TMC PULSE

t m c » p u l s e | m a r c h 2 0 1 9 30 Replacing a Pill with an App Digital therapeutics could be part of your doctor's next prescription B y S h a n l e y P i e r c e O n Aug. 25, 2017, Elizabeth Newlin, M.D., watched from her office window as rain engulfed the city. She was part of The University of Texas Health Science Center at Houston (UTHealth) ride-out team during Hurricane Harvey, the catastrophic storm that unleashed more than 50 inches of rain over six days, displacing more than 30,000 people and prompting more than 17,000 rescues. "We knew after a disaster of that magnitude there would be an increase in demand for mental health care. At the same time, we knew that resources were already limited," said Newlin, who serves as the associate executive director at UTHealth's Trauma and Resilience Center. "Many people lost their cars, for example. Transportation to get to appointments became more of a challenge. … In the immediate hours and days following the storm, I started thinking, 'Wow, we're going to need to really think about how to triage and reach people in inno- vative ways because the needs are going to be overwhelming.'" In response to the mental trauma left in Harvey's wake, Newlin spear- headed an effort to create an app for mobile devices that would provide patients with the same psychiatric support they would receive in the clinic. UTHealth partnered with Magellan Health to create the On to Better Health app, which officially launched in January 2019. The app, which is available to all UTHealth Trauma and Resilience Center patients free of charge, offers six different programs: MoodCalmer for depression, which helps break the cycle of negative thinking; FearFighter for anxiety, panic and phobias, which helps users con- front and change their thoughts; ComfortAble for chronic pain; Restore for insomnia and sleep problems; OCFighter for obsessive compulsive disorder; and Shade for alcohol and substance abuse. Each module contains between 4 and 10 sessions that last from 25 to 50 minutes. "It's not unusual for me to recom- mend an app to one of my patients," Newlin said. "There's an app for just about everything now." The app has undergone 12 clinical trials and covers the selected conditions because of their prevalence among the adult pop- ulation, said Summer Danner, program coor- dinator at UTHealth. "These conditions are present in over 25 percent of all adults and make up 90 per- cent of behavioral health complaints," Danner said. A spoonful of software UTHealth's On to Better Health app is just one example of a new, emerg- ing trend in medicine called digital therapeutics. "[Digital therapeutics] is a digital product delivering an intervention to a patient with a goal of preventing, managing, or treating a disease and optimizing medication," said Megan Coder, executive director of the Digital Therapeutics Alliance, a non-profit trade organization. Delivering personalized medi- cine with a few taps and swipes on patients' smartphones is the next medical frontier. According to McKinsey & Company, a global management consulting firm, there are two types of digital therapeutics: digital companions, used to augment treatments along with a health care provider; and replacement thera- pies, which—as the name suggests— potentially replace traditional pharmaceutical drugs. Much like UTHealth's On to Better Health app, the U.S. Department of Veterans Affairs (VA) developed several digital The app uses cognitive behavioral therapy (CBT), which is considered the gold standard of psychotherapy for treating a wide range of mental health issues. Experts tout it as an extremely effective, evidence-based intervention for psychological disorders without a high price tag or potential side effects from psychotro- pic drugs (including antidepressants, antipsychotics and mood stabilizers), which work by influencing the neuro- chemicals that regulate emotions and thought patterns. "CBT is a type of talk therapy that helps people identify and develop skills that help them change their negative thought patterns and behaviors," Newlin explained. "By changing their negative or distorted thoughts or behaviors they've devel- oped over time as a result of living with pain, for example, they can change their awareness and develop better ways to cope with that pain— even if their actual physical level of pain stays the same. In other words, the focus can shift from 'I have to get rid of this pain. I have to stop this pain' to 'How can I live more effectively and experience my life differently despite this pain?'" Credit: Xiaomeng Yang

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