Josh Gunn, PhD is the Chief Scientific Officer for Ethos Laboratories. Ethos began with the mission to incorporate more functional medicine principles into conventional care and to help patients gain insight into the root causes of their pain.
With a background in forensic toxicology, Dr. Gunn and the team have developed a new tool at Ethos called the Foundation Pain Index. The Pain Index is a biometric test designed to identify potential biochemical origins of patients’ chronic pain. The test results categorize health insights in a way that is actionable for all physicians, even if they are not trained in functional medicine. This personalized method also acknowledges that patient recovery often requires a multimodal approach, including lifestyle and community considerations.
Practitioners who run OAT tests or other labs may already have access to some of these data points, but uniquely, the Foundation Pain Index test is covered by Medicare, Medicaid and most insurance plans. This is especially important for chronic pain patients with a lower socioeconomic status because statistically, they have been over-prescribed opioids.
The full conversation is densely packed with insights such as:
- Socioeconomic status is a strong factor in opioid over-prescription, misuse and abuse
- Why it is essential to bring elements of functional medicine into conventional care
- How nutrient depletion may contribute to pain
- Why an interdisciplinary approach is required to help patients with chronic pain
- And much more!
Resources mentioned in this episode:
James Maskell:
Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.
Hello and welcome to the podcast. This week we are speaking to Dr. Joshua Gunn. He is the Chief Scientific Officer at Ethos Labs. They are helping doctors of all varieties get to the root cause of chronic pain. This is something that’s probably very familiar to you if you are in the functional medicine space, but part of why we’re bringing this as our Year of Growth is… I think a lot of his thinking, and their thinking at Ethos Labs, is super relevant for all of us if we want to think about, “How do we organize functional medicine in a way that it can make it to the masses?”
And obviously, chronic pain is a huge issue, and there’s so many reasons why we have to take this really seriously. So check out Dr. Joshua Gunn. We’ll have all the details about the Foundation Pain Index, which is their unique test that is paid for by Medicare, Medicaid, and many commercial insurances and helps doctors get to the root cause of chronic pain. Really interesting half an hour. Enjoy.
A warm welcome to the podcast, Dr. Joshua Gunn. Welcome, doc.
Dr. Joshua Gunn:
Thank you for having me, James. I’ve been a long-time follower, so it’s great to get the opportunity to sit and chat, and tell you a little bit about our story.
James Maskell:
Awesome. Let’s jump into it. This year, our podcast is all about the Year of Growth, and we’ve touched on a number of different ways that we see growth both at the community level, personal growth, patient growth, practice growth. But the thing that really struck me from our first conversation is just your dedication to taking concepts that have been within functional medicine and helping them grow, and thinking about what would it take to have them grow in the industry.
Why don’t we just start with the beginning of Ethos, where it started, and start from there?
Dr. Joshua Gunn:
Yeah. No problem. Ethos Research and Development dates back to early 2013, and we were founded based on my past experience in the forensic toxicology world and my partner’s experience in the chronic pain world. And we realized, through our passion for laboratory science and the desire to help the chronic pain community, that there was a severe lack of objective tools in the chronic pain provider’s toolkit, if you will.
Chronic pain… it is such a subjective experience, and we know that it’s going to be impossible to fully objectify or interpret someone’s experience with pain, but we started Ethos with the goal of developing novel laboratory tools to provide more root-cause insight to these providers who treat chronic patients every day. And when I talk about chronic pain providers, obviously there is a subset of those providers who are board certified interventional pain practitioners. But there’s obviously an awful lot of primary care, internists and other providers who treat chronic pain on a daily basis, and they’re somewhat limited in their toolkits.
So Ethos was founded with the intent to do novel research in the hopes of identifying relevant underlying biochemistry that drives the development or worsening of chronic pain, and to develop biomarker panels, and to help these providers better understand why their patients are presenting with the symptomologies they are. But equally importantly, if these pathways are modulatable or druggable, if you will, in pharma terms, are there ways that we can target the relevant pathways to reverse chronic disease, as opposed to treating symptoms with medications like opioids? So that’s the origin.
And obviously, we’ll talk more about the progression from there, but that was our mission and vision from day one. It’s expanded a little bit into more chronic disease in general, which I think jives well with functional medicine in general, but that’s the origin of Ethos Research and Development. And obviously, we’ve released products and commercialized test panels and grown significantly since then. And I’m sure we’ll dive into a little bit of that, too.
James Maskell:
Let’s just start. What were some clinical moments early on where you realized that there was some suboptimal biochemistry that was happening that was driving chronic pain, and you realized that wasn’t an insight that most doctors were getting?
Dr. Joshua Gunn:
It’s a good question. Obviously, one of the important elements of starting an R&D company focused on a specific disease type was we spent a lot of time speaking to providers—and patients, for that matter. And quickly realized through our previous experience and our early research that chronic pain is very much a field that is trial-and-error based. And many of these patients have been experiencing chronic symptoms for decades and in a lot of cases are told that, “There’s not a lot we can do. We don’t necessarily understand why you’re experiencing this pain, and so we’re going to treat this way.” And that becomes the routine for those patients.
We were very much of the mindset that there had to be biological subtypes or classifications in these patients that were relevant and that could aid in improving that treatment modality. We did a lot of blue-sky research, as I refer to it, where we recruited patients from various chronic pain categories and analyzed blood, urine, saliva samples, looking at all kinds of proteomic, metabolomic, and genomic markers, trying to identify, “Are there things that are common amongst chronic pain patients that could form the basis of some of our hypotheses? Or are they really all unique in a biochemical sense as well?”
And so some of those early findings, combined with the clinical reporting from providers about these patients and how they present, formed our early opinions and realized that the world of functional medicine at that time in 2013 was already looking at a lot of these relevant biochemical pathways. And a lot of the laboratories that led the diagnostic tool development in functional medicine were already talking about a lot of these pathways. So we saw it as our duty to bring that to the chronic pain space, who weren’t necessarily the patients who were seeing these functional medicine practitioners.
James Maskell:
Yeah, absolutely. We recently spent more time together, but when I was looking back, I think we had a LinkedIn conversation in 2015 where I think you were just trying to get a pulse of what the energy was in functional medicine, who’s using insurance, who’s not using insurance, what percentage you do in cash. And so I could see, even going back to a six-years-ago conversation, I can see that was the beginning of your thought process in that journey. I guess, before COVID came along, chronic pain was probably the biggest topic in America, right?
Dr. Joshua Gunn:
Absolutely. It’s still there. It’s worse. It’s going to be front-page news again here very soon, unfortunately, the opioid epidemic in general—now referred to as sometimes the illicit opioid epidemic. But yes, very much. And that was the motivation behind a lot of the things we were doing, was that patients were limited in the treatments they could receive as chronic pain patients. And the ones that they did receive, in a lot of cases, were also the ones that were fueling these incredible overdose and misuse statistics that we were also reading about in the news every day.
And I realized early on that this conversation is much larger than science. We talked to providers and realized that, depending on your insurance type, opioids may be the only thing that you’re likely to receive as a chronic pain patient. And so the realization that marginalized communities or patients at the lower end on the socioeconomic scale are destined to receive some of those treatments, which are also of the highest risk.
And so we wanted to find a way to bring some of the functional medicine way of thinking to traditional medicine and in particular to patient populations who have been marginalized or are in the lower ranks in the socioeconomic scale, but knowing that we couldn’t bring it all. Because functional medicine practitioners spend an incredible amount of time learning and teaching and educating patients. We needed to bring something more digestible as a way of introducing these concepts to the traditional clinic.
But yes, the opioid epidemic was very much the driving factor. And my background in postmortem toxicology and forensic toxicology was my introduction to many of these physicians we work with today, and I think that will continue to be a story for the next decade.
James Maskell:
Absolutely. Let’s get into that. I guess part of what we’re trying to do on this podcast series is shift the thinking of the greater functional medicine community to start to think about what would it take for functional medicine to really grow into these niches. And I think more than anyone that I’ve met, almost from the beginning in this one particular area, you were trying to wrap your head around: what would it take to get functional medicine thinking to patients who can’t currently afford to participate with functional medicine? As you started, what were the first parts of your thinking, and how did you come up with a V1?
Dr. Joshua Gunn:
It was absolutely the biggest challenge in trying to think about the way in which functional medicine practitioners who were leading that charge were thinking was so clearly the future of medicine. I met with many of them and spent time with them in their practices and realized that there is no doubt that this is the evolution of medicine, if you will.
But I also immediately saw the quite significant gap that existed between those providers and clinics—and patient types—and those that I was used to frequenting as part of our typical clinical call points. Clinics that were on the other end of the scale, very busy, very understaffed, very under-resourced, patient populations that were largely Medicaid and Medicare, very opposed to any out-of-pocket patient costs and understandably so, and physicians who no longer have time to even attend weekend conferences to obtain their CMEs, let alone go back and become IFM certified, for example.
How do we bridge that gap? How do we bring some of the benefits and advancements of functional medicine to the traditional busy clinic? And obviously, I saw three areas that needed to be optimized in order to do that.
One was obviously provider knowledge. Again, some of the functional medicine practitioners that I’ve met are some of the most incredibly self-learned and educated folks who have gone back mid-career and become IFM certified or A4M certified and learn a tremendous amount of basic biochemistry and cell biology in order to be able to educate their patients. So the scalability of that physician knowledge and learning was definitely something that was I think impairing the scalability of this approach in general.
Patient types is the other thing. I met a lot of patients who were in these functional practices who, through maybe getting to the end of the line or maybe having certain experiences with traditional medicine, were looking for something else. They were looking for a new way to alleviate their chronic disease. And they might not all be motivated to the extent that they’re a hundred percent compliant with everything a functional practitioner says, but they’re aware that they’re about to start a new journey, and they’re open to that experience.
In the chronic pain clinic, we have a lot of patients who are quite used to a routine of very different characteristics where, “I come back every 30 days and I receive my script for an opioid, and I probably talk to a counselor or a psychiatrist, psychologist.” But that’s really the extent of it. There’s not a lot of new. There’s not a lot of deviation from that path.
And the third thing was obviously the cost. Again, my limited experience with the business side of functional medicine indicated that there was significant out-of-pocket cost, depending on how they seek providers and which providers they choose to see. But having experienced just the implementation of clinical diagnostics in a routine clinic, I knew that out-of-pocket costs was something we would have to tackle, something we would have to optimize if we want to take this to the masses, if you will, the Medicaid populations of the world and the Medicare populations of the world. Those were the three things.
Now, I say physicians, patients and cost. Well, it might only be three things, but that’s everything, right? I mean that’s a big piece, so how do we begin to do that? Long story short, one of the things we realized early on was that even though we thought the science was the most important part of our innovations, we realized that we needed to navigate the insurance channels, AMA and CMS channels, in order to have our diagnostic services recognized and covered and provided to patients at no out-of-pocket cost.
We saw that… as treacherous as those journeys can be and as bureaucratic as some of those processes can be… we saw that as the easiest way for us to have a direct impact on the accessibility of our technologies to the general population. And so that is the journey we started, was to have our testing recognized and covered so that patients who don’t have the resources to seek traditional functional medicine practices can access this testing and hopefully benefit from that way of thinking.
James Maskell:
Yeah, absolutely. Well, it’s such a great way of thinking because I just feel like if you start with the end in mind… What is the end? The goal is that all these people who can’t get access to this way of thinking about medicine and about chronic pain specifically. How do we give them access? How do we get them better? And so I’m really grateful that you think in that way because ultimately, a lot of the work that you’ve done to get this test to a point where you can be paid for by Medicare and Medicaid is a big deal, and I think is opening up a lot of pathways to it.
So I guess the next thing is we could get into talking about the Foundation Pain Index, and I guess one of the topics that I want to start with is this idea of bucketing. I think in functional medicine we all think it’s completely individualized, but I think if you look at it more generally, what you’re really trying to see is which one of four to six buckets does this patient fit in. You’ve got this chronic illness. What caused it? You see this with Dale Bredesen with the work that he’s done with Alzheimer’s. There are three or four different buckets that patients fit in as far as, “What was the etiology of this patient’s Alzheimer’s,” which allows you to work on that particular thing.
And I think as we start to try and take functional medicine concepts into the mainstream, I think this is quite useful for doctors and new doctors but also decision-makers because I think conceptually you can understand that if you have 10 people with diabetes, some people got there from food, and some people got there from stress, some people got there from environmental insults. And let’s just treat them according to how they got here, and so it makes a lot of sense. And I think one of the goals that I have in the next decade is really to spend more time talking to the decision-makers in healthcare. And I think that conversation typically goes down quite well because they recognize the limitations of only treating based on the symptoms, which is pathogenesis 101, right?
Dr. Joshua Gunn:
That’s right. Exactly. It’s an interesting point. And the Foundation Pain Index… it’s had its own evolution over time. When we first started identifying aberrant biochemical patterns in chronic pain patients, we really wanted to create this test panel that would encompass most of the important factors. For example, our criteria to develop this test were based on biomarkers that were prevalent enough to justify using in any patient population who was experiencing chronic pain. We didn’t want to be seeking reimbursement for a test that identified a rare abnormality that occurs in 1-in-10,000 folks.
It needed to be prevalent, perturbed biochemical function that clearly has a direct correlation with chronic pain etiology. It needed to be easy to use, so we sought out all of the relevant science and conducted all of our own on the utility of these markers in the urine matrix. We started with CSF fluid in a lot of cases and then expanded out into peripheral specimens to identify measurable and robust markers in the urine that are reflective of central biochemical function. So it had to be easy to use.
And three, and probably the most importantly, we wanted each of the biomarkers in this test panel to be treatable, if you will. If I find an aberrant biomarker A, there needs to be something that provider can do about that today. Now whether the patient is compliant with the recommendations, we’ll talk more about that side of the equation, but there needs to be an option for the provider, should they observe an aberrant finding.
That element is so important because when it comes to reimbursement, one of the things that CMS, for example, weights very heavily is the clinical utility of these tests. When put into practice, how does this technology change the way a patient is treated by that provider, based on that technology? And if the answer is, “Well, they don’t really do anything differently,” well then guess what? Nobody’s going to want to pay for that. So we needed to have all of those elements.
But in order to get back to your question, the bucketing and categorization is very important because it greatly assists with messaging as well. We see patient subtypes. For example, we look at broad categories of markers, things as simple as intracellular micronutrient status. A very, very simple example of biochemistry potentially gone awry in a chronic pain patient. We see patients every day with painful peripheral neuropathies, maybe diabetic related, maybe not. And when we conduct this testing, we find these ridiculously severe intracellular vitamin B12 or B6 deficiencies that have gone undetected for who knows how long.
And I think the saddest elements of some of those findings are: a) they may have had a serum B12 measurement done over the years, but as we know, serum B12 doesn’t necessarily reflect intracellular function. But I think more tragic is the fact that, in many cases, these biochemical perturbations are actually a result of long-term prescription medication use that’s not even really justified anymore.
You look at things like proton-pump inhibitors and—I mean, I don’t need to preach to your audience. They understand the potential side effects of these medications. But we realize that these patients are on these meds because a physician told them to take it 15 years ago, and they’ve just continued to take it. And as a result, they’ve developed this severe biochemical abnormality that’s now driving their painful symptoms. And so you feel like you wish you could have intervened earlier in those cases.
But so having categories like micronutrient status, various inflammation markers—that again are very, very hot topics in many chronic disease states—and being able to message a patient’s findings to a physician or to a payer based on broad categories, as opposed to an individual biomarker—which nobody’s ever heard of, let alone can pronounce—is a much more meaningful way to not only communicate the findings but also create meaningful research where we can look at phenotypes based on categories of perturbation. So that’s been a big part of the evolution, and I think we’ll continue to perfect that over time.
James Maskell:
Yeah, let’s talk a little bit about the scoring, too. Because I think in pain generally, obviously if you’ve watched… I just watched Dopesick on Hulu here and came to recognize: why is the only measure of pain that we have, the only NIH validated measure of pain, “How is your pain from 1 to 10?” Which might be different day-to-day, which is obviously a function of so many things, a big one being loneliness. Lonely people have higher pain scores. We’ve just got this one number that drives everything. One of the things that really excited me when I saw your test is a score out of a 100.
And I just think one of the things that—even in the functional medicine world more broadly, and I would probably speak to everyone who has created tests—we haven’t done a great job of making it easy. It’s a lot of information. I think most doctors, when they come to functional medicine, get very overwhelmed by the testing side of it because it’s all new data, and it’s not that easily thought through and worked through.
Can you speak to: one, your thoughts as to how to make it easy, so that this wasn’t going to have to be a long learning process? And then how you came up with the idea of a score out of 100, and what that score means, and how patients can track that score and improve that score?
Dr. Joshua Gunn:
Yeah. So some great observations there. And just the leading comment, based on the subjectivity or the reliance on patient feedback on a scale of 1 to 10: I think that in and of itself is one of the reasons why we’ve seen such a lack of innovation in the chronic pain space, whether it be from a diagnostic or pharmaceutical standpoint, because the cost of developing these technologies has reached a point that is so significant that you’re now hanging your hat on patients reporting improvement on a scale of 1 to 10 in a clinical trial.
There’s no objective endpoints for these drug companies or diagnostic companies to show that their technologies are working other than a patient saying, “I’m a 6, and I was an 8. So yes it’s worked.” It’s a very primitive field when it comes to measurement of endpoints, so I think that’s why a lot of companies shy away from innovation here because it’s risky, and you don’t have those objective endpoints like a biopsy or something more definitive. I just wanted to reiterate what you’re saying there.
Now, at the clinic level, we recognized very early on that these 11 biomarkers that were finalized as the panel for the Foundation Pain Index—à la carte, as they were offered individually, or as a panel of 11 individual markers—provided a lot of information. But in a lot of cases, it was too much information for most of our clients because it was new information. Here’s a test that I’ve never used before, and now I get a report back 48 hours later that says you looked at 11 pain biomarkers, and this patient has seven out of 11 that are abnormal and could benefit from adjustment. Well, “What are they? How do I understand the relevance of this? What do I do about it?” is obviously the back end of this equation.
And so we realized that in the busy clinic there needed to be an easier way for these providers to get a snapshot of, “How relevant were the findings for this patient from this test?” And so the Foundation Pain Index… the development of that stemmed from one of our NIH grants that we’re conducting looking at biomarkers in juvenile populations with chronic pain disorders.
And we realized that by creating a proprietary algorithm and weighting each of these biomarkers based on the clinical evidence of their role in pain, we could generate a single numeric score on a scale of 0 to 100 that provides the provider with a very quick readout of, “How significantly perturbed, how aberrant, how different or abnormal is this patient’s biochemistry in the context of pain?”
And the meaning behind that or the vision behind that was if you get a Foundation Pain Index report back and the patient’s score is zero, that essentially means their biochemistry is completely normal. It looks like a healthy individual. It looks like a control population. So what does that mean? Well, that doesn’t mean that patient’s not in pain. That absolutely doesn’t mean that patient’s not in pain because biochemistry is not going to drive 100% of chronic pain types.
But it means that whatever you were going to move onto next with that patient is probably even more justified now because addressing biochemistry probably doesn’t afford that much in the way of moving the dial. It’s probably not a low-hanging fruit for you to treat that patient quickly and effectively and give them some immediate relief. So proceed as you were, if you will.
Whereas if you get a report back on a patient and their Foundation Pain Index score is greater than 75 or 95 or whatever it may be, that’s a very quick litmus for you to realize, “Wow. There are some significant perturbations in this patient’s biochemical function obviously impacting their pain, so let’s start there. Let’s look at the ways in which we can improve this score quickly, given that most of these biomarkers can be modulated in a relatively short timeframe, and let’s see if we can get some relief that way.” We may not need to go to more risky or intrusive procedures if this provides us with a good level of pain reduction so that the patient can get moving again.
It was really a way for them to be able to interpret the report without understanding those 11 individual biomarkers in detail. And the closing comment was that again I don’t want to take anything away from the complexity and the importance around understanding these concepts in their full form. And like most functional medicine providers do, they’ve spent a lot of time understanding a 20-page report from some of the larger functional labs. That’s amazing, and I applaud that. But we also realized that it needed to be more digestible so that these providers who we were working with can get a feel for how impactful this approach can be without doing all that front-end learning. And so that was a big piece behind the validation of the index itself.
And obviously, the last thing that the index affords is the ability to track longitudinally. If a patient starts at a 95 and you implement a treatment regimen to improve that foundation pain score over time, they come back in three months, you test it again, and now they’re a 60. They’re going to be motivated to continue that program because: a) they feel better and b) there’s an objective proof that they have improved. And they’re going to want to beat that next time they come back.
It’s the old adage of, “If you just tell everybody to take fish oil and vitamin D, they might all start it, but how many of them are still taking it six months later?” If we can provide objectivity to track progress, I think compliance goes through the roof, which is what we need in a lot of these patient populations.
James Maskell:
Yeah. That’s well said. I remember the first time I showed this test to my functional medicine doctor, who does all the tests and knows all the information, she was just like, “Look, I get all this information in the test that I get.” And when I shared with her, “I get that, but this really isn’t for you. This is really for every other doctor that needs a root-cause approach understanding to chronic pain, is never going to order the Genova panel or the organic acid panel, and actually what they’re looking for is a little bit of information to help them bucket into these different areas of chronic pain. And then maybe be able to help the patients with something a little bit more simple.”
And then she got it. She was like, “Okay, I get it,” because she realizes that she’s not a normal doctor. If the only plan to grow functional medicine concepts is to have everyone follow her path, we’ll be here forever because most doctors don’t have that inclination, drive or desire. That was a good conversation that we had.
And then she realized, “Okay, I could see a chronic pain doctor, a pain clinic, a primary care doctor using this as an entry point to functional medicine concepts, and then getting good outcomes here, and then maybe exciting them about moving forward into getting more of this data for more of their patients moving forward.” Just so we’re clear as well, this could be prescribed in Medicare and Medicaid, it’s a zero out-of-pocket, and it’s being used in that way right now. What about commercial insurance?
Dr. Joshua Gunn:
A couple points there. Part of us obtaining a billing CPT code for this test and having it approved for coverage… it starts with the AMA and moves then to CMS, and it’s for Medicare and Medicaid. And so once it was approved and given a positive coverage determination with CMS, it’s covered by Medicare.
Now Medicaid is a little different because obviously Medicaid is different in every state of the US, and Medicaid is then subdivided into managed care organizations as well. Medicaid is an ongoing process. Medicaid involves lobbying to each of the state Medicaid plans individually, if you will, so that is an evolving process. And depending on where you are located, it may or may not be fully covered by Medicaid. Medicare it is.
Commercial payers is growing. So again, we have to provide clinical validation and support to convince each of the commercial payers that this is a service that should be covered. And so that list is growing every week, every month, but it is an ongoing process of us submitting peer-reviewed literature that we continue to publish, clinical dossiers, case studies, outcomes, similar to your approach. Okay? We’ve got to show that this works but also that there’s an ROI. If you’re a payer and it’s a new technology, it’s very easy to look at that through the lens of, “Well, this is just another expense.”
So focusing on the economic impact statement and the return for these payers—based on the fact that, if we can identify biochemical drivers of pain that can be treated with non-opioid medications—how many ER visitations, overdoses, adverse events, diversion, can we reduce, and what’s the cost significance of that? So the commercial payers is ongoing.
If anyone’s interested in where we stand with any specific payers, please reach out to me. We obviously have an up-to-date list that we can provide. But I just wanted to make those clarifications because we are still in the relatively early stages of this, and so that’s a continuing process.
On your point before, just quickly, I think that’s tremendous thoughts, and I completely agree with why the functional physician saw the test as, “Well, I already get a lot of this.” I just wanted to make the point that we absolutely took a lot of our inspiration from the test panels that were out there in the functional world, but we wanted to narrow them down to those that were most relevant to chronic pain. And so many of these biomarkers as individual markers, they will be familiar to functional pain practitioners.
But as you say, we wanted to bring this as an introductory tool to those that aren’t educated in the functional medicine world. So those were really accurate observations, and I would say that’s exactly why this was built and how it’s being used.
James Maskell:
I guess just to come on to the final, to the point that I wanted to bring on, to communicate. We spoke once in 2015 on a LinkedIn message, and then we didn’t speak again for six years. And obviously you got busy, and I got busy. We ended up having another conversation, and it was because I think you recognized something that I was doing now and the energy that I was bringing to Evolution of Medicine and also with HealCommunity was… there was an alignment there. Can you just share, from your perspective, why you decided to get back in touch, and what you think is possible in the future of scaling root-cause pain medicine to the masses?
Dr. Joshua Gunn:
Yeah. As soon as we started doing clinical testing with Foundation Pain Index, a couple of things were abundantly clear. One was there was significant biochemical abnormalities about these patients, many of which could be treated not only with potent nutraceuticals but even lifestyle interventions. Number two was that, as a laboratory, our product is information. We provide information to our clients in the form of laboratory reports.
But having said that, one of the most common feedback types we got from clients early on was, “We love this testing. We’ve never thought about chronic pain in this way. Now that I’ve got these reports, what do I do about it?” I’ve got a patient who’s got an FPI score of 85; these are the biomarkers that are abnormal. How do I correct them? How do I adjust them? How do I normalize them? How do I modulate them?”
The back end of this equation became really clear. We didn’t have any pushback on the front end because novel information was welcomed with open arms in this field. It was more about, “What do I do with this and how do I implement change?” So I have been continuously on the lookout for the right partners and collaborators for the last nine years on, “How do we team-up with folks more on that therapy treatment impact side so that we can use FPI in a meaningful way?” And ensure that it doesn’t just become a test that gets ordered, but nothing is done about the results because the tools aren’t there, or the loop is not closed, if you will.
That could be as simple as us recognizing relevant partners in the nutraceutical space who, for example, if there’s a B12 deficiency, we should have a partner in the nutraceutical space who can go into that doctor and say, “Here’s a high-quality methylcobalamin,” so on and so forth, as a very simplistic example. But we knew that it was bigger than that.
We knew that these patients, in many cases, had been dealing with these illnesses for years and, as a result, had comorbidities, mental health issues, disabilities. Their life may have fallen apart around them because of their chronic pain, and I really thought that there was something more and bigger than just addressing the biochemical insufficiencies themselves.
So when I read about the early stages of HealCommunity and the impact it was having on groups and patients in the chronic disease categories, I realized pretty instantly that what you were doing could form the perfect backend for what we were doing. In the sense that—if someone’s biochemical function is all over the place, it’s an absolute mess, it’s severely perturbed, it’s going to be for a number of reasons that probably relate to stress, sleep, environment, lifestyle and dietary patterns, you name it—to think that person could fix that with just one change is probably unrealistic.
I saw what you were doing and where you were going with it as a way for us to potentially collaborate and use Foundation Pain Index as a way to identify patients who would likely benefit from something like HealCommunity is putting together. So can we take patients with documented, abnormal biochemical function, put them into groups, and not only allow them to build a community of support around them and have accountability but to really become empowered to make sustainable long-term change. And reap the benefits of that, and work on it in their own time as well as during their monthly consults with their providers. And I saw it as the sky’s the limit.
We’re in the very early stages of this obviously, but I have tremendous hope for this model. I think combining objective measures with programs like this is the future of chronic disease management and resolution. And I couldn’t be more excited about testing these waters because we are meshing two worlds that haven’t necessarily mixed in the past, but I think that’s the most exciting part of this. Because the populations that need what you are doing are larger and broader and more diverse than some people may think.
So that’s why I reached out. I saw what you were doing, I want to be part of it, and I know you’ll have success with it. What I’m hoping is that I can bring our patient populations into that success story and see their testimonials—six, 12, 18 months, two years from now—and feel good about Foundation Pain Index being their way into this.
James Maskell:
Yeah. Well, I’m excited. If you read my book, you know that individualized medicine and group medicine are not mutually exclusive. In fact, you can potentiate… In order to practice personalized medicine, you need a baseline layer of participation, and ultimately, the group model facilitates that. And I think adding testing into a group model really allows groups of patients to realize they’re not all the same. And actually, that’s part of… If they got there through unique means, they’re going to come back in a new, unique way.
So yeah, I’m really excited for it too, and I’m glad that some of the pilots we have going on are starting to reap rewards. Where do you see, just from your perspective… If you can mesh the diagnostics and the treatment in a scalable way, where do you see the opportunities then to take root-cause integrated programs and bring them to the people that really need them?
Dr. Joshua Gunn:
It’s a good question. I think that the way in which we’re collaborating now will form the foundation for a combined program here that will involve advanced diagnostics that are covered and reimbursed by payers. And group therapy and lifestyle change that we can take as a package to individual states and the federal government. But I think the individual states are looking for programs like this as we try to claw our way out of the opioid epidemic.
This program is perfectly suited to the unfortunate other end of this opioid story, which is those in rehabilitation and suffering from addiction issues. As you probably know, I think it was Johann Hari that said, “The opposite of addiction is not sobriety; it’s human connection.” And I think that what you’re doing, that is true not only for addiction, but for chronic pain and anyone that’s lived with a long-term disability or chronic disease.
I want to see us build this program collaboratively and take it to the individual states and implement it at a public health level. I think in order to do that, it needs to be more than just a diagnostic because just a diagnostic is great information, but what do we do with it? And HealCommunity on its own, states will say, “Well, who’s it for? Who qualifies for this?” And nobody wants to hear from either side, “This is for everybody,” because that sounds costly, right?
Let’s join forces and use objective measures to identify the best candidates for this program and paint a picture for each of the states that there is an ROI on this that you can’t even comprehend right now. But allow us to come in and implement it at a state level and work with your providers, either through federally qualified health centers or other practice types, and pilot it. And that may be in the form of two to three years of collaborative studies with state Medicaid programs or FHQCs. Either way, regardless of how they want to draw it up, James, I’m dedicated to this, and I see that combined approach being something that is incredibly powerful and something that I think will improve a lot of lives out there.
James Maskell:
Absolutely. Well, look, if you’re listening to this, there’s many different ways you could take this information. You could either feel good about yourself, that you’re getting some of this information. If you could just Google Foundation Pain Index, you’ll see the details of the Ethos test of the same name, and you can see the biomarkers there. They’re probably very familiar to you, if you’ve been listening to this podcast for a long time.
But I would say one of the reasons why we’re excited about it is that, can we bring these kinds of approaches to doctors that don’t do it right now? And that’s why we started the meetup groups, and that’s why everything that we’ve done is to try and bring new doctors into the fold. So, imagine: who are the 10 pain doctors near you that are practicing really in allopathic ways? And maybe you’ve helped some of their patients with your efforts, but you know that most of their patients are not making it to your clinic, new ways to really get involved in your community. I wanted to bring this in our Year of Growth.
I guess just to aid the thinking of other people who are listening to this, who may just start to think of themselves like, “Okay. I recognize that if we run functional medicine the way we’ve been running it, we may be able to help 10, 15, 20 percent of the population. But if we really want to get in to help everyone, we really need to think about streamlining the way that we deliver it.” And I think it’s such a great example that you not just have given today, Josh, but also that you are with the business and the way that you’ve created it.
We’ll have all the information about the Foundation Pain Index in the show notes. If there’s anything else that jumped out at you during this session, feel free to get in touch either with Josh at Ethos Labs or with myself. And yeah, really excited about the future together, we’ve got some exciting things moving forward. Just grateful for our conversations and collaborations thus far, and I know we’re just getting started. So thank you.
Dr. Joshua Gunn:
Yeah. I appreciate the opportunity. Thanks for having me, and I’m very excited about continuing to work with you and everything you’re doing. Thanks for the time.
James Maskell:
Alright, this is the Evolution of Medicine Podcast. We’re in our Year of Growth. We’ve been talking to Dr. Joshua Gunn, Head of Research and Development at Ethos Labs. Check out all of the show page where we’ll have links to everything we’ve discussed today. Thanks so much for tuning in, and we’ll see you next time.
Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.
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