Atai's Enabling Technologies; Trends in Digital Health & Neurotech: Part 1
Technologies & Trends Shaping the Future of Psychedelic Medicine
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The upcoming Atai Life Sciences IPO is a good opportunity to look at the role of technology in delivering psychedelic therapies through their clinically oriented enabling technologies, Introspect Digital Therapeutics, Psyber, and Psyprotix.
While the details are limited, we can infer much from what they have disclosed against the broader trends in 1. translational neuroscience, 2. adoption of digital health products, and 3. the movement towards personalized medicine.
In this post, we’ll look at the trends that set the stage for the role of technology in psychedelic therapies.
In Part II, we’ll dive into the companies.
TL;DR
Psychedelic medicine is coming of age with coinciding paradigm shifts in:
Our understanding of the brain and brain health
The adoption of digital technology in healthcare
The movement towards personalized medicine
Lack of innovation in reliable mental health treatments has built up tremendous pressure on a patient population and professional field desperate for solutions.
Software, algorithms, and sensors combined with pharmaceutical drugs enable new strategies for treatment and patent protection.
For an in-depth conversation on the details of Atai’s drug pipeline and forthcoming IPO check out the most recent Business Trip Podcast, hosted by PsyMed Venture’s Matias Serebrinski with Psilocybin Alpha’s Josh Hardman, Michael Haichen, and Graham Pechenik.
Digital Health & Neurotech Trends
“What I would suspect is that in 10, 20, 50 years psychedelics are going to be considered very crude tools... we're going to have much better ways, more precise ways to intervene in this process to occasion experiences of this sort… it doesn’t have to be psychedelics, we’re going to learn more about the nature of these experiences and who knows, there may be a way to do this with electro cranial stimulation or other kinds of manipulation.
Rolland Griffiths, Director, Center for Psychedelic and Consciousness Research at Johns Hopkins
You’re reading this because you have a deep interest in the emerging field of psychedelic science, medicine, and the evolving industry. You recognize the devastating consequences of the growing mental health crisis and see psychedelic medicine as a promising innovation.
However, equally fascinating and significant are the concurrent developments in the realm of digital health technologies, which are increasingly:
Used in the treatment of mental health and
Expected to feature prominently in the future of psychedelic science and medicine.
I am completely fascinated by the intersection of psychedelics and technology, and today, we are looking at the trends psychedelic stakeholders should be aware of.
Science & Healthcare Meta Trends
The timing of the psychedelic emergence is auspicious as three coinciding paradigm shifts are also underway and can be thought of as the “Set and Setting” for the nascent field of psychedelic science and medicine:
The ‘Neuroplastic Revolution’
Adoption and development of Digital Health Technologies
The Personalized Medicine Movement
‘Neuroplastic Revolution’
The concept of neuroplasticity has been around for a while. First proposed in 1894 by Spanish neuroscientist Santiago Ramón y Cajal, it essentially states that the human brain and central nervous system will change their functionality and/or structure in response to environmental stimuli.
Neuroplasticity underpins changes to the brain's connections in response to learning a new skill, developing a new habit, or exposure to repeated stimuli, like meditation.
However, harnessing the power of neuroplasticity for the precise, targeted stimulation of specific brain regions or networks —Applied Neuroplasticity1— is in its infancy.
Neuroplasticity has been relegated to an explanation, not a practice.
This seems about to change with the advent of
Psychedelics and Psychoplastogens
Neuromodulation techniques like Neurofeedback, Virtual Reality, Transcranial Direct Current Stimulation, and Closed-Loop Experiential Medicine
The prospect of targeting specific regions or neural connections with a precise dose of stimulation is firmly on the table. Thus the treatment of mental, emotional, and behavioral health conditions will become increasingly targetted2.
As brain imaging and sensing techniques improve, clinicians will more finely target specific functional and structural changes to treat mental health conditions.
In this future, psychedelics and plasticity-dependent neurotechnologies3 will prove to be the most powerful4 tools for leveraging the brain’s innate capacity for reorganization—and thus the most powerful mental health treatments.
Adoption of Digital Health Technology
If software has been eating the world, then healthcare is one of the last bastions of the pre-internet status quo.
Adopting new technologies5 must be cautious, by consensus, and thus slower than consumer-focused and other corporate segments of the economy.
A milestone in healthcare’s adoption of tech was the 2016 Cures Act which set guidelines for the approval and regulation of medical software, interoperability of electronic health data, and established special patent protections for drug-software combination products. Another is the FDA’s Digital Health Innovation Action Plan.
Academic and commercial projects have taken notice, and the proliferation of digital health studies look remarkably similar to the growth curve of psychedelic studies—up and to the right:
The authority I have come to trust in this arena is Andrea Coravos, CEO of Human First (formerly Elektra Labs), who notes:
“It's clear that software is exerting a powerful force on our health. Recent advancements in clinical-grade wearables, powerful machine learning algorithms, and a forward-looking FDA are giving rise to a new wave of software applications used to measure, diagnose, and treat disease. And unlike previous "digital health," products, which might measure the fuzzy concept of wellness, these software-as-medicine tools demonstrate success in clinical trials.”
There are seemingly endless categories of digital health technology, but two that strike as particularly impactful for the field of psychedelic science and medicine6 are:
Remote Patient Monitoring
Digital Biomarkers via wearables/sensors, etc.
Passive data collection via phone
Neurotechnology
Brain/Neural Activity Imaging (EEG, and emerging technologies like Time Domain function Near-Infrared Spectroscopy (TD-fNIRS))
Brain/Neural stimulation
Electrical stimulation (tDCS)
Self-mediated modulation (neurofeedback)
Experiential modulation (virtual reality, closed-loop technologies)
Simply put, the “tech layer” of psychedelic therapy will consist of a monitoring function and a stimulation function.
Personalized Medicine
Personalized Medicine (PM), or Precision Medicine, refers to the lofty goal of making treatments more individualized based on lifestyle, genetics, and artificial intelligence.
The movement started with the field of genomics, which created a proliferation of diagnostic and treatment techniques based on the presence or absence of certain genes, mutations, or polymorphisms.
However, the promise of PM seems to always be at arm’s length, especially in mental health.
That could be changing with the development in the above-mentioned fields of digital biomarkers, neuroimaging, and stimulation techniques point towards personalization in psychiatry.
There seems to be a new emphasis on real-time analysis of changing parameters like proteins, structural and functional neural connections, and other measurable (and malleable) biomarkers.
From the authors of The revolution of personalized psychiatry: will technology make it happen sooner?:
“Tailoring diagnosis and treatments seems to be an ideal paradigm. A common effort to move beyond our usual practice in clinical and research endeavors, incorporating new technologies in our daily thinking, will enable us to open a new era in psychiatry and behavioral sciences.”
Put succinctly, psychedelic medicine is coming of age at a massive inflection point in our understanding of the brain, the utility and adoption of technology, and the personalization of healthcare7.
Tech Enabled Treatment & IP Strategies
If neuroplasticity, adoption of digital health, and striving towards personalized medicine will affect healthcare at large, then two specific forces are driving the adoption of technology by psychedelic pharma developers:
The challenge of scaling psychedelic therapy
The challenge of protecting investment on molecules in the public domain
Companies like Atai, MindMed, and Compass Pathways, which all have tech divisions, seek to create novel approaches to mental health treatment and proprietary moats using drug-software combination products.
Conventionally, pharmaceutical companies invest heavily in R&D to discover or create new drugs and protect this investment with Composition of Matter patents, the gold standard of IP protection that ensures a market monopoly for years.
This is impossible with the first generation of psychedelic therapies based on classical psychedelics because they have been in the public domain for decades.
One way that psychedelic developers are approaching this is by tweaking the chemical structures of molecules like psilocybin, MDMA, and LSD.
But another is through the creation of Combination Products.
From FDA Combination Products page:
“A combination product is a product composed of any combination of a drug and a device; a biological product and a device; a drug and a biological product; or a drug, device, and a biological product.”
Drug-software Combination Products are gaining in popularity.
The cardinal example of a drug-software combination product is Pear Therapeutics’ Reset-O which combines a prescription smartphone app that provides cognitive behavioral therapy, fluency training, and contingency management, with the prescription drug buprenorphine, for the treatment of Opioid Use Disorder (OUD).
The thinking is that many treatments, such as buprenorphine for OUD, could be improved with a “tech layer” that is low risk and synergistic, thus improving treatment adherence and/or efficacy. And combining a novel technological approach with a well-known, off-patent drug creates new business opportunities.
Looking Ahead
The trends we’ve covered are opening a “neuroplastic window” in which healthcare institutions, systems, and incentives are ripe for transformation.
The combination of psychedelic therapy with Remote Patient Monitoring and Neurotechnology that enables real-time feedback and stimulation represents the two features of the psychedelic therapy “tech layer.”
As stand-alone interventions, psychedelics and neurotechnologies appear to be compelling tools for treatment and transformation—what happens when we combine them?
In Part II, we’ll look at how Atai is thinking about building this functionality through their enabling technologies Introspect, Psyber, and Psyprotix.
Thanks for reading,
Zach
Thanks to Dr. Rhea Mehta, co-founder of Bowhead Health, for reading an early draft and her insightful input.
Researchers, if there is an accepted term for this, please let me know.
The challenge here will be not to lose sight of these conditions' biopsychosocial nature and thus make these tools to empower therapists, not replace them.
Redundant phrasing since that common mechanism of action of all neurotech is some form of change in the brain.
I mean powerful in the most literal sense, P=W/t, where the work (W) is the structural/function modulation of neural connections/pathways.
The timeline for FDA approval is a proxy for broader technology adoption in healthcare.
I am thinking of standardizing the phrase “psychedelic administration” as I try to capture the full range of administered experiences, including 1. Clinical Practice (i.e., Medicalization - Ketamine now, MDMA soon, eventually more) 2. Clinical Research Settings, 3. Retreat and Tourism Settings 4. Citizen Science/Biohacking/Real World Data Settings. Let me know if that works.
The movement towards Value-Based Care also deserves mention, but the three trends highlighted apply to all categories of psychedelic administration, DIY, Legal contexts, and medical settings.