01/19/2026 Robert Kornfeld, DPM
The Quest for Non-Covered Services (Allen Jacobs, DPM)
I did invite conversation on this subject and Dr.
Jacobs responded with a post that curiously both
lauds and dismisses functional medicine at the
same time. However, his post is not
“conversational”, but rather more opinionated.
Conversation invites inquiry. Inquiry elucidates
things in an educational way. But when someone has
strong opinions on something they have never
studied or applied to their practice, that is
called bias. His positive comments here are erased
by this bias.
Dr. Jacobs dismisses functional medicine because
of the cost. Something he brought up a few times.
He also states that insurance does not pay for it
as if insurance companies have the right to decide
the standard of care, which, unfortunately, they
do but only when you are in an insurance-dependent
business. Let me comment first on this. The “cost”
of care for someone covered by insurance is not
inexpensive. There are premiums, co-pays,
deductibles, non-covered services and rejected
claims that they must pay for. These are real
monthly costs for the patient.
Dr. Jacobs makes it seem like the people who can’t
afford direct-pay medicine get medical care for
free. They don’t. Additionally, don’t be so
haughty to decide who will be willing to pay for
these services. You would be shocked at how many
blue collar workers I have treated over the past
25 years that found value in what I do and somehow
found a way to pay for it. Especially when the
traditional medicine-insurance based care failed
them after seeing many doctors.
Dr. Jacobs also refers to functional medicine as
being “unproven” with a “lack of large-scale
studies”. Both of these statements could not be
further from the truth. Dr. Jacobs obviously has
not delved into the literature in this field and
puts a bias out there that is based on a non-
reality. In fact, and this is where functional
medicine gets criticized as not being evidence-
based, RCTs do not work for most things we do.
Why? Because functional medicine addresses
underlying causes. It is not single agent/modality
based. To that end, a typical protocol has many
parts to it. Each, on its own, cannot be shown to
heal pathology. It is a PATIENT-SPECIFIC approach
with a combination of therapies that get the job
done.
That is why, from a clinical point of view, meta-
analysis is how we evaluate what we do. This, in
addition to the untold thousands of studies on
nutrition, vitamins, mineral, hormones, enzymes,
neurotransmitters, the microbiome, immune system
activity, stress, lack of sleep, lack of adequate
hydration, etc., etc., gives us a strong
scientific base to work with. But as I said,
functional medicine is patient-specific and
therefore generic therapies are unreliable.
Dr. Jacobs gives examples of conditions treated
via “functional medicine” and speaks about some
simple “functional medicine principles” that can
be applied to up code your E&M encounter.
Functional medicine is not about upcoding. It is
not about making generic recommendations. It is
about understanding each patient’s unique
epigenetics, genetics, medical history, family
history, review of systems and prior therapies so
we can create a logical and pointed approach to
the patient in front of us. What is good for one
patient does not necessarily work on another. Our
responsibility as doctors is to meet each patient
where they are and treat them as the unique beings
that they are.
There is no question that not everyone can
“afford” direct-pay services and that is
unfortunate. Not everyone can afford their
deductible as well. And even though functional
medicine has been around for well over 30 years,
it still faces challenges because too few doctors
are practicing it compared to the total population
of doctors in the country. As such, it does not
have the numbers needed to make it a mainstream
part of our approach to patient care. But all
change must start somewhere. Dr. Jacobs’ dismissal
of this amazing paradigm keeps the bias and lack
of inquiry going and makes medicine less
effective. He cannot deny that in spite of all of
the “approved” protocols in traditional medicine,
morbidity has never been higher in our society.
What this proves is that traditional medicine is
aching for a partner. And functional medicine is
that partner.
Finally, he brings up the fact that I have a
course on functional medicine. I did not put in a
disclaimer in my first post because I was not
trying to solicit students with a cheap form of
advertising. It is my passion for the paradigm and
my frustration with this profession that keeps me
bringing it to PM News subscribers. As Dr. Jacobs
stated, I have been discussing this topic on this
forum for many years, decades before I had a
course. My intention was to keep the focus on
functional medicine. Not to put in a disclaimer
that would alert people to the fact that I have a
course on this subject. You brought it up, Dr.
Jacobs, not me. And I deeply resent your implying
that my intentions were self-serving.
In summary, I can say this. I do not know a single
functional medicine doctor that is unhappy in
practice. And I know many. We help our patients in
a profound way and the results of our efforts are
extremely gratifying. Needless to say, I have all
of the traditional training that all podiatrists
have. And in comparison to the way I practice now,
I have become a much more effective and happier
doctor. My healing skills have grown
astronomically through this paradigm. And I have
very happy patients as well.
Robert Kornfeld, DPM, New York, NY
