Technology: The Digital Drug – part II – Digital Medicine

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.

Project: Evo

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.

10 comments

  1. I really enjoyed this post, it gave some great insight into what Akili is doing and the potential benefits that could come from it. Utilizing technology as a form of medicine, especially when it comes to treating existing cognitive defects, makes a lot of sense in many ways. This is particularly true with the example you shared of how the first product that they are trying to get FDA approval for is a video game treatment for pediatric ADHD. Children are more or less born with technology at their fingertips, learning how to navigate iPhones, computers, video games and smart TVs at an early age, so it appears to be the perfect market. Rather than being a typical medicine that has to be taken every day to treat symptoms, this could just be another game that they get to play on an iPad or iPhone, all the while serving a much greater purpose. It will be interesting to see how the approval process goes and what Akili will be able to come up with next.

  2. Very interesting post! My mom has worked in the pharma industry for her entire life, so I am interested to see how technology continues to play a role in treatments of certain diseases. Akili and its products sound like they are going to change the lives of many. I know quite a few people from high school who needed ADHD meds to focus, but their parents didn’t want them to take additional “unnecessary” medicine. By using video games to stimulate the affected areas of the brain, Akili takes away this fear of excess drug use seen in some parents/users.

    If these type of games become more popular, I am interested to see the type of regulation the FDA uses before they are allowed to be prescribed in place of traditional drugs on the market. I also wonder whether or not they will be as critical of advertising and marketing of prescribed games as they are with traditional drugs.

  3. This really interesting! I’m not a science major, so whenever I see some study, research, etc. promising something, I get really excited. I will share it with my more “science-inclined” roommates, who are quick to tell me it’s probably a false promise, or nothing is really proven yet. So I love that Akili is really taking the steps, and money, to ensure that what they are providing is legit. It may not make them money as fast, but it gets to the heart of what discovery is all about–actually making people’s lives better. I think the power with medicine/healthcare via technology is improved accessibly for people that are not conveniently located or do not have the money to travel. Great post!

  4. Great post! I had no idea Lumosity didn’t have the science and data to back their claims, yet I still played their games thinking I was helping to improve my cognitive function. Although the games were fun, maybe it was more so the placebo effect that made me feel like I was doing something beneficial for my health. I think with the improvement in technology, a lot of it should be put towards helping to improve the lives of those with disorders and diseases. While not all technology is one size fits all, I’m glad to hear that Akili is pushing for FDA approval through a video game treatment. I think video games have many great benefits, one as a stress reliever but also the other as a way to improve cognitive functions like processing speed. If approved, I can’t wait to see what the results are like from the project!

  5. I think it is really cool how tech is merging with therapy and going through the loops of FDA approval like it is a chemical drug. While I definitely think companies are still in the development stages of figuring out what does and doesn’t work in a cognitive setting, I think this is an interesting turning point for medicine, and may have a strong impact on the way we approach treatment, therapy, recovery, and prevention in the future. I’m interested to see if doctors will start recommending games like these as opposed to prescription drugs. For example, an Akili game for ADHD rather than adderall.

  6. Very interesting topic and great post! I had no idea that technology was able to be used for treatment instead of prevention as it is in the brain training category. I have heard of Lumosity, but I never really put too much weight on them actually preventing any diseases. If approved this seems like a great, non invasive, way to treat certain diseases. I could see this being especially effective in younger children since it would be easy to have them buy into playing a game instead of taking a medication. Hopefully Akili gets approval and help transform the medical industry!

  7. The approach of FDA approval first is a smart one and an option that I think will help establish this company as a trusted source for treatment. Hadn’t thought about Luminosity in a while, and I’m actually really surprised that they got dinged for false advertising by the FTC considering how innocuous this seems compared to other pretty blatant false and harmful advertising. Between this and the HIPPA compliant Amazon voice skills news from earlier this week, compliance with government regulations will open the door for tech companies to seek regulatory approval to pursue the medical sector and improving the medical experience for both patients and administration.

  8. I love love love this post! I had no idea that such an innovative way to treat patients was becoming available and I think any time we can solve an issue without resorting to medication is ideal. Based on the images you supplied it looks like this technology would be most beneficial to children so I think it’s great that the company is willing to pay the upfront costs too get FDA approval rather than jump to trial testing that can be uncertain.
    I for one hope this gets approved so I can try it!

  9. Really interesting blog! The intersection of tech and health (mental and physical) has intrigued me for quite some time. I started using Headspace my sophomore year, when I noticed I was experiencing a lot of anxiety, and have continued use it fairly regularly to help maintain my mental health. Similarly, I use an app to track my workouts and amounts of protein consumed in a given day. While it wouldn’t be terribly difficult to give up either of these and switch to good ole’ pen and paper, I definitely think it would be harder to maintain the routine. Additionally, I have done some research into treatment of depression and anxiety using Cognitive Behavioral Therapy (CBT) techniques, and I’ve concluded that there’s a decent chance that apps teaching CBT will disrupt the therapy industry, as it seems Akili is trying to do. That sort of tech is easily scalable, and while it isn’t a substitute for real human connection, it could easily be used to supplement the work of therapists and track progress. Really excited to see how this plays out!

  10. This is so cool! I love the idea of using apps and the like instead of, or even as a supplement to, prescription medicines. I have several friends with ADHD whose decision to take their meds on a daily basis will depend on what they need to do that day, as the side effects can be so prominent.

    As these diagnoses contain to rise, especially among young children, having alternative treatments available will offer a great deal of flexibility to both parents and children. I’m really excited to see where this goes!

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