Curative and functional: two ways of organising care
Simplified, at the risk of being blunt.
The curative approach starts from the symptom or the disease. It identifies, it names, it treats. It is extraordinarily effective when there is something to treat: an infection, a fracture, a heart attack, a cancer. European medicine does this among the best in the world, and that belongs at the front of any honest description.
The functional approach starts from the person. It looks at what in their lifestyle, their history and their environment produces or sustains an imbalance, and works on that. It does not wait for a disease to be established. That is its strength and also its weakness: the less illness there is, the harder it becomes to prove what you avoided.
The difference is in the question asked. The curative approach asks what the disease is and how to treat it. The functional approach asks why this person has drifted from their usual functioning, and what brings them back.
The two are not in opposition, they belong to different moments. The problem is that only one of them is organised, funded and reimbursed.
Why the demand exists
The demand did not arrive as a fashion, and there is a plain piece of evidence for that from an unexpected direction. When the American Academy of Family Physicians reopened continuing education credit for functional medicine in 2018, after four years of moratorium, the reasoning its commission chair gave was not that the evidence had improved. It was that patients are asking about it, so members should be informed. A critic conceding that the demand is real is worth more than an advocate asserting it.
The second piece is the consultation itself. A first appointment of sixty to ninety minutes is not a comfort, it is the entry condition of the method. You cannot go through someone's diet, sleep, stress, history and environment in twelve minutes. Where a health system does not fund that time, the patient goes looking for it elsewhere and pays for it herself.
Where the term comes from
Functional medicine was created by Jeffrey Bland in the early 1990s, as part of his company HealthComm. The Institute for Functional Medicine (IFM), based in Washington state, became a registered nonprofit in 2001; Mark Hyman later joined its board and became its most visible spokesperson. IFM itself says it has been training clinicians since 1991, and it ran its inaugural certification class in 2013 with 125 practitioners. By May 2019 it announced it had certified more than 1,000 practitioners worldwide. No more recent global figure has been published.
The most visible institutional adoption came in 2014, when the Cleveland Clinic opened its Center for Functional Medicine on 23 September, led by Mark Hyman with Patrick Hanaway as medical director, in collaboration with IFM.
Two things are worth noting for anyone weighing up the field. The origin is American and commercial rather than academic, and the institutional footprint in Europe is thin: IFM's international partner page lists FMC Ireland and AIMF in Italy, alongside a set of organisations whose country is not stated. IFM's international page lists no European body of comparable scope.
What a functional medicine practitioner actually does
The word suggests a secret protocol or a parallel discipline. The reality is simpler and more artisanal: a long first consultation, a timeline of the patient's history, a reading by systems rather than by organs, and a plan built on levers nobody disputes, sleep, food, physical activity, stress load, and where relevant targeted supplementation. The Institute for Functional Medicine formalised the timeline as a tool, but it is thorough history-taking, not magic. Nothing on that list of levers is contested in public health.
IFM's own curriculum gives the clearest picture of what the training covers. The foundation course, Applying Functional Medicine in Clinical Practice (AFMCP), runs eleven weeks online and carries up to 39 credit hours. Six Advanced Practice Modules follow. Certification currently requires a minimum of 100 hours of instruction, rising to 150 hours from January 2027, and IFM states that only its own core curriculum fully satisfies that requirement.
Prices published by a Dublin clinic give a sense of the commercial shape of the work: 340 euro for an initial online consultation, 375 euro in person for a comprehensive sixty-minute appointment, 195 euro for a follow-up, and 995 euro for a three-month programme including four thirty-minute reviews. That is a single clinic's price list rather than a market average, and no Irish professional body publishes one.
The point to hold on to is that the consultation model, not the label, is what a client pays for. The label carries no legal weight, which is exactly what IFM says itself: its credentials "are voluntary, and the credentials do not grant any additional legal or specialty status, nor do they expand or reduce scope of professional licensure."
Functional, integrative, nutritional therapy, naturopathy, orthomolecular
These five terms are used interchangeably in marketing and mean different things in practice. The distinction that matters is not philosophical, it is regulatory: some of them attach to a protected title and some do not.
The detailed table for this section is shown at the end of the article.
If you work in English across Europe, the practical consequence is that your audience uses a different word depending on where they sit. A Dutch practitioner will search for orthomoleculair therapeut, a British or Irish one for nutritional therapist, a German one for Heilpraktiker. Functional medicine is the term that travels across all of them without belonging to any of them.
What the evidence shows, and where the debate stands
The most cited study is Beidelschies and colleagues, published in JAMA Network Open in 2019 under the title "Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes". It is worth reading properly rather than through either side's summary.
Design: a retrospective cohort study with propensity score matching, comparing patients at the Cleveland Clinic Center for Functional Medicine with patients at the Cleveland Clinic Twinsburg Family Health Center, between April 2015 and March 2017. The full cohort was 7,252 patients (1,595 functional medicine, 5,657 family medicine), with 398 matched pairs at six months and 220 at twelve months.
Results, on the PROMIS Global Physical Health score, where the authors define a clinically meaningful change as at least 5 points: at six months the functional medicine group improved by 1.59 points against 0.33 for primary care (P = .004), and 30.9 per cent versus 22.1 per cent reached a clinically meaningful improvement. At twelve months the difference was 1.60 against 1.09 and was not statistically significant (P = .41). A sensitivity analysis restricted to patients with data at both time points gave 2.61 against 0.25 (P = .02).
Read honestly, that is a real but modest signal. The mean improvement stays below the study's own five-point threshold for clinical meaningfulness, and the twelve-month difference does not reach significance. The authors say as much: they describe it as a first systematic attempt using validated measures, and write that prospective studies are warranted to confirm the findings. It is also worth knowing that Patrick Hanaway, a co-author, was the founding medical director of the centre being studied.
On the other side, the American Academy of Family Physicians placed a moratorium on CME credit for functional medicine in February 2014, finding the evidence insufficient and, in some cases, judging the claims being made to be potentially dangerous. In March 2018 it lifted the moratorium conditionally: activities that give an overview or scope of functional medicine became eligible, while activities that teach clinicians how to perform functional medicine techniques in their own practice remained ineligible. The reasoning given by the commission's chair was pragmatic: sufficient evidence does not exist, but patients are asking about it, so members should be informed. Critics including David Gorski and Jann Bellamy at Science-Based Medicine have gone further, in considerably harsher language, focusing on testing that they argue is unnecessary and expensive, and on practitioners selling the supplements they recommend. Wikipedia's article reflects that position rather than a neutral one.
Two practical conclusions follow, and both are useful whatever you make of the debate. First, the evidence base is thin enough that a practitioner who promises outcomes is on weak ground, professionally and legally. Second, the criticism that lands hardest is the commercial one, about testing volume and about selling what you prescribe. That is the part of the model a practitioner can actually control.
How the profession is regulated in Europe: mostly, it isn't
Across every official source reviewed, one pattern holds: functional medicine appears nowhere as a profession or a protected title. Your obligations come from your base qualification.
The detailed table for this section is shown at the end of the article.
Ireland in detail
Ireland is the clearest case of a country where the title is open and the obligations are indirect.
The Dietitians Registration Board was established on 14 February 2013, its register opened on 31 October 2014, and the title of dietitian became officially protected on 31 October 2016. Everything else in the nutrition space is unprotected. The Irish Nutrition and Dietetic Institute states it plainly: the term nutritionist is not protected by law, so people with widely different levels of training can use it, and nutritional therapists are eligible neither for CORU registration nor for the UK Voluntary Register of Nutritionists.
The Department of Health confirms that complementary therapy practitioners are not subject to professional statutory regulation, while remaining subject to consumer, competition, contract and criminal law, and says it supports greater voluntary self-regulation of the sector.
For doctors, the position is different and stricter. The Medical Council's Guide to Professional Conduct and Ethics, ninth edition, in force since 1 January 2024, requires that you prescribe only when you have adequate knowledge of the patient's condition and believe the prescription is indicated, and that any treatment or therapy prescribed is safe and evidence-based.
Voluntary self-regulation in practice means NTOI, Nutritional Therapists of Ireland, whose members study for a minimum of three years at a recognised college, must be fully insured and must meet CPD requirements. That membership has a direct commercial consequence with at least one insurer: on the strength of an undated schedule published by NTOI, Irish Life Health contributes between 25 and 50 euro per visit for a nutritionist, for between 2 and 13 visits depending on the plan, on condition that the practitioner is registered with NTOI. No other insurer's published list covers nutritional therapy, so confirm current terms with each one.
On VAT, the picture is less comfortable. Revenue's manual on medical services grants exemption to practitioners registered under the Medical Practitioners Act 2007, the Nurses and Midwives Act 2011, and the designated CORU professions including dietitians, plus chiropodists, chiropractors and osteopaths. Nutritionists and nutritional therapists appear on neither the exempt list nor the reduced-rate list, so the exact treatment of a nutritional therapy consultation is not settled by the published guidance. The standard Irish rate is 23 per cent as of 1 January 2026, and the registration threshold for services is 42,500 euro. Get this confirmed by your accountant before you invoice.
What this changes for you
If you are a registered doctor, dietitian or other regulated professional, functional medicine is a set of methods you add inside a scope you already have. Your council's rules travel with you, and in Ireland that means the evidence-based standard in the 2024 guide applies to whatever you prescribe.
If you are not, the label gives you nothing legally, and your credibility rests on two things you choose: the professional body you join and the way you separate advice from product sales. In Ireland, NTOI registration is the condition Irish Life Health attaches to its nutritionist contributions. In the UK it is BANT and the CNHC register. In the Netherlands it is MBOG, VBAG or another RBCZ-affiliated body.
And whichever country you are in, an IFM certification is worth having for the training rather than the status. IFM says so itself.
The commercial context in Europe
One structural fact shapes the market. Fullscript, the best-known North American practitioner dispensary, states in its own support documentation that practitioners may serve patients in the United States and Canada only, and that it cannot accept proof of licensure for international accounts. It publishes no European offer. In the UK, The Natural Dispensary fills part of that role, with practitioners routing clients to it under commission arrangements whose percentages are not publicly disclosed.
That leaves European practitioners with a patchwork, and it explains why the supplement-recommendation question keeps coming back to the same tension: the commercial model that is easiest to set up (buy at trade price, resell at retail) is exactly the one that draws the strongest criticism.
Simplycure lets practitioners recommend supplements from multiple laboratories without holding stock or fronting cash: the client orders and is delivered directly. Create a free practitioner account.
What we think, at Simplycure
We are not neutral on this subject, and it seems better to write that down than to let you work it out.
Simplycure exists because its founders saw the problem up close. William Detry puts it this way in the letter on our About page: "In the summer of 2019, my father had a TIA, a precursor to a stroke. Conventional medicine recommended a stent and lifelong statins; functional medicine, a change in lifestyle and tailored supplementation." It is not one against the other. They are two answers at two different moments, and the system organises only one of them. What the founders found next, looking at what he actually had to take, was a broken supply chain: five or six labs, a practitioner losing an extraordinary amount of time on prescribing, and less than 30 per cent of prescriptions actually purchased. The full letter is on our About page, and it opens on the line that describes our position better than anything we could add here: another form of medicine is emerging in Europe, functional, integrative, preventive, but the infrastructure to practise it at scale does not yet exist.
We think a medicine that looks after people before they fall ill is worth more than one that waits for a diagnosis. We think a practitioner with forty-five minutes does better work than one with twelve. And we think the question of whether "functional" is the right label matters a great deal less than whether the patient leaves with a plan they can hold to.
We also have an interest here, and we would rather say it than have you infer it: our platform serves practitioners who recommend supplements. That does not make our position less sincere, it lets you read it for what it is. And it changes nothing about the line we hold everywhere: we attribute no therapeutic properties to food supplements.
Key points
- Functional medicine was created by Jeffrey Bland in the early 1990s; IFM became a nonprofit in 2001 and certified its first cohort of 125 practitioners in 2013.
- No European regulator recognises it as a profession or protected title. Your legal position comes from your base qualification.
- The main published study (JAMA Network Open, 2019) shows a modest six-month effect that does not hold at twelve months; the AAFP has restricted CME credit since 2014.
- IFM states explicitly that its credentials are voluntary and confer no legal or specialty status.
- In Ireland, "dietitian" has been protected since 31 October 2016; "nutritionist" and "nutritional therapist" are not. NTOI registration is the condition Irish Life Health attaches to its nutritionist contributions.
- Fullscript's own documentation limits practitioners to patients in the United States and Canada, and it publishes no European offer.
- At Simplycure we back the preventive approach and we say so. We attribute no therapeutic properties to food supplements. The dispensary question is unresolved for most European practitioners, and the commercial model you choose is the part of the criticism you can actually answer.
This article is informational and does not replace legal, tax or accounting advice. Verify your own position with a professional. The author is not a healthcare professional; this article covers the profession, the legal framework and practice economics, not clinical content.
Continue with Becoming a functional medicine practitioner in Europe: training and status by country.
Sources
- Beidelschies M. et al., "Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes", JAMA Network Open, 2019. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753520
- Wikipedia, "Functional medicine". https://en.wikipedia.org/wiki/Functional_medicine
- IFM, certification eligibility, credentials and fees. https://www.ifm.org/certification/eligibility ; https://www.ifm.org/certification/fmcp ; https://www.ifm.org/certification/fees
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- OdA AM and Dakomed (Switzerland), federal diploma for Naturheilpraktiker. https://www.oda-am.ch/de/hoehere-fachpruefung/ ; https://www.dakomed.ch/2015/05/04/eidgen%C3%B6ssischer-naturheilpraktiker-in-ist-realit%C3%A4t/
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- Fullscript support, dispensary setup for international providers. https://support.fullscript.com/articles/dispensary-setup-for-international-practitioners
- The Natural Dispensary. https://www.naturaldispensary.co.uk/
- Dublin Centre for Functional Medicine, pricing. https://dublincfm.com/pricing/
