Inside the push to get doctors to prescribe video games
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Hundreds of patients with mental illness are signing up to test an unusual experimental treatment: video games.

It’s part of a bold push by several companies, led by two Boston startups, to secure permission from federal regulators to market their video games as medical therapies, to be prescribed by physicians for conditions ranging from depression to autism to even, perhaps, Alzheimer’s disease.

The video games look familiar at first glance. They transport the player to virtual worlds — an icy river in one, a tropical island in another — and present challenges such as racing around obstacles or hunting for treasure.

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But the developers say their games, often based on prototypes developed in academic labs, will offer genuine relief for patients when prescribed either as standalone treatments or alongside traditional drugs. Patients of all ages have signed up for the national clinical trials. And the startups — Pear Therapeutics and Akili Interactive Labs, both based in Boston — are beginning to draw heavyweight backing from big pharma, venture capital, and a patient foundation.

But they have a long way to go in convincing doctors and scientists.

“We have a lot of findings, but none of them are specific enough right now to be clinically used,” said Dr. Gagan Joshi, a Massachusetts General Hospital psychiatrist who works with high-functioning autistic patients. He worries about them wasting time with unproven games, instead of taking advantage of validated interventions such as social skills training.

A 2013 analysis that looked at 46 experiments found video-game play yielded “negligible” effects for players’ executive functions, which are the mental skills responsible for everything from remembering details to switching focus.

Playing video games yields “small to no effects at all in terms of broader cognitive abilities” across age groups, said Ulrich Mayr, a neuroscientist at the University of Oregon.

The Italian Institute for AuxologyPear Therapeutics is developing a therapy game for anxiety based on the work of cognitive scientists at the Italian Institute for Auxology in Italy.

Games as ‘electronic medicine’

To try to counter these doubts, companies are drawing explicit contrasts between their targeted products, which aim to treat specific groups — such as preteens with attention deficit hyperactivity disorder — and the mass-market blockbusters produced by companies like Lumosity.

Though Lumosity says its wildly popular “brain training” games were designed by neuroscientists and can boost cognitive skills, it doesn’t claim that they treat disease and, thus, don’t need permission from the Food and Drug Administration to sell them. Lumosity did not respond to repeated requests for comment.

Corey McCann, chief executive of Pear Therapeutics, is quick to distinguish “the Lumositys of the world” from his own team, which he described as  “a bunch of stodgy clinical and regulatory folks like myself.”

And at Akili, CEO Eddie Martucci calls his approach and the commercial brain-training business “two different industries.” To underscore the difference, Akili has trademarked the phrase “electronic medicine” to describe its video games.

10/7/2015 - Boston, MA - Akili - This is most of the team at Akili. From left: Eddie Martucci, cq, CEO; Scott Kellogg, cq, VP; Ashely Mateus, cq, senior manager for product strategy; Isabella Slaby, cq, clinical coordinator; and Jeff Bower, cq, director of data science. Akili is a company that seeks to create clinically-validated cognitive therapeutics, assessments, and diagnostics that look and feel like high-quality video games.
Dina Rudick/The Boston GlobeAkili staff members, from left, CEO Eddie Martucci, VP Scott Kellogg, senior manager Ashley Mateus, clinical coordinator Isabella Slaby, and director of data science Jeff Bower.

The companies also take pains to highlight their roots in academia, since researchers around the world have long been studying the therapeutic potential of video games. Akili’s game is based on a prototype licensed from a lab at the University of California, San Francisco; Pear’s game for anxiety came out of an Italian institute.

Therapeutic gaming advocates are betting on the science of brain plasticity, which suggests that the brain can modify itself in response to interactions with the environment. The idea is that playing a well-designed video game can help patients get better at multitasking, staying focused, processing information, or relaxing — and that these cognitive gains can be transferred beyond the game to relieve symptoms of medical conditions.

“It wasn’t going to be another snake-oil app”

Dan Smith, Autism Speaks venture capital arm

The FDA has cleared a handful of medical devices with gamified elements in the past, such as software made by Seattle-based Jintronix that turns physical therapy exercises into games. But the agency wouldn’t comment on companies seeking approval or clearance for therapeutic video games. No decisions are imminent.

Growing interest from big pharma

Even so, the concept of therapeutic gaming is beginning to draw high-level attention from investors who traditionally work in the health space — and who have shied away from the online brain-training industry.

Take Akili: It counts the pharmaceutical company Shire as an early investor and research backer. Also funding its research: pharma industry titan Pfizer. And the patient advocacy group Autism Speaks pledged $500,000 to help bankroll an upcoming clinical trial with autistic children.

“It wasn’t going to be another snake-oil app or electronic device sitting out there in the space without basis on real science,” said Dan Smith, who runs the group’s venture capital arm.

Venture funding that typically flows to life science industries, such as biotech drug development, is beginning to reach game developers, too.

Akili has backing from PureTech, a Boston-based venture firm and incubator of health-related startups. 5AM Ventures, a venture capital firm which focuses on life sciences companies, recently invested in Pear Therapeutics. And two angel investors committed $1 million to Atlanta-based Amblyotech, which seeks to treat lazy eye with a game that sends players digging for gold and treasure.

There’s even public money in the mix. Researchers at the University of California, San Francisco have an $800,000 federal grant, in part to study Akili’s game in patients with depression.

10/7/2015 - Boston, MA - Akili - Eddie Martucci, cq, right, the CEO of Akili, cq, talks about Akili's video game "Project: EVO" with Jeff Bower, cq, Akili's director of data science. Akili is a company that seeks to create clinically-validated cognitive therapeutics, assessments, and diagnostics that look and feel like high-quality video games. Topic: xxSTATvideogame. Story by Alissa Ambrose/Globe Staff. Dina Rudick/Globe Staff.
Dina Rudick/The Boston GlobeCEO Eddie Martucci, right, discusses Akili’s video game “Project: EVO” with Jeff Bower, Akili’s director of data science.

All the investments, so far, are small compared to the vast sums poured into traditional drug development. Yet they signal growing interest and the hope that therapeutic video games could one day be a lucrative market, especially for pharmaceutical companies.

Pear’s business model, for example, could effectively extend patent protection on highly lucrative prescription medications. Each prescription for a condition such as depression or anxiety would come with both traditional pills and a code to access a video game.

Other companies are working on standalone games that could appeal to patients for whom traditional drugs don’t work — or who just don’t want to take conventional medicines. “There are a lot of parents out there who are unwilling to put their kids on Ritalin” for attention deficit hyperactivity disorder, said Zack Lynch, executive director of the Neurotechnology Industry Organization, a trade group.

Akili, for instance, wants physicians to prescribe games to treat ADHD, autism, and depression.

Late last month, the company reported that after a month of playing its game, 40 preteens with ADHD performed better on tests measuring attention span, impulsivity, and working memory. Akili’s next step: a large randomized trial of pediatric ADHD patients, planned to start in the coming months.

The company is also testing its game to improve cognitive function in patients with presymptomatic Alzheimer’s disease, although it has yet to report any results in patients.

One version of Akili’s game immerses patients in a frozen world and sends them racing through the icy landscape, dodging jagged icebergs while they tap red fish. Patients would play it 30 minutes a day, five days a week. (To prevent them from spending too much time in front of the screen, the system would lock them out after they met their prescribed “dose” of daily game play.) Physicians could monitor their patients’ performance in real time and adjust treatment accordingly.

Pear’s therapy for anxiety, meanwhile, would seek to boost the effects of conventional medication with software that sends patients to a virtual tropical island to practice deep breathing. In a prototype of the game, a sandy path passes a cascading waterfall and a hammock draped invitingly between two palm trees.

“It’s time to relax your mind. To enjoy some ‘me’ quality time…” a soothing voice intones over the gentle sound of waves lapping against the shore. “Peace and tranquility await you.”

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