Digital therapeutics have made surprising progress. This is good news, because digital therapeutics are typically cheap, and they have shown impressive ability to change behavior, one of the most important challenges in healthcare.
Dr. Joe Kvedar of Partners Healthcare and his co-authors recently published a very useful book, The Internet Of Healthy Things. Joe has led Partners’ efforts in connected health (using technology to connect Partners’ medical resources to patients outside the hospital) for 20 years, beginning before the era of smart phones and web-based services. Much of his material is familiar to me, however, I was quite impressed by the progress he describes on multiple fronts with digital therapeutics.
The term “digital therapeutics” refers to using a digital system to treat a medical condition, much as one might use a drug, a human counselor, or surgery. Digital therapeutics are used both stand-alone and in combination with conventional therapies.
Digital therapeutics excite me because they can effect behavior change, and behavior change is vital to progress against two major challenges facing healthcare in developed countries: chronic diseases, which drive over 80% of U.S. healthcare spending are strongly rooted in unhealthy behaviors, and poor drug compliance, a $300 billion problem in the U.S. (1). Conventional medical treatment struggles to change patient behavior and has not been able to solve the drug adherence problem.
Kvedar cites a surprising number of successful digital therapeutics (2):
Proteus (a California startup) has developed an ingestible radio tag that, when incorporated into pills, communicates with a sensor device worn on the abdomen. Together they track when medications are taken and continuously record vital signs of the user. The data enables providers to monitor drug adherence and analyze the effect of the drug and the user’s vital signs. This data is motivating for users: they know their providers are tracking their progress [Kvedar calls this the “sentinel effect”], and they can see better the connection between taking their medication, their lifestyle choices, and how well they are doing. The Proteus product has received FDA clearance as a medical sensor and is in commercial use in the U.S. and by the U.K. National Health Service.
Partners Connected Health conducted an internal study of teen-agers with asthma. They are a notoriously hard population to manage to compliance with medication and behavior regimens, for just the reasons you might suspect. As a result, they are frequent fliers to the emergency room creating high family stress and costs. Partners created a private Facebook group for it’s asthmatic teen-agers. The results were remarkable: engagement and compliance soared. The level of asthma control achieved was equal or better than that measured for a new asthma inhaler product. And the teen-agers liked the approach so much that they petitioned Partners to extend the study.
In another internal study, Partners designed an app to help cancer survivors manage pain during cancer treatment. Pain is common, but survivors report it to providers in only 35% of occurrences. The app, which made it easy to report pain without feeling like a complainer and order refills of palliative medications, increased the reporting rate to 80%. The pay-off here is quality of life.
Omada Health (a startup) has created “Prevent”, a digital, on-line, interactive lifestyle intervention program targeted to people with pre-diabetes. The Omada program involves human health coaches, however, the digital platform enables them to be highly efficient and timely in their interactions with users. It is approved by the U.S. Centers for Disease Control. Peer-reviewed studies show that Omada works as well and sometimes better than face-to-face counseling. Users of Prevent achieved significant reductions in weight and A1c (a blood sugar measure that is a key biomarker for diabetes risk) and sustained them for two years, with average A1c levels dropping below the pre-diabetic threshold, in contrast to the expected progression to higher levels.
WellDoc’s BlueStar product guides diabetic people to optimize their insulin doses (amount and time) to control their blood sugar, and it shows them how their need for insulin interacts with their behavior. The app uses data and algorithms to provide what the FDA considers medical advice. In 2013 BlueStar was the first mobile therapy to be approved by the FDA as a Class II medical device. BlueStar’s results are impressive: clinical trials showed that BlueStar produced reductions in A1c levels over 2x the reductions achieved by people using the usual standard of care, and 2x the threshold for approval for a new diabetes drug.
Twine is a startup digital therapeutics company helping people with hypertension (high blood pressure). Its approach is broadly similar to Omada. And results have been strong: a 2014 study reported that 100% of users brought their blood pressure down to 140/90 (below the threshold for Stage 1 hypertension) within 90 days, versus about 30% typical success rate with conventional therapy (3).
And, there are other examples of digital therapeutics that are building impressive records of engagement effectiveness, particularly in the area of nutrition and healthy eating.
The take-aways: digital therapeutics can be as or more effective than conventional therapies which are typically based on drugs and intermittent face-to-face coaching. Digital therapeutics are much more scalable than drug-based therapies and human providers, which have high variable cost, and can be highly cost-effective for that reason. And [this bears repeating] they are effective in changing behavior, which is the biggest challenge to 21st century healthcare in the U.S.
But digital therapeutics require new skills and approaches to design, often drawn from the consumer internet, and new types of interaction and skill sets for providers. People across the medical spectrum will need to learn to think a bit outside the [pill] box.
I am a partner in NAV.VC, a venture capital fund. Neither I nor NAV.VC have a financial interest in any of the companies mentioned in this post. We do invest in similar companies.
