In my last blog I talked about our addiction to technology and how our addiction to technology is impacting our lives. This week I wanted to cover one of the more positive aspects of technology, specifically how one company based out of Boston is using video games to directly target neurologic diseases and improve cognitive deficits.
Akili is the leader in digital therapeutics, specialising in the development of highly-engaging digital medicine that directly activates neural physiology to treat disease. Akili’s thesis is that medicine has the potential to be delivered and experienced in a completely different way. They are throwing out the traditional notion of pharmaceutical drugs and are instead creating a new class of targeted prescription digital medicines, delivered through video game experiences.
Akili Interactive Labs
The company was founded in 2011 by Adam Gazzaley and Eddie Martucci, and while Akili itself is a relatively young company, the idea behind using digital technology to improve health outcomes can be traced back to the early 2000s. Since that time the applications have been largely preventative and have been colloquially deemed as ‘brain training’ applications.
Unfortunately, the research on ‘brain training’ is rather mixed. In fact, in 2016 Lumosity, a very popular brain training program, had to pay $2 million to settle Federal Trade Commission ‘Deceptive Advertising’ charges. According to Jessica Rich, Director of the FTC’s Bureau of Consumer Protection “Lumosity preyed on consumers’ fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer’s disease, but Lumosity simply did not have the science to back up its ads”.
So how is Akili different?
Well firstly Akili is targeting treatment of existing cognitive deficits. That is, they are going for treatment over prevention.
Secondly, Akili is licensing its technology from Gazzaley’s work with the cognitive neuroscience lab in UCSF, where the technology has been put through several rigorous scientific tests and has been published in very reputable scientific journals such as Nature.
And finally, but possibly most importantly, Akili is focused on an ‘FDA approval first’ strategy. But FDA approval involves arduous clinical trials and is significantly more expensive than a direct to consumer approach. So why are they pursuing this strategy?
Akili believe that approval is an essential component to building trust from the multiple stakeholders involved, and in distancing them from the existing brain training genre. In addition, if approval is granted the technology would be considered a suitable substitute for traditional drugs and therapies. This would be a significant step for Akili. Surprisingly though, this would not be a first for the FDA. In late 2017 Pear Therapeutics, another Boston based company, earned the FDA’s approval for a mobile app to help substance abusers stay clean. It was one of the first examples of a prescription digital therapeutic, supported by clinical trial results, to win FDA clearance.
Akili’s first product that is going for FDA approval is Project: EVO, a video game treatment for pediatric ADHD. The product is currently in the middle of a multi-center, randomized, double-blind, active-controlled pivotal study. If approved by the FDA, Akili will likely seek FDA approval for some more of its other products.
The other indications that Akili is currently working on are Autism Spectrum Disorder and Major Depressive Disorder, both of which are in pilot study phases, and Multiple Sclerosis which is in the feasibility study phase.
But how does this technology work?
Well that’s where a background in Neuroscience would be really helpful, but from a high level the game uses complex algorithms to target specific functions within the prefrontal cortex that require cognitive control. The game stimulates these areas through multitasking within the game and adapts to the player throughout the game levels. Over time playing the game reconditions the brain for durable change. The hope is that this will have a lasting impact on improving cognitive brain deficits as opposed to traditional drugs such as Ritalin or Adderall which are known for treating symptoms only and lasting for only as long it takes to pass through your system.
It remains to be seen if these digital therapies can and will achieve these lofty goals, however I for one am excited to see what happens next.