On the Health Record: Dr. Alex Keller from Fullscript

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In a recent episode of the On the Health Record podcast, we spoke with Dr. Alex Keller, the medical director at Fullscript, about naturopathic medicine, supplement dispensing and how the Fullscript platform has grown over the years. Take a look at some highlights from that conversation in this blog!

Dr. Keller, you chose to study naturopathic medicine. Can you give an overview of what naturopathic medicine is?

Naturopathic medicine is a holistic system of medicine, so it’s based on improving the foundations of a person’s health. Unfortunately, over the years, it’s gotten a bit of a bad rap in that it’s often associated with kinds of alternative medicine, which are often more on the fringe. When you look at the modern naturopathic curriculum, it’s actually very evidence based. It’s primarily focused on nutrition, lifestyle, behavioral change, and, to some degree, supplementation with nutrients, botanicals, and sometimes hormones with the goal of rebalancing a person’s health.

We deal with a lot of chronic diseases in Canada. People typically get maybe five to 10 minutes with their doctor, so they come to us for the more extensive visits and to solve the more complex problems. That’s why I consider naturopathic medicine to be more complimentary than alternative.

I think that over time, we started becoming more reductionist in our approach to healthcare where we were looking mostly at the minutiae of how the body functioned. We were treating things based on single factors and not looking at the whole picture, and that was extremely effective when most of what we were dealing with as doctors was acute care disease, infections, accidents, and things like that. However, as time went on, we perhaps focused too much on the minutia, and lost sight of the whole.

That’s where the holistic perspective comes in. When you look at just the term holistic, it just means looking at the sum of the parts. Despite that, holistic has become somewhat of a fringe term. That’s so unfortunate because really the intention is just to look at the whole picture when a patient walks in the door. Only addressing a specific symptom can turn into whackamole where one goes down and another one may pop up.

Whereas if you look at the big picture, you may find that the symptoms are being caused by a whole host of issues. Maybe they’re not eating a full diet, moving enough or sleeping enough. By focusing on the holistic picture, you have an opportunity to improve the person’s long-term health, their overall health, and generally make them feel better.

One helpful metaphor is to think of your body as a bike. If you have a flat tire, you’re going to fix that tire, but if you don’t lubricate your chain and more proactively work on your bike, then eventually the bike will break down faster than it should. Similarly with our bodies, it’s not just about treating the thing that’s wrong. We have to treat things preventatively before they go wrong. That’s another major aspect of naturopathic medicine.

Let’s break down the stigma of supplements real quick. What are supplements? How do they fit into the overall picture of a patient’s health?

Personally, I’m not a huge fan of the word supplement because it really only addresses one aspect of using what I prefer to call natural health products. In Canada, they’re actually officially termed natural health products. We have a very sophisticated system up here where anybody in the public can log onto a database and see every single natural health product that’s officially listed for use in Canada, see exactly what its ingredients are, and what its natural product number is. In the US though, we refer to these products as supplements, and to me it is meant to indicate something that supplements your diet or supplements your lifestyle.

It’s kind of like augmented something that you should already be doing. When you take a nutrient or micronutrient, such as zinc, vitamin D or vitamin C, you are supplementing what you should ideally be getting from your diet or from sun exposure. However, there’s another side to natural health products which is the therapeutic side where you’re not supplementing your diet or your lifestyle per se. You’re actually treating something with a botanical, nutraceutical, nutrient, hormonal or a probiotic in order to affect a change. You can use supplements for so many different therapeutic purposes, whether it be increasing nutrient levels or hormonal levels because of either genetic factors or lifestyle factors. For example, if your sleep cycle is off because you’re a shift worker, then melatonin is something that you can strategically use to help improve your sleep cycle.

In these instances, you’re essentially following the body’s patterns and just using certain interventions in order to rebalance it to get it to the place that you need. Though there is some stigma around supplements in weightlifting and athletic spaces, some of those are still very legitimate. Actually athletes in particular will often drive the innovation in this space because they’re pushing themselves to the human limit. Still, as with anything, overuse and abuse of these supplements can have the negative effects that people may be thinking about.

You joined Fullscript in 2017, but can you share some background on Fullscript, how it was started and who founded the company?

Fullscript is a prescribing platform for practitioners who want to use natural health products, and I use that term again specifically because it’s not just nutrients. Its original idea came from one of the founders. His wife is a naturopathic doctor here in Canada, who upon starting her clinic in 2010, was faced with the reality of having to start an in-house supplement dispensary. For the audience who doesn’t know what we’re talking about, dispensary is often associated with cannabis, but in the integrative or naturopathic world, dispensary is also usually associated with practitioners or clinics having supplements for sale in their office.

Before 2010, most practitioners would have to carry products in their office and sell those to their patients when they were recommending something. At the time, though, e-commerce was really starting to take off, so you could refer people to an e-commerce site. But you had no idea what they were going to get since, especially 10-12 years ago, things were not nearly as refined as they are now.

Brad Dyment was one of the founders. He was a developer and a designer, specifically a product designer by trade. His wife, Dr. Alana Dyment was the one who presented the problem, and Brad realized they could use technology to solve this. Then he started talking with Kyle Braatz, who was more trained on the business side of things. Eventually they brought in another co-founder named Chris Wise, who had a technology background.

After some iteration, it didn’t take long for them to figure out that a recommendation platform would be much more useful and more easily adopted. Within a matter of two to three years, they pivoted to that kind of an offering. That’s when Fullscript really started to take off. Very quickly, they got to a point where they needed to have an official distribution facility, and then they jumped into the US market by partnering with a distributor in the US as well. The US has been a huge market for Fullscript.

In fact, just recently, we went through a significant fundraising round with an organization that ended up giving us a $240 million infusion which, as far as we know, is the largest cash infusion into a company like this in this space. That’s obviously exciting for us, but it’s also big for the industry. When you have an investor bring that kind of money into a company like Fullscript, it’s a sign that there is a significant increase in interest in a more preventative foundational system of medicine.

There’s also a patient adherence tool side to Fullscript. Can you explain how that works?

Yeah, absolutely, I’ll actually also talk about our integrations with partners like DrChrono because that is also absolutely critical to this overall mission. First of all, on adherence, this past year was a big shift for us because we realized that for 10 years, we had really been focused on one singular problem. That was the original problem that Dr. Dyment brought to the table of how frustrating it is to manage the sale of these products yourself when you’d much rather be focusing on patient care.

Then we realized that there’s so much more that happens after the patient purchases those products and engages in the overall treatment plan. The treatment plan in integrative medicine is certainly not just about supplements, it’s about diet and lifestyle. It’s about a bigger behavioral change that takes place. We conducted a study to do a deep dive into what adherence is within the space of integrative medicine, and we found that there’s a major gap as it relates to clinicians having the tools in order to keep their patients adherent to their treatments all across healthcare. That’s why we took it upon ourselves to try to solve this problem now for integrative practitioners who use us.

As a result, we’ve expanded our tooling. We’ve expanded our content in our educational offering to help practitioners maintain their patients on their plans as long as possible. On one hand, obviously that’s good for our business model. If they continue to renew their products, and they’re staying on their plan, that’s great, but it’s much bigger than that. Because if a patient stays in their plan, then they get momentum in their care, and they get momentum in seeing the changes that take place within their health.

Part of our adherence push is trying to support practitioners in delivering content to their patients to help them with their own health literacy, which subsequently results in better adherence and long term behavioral change. Then jumping over to the integrations, a few years ago, we started to realize that we had to meet the practitioners where they were working. In practical terms, you’d have to open another window on your browser, or you’d have to have a device with the window open for Fullscript. We thought it would make much more sense to have Fullscript built right into the EHR considering many practitioners already use an electronic health record in order to recommend products or to write a treatment plan, so they’d never have to leave the platform.

Those integrations have been a big success for us. We have found that if you can really tap into the problems that people face and use technology to solve those problems, the sky’s the limit in terms of where we can go with all this.