of my life, 20:35 that would be a good place. 20:36 Where should people go if they want to find out more about it? 20:39 Well, the other option is to have a career there. 20:41 Yeah. 20:42 We have some brilliant people who plan to stay. 20:45 That's right. 20:47 They can check out our website and just search us and look us up and reach out to me through you if they can't find the website. 20:59 And we have a lot of opportunities for people who have, even people have particular areas they want to focus on. 21:07 We have opportunities to do that with the functional medicine foundation. 21:13 I agree with you that some want to come and just stay for a few years, but we are looking for people who understand the value of being part of the Cleveland 21:23 Clinic enterprise for their whole career. 21:25 We're a global enterprise, we have clinics and a footprint all over the world. 21:32 So there's a lot of opportunity for growth and even change when you want it to change. 21:37 There's brain specific entity, right?
Recruiting Talent and the Future of the Program 21:39 Is that right. 21:40 Yes. 21:40 Can you tell me a little bit more about that? 21:42 Well, we're expanding that in Nevada. 21:44 We have shared medical appointments for that and we are growing that part of our program. 21:51 It's very exciting. 21:52 People are clearly concerned about brain health and using a similar model that we use with women's health. 22:00 So we using that type of model to keep growing what we do and touching as many people as possible. 22:06 Amazing. 22:07 Why do you keep coming back to annual conference here apart from giving your lectures and keynoting? 22:11 What is it about the conference that lights you up? 22:15 This time I wanted to see what talent was out there that I could convince to come and work for us. 22:21 That's the truth. 22:22 Yeah. 22:23 that was my main motivation. 22:24 I did enjoy doing the presentation, but I want to keep my understanding of what people are looking for in practice. 22:33 They don't think what we're doing is possible. 22:35 That's part of why they're gravitating to doing this, their own little practice niche. 22:42 And they don' think it's possible in an assurance based model to provide good care and feel valued and field productive. 22:51 Yeah. 22:51 We believe there there's a way to do that. 22:54 Yeah, well, you're proving it out that there is a way to do that. 22:57 And yeah, I think I was really excited to see, on the main stage at the very beginning, talking about community as medicine, 23:05 group visits, those kinds of things. 23:07 This is proving that these kind of models can take it into different places. 23:12 Well, thank you so much for being part of the group. 23:14 I hope that if you hear this, you get in touch and come and be part the revolution over there. 23:20 There's a long way to go for us to transform healthcare and the Cleveland Clinic has been on a cutting edge of bringing these ideas into conventional medicine 23:28 at a place with credibility, impact, data. 23:32 It's very, very important project. 23:34 And that's Carter. 23:36 Thanks so. 23:36 Good to see you. 23:39 So I just want to take a minute to talk about the incredible mission partners that we have here at The Evolution of Medicine that have made this possible. 23:46 So first and foremost, I want thank Fullscript and Full script Journey. 23:50 Full scripts has been an amazing partner for 10 years. 23:53 We only pick partners, that can help us achieve our vision and help you achieve your practice vision. 23:58 And Full Script have been incredible partner, for a decade, but their new offering journeys, this is why we called it The evolution of medicine journeys. 24:05 is allowing practitioners to combine the relationships that they have with the newest technology to sell direct to consumer lab testing and use it as a 24:15 funnel to bring into your practice and it's a game changer for the whole industry. 24:18 So go to goevomed.com slash journeys and you can get started on building the journeys for your practice, an optimal way into your practise. 24:26 We're gonna have some conversations about it. 24:28 This is a game changer. 24:30 Next, Genova. 24:31 Genoa have been fans of the evolution of medicine for a long time. 24:34 we're big fans with them and they now have a lot more specialty testing. 24:38 They have lot of more tools and it's a key part of understanding the body ecologically. 24:44 So go to goehomed.com slash Genova to find out more. 24:47 Come on over here and I wanna show you about the other mission partners. 24:51 If you've been following us for a while, you know that these are organizations that we trust, that add a lot of value. 24:57 Freedom Practice Coaching, I have been supported by them since the beginning. 25:02 And so many of the issues that practitioners face in building a successful practice, scaling a success practice come down to having the right support with 25:12 people who have done that. 25:13 Go to goevomed.com. 25:17 Big boost marketing, Uli and his team are the best in the business when it comes to really understanding how to market your functional medicine practice. 25:25 Go to goevomed.com slash big boost and see how they can help you. 25:30 And then what you're going to be hearing a lot about is the formation of clinical networks. 25:35 And ultimately, True Neura is our first effort at that, which is to build an integrated clinical network combining independent practices from across the 25:44 country into a network that can reverse cognitive decline. 25:47 And if you go to goevomed.com slash TrueNeura, you can get a demo. 25:52 You can see what it means to be part of an Integrated Clinical Network. 25:56 That's mentorship, that's software, and that is making it easier for you to get incredible outcomes in a disease state where there are no other options. 26:04 So thanks to our mission partners. 26:06 Let's get back to the content.
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