If you’ve ever visited a doctor you’ll probably be aware that drugs dominate healthcare. Almost 60% of Americans use prescription drugs and three quarters of all US doctors’ visits involve prescribing, contributing to over $800bn in global drug sales. But this is about to change. For the first time since the modern drug industry was founded 150 years ago there is a credible alternative: digital medicine.
Digital medicine can be defined as automated psychological therapy. Hundreds of controlled clinical trials have shown non-drug therapies such as cognitive behavioral therapy (CBT) to be effective in achieving sustained improvement in many chronic health conditions, from anxiety to obesity, results that drugs have been unable to achieve. But since they are traditionally delivered by human therapists, such therapies have never attained the broad accessibility of pharmaceuticals. By automating these non-drug techniques, digital medicine harnesses the very qualities that have made drugs so successful - efficient scalability, instant availability, and total consistency.
Consider the standard drug model. A drug company discovers a molecule, tests it, patents it, and eventually manufactures millions of identical copies of it in pill form, at very low per-unit cost. Whether you pop one of those pills in Detroit or New Delhi you’re likely to experience a very similar biochemical effect.
Switch “molecule” for “algorithm” and the dynamics are fundamentally the same. With pure, algorithmic software it’s possible to create near infinite copies at marginal incremental cost. And because it’s automated each individual who uses the software will experience the same therapeutic protocol. In this way digital medicine is more akin to a molecule than a human therapist, avoiding the inconsistencies, off-days and hangovers all too familiar to us humans. And it’s only a visit to the app store away, day or night.
But the real power of digital medicine is its scope to go beyond the traditional drug model, and provide personalized medicine by default. Unlike a drug, digital medicine is driven by a constant feedback loop of data, either reported by the user or passively collected from their devices. This allows it to react in the moment to an individual’s state and provide appropriate help, optimizing the course of treatment over time to each user. This same data can provide unprecedented insight into usage and effectiveness, in turn allowing payment models rooted in outcomes and potentially saving health systems vast sums versus standard care.
Digital medicine will transform how we address chronic disease. With internet access approaching ubiquity, in the next 10 years digital medicine will become first line therapy for common mental health problems. To give a sense of scale: if just 20% those receiving antidepressants in the US alone accessed effective digital medicine, over 60m prescriptions a year could be avoided¹. With more sustainable patient outcomes and less risk than pharmaceutical alternatives, sufferers will for the first time be able to choose non-drug solutions and be empowered to fix their own problems. Clinicians will be able to provide immediate access to psychological treatment, finally allowing clinical guidelines that recommend non-drug solutions to be followed. Communities across the world without developed healthcare infrastructure will be able to access gold-standard psychological medicine. And as a result, we will finally have the tools we need to tackle chronic disease on a global scale.
Peter Hames is CEO and Co-Founder of Big Health, a digital medicine company. Thanks to Prof Colin Espie for his significant contributions.1. Number of prescriptions per year in the US: 314m (IMS Health National Prescription Audit 2015). 20% x 314m = 63m