A conversational interview with Aaron Hartman, MD about functional (personalized/precision/biologic) medicine. Hartman argues against siloed specialty care and for a whole-person approach that seeks root causes (diet, lifestyle, microbiome, connective tissue, etc.). He critiques reliance solely on randomized controlled trials and procedure-focused reimbursement, gives examples of medication repurposing (Viagra, Topamax, Benadryl), and explains that clinical experience and individualized inquiry drive his practice—partly motivated by helping his daughter and similar patients.
Chapters
Part of. I think what I've heard is the challenge is that you have almost siloed experts. So you are an expert in endocrinology. You focus on the heart of the lungs. And it seems to me that at least the people I've been speaking with, they're backing off of that siloed approach. And they're saying, wait a minute, let's get to root cause and let's back off of these silos and let's pull back all of that back and let's look at the entire person. So let's look at their, you know, their diet, their relationship to sun or any number of things. I mean, would that. Would that characterize kind of the work that you do in the terms of, like, being more of a. Generally looking at the overall client as a unique human being that has all these different aspects hitting them, not just one thing?
Well, it's different. You can call it precision medicine, you can call it personalized medicine, functional medicine, biologic medicine, but the idea is you can't afford to stop learning. So you're always learning broader and deeper. And then when you meet an individual, like, you're hypermobile. I knew nothing about that. Then that physician practitioner was supposed to stop. Let's go do a PubMed search for a couple weeks and research all the articles in this. And I become the expert on that. If you do that with patients, you see, because, like, for me, like, part of my medical training is the buck stops here. My first board certification is in family medicine. And the family medicine world's like, I have to know about autoimmune issues and heart issues and a whole bunch of other stuff, which I enjoy. So it doesn't, you know, when you specialize, you get to say, I'm only going to know about one organ system, but you don't ever connect the dots between the heart and the kidneys.
Right.
Or the heart and the heart and the gut.
Right.
Did you know there's a neurological gut brain and gut heart access and heart brain access. Is it.
They call it your second brain or something, or your brain is here, here and here? I guess. I don't know.
Yeah, exactly. And so it's one of those things where it's like all of a sudden now, like the functional medicine expert. I kind of like this. As a uber generalist. You don't have the luxury. And that's one of the things that intellectually really I enjoy. Like, I don't have the luxury of just stopping where I'm at. I gotta keep on learning and, yeah, and so I enjoy that, but the primary driver for that was like my daughter helping her, helping other kids, helping patients, and then realizing, wait a second, this is so many people you can help with this.
So it starts with doctors who have a willingness to learn new things and God forbid, question authority and question. And it's so interesting to me. You speak about these things that were hidden under 50s or you go back to. I know we talked earlier about the stuff in B.C. and way back when. So it's interesting that that stuff remains hidden. And it's just, it's not really pushed today in the modern concept of Western medicine.
Well, the problem is that our current healthcare system says we only accept randomized, double blinded placebo controlled trials. So If I see 10 people and I do a therapy of 10 people and they all get better, no one listens to that. I need to do a randomized trial.
Right. Because that's anecdotal, right?
It's anecdotal, yes. The fact that I've seen 100,000 people in my career is considered anecdote now.
Amazing, right? It's 110 and then all of a.
Sudden, I guess I haven't reached the number yet, whatever that number is. I mean, maybe I'll never reach them, but doing this for 22 years, I guess, man, I need to reach 200,000 or whatever. But, but it's like interesting because the way we get. And it's, it's useful. Like the way you find out that a medication like Plavix can prevent strokes. As you find people who've had strokes have a high risk, you give them the medication, you eliminate all other factors and nuances, confounding factors, it's called. You find out if that medication works. The problem is you create a pseudo population that does not exist in the real world. I see. So I'm a clinical researcher and like literally we call people every month to make sure they're taking their medication, right? We see them every three days. If you're someone who doesn't take your medication or you've had two strokes, not one stroke, or your last stroke was in the last three months, you can't get in the study. So we found a stable population of people that does not exist in the real world. You give them a therapy and then we're like, okay, good, that works. It doesn't work. It's like. But that's not the real world. Not the real world. Well, people forget. They talk about things that are FDA approved and it's like most of what physicians do in practice does not have a randomized trial to back it up. It's just like, for example, using seizure medications for migraines. Yes. Topamax has been studied for that, but originally it was a seizure drug, and then neurologists figured out it can help migraines. And then the pharmaceutical company was like, well, we can make more money for migraines because that's super common seizures. Well, another great example is Viagra.
Right?
So Viagra was originally looked at to treat a thing called pulmonary hypertension, which is basically the arteries in your lungs get small and you eventually suffocate, and it's a bad way to die. Well, they did a study using 20 milligrams of sildenafil, which is the generic for biograph, to treat that. So they're in the study, it worked. They're going to FDA approve it. They're trying to get the medication back. And the guys were like, we're not giving this back. Why is that? Well, I'm having sex again. Oh. And they're like, wait a second.
Okay.
Homemade hypertension. Rare erectiles function common. And so they change every move over. Yeah. And the thing is, that happens all the time with medications, right? Using Benadryl to treat migraines. I use Benadryl all the time. You come with a terrible migraine, I can give you a shot of Benadryl and knock it out.
Right?
Not FDA approved, but we've been doing it for decades.
And I had just listened to a recent podcast. Podcast, which spoke about the idea that if you can create different uses for it, you extend patents. And by extending patents, it keeps it off the generic market. So obviously, there's a massive profit motive generated by big pharma to take this stuff and repurpose it and do a different type of cure. But again, it all comes down to the idea that you're not really looking at the root cause of all this stuff. It's really just, let's slap a band aid on it, let's take care of it for right now, but we'll see in six months.
Our current healthcare system reimburses for procedures, not cognitive work.
Right.
So, you know, if I. I used to go to the hospital and see patients in the hospital, I'd spend 45 minutes seeing a patient, go to the ICU, get calls all night long from the nurse. Now I get paid. Medicare would pay me $85 for that visit. And my plumber comes up to my house. I have to pay him 150 bucks to show up, he's there for an hour. It's like, we wonder why so many procedures are done in our healthcare system. It's, you get what you pay for, right? And the European system is totally different. And they have. Their system is 75% general practitioners, 25 specialists, and ours is the opposite, 75% specialists. And so what's the difference since we're paying for procedures, right? So the reason all the physicians are specializing and the reason why the system's the way it is is because you get what you pay for.
