Is the mobile app ready to replace your pill?

Moreover, the app measures her joint movements and suggests that her knee can go without a surgery for almost five years based on the degree of movement and a few other parameters. No pills, no side-effects or physical therapy visits, the entire treatment can be accessed from the app store through a prescription given by her doctor.

Sounds like a byte from a Star-Trek episode, but given the pace at which digital therapeutics is evolving, these treatment modalities might be accessible to all of us way sooner than 2050. So, the first question that arises for many of us is, what is digital therapeutics? Digital therapeutics is a health discipline and treatment option that utilizes digital and often online health technologies to treat a medical or psychological condition. 

Usually the treatment relies on behavioral and lifestyle changes usually spurred by a collection of digital impetuses. While the initial application of such solutions started mainly with cognitive and psychological disorders, with expanding advent of technology now companies are targeting a wide variety of diseases including diabetes, heart failure, obesity, Alzheimer’s disease, dementia, asthma, substance abuse, ADHD, panic attacks, anxiety, depression, and several others. 

The US is currently leading the way in terms of development and adoption of digital therapeutics (also known as digital medicine). They define it as clinicallyvalidated, FDA approved, prescription disease management and treatment technologies that can enhance or replace current medical treatments. It is classified into two broad categories:

Digital companions: Digital solutions clinically proven to support patients and enable them to self-manage / coordinate with providers while on a medical treatment for a specific disease. 

Replacement therapies: Digital solutions that can be used to treat a specific disease instead of a pharmaceutical product (essentially replacing the need for the pharmaceutical product). 

Big Health, a San Francisco-based start-up recently launched Sleepio, a digital sleep improvement programme featuring Cognitive Behavioral Therapy (CBT) techniques to help overcome long-term poor sleep. Sleepio has been scientifically designed and clinically validated for improving sleep quality. The application is already accessible to over a million people through their insurers. 

Pear  Therapeutics, another Boston-based company, considered a pioneer in this area, is working on treatment for ten diseases ranging from psychiatric disorders to autoimmune conditions and cancers. Now they are partnering with pharma companies such as Novartis to commercially distribute these products to patients at scale. Extending their commitment they established PearConnect, a first of a kind patient service centre helping with relevant patient guidance, physician monitoring of patient condition and timely insurance reimbursements. 

Wellthy Therapeutics, a Mumbai-based company recently became the first Indian company in this category. Wellthy has an application to manage diabetes, which  has clinically proven results across multiple studies and was well received by diabetologist and endocrinologists recently at RSSSDI, Asia’s largest diabetes conference. 

But are all mobile and desktop health applications considered digital therapeutics? No, it is only those digital solutions that are focused on treatment, have evidence proving their outcomes and that require to be prescribed by a physician form this niche category. A regular fitness app that connects to your pedometer or measures calories is not a digital therapeutic. We see the Internet loaded with thousands of such solutions that claim to improve health, but it only leaves the patient with a problem of plenty and makes it difficult to choose the right solution. 

Digital  therapeutics is an evidence-based solution where clinical studies have been conducted to measure the safety and efficacy of the solution. It allows clear data to make an informed selection of the right solution, overcoming the problem faced by patients in selecting the right solution. Moreover, the selection here is made by the physician and not the patient, adding a layer of right expertise during selection. 

With such rapid evolution in the area of digital therapeutics, the key question is why is it better as compared to traditional medicine? There numerous aspects making these treatments highly desirable including ease of access, lower cost, fewer side-effects, non-invasive nature, ease of monitoring and personalisation. It has to be created once and can be accessed by millions of patients with almost no incremental cost. With mobile and Internet penetration spreading rapidly to remote parts of India, it is also much easier to distribute. Given the digital nature, data is continuously generated and tracked, helping overcome the issue of non-adherence in chronic diseases, helping improve treatment outcomes. 

With all its advantages, can digital therapeutics replace conventional medicines? No. Digital therapeutics by design work only in certain situations, usually ones that are chronic in nature requiring a long-term treatment and where lifestyle changes, physical therapy, dose alteration, continuous monitoring, etc. have a considerable role. For example, digital therapeutics might not be as effective in relieving acute pain in a joint or splitting headache that hits a migraine patient as a pain killer. But it can help with a structured posture and exercise programme for relieving joint pain in the longer run, or a meditation programme that can prevent migraine episodes over time. 

As our understanding of various diseases evolves, digital solutions will start becoming more and more relevant in terms of either supplementing or complimenting current treatment. Moreover, wider development and adoption of digital solutions will also require maturity and evolution by the industry as a whole. Doctors and hospitals will have to evolve in understanding and prescribing these treatments, regulators will need to develop sophistication to evaluate digital solutions and insurers will have to learn to model reimbursement and risk-benefit ratio. 

While there is more work to be done to get digital therapeutics in the hands of every other patient, the future is not as distant as it may seem.