Digital medicine and treatment development for brain disorders
One of the most famous quotes attributed to Charles Darwin is “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.” In a world in which there are more mobile phones than cars, in which our memories – and medical records – reside in the cloud, in which 3D printing makes it possible to print organs that can then be implanted, in which artificial intelligence and big data allow us to do things that were unthinkable just a few years ago, and in which medical e-visits are becoming the rule rather than the exception, we need to make sure that we get the best that digital medicine has to offer to patients with brain disorders. The digital (and very much App) economy in healthcare is already here, and digital tools designed for brain disorders are at the forefront of this boom. And it should now be clear that they are here to stay (and transforming rapidly).
Clinical trials have recently been published in depression, anxiety, eating disorders, schizophrenia, Alzheimer´s disease, Parkinson’s disease, and many other brain disorders comparing internet tools (online CBT, psychoeducation, symptom monitoring, etc.) to standard care with promising results. The FDA has approved an antipsychotic with a sensor that digitally tracks whether patients have ingested their medication, which may improve adherence but will surely increase measurement adherence in clinical trials. Many papers have been published, talks have been given, and money has been invested in the use of big data in mental health and brain disorders. However, enthusiasm for the changes that digital medicine will bring about should be tempered by the recognition that, at present, we are still at the stage where there is abundant exuberance and excessive hype. There is a clear need to apply the same stringent criteria to digital medicine that we apply to drugs in RCTs in order to gather evidence-based information about real effectiveness.
As with all changes throughout history, there are many potential challenges and issues. Patient access, lack of a personal relationship/lack of emotional contact (will algorithms ever solve this?), and privacy and ethical risks are just a few of them.
The role of digital medicine in therapy development for brain disorders, in its broadest sense, will be discussed at the next ECNP New Frontiers Meeting, which will take place on 10-11 March 2019 in Nice, France. Representatives from IT, the pharma and medical devices industry, regulators, and patient and family associations will discuss their different points of view on the opportunities and risks that digital medicine implies for treatment development for brain disorders.
Going back to Darwin… he also stated that “Intelligence is based on how efficient a species became at doing the things they need to survive.” Let us not be fools.