Better Health With Digital Therapeutics

Illustration by Gloria Dilanni

Technology has seeped into nearly every aspect of our lives, leading us to become data-driven. When it comes to health, for instance, many of us track each day the number of footsteps we take, stairs we climb and calories we burn. For those who are so inclined, there’s even a new toothbrush on the market that records how often and effectively you brush, and links with a mobile app to display your brushing data in a bar graph.

But in the burgeoning field of digital therapeutics, opportunities to improve health have progressed beyond mere tracking to include an array of interactive software and devices that help prevent, treat or manage mental, as well as physical, disorders or disease. There are, for example, smart watches that guide wearers through calming deep-breathing exercises, apps that prompt people with diabetes to check their blood glucose, and virtual-reality headgear sets that help assess and diagnose ADHD.

Digital therapeutics can extend the reach of clinicians by nature of their ’round-the-clock availability and enable better communication between provider and patient. “[They] provide access if there are barriers to care, and I think empower patients to be more involved in their health care,” says Lauren McMullen, M.S.N., A.P.R.N., N.P.-C., a nurse practitioner at Appledore Family Medicine in Portsmouth.

They also nudge people toward replacing harmful behaviors with a repertoire of good habits. “[These] are tools that can literally be with you in your pocket, like a clinician in your pocket 24/7,” says Lisa A. Marsch, Ph.D., director of the Center for Technology and Behavioral Health at the Geisel School of Medicine at Dartmouth College. Because they are accessible on demand, people who, say, struggle with drug addiction and feel at risk of relapse at 2 a.m. on a Saturday night can reach for the digital therapeutic on their phone to help them at that moment.

Researchers have seen encouraging indications of digital therapeutics’ ability to improve health-related behavior. One digital treatment, for example, when offered as part of addiction treatment, roughly doubled abstinence rates from drug use, Marsch says. Digital therapeutics have also improved depression and anxiety, medication compliance and exercise habits, and have helped people manage diabetes.

Indeed, digital therapeutics have brought significant results across many health domains, and have evolved to the point where now “you can predict that a person with bipolar disorder looks like they’re at risk of a manic episode, or a person with a substance-use disorder … looks like they’re at risk of a relapse,” Marsch says. “With that kind of data, you can trigger an in-the-moment intervention right there and then that might prevent escalation” of the problem.

With continuous gains in technological capabilities, plus the prevalence of smart devices — “No one leaves home without their phone now,” McMullen points out — possible applications of digital therapeutics seem endless. COVID-19 also helped propel their advancement, particularly because it led insurance companies to recognize the need for digital approaches to health. “It’s one of the best things to come out of COVID-19,” McMullen says.

While some people seek out digital therapeutics on their own, such as when they download a mindfulness app, some health care providers actively integrate technology-based interventions into their practice. “I think there’s tremendous value in direct-to-consumer kinds of models and people seeking self-help around using these types of tools,” Marsch says. The challenge is knowing which ones, among the thousands that claim to be useful, are most effective.

It helps that beginning in 2017, the FDA began to designate some products as “prescription digital therapeutics” after vetting them for safety and effectiveness. However, many others exist that are also effective and safe, but “haven’t gone down that regulatory pathway,” Marsch says.

Another drawback to digital therapeutics is the privacy and ethical concerns that they raise. Predictive models capture lots and lots of data about people’s behavior. “Do people understand what they’re sharing? Who’s getting the data? What is it being used for? Who’s responsible for the monitoring of this and the intervention? There are a lot of really important ethical questions in this space,” Marsch says.

Still, a growing number of consumers and health care providers are embracing digital therapeutics. “We see a lot of excitement [among clinicians] now,” Marsch says, as they’ve come to appreciate the actionable data, 24/7 help for patients, and opportunities for personalized health resources that digital approaches provide.

Digital therapeutics are the future of health care, Marsch says. “Digital health is not going to go away; it’s going to grow. I’m sure of it.” 

Too much information?

The ubiquitous digital health trackers that you see on nearly every wrist these days provide a valuable window into people’s behavior and a great service by prompting people to sit less, exercise more, and integrate other healthful behavior into each day. Sometimes our gizmos get the best of us though, as they create obsessive worry that does more harm than good.

Sleep trackers, for example, have been known to create such unease that, ironically, they interfere with sleep, as their users fret about their tracker’s reports of insufficient or poor-quality sleep during previous nights.

“If a person’s watch picks up on an erratic heartbeat and they bring that to my attention, that’s really helpful,” says Lauren McMullen, M.S.N., A.P.R.N., N.P.-C., a nurse practitioner at Appledore Family Medicine in Portsmouth. “But I think having constant access to your heart rate and all these things can sometimes create anxiety.”

McMullen advises that people discuss their use of trackers and any concerns related to them with their providers. “We try to empower people and teach them to use technology,” she says, “but not too much.”