Samantha Citro Alexander, the co-founder and CEO of bitewell, a novel food pharmacy that dispenses food-as-medicine and healthy-eating services, joins Pharmacy Times to discuss a concept growing in popularity- the farmacy. Tune in to a discussion about the benefits of using AI to identify foods that are uniquely healthy to an individual, the importance of bridging the gap between the provider and grocery store, and the connection between a community pharmacy and food farmacy (in addition, there is also a timely food pun). This is not a discussion to miss.
- Bitewell is the bridge between the provider and the grocery store.
- People can identify foods that are uniquely healthy to them or receive food prescriptions based on advice recommended by dieticians or healthcare providers.
- This concept is rooted in the idea that the food and pharmacy are connected.
PT Staff: You call bitewell a food farmacy (spelled FARMacy). Can you please describe this concept?
Samantha Citro Alexander: If you think about the definition of a pharmacy (a PH-pharmacy as we say in our office), the definition of a PH-pharmacy is a store that dispenses and sells pharmaceuticals, right? Both prescription and over the counter. When we think about the growth of this movement called food-as-medicine… if we are going to (quote unquote) prescribe food as medicine, then doesn't it make sense that we also need a store that dispenses and sells food-as-medicine, both prescribed (quote, unquote [I'm using quotes if anyone is not actually seeing me]) by a doctor, but also (quote unquote) over the counter food-as-medicine that you want to buy yourself to treat or manage a particular condition that you know is rooted in food.
PT Staff: Could youexplain this to me—is it that, when you go into the food pharmacy, you are being prescribed those foods by someone? Or are you choosing those foods after having been told the dietary guidelines that you should be following?
Samantha Citro Alexander: Great question. So in the same way that, in a PH-pharmacy, you can either walk in and buy something over the counter (you can pick up cough syrup or you can pick up whatever on your own) or you can have a prescription from a doctor that helps you to understand which medication you need to take to treat a particular condition, the food pharmacy works kind of the same.
When you set up a profile in the food pharmacy, [what] we call your member profile, we learn about your health conditions, your needs, allergies, and tolerances and any health goals that you have. At any time, you can just pop into the food pharmacy and shop for food that meet those needs. So the whole shop is personalized for you. If you're working with a provider who is writing food prescriptions— and we're starting to see this happen in a couple of different spaces, especially around diabetes management or heart health management— then you can come to the pharmacy to essentially fulfill that food prescription and buy the foods that have been prescribed to you by your provider. Both are an option.
PT Staff: [Within the realm of] healthy eating and good food, it's overwhelming to a lot of people to know what to choose for them. Do you ever run into a problem with patients, where think they are eating healthy but maybe they're not actually eating healthy? Or vice versa? They think that certain foods are healthy, but maybe it's not healthy for them? How do you discern that?
Samantha Citro Alexander: We have created a proprietary metric that we call the bitewell FoodHealth Score. And that score ranges from 0 to 10. It's exactly what you're talking about— it helps you to figure out how well a food fits your individual personal health needs.
[This] means that for some people, if we are talking about a kale salad—say you put 10 people [together], 10 out of 10 people will say a kale salad is healthy, which is by and large correct. But there are specific medications that you might be on where the vitamin K count in kale is actually too high for you; not a good choice for you that shouldn't be in your food pharmacy—there is an instance where a kale salad might not be healthy for you. And so, if we actually took those 10 people, learned about their health conditions, needs, goals, and scored that kale salad for them, it might range anywhere from a 2 to a 10.
PT Staff: So it is this relationship between your farmacy and a real pharmacy, in the sense that you do have to have an understanding of how medications work. [But for] many people, I feel they don't understand all this nutritional information in those foods like kale, so they're not able to know any better.
Image credit: alicja neumiler | stock.adobe.com
Samantha Citro Alexander: No, and it's so hard. Registered dietitians have masters and PhDs. I don't think that it's reasonable to expect every person to understand the nutritional content of food, and how food impacts their body. It's like asking every person in the world to become a pharmacist to be able to figure out what to eat. It's a crazy thing to ask people to do. And so we can use technology to help people understand what food they should eat for their body. And to your point earlier around understanding pharmacy and pharmacy science plus food science, [I’ll say] yes, certainly. Our view is that it's not food versus pharma, it's food and pharma in most cases.
PT Staff: How are you working with, rather how can these concepts [of food pharmacy and community pharmacy] come together? How can the community pharmacy learn about these types of services, and how do you facilitate a relationship between the 2 of you to make a better patient experience?
Samantha Citro Alexander: That's a great question. I have an idea that we haven't put in practice yet, so if there are any pharmacy leaders who are watching or listening, contact me. Let's figure this out.
What is interesting, when you think about walking into a pharmacy, is that most pharmacies have aisles of food, right? But the food that you find in those pharmacy aisles is generally not healthy. It's things that are not necessarily what you want to be putting in your body to improve your health. And so what if bitewell took over those shelves? What if we merchandised them for you? What if we helped people understand which foods they should pick up off of that shelf to improve their health alongside what you already know about your patients who are walking into the pharmacy and picking up medications? That's one way just one way that I could see these two worlds playing well together. Food for thought.
PT Staff: Food for thought [cue face slap]. That was so bad, I am so sorry [laughs].
Samantha Citro Alexander: No, I love it! When we start getting people on the other end of the line telling food puns, that's when I know I've told the story. People are getting it were food putting together.
PT Staff: I'm curious, food-as-medicine prescriptions help patients in a treatment plan, right? They're scored. How does this include clinical prescriptions currently?
Samantha Citro Alexander: Now, the linkage is light. Meaning, we understand (either through the patient themselves, through the provider who's prescribing, or essentially the sponsor of the program) the patient's medical conditions, Medicaid patients, and health goals—those are the primary drivers, in addition to some other things like allergies and intolerances. These medical conditions, medications, and health goals are the primary drivers of your recommendations inside of [our] pharmacy.
We do not have a full library of contraindications for every single medication, but we have the most popular ones in there. And so we're either finding out, in most cases from the patient, what medications they're taking, and [we] take that into account when we filter [foods] in the pharmacy. But this to me is like level 1. This is the basement level of what we could possibly be doing.