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At the Biotech Showcase in January, a panel discussed how video games are replacing drug therapies in a variety of diseases. If you haven’t seen the latest technology in this space, companies like Akili are providing drug-alternative therapies to kids with ADHD and Pear Therapeutics’ software is aimed at helping people with addiction.
Technologists have reached incredible heights in getting people to voluntarily spend large amounts of their time playing video games and now entrepreneurs are combining those practices with neuroscience to create many exciting new startups. Let’s take a deeper look at this trend and see how these digital products are changing the face of healthcare.
How gaming works as a prescription
Imagine you’re at the doctor’s office and she hands you a prescription as you walk out of the clinic. Instead of heading to your local pharmacy for a bottle of pills, though, this Rx entitles you to a set of 30 sessions on a video game console. Akili’s pediatric digital therapeutic for ADHD (currently in Phase 3 clinical trials) will be prescribed exactly in this way.
“The label [for its digital therapeutic] will read ‘for the treatment of ADHD’ — not disease management, not patient engagement, but a direct therapeutically active software platform,” said Akili’s CEO Eddie Martucci.
These digital therapeutics are going beyond what traditional pharma companies do when it comes to providing data on long-term assessment, expanding monitoring from just one to two months to nine months of impact assessment. These software companies are also reporting adverse events in the same way that pharma companies do.
So how does that change things for the patient? Some early clinical indications show fewer side effects on Akili’s software solution. Kids reported some headaches and frustration, but far fewer side effects than drugs like Ritalin.
WellDoc, founded in 2005 as a software prescribed by physicians to better manage diabetes as part of its BlueStar program, is seeing tremendous results in their clinical studies and with patients.
“We are not only seeing reductions in A1c, but also reductions in acute utilization and control, reduced blood-glucose scatter. We have to look at control of extreme out of bound events and we are seeing significant reduction in those. We saw in one study a 15 percent reduction in acute utilization,” said WellDoc’s chief strategy officer Anand Iyer.
Video games as medical devices are succeeding, and more are arriving on the market each year.
What is driving this trend?
A few elements are coalescing to create the environment for games to succeed as medicine.
1) There is a real, unmet need in many areas like mental health. The driver is the public health – how to reduce morbidity and mortality. In the US, we’ll lose more people to suicide than breast cancer this year. Drug overdoses will claim more lives this year than the Vietnam War. Entrepreneurs are asking themselves, “Why have we not done better? What can we do differently?”
2) People are already gaming, so healthcare is “going with the flow.” Smart technologists who are leading “software as a medical device (SAMD)” are working with easy, everyday life practices to help transform patient adherence. What do people already enjoy doing, and do effortlessly? Smartphones have a highly addictive quality: people check their smartphones up to 150 times per day by some estimates, and healthcare is beginning to change the way we use that data. Companies are beginning to measure biomarkers on how people are doing while they use their cell phones and leveraging that data to develop digital therapies. One of the panelists at the Biotech Showcase said that getting objective measurement on outcomes for mental health is incredibly important.
“It’s possible to see from keyboard patterns playing Candy Crush Saga when an older adult has early onset Parkinson’s Disease. Depression also has a predictable footprint – what if the phone began to ask you how you’re doing today?” said another panelist.
Leveraging the addictive quality that smartphones have is part of the “gamifying” of healthcare. Anyone who has been injured can attest that unless you have the discipline of an athlete, it’s difficult to stay the course with physical therapy.
“It’s painful and boring, but companies like Mindmaze are gamifying that,” said one Biotech panelist.
Technologists are hoping that by leveraging the addictive quality of video games, they can help people stay the course on their therapy regimens.
3) The drive to lower healthcare costs encourages digital solutions. As we migrate to a value-based cost structure and
away from fee-for-service, therapies that have a high adherence and high ROI will become the leaders in healthcare. Numerous studies have found as many as 75% of Americans fail to take medications as directed by their prescription. CVS Caremark reports in a new study that among more than 2,400 of retail pharmacists, 62% believe the high cost of drugs is the biggest reason why patients don’t adhere to their prescription. During the course of a year, the pharmacists estimated that nearly one third of their patients decide not to fill a prescription due to price. Furthermore, non-adherence has a huge price for society. CVS Caremark goes on the estimate that failure to take prescriptions as prescribed is associated with 125,000 deaths each year, as well as up to 20% of hospital and nursing home admissions annually. The NIH estimates the cost of non-adherence at up to $300 billion each year.
Video games, being both more addictive and more affordable, could have an intrinsic advantage over big pharma in the cost arena. It remains to be seen over the coming years whether these digital products make good on the promise of improving adherence and lowering costs.
The future of gaming as therapy
This new digital frontier is exciting, but there are some challenges to commercializing these products. We tend to think that giving kids with ADHD a video game would be fun, but it’s important to remember that these games target the very thing that kids have difficulty with.
“It’s a tough game for them, and they’re exhausted at the end,” said one of the panelists. “It’s important that the game be designed so that the kids don’t get overwhelmed and give up, saying ‘This is hard, I’m going back to Minecraft.’”
In order to be viable, digital products must understand the underlying science of the condition they’re treating.
Successful games leverage the brain’s reward system to alter the cognitive process. What does that mean? Well, the brain enjoys a lot of different kinds of fun, but the area that video health-games address is the fact that people enjoy having a challenge that is just at the limit of their abilities. Thus, the video game must have a dynamic difficulty adjustor. For example, in the Akili game, the ADHD kids are challenged by having many things thrown at them that they have to ignore. Truly successful games will tap into an emotion called “Fiero,” or the pride experienced in the moments following a personal triumph over adversity.
Another important element for the future of video games as a successful therapy is a strong digital ecosystem. Entrepreneurs need to think beyond the app, and work together with EHR’s and other healthcare IT elements to create a platform and operating system.
A future healthcare system will shift away from isolated product development to thinking about a health model that focuses on delivery. Entrepreneurs need to place their work within an ecosystem that can make best use of their innovation. For example, creating a new delivery ecosystem that goes beyond the CVS prescription experience and leverages more consumer-centric delivery models could give rise to new patient experiences. What if the video arcade merged with a walk-in clinic? What if patients can log on from anywhere, yet still have the privacy of HIPAA and protection from cybersecurity? These are just some of the questions digital product designers are beginning to ask.
If you’re developing a digital product or addressing some of our most pressing patient care issues, these trends could be in your favor – but as always, we’ll keep you updated as the market unfolds.
Tracy MacNeal is executive VP of corporate development at Ximedica.
The opinions expressed in this blog post are the author’s only and do not necessarily reflect those of MedicalDesignandOutsourcing.com or its employees.
