In this episode, we learned about emerging, research-based treatments for alcohol use disorder (AUD) that pair well with functional medicine values.
Traditional 12-step programs have startlingly low success rates (8% for Alcoholics Anonymous) and teach some principles that are not supported by scientific literature—for example, that patients must abstain and avoid exposure indefinitely to stay in recovery.
James’ guest, Amanda Wilson, MD, is an addiction physician who cofounded NorthStar Care, an alcohol treatment center that approaches AUD as a medical issue and offers a year-long, physician-monitored, at-home program. They incorporate functional medicine elements, including nutrition therapy, genomics for personalized medication selection, social support groups, and several technologies, such as virtual reality (VR) and wearables.
NorthStar Care is partnering with a company developing a wearable device to continuously track not only blood alcohol levels but also glucose and sleep patterns. For their peer support group meetings, they use VR headsets so patients can participate remotely using anonymous avatars, virtual backgrounds and even voice changers for privacy.
Download and listen to the full conversation to learn about:
- A genetic factor that makes naltrexone ineffective for a portion of the population
- The shortcomings of rapid-detox, inpatient rehabilitation and 12-step programs
- The importance of medical support throughout the recovery process
- The benefits of using VR for peer support networks
- And much more!
Dr. Amanda Wilson: I spent the last 15 years as an addiction physician working in the opioid use disorder space and built two previous companies to treat patients with opioid use disorder. That is obviously a super passion of mine. I really care about that. And it’s obviously getting a lot of attention today in the press regarding the prevalence now of opioid use disorder and the problem with fentanyl and other challenges. But in 2020, it hit me that this number of people who were dramatically increasing their alcohol intake over COVID was going to result in a huge increase in the number of people meeting criteria now for alcohol use disorder. And quite frankly, that space has not evolved. The treatment for alcohol use disorder has not evolved really at all. If you look back over the last 90 years or so, rehab today looks very similar to what rehab looked like then and largely is 12-step based and largely is not science driven.
And so, for that reason, I felt like it was time to reboot how we treat patients with alcohol use disorder. And this disorder actually is 10 times more prevalent than opioid use disorder. So, it’s really deserving of attention.
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 and 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 integrated 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, I have such a treat for you. We are going to be talking to Dr. Amanda Wilson of NorthStar Care. She is an incredible physician. She’s had an amazing track record of building services for opiate disorders, and she is now taking on alcoholism and is bringing together genomics, functional medicine, VR, wearables, medication. And to celebrate our year of connection, I thought this would be such a powerful tool. So, check out this amazing… I think you’ll really get a lot out of it. I really look forward to hearing your feedback and enjoy.
James Maskell: So, a warm welcome to the Evolution of Medicine podcast for the first time, Dr. Amanda Wilson. Welcome, doctor.
Dr. Amanda Wilson: Thank you. Such a pleasure to be here. I really appreciate the invite, James.
James Maskell: Well, we are talking about the year of connection, and I really wanted to showcase something that was connecting the different areas that are sort of converging right now. You’ve got obviously the world of functional medicine. You’ve got real issues in chronic illness that are not being dealt with effectively by conventional care and conventional care methods. Then you’ve got wearables and technology and VR and group medicine and all the things that we’ve talked about here. And when I had a chance for us to meet a few weeks ago, I was like, here’s someone who’s really doing it. So, I’m grateful to share this with our community for so many reasons. If you look at this community, there are doctors and practitioners from all over the world who are defining their own care paradigm, their own niche and what they’re doing, and obviously looking to create new models for reversing chronic illness.
And so, hopefully what you’re going to hear today is an inspirational story of solving some of the hardest things to solve. And we’re going to dispel some myths I think a little bit later on as well. So, let’s just get into it. What is NorthStar Care? What are you trying to do? What problem are you solving?
Dr. Amanda Wilson: Sure. Such a pleasure to talk about this with you, and I really feel like when you are managing chronic medical illness, if you don’t approach it from numerous different aspects of the disorder and really wrap around patients using all of those different tools that you just described, then it’s often not successful. So, we really spent a lot of time thinking carefully about how to make use of all of those varieties of tools, and we’ll talk about them as we dive into the program.
But essentially, NorthStar Care is the first attempt to enable patients to have a fully comprehensive rehabilitation experience for alcohol use disorder in the home. And provide a year-long treatment program that actually is monitored by physicians, incorporates many functional medicine aspects in terms of wellness, wholeness of treatment, nutrient therapies, a whole host of different things. Using wearables in order to monitor patient success and being able to use numerous different technology tools to connect patients both to each other but also to their team. So, I’m excited to tell you more about that. Essentially, today’s rehab opportunities for patients are largely identical and, unfortunately, not very effective.
James Maskell: So, why alcoholism? Why is this your thing to do as opposed to anything else that you’ve done previously or things that you could be doing?
Dr. Amanda Wilson: I spent the last 15 years as an addiction physician working in the opioid use disorder space and built two previous companies to treat patients with opioid use disorder. That is obviously a super passion of mine. I really care about that. And it’s obviously getting a lot of attention today in the press regarding the prevalence now of opioid use disorder and the problem with fentanyl and other challenges.
But in 2020, it hit me that this number of people who were dramatically increasing their alcohol intake over COVID was going to result in a huge increase in the number of people meeting criteria now for alcohol use disorder. And quite frankly, that space has not evolved. The treatment for alcohol use disorder has not evolved really at all. If you look back over the last 90 years or so, rehab today looks very similar to what rehab looked like then and largely is 12-step based and largely is not science driven.
And so, for that reason, I felt like it was time to reboot how we treat patients with alcohol use disorder. And this disorder actually is 10 times more prevalent than opioid use disorder. So, it’s really deserving of attention.
James Maskell: So, you mentioned there are things that don’t work. What is the standard of care today, and why doesn’t it work?
Dr. Amanda Wilson: Sure. I think that most people when they think of, where would I send a loved one that was struggling with alcohol use? Top of mind for most people is AA. Second in line might be detox. And then third in line is generally inpatient rehabilitation. Those are sort of the top three that people think about.
AA is a community group. There are many things about that that are challenging. Many of the beliefs that AA propagate include things like you’re allergic to alcohol, that you can never be in contact with alcohol again, that the best way to deal with your disease is to hit bottom. I mean, there’s several different core principles that are taught there that unfortunately aren’t really scientific or held up by the literature. And unfortunately, what they don’t want people to know is that the success rate of AA is 8%.
And so, in no way do I mean to diss AA. I think there is a number of aspects about that community engagement that have been profoundly helpful to many, many people. And I love that it helps the people that it helps, but unfortunately, 92% of people, it’s not helping. We want to try to provide alternative options for them.
For detox, roughly about 10% of people are successful with detox. It’s generally a three to seven day stay. You’re receiving medications to essentially abruptly cease alcohol consumption. And there’s a number of risks and challenges with doing that. It can’t really be done in the home as easily in that way, in that method with abrupt cessation. And so, in my opinion, it’s sort of a risky endeavor when you could actually approach this in a very different clinical way. And the success of detox is 10%.
And then lastly, for rehab, essentially what inpatient rehab is a place to go away for 30 days typically, and largely what’s done there are working 12 steps. You’re in large groups of people with multiple different kinds of addictions. And you spend the day, Monday through Friday, typically nine hours a day in groups working the steps. That is nonmedical, there’s no clinical, no medical supervision. Many patients aren’t placed on medications, and they’re generally discharged with no follow up other than to advise them to pursue going to 90 AA meetings over the next 90 days.
So, there’s just been so many challenges with that, and its success rate is 13%. So, we have three tools out there available today that unfortunately aren’t working for most patients, and we need to… It’s time to reboot that principle and approach this in a very different way.
James Maskell: It’s interesting that as you say that, what I’m reminded of is when you look at the numbers of, let’s say, the 10 leading drugs in America by dollars, and you look at not average risk reduction or relative risk reduction, but you look at something like number needed to treat, you see that those drugs are not that effective either. And I actually had something from Nature in 2015 in my book showcasing essentially that it’s basically anywhere between one in five or one in four, which would be like 25 or 20% success rate all the way down to one in 25 for these really well-known, really well-thought of drugs. And so, when you see that, you see, well, what are we going to do for the other 80 or 95%? Because ultimately, the vast majority of people are not getting better with the first line drug therapy.
And so, that’s why people find their way to something like functional medicine because if you look at the results of any kinds of organizations that are accounting a significant amount of data, if you bring people in, you have them do lifestyle changes over a period of time. You have them hopefully come off medication that’s not working and go into things that are going to create health, the outcomes can be a lot more consistently effective. And so, I’m not surprised that that’s the case because it seems like it’s the case in almost any chronic condition because the single-use or single-focus drug therapies for multi-systemic chronic illness is just a very unlikely combination. And I think proving itself to be like that, right?
Dr. Amanda Wilson: Well said. I often use the parallel example of oncology care. If a loved one developed a new cancer, a breast cancer, for example, and they went into treatment, you’d expect that they’d be seeing a physician actually, potentially, more than one, different types of physicians, radiology oncologist in addition to a traditional oncologist. You might see a breast surgeon. You for sure would be having a nurse practitioner and a nurse involved in your care. You would be advised to see a nutritionist. Generally, there’s a navigator who helps you coordinate all of this care, and you’re usually advised to participate in some type of a support group, but people don’t think about the support group as being the mainstay of treatment. And number two, you’re using numerous modalities in that chronic disease management, including diet, including lifestyle changes, including social support, including usually many medications. Chemotherapy isn’t generally a one-drug regimen.
So, if you put that same approach to how we might treat alcohol use disorder, which also is a genetic driven chronic medical condition. If you put that same approach, you can wrap around patients in a way that’s much more successful and have way better outcomes.
James Maskell: Awesome. Well, you mentioned three things that I think are so cutting edge, I would say. And you’re using, I know all of them in your clinic, so maybe you could talk about those three things and how you use them. So, the first is genetics. You just mentioned it’s a genetic disorder. So, how do you use genetics. Second, wearables, and then third, VR. Because if you’re listening to this audio, you won’t appreciate how cool your background is, but I could see that there’s some, you’re playing in this sort of VR space, and I know you been on the cutting edge of that. So, can you go through those three and how you use them and how you integrate them into your program and why you chose to do that and how it works, essentially.
Dr. Amanda Wilson: Sure. So, before launching NorthStar, my co-founder and I, my co-founder is a person with a PhD in developmental psychology. She is a professor of research and statistics at the graduate level and has over 70 peer reviewed publications herself in the addiction space. And between myself as an addiction physician and she as a PhD researcher and data scientist. What we did is we spent a year and a half literally reading every single paper published on alcohol use disorder both across the US but also in the UK, in Europe and in Australia because, in those countries, they really take a radically different approach to medical treatment for AUD.
So, by doing that, there were several themes that became really clear. And really, the first of them was that there are in fact numerous medications that have been studied and have been shown to be efficacious in the treatment of alcohol use disorder. And sadly, they’re just not being used. On average, most patients, if they’re offered a medication at all—and less than 0.4% of them are, so very few people are being offered medication treatment—but if they are, typically it’s naltrexone. And so, genetics come into play with this, and it’s a great example.
If you don’t have the OPRM1 gene, naltrexone is not going to work for you. And yet, it’s the most commonly prescribed medication. Roughly 60% of people have that gene, 40% don’t in the US. And so, we’re giving this medication most broadly and sweepingly without doing any genetic testing on patients, and therefore, guaranteed, 40% of people it’s not going to be effective for. So, we started pouring more into the genetics literature and started creating key relationships with organizations like Stanford that are looking at these things in a much more scientific way.
And by doing that, we found several additional key themes. Number one, there is a great body of literature now helping to guide pharmacogenomic assessments and help you determine which medications are likely to be best for which patients. So, we’ve been using quite a bit of that data to help us formulate a unique prescribed plan of treatment for each patient and using those medications based on their genetic needs.
In addition, genetics really help us understand how best to replete patients from a nutrient standpoint. I love that this is for functional medicine providers. What we did is we actually collaborated with a psychiatrist who’s a functional medicine psychiatrist. He’s been working in this space treating patients with alcohol use disorder, other use disorders, and also working bipolar illness, schizophrenia, treating it from a functional medicine perspective. And what we did is using genomics and using his background information and experience, we were able to build a comprehensive formulary of key nutrient therapies that we provide to every patient when they start treatment.
One of the things that’s really notable in alcohol use disorder that separates it from the other use disorders is that you have a significant detriment to the microbiome. A person’s essentially consuming a solvent every day, right? And when you’re ingesting alcohol at that level on a daily basis, you’re doing significant harm to the microbiome. And in addition, significant inflammatory harm to the lining of the intestinal in the lumen. So, it diminishes your ability to absorb certain key nutrients, the burden of free radical damage that’s happening as a result of the insult to the body from constant alcohol consumption across all the different systems. It can severely deplete glutamate and other neurotransmitter, other transmitters. I’m sorry.
So, it’s incredibly important for us to address that head on. And by getting patients initiated on a course of nutrient therapy and medications that are all genetically selected and individualized for each patient, we improve clinical outcomes dramatically. We are able to drop patients’ alcohol use from on average three times the drunk driving limit when they start our program down to a breath alcohol level of 0.005, which is less than a 10th of the legal limit. So, it’s several hundred fold diminishment in their use in just four and a half weeks once they stabilize on that medication and nutrient regimen.
James Maskell: That’s awesome. I love that. And that is the personalized medicine that we all want to see, and I’m excited to see that. So, that’s genomics. Tell us about what you do with the wearables. What do you send people? What information are you looking for? How do you synthesize that? I know just having come back from the functional medicine conference, wearables are a hit amongst practitioners who want to know their own scores.
But I know that wearables are in general like a giant pain in the ass for practitioners who their patients come in with their information and say, “Tell me what to do with this.” And it’s like, well, we’ve only got an hour and you’ve got three functional medicine tests to look at too, and how do you think about prioritizing all that information? So, what do you do with your wearables, and what are you looking for in that?
Dr. Amanda Wilson: Sure. Great questions. So, there are a number of different things that we are doing digitally and want to do over time. With respect to monitoring alcohol levels, for example, what we can do today, what’s available in this moment are breathalyzers. There are at-home breathalyzers that you can use. There’s a digital breathalyzer that actually sends that digital data point to our application and uploads it directly. So, we’re bypassing having the patient have to upload that information, and we can track that longitudinally.
Well, we had the idea well over a year ago that it would be so much easier if we could have a wearable for this purpose. So, we met with quite literally every single company in the country that’s making a sincere effort to bring a wearable into fruition that would be effective at monitoring alcohol levels 24/7. Many of them operate by essentially capturing a gas, essentially the leakage of alcohol through the skin and quantifying the amount of alcohol that’s leaking through the skin and just determining whether or not there is alcohol in the system or not.
However, the newer technology is really exciting. A company called Rockley Photonics that we’re working with, they’re in the midst of developing the first laser monitor. It essentially works by using very narrow nanometer wavelength lasers and without any sensation. It doesn’t cause any burning. There’s no sensation through the skin, very much like an Apple or Fitbit watch that you might wear. You don’t feel it, but it is constantly able to detect both alcohol levels as well as glucose levels and lactate levels. In addition, their watch does all the other things that an Apple Watch will do. For example, it will help us monitor their sleep, which, as you might imagine in patients with alcohol use disorder, is a significant problem. Many, many people have a significant sleep disorder. So, tracking how they’re improving and what their sleep architecture looks like and using combinations of different nutrients and medications to help that as well as coaching them for sleep all become a big part of what we do.
We are very focused on activity, encouraging people to keep busy, to do things that they love, to start spurring that healing neuron growth that we want for them by having them be active in their lives. So, tracking that activity: How much are they exercising? How much are they up and around? How active just are they on a day-to-day basis? Tracking that improvement also helps us measure how the patients are doing functionally. So, these are all things that we intend and plan to track.
We also formed a partnership with a company that has figured out how to extract essentially patients’ stress levels by monitoring their heart rate variability over time. So, we want to be looking essentially at patient stress levels when they start our program and how does that ideally go down over time as they’re getting their alcohol use disorder under control. So, there’s so much data to be gathered from that.
James Maskell: Awesome. And then last but not least, let’s talk about virtual reality because I’m interested in that. Obviously, someone, I’ve been involved in a group, and I recognize running virtual groups is okay via Zoom, and we’ve definitely got some great outcomes. But I see a future, I mean, I’ve literally seen things where there are new technologies arriving where it feels like you’re in the room with someone, and I think you are sort of pioneering that space. I guess first of all, you mentioned a little bit about AA earlier, what is this sort of, why do you have group as part of your offering and what do you think it offers to the patients? And then why are you innovating VR for that part of the group? The service?
Dr. Amanda Wilson: Great question. So, when we did that deep dive in the literature, we found a paper that showed that people who participate in peer support who are engaged in medical treatment for an addictive disorder have a 300% improvement in their patient retention. So, every single component of our program that we selected, we selected because we knew it would drive improvements in the quality and outcome of the care.
So, we started looking at that idea of doing groups, just online Zoom groups, which were done largely through, it’s a way that people were able to still get some type of peer support during COVID, for example, when they couldn’t actually go to an in-person group meeting. The feedback that we got, we actually brought together a group of people to become what we called guiding counsel. People with lived experience who could teach us about what they would want to see in a clinical program.
So, we would meet with them biweekly, brought ideas by them. When we talked to them about what were groups like for them that they did on Zoom, we heard consistent themes that they were just not engaging, that they didn’t feel the same sort of energy that they would feel when they were in person with the people. That many people would shut their video off and their audio off and just sort of be there. And when you’re staring at a screen of numerous blanks, that that was sort of off-putting and made it hard to feel like you’re really sharing with people. So, there just was a significant decrease in the utilization of that over time. And I don’t think that there are as many online groups going because of that disengagement. It was really difficult for people.
The things that they liked about it though were that you could curate the groups. You could say, “Well, I want a group that’s just for women with young children, or I want a group…” You can’t do that with AA in your community as easily. I mean, unless you live in a huge community and there’s thousands of people to pick from and you can offer a men’s group or a women’s group, for example. But in general, you’re not likely to find a Native American group or necessarily an LGBTQ group. So, we had this thought, how could we deliver the ability for patients to engage in peer support, but do that in an environment that number one, makes it easy for them. If they’re home, they don’t have to take a bus or drive or coordinate or plan, figure out daycare, all of that in order to attend a meeting. They can attend a meeting from home from the comfort of their couch.
Number two, let’s make this really engaging and interactive. When you go into virtual reality—most people haven’t gotten to try it yet—but I can tell you it is a deeply visceral experience. When you’re sitting with people, you still have that amazing feeling of connectivity. We’ll all ask each other in a room, for example, where are you? And it’s just sort of fun to know that everybody’s from all over the country, but you can actually high five one another and feel it. You can actually talk with your hands in a very naturalistic way.
So, it just feels very much after about 10 minutes being in that space, you basically forget that you’re an avatar. But you get to be an avatar, which lends yet another whole level of beauty to this. People can come into these groups and know with absolute certainty, they’re completely anonymous. There’s literally no possibility of someone knowing who they are because they can create their own avatar. They can represent themselves with any gender. They can mask their voice so that their voice, nobody would be able to tell that it’s them. We often joke around that if Cher decided to participate in our program, if she needed that, she could come in and no one would know it was her.
So, there’s ways to make use of that anonymity. And in many ways, if you think about it, AA, rehab, detox, these are not anonymous treatment options. You’re showing your face, you’re in person, and that is a huge barrier to entry for a lot of people, and a big part of why less than 9% of people who have this problem ever seek treatment.
James Maskell: I can see that. So, what does that look like, just sort of practically how you’re shipping someone a headset? How do you make it easy for them to get started?
Dr. Amanda Wilson: We knew that the number of people who have Oculus headsets, for example, in the home, something like less than 9 million people right now. So, it’s a small percentage of the country. So, as a part of someone launching treatment with us, we do include a brand new Oculus headset for every patient. That’s part of the treatment program. So, they receive that along with the initial 90 days of nutrient therapies and several other things that they need to be a part of our program, like the breathalyzer for right now but ultimately the wearable watch that we’re moving toward. All of those items come in a kit that’s overnighted to them. So, that is included.
In terms of practicality, we offer groups seven days a week, morning, noon, and night. We have a number of groups that are for specific purposes. For example, we have a clinical group where they can meet with physicians and just ask questions about treatment in general or the science behind how we’re treating them with this approach. We have a group that’s for meditation. Every Monday night, there’s a meditation group. There’s groups that are to talk about skills and how to use certain skills to cope with certain stressors at different times in your life.
And there’s groups that are specifically for a certain group, like a men’s group, a women’s group, a group for women with young children under the age of five. That group was hit particularly hard through COVID. So, all of these groups can now be really sort of narrowed to that group type. So, there are 14 different environments. So, the patients pick. Do they want to meet in a sort of comfortable office space that looks more like an office, a clinical office, or would they prefer to meet on a beach? Would they prefer to meet at a campfire? So, around the campfire, they can roast marshmallows. I mean, literally, the sky’s limit about what you can create and do.
And then lastly, the way we use VR is that our peer guides, every patient has two peer guides that they work very closely with throughout the year of treatment. And those peer guides become really tight and know their patient very, very well. And what ends up happening is they’ll spend time with them one-on-one, right? You sort of think of it something like the sponsor idea. Instead of being able to go out for a coffee with your peer guide, you can actually, you might not be in the same state, but you can meet in VR and potentially go for a walk on a beach or walk through Rome or go play a video game together. I mean, there’s just all kinds of things that can be done in VR together where you’re spending time together, but you’re actually talking about the things that are going on with your life as you’re doing that. It’s incredibly engaging and brings them even closer together.
James Maskell: Some of that sounds amazing and some of that sounds, I just feel like I don’t know what the implications of living in that world are, but I understand for the general public, but I think specifically for dealing with people who are already struggling with something that they’re not getting great outcomes with, I think this is a beautiful engagement with it. Kind of like when you hear about Neuralink, you might think, well, that sounds terrifying. But then you hear about, talking about, well, who are the first people that are going to benefit from it? Well, it’s people with motor neuron disease, and they then have those kinds of things. I understand that for sure.
I guess based on your previous experience of having successful companies and exits in the narcotic space, how are you tracking the outcomes of what you’re doing now? And then, what is your hopes for this business in the future? And what do you think you can do in the alcohol space in a decade, let’s say?
Dr. Amanda Wilson: Great questions. So, my hopes long term, my previous companies are in the opioid space, continuing to grow and provide care for patients in that realm. Alcohol use disorder, just there’s been no disruption frankly, in this treatment yet. So, we are excited to do something completely novel and quite frankly, prove this out to insurers, to other stakeholders who are really searching for alternative options that may be more effective.
And so far, our success rate is actually 600% more effective than rehab is today. So, we have an 86% success rate and an 85% patient retention rate, which is dramatically better than the 13% that rehabs are offering to treatment today. So, a yearlong program makes a big difference. We really believe that’s going to change the game, and it seems to be what the payers want. As we’ve been meeting with large-scale payers, national payers, they’re very interested in finding non-resort style treatment.
They really feel like it makes more sense to have longitudinal treatment that is strongly evidence-based, and it is multidisciplinary. These are really the goals that we keep hearing. So, we seem to be aligning with that. Over the next decade, I would hope to honestly have some of the same impact that my first company had I think in the opioid use disorder space. When opioid use disorder was first being treated with buprenorphine in late 2000s, so 2008, 2009, it was still not well known, and it was largely, quite frankly, frowned upon initially. People thought you were substituting one substance problem for another. That was a widely held belief and that the best thing to do is to put people in a bed somewhere. That was something that I heard quite a bit.
And over the next 15 years, what we’ve seen is a radical shift to people really recognizing the impact and the importance of medication in this treatment of a medical approach to this treatment in combination with behavioral support. And so, we went from calling it medication assisted treatment to calling it MOUD now, right, because it’s medication for OUD, medical treatment for OUD, but we’re not sort of calling it assisted treatment and seeing that either groups or simply counseling alone are the core of the treatment.
And I would argue that that’s exactly the transformation that I hope to see over this next decade in the alcohol use space. That through publications, which we will do, sharing our evidence-based results, really doing what we did in the opioid use disorder space. Dr. Chiodo and I published over a dozen peer-reviewed journal articles talking about best practices in the opioid space. And we will do the same in the alcohol space with the hope that we can really transform how this care is delivered so that it becomes more successful to patients, more accessible to patients, and something they can stay engaged in over the long haul so that they actually really do move toward wellness.
You asked how we’re tracking our success. There’s a whole host of different metrics that we’re using. My co-founder being a data scientist and researcher, it’s been her passion to build the best methodology into the program structure itself so that we can gather actually an extremely large amount of data from each patient. Of course, the wearable data will be hugely beneficial, but right now, we’re using 20 different validated tools that help us monitor patient cognitive function, their depressive symptoms, anxiety symptoms, sleep function. How are they engaging with their community? How are they doing in terms of home and family life? So, we’re tracking all of those things very frequently through the year of care. They get tracked at two weeks, again at six weeks, monthly, and then after that quarterly, so that we can really see that progression through that year of care. And it’s been profoundly impactful to see how much of an impact it has, how quickly on patients.
We’re tracking their breath alcohol level itself, of course, right now, and soon hopefully we’ll have this wristwatch wearable to enable us to track that in real time, 24/7. But right now, we get it roughly three to five times a day on every patient throughout the entire year. So, that gives us a lot of data, just real time, are they drinking? And if they are, how can we pivot the program to adjust it to their needs and help it become more and more successful over time?
And then lastly, we follow functional metrics, not just patient reported with the validated tools, but the monitoring that our clinical providers are doing on a week-to-week basis. All of the physicians, nurses, nurse practitioners, navigators, and peers document in every clinical encounter that they have through telehealth or in any encounter that they’re having in groups or one-on-one with their peers. All of these encounters are tracked over time and we’re following functional metrics there too.
Are they resolving criminal justice issues that have come up? Are they restoring relationships with their family? Are they repairing relationships in their immediate family lives? Having the ability to care for their children again, if that was removed? So, different types of metrics like that that track clinical progress in addition to the tools that I mentioned. So, we’re gathering just hundreds and hundreds of data points on patients over the course of this year of care in addition to their genetics and in addition to their response to any of the interventions that we try for them.
James Maskell: I’m so glad that you shared that because I just feel like when it comes to these chronic conditions and these underserved populations, the metrics by which they engage with the rest of their life is really the most important ones because that really determines where they’re going from here. So, that’s such a great, great point. Well, look, this interview has done exactly what I’d hoped it would do. This is our year of connection, and that’s our theme for the year. And so, I really wanted to just showcase a service that was connecting the dots of the future of chronic illness and having a massive impact. And I know that, and also for it to be showcasing the power of functional medicine alongside other tools that are sort of happening in this convergence. And I think you are doing such a beautiful job of it, and I just really want to share my appreciation for turning your efforts to this particular issue.
Personally, I’ve been in a men’s group for four years, and most of the people, most of the men in the group have gotten off drinking alcohol at all in the group. And it’s been very helpful for me because I need to do that as well and have made progress. And also, I’m glad to hear that it’s possible to just not have to completely abstain because I think I’m personally at a point where my alcohol consumption is depending on where you go back to, but if you compare it to university, 95% lower. If you compare it to a couple of years ago, probably 80% lower or 50% lower. And it’s not a regular part of my life anymore.
And I don’t think that would’ve been possible without the group. It’s been really helpful and valuable, and it’s free, and it’s something that I’ve been participating in, so I can see the power of that. But it takes a while for that container to happen, and everyone who’s there is there at their own free will and not everyone makes those choices.
So, to take community into medicine, to go to places where there’s a real need and to look to get it right first and then to find new places to do it, I just salute you for that. So, thank you for coming on the Evolution of Medicine podcast, and thank you for the great work. And if you want to find out more about NorthStar Care, check out the website. We’ll have all the details in the show notes. And thanks so much for participating in and leading the evolution of medicine.
Dr. Amanda Wilson: Well, thank you very much for having me. It was really a pleasure, James. Nice to see you.
James Maskell: Thank you.
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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