The age of digital medicine is here

Digital therapeutics are the new biosimilars
Digital health innovation happens everywhere
AI is unlocking the power of healthcare big data

As technology and traditional healthcare converge, Dr Paul Tunnah reflects on trends in cutting-edge innovation and the current state of play in digital health

Andrew Thompson, CEO of Proteus, made a bold claim in his opening keynote at the recent Frontiers Health conference, stating that the FDA approval of Abilify MyCite, combining his company’s digital tracking technology with Otsuka’s schizophrenia medicine, represented the biggest revolution in medicine in over 30 years.

He told the audience at Berlin’s historic Funkhaus venue in November that he believes Proteus is driving the birth of an entirely new industry, called ‘digital medicines’, in the same way that Genentech launched the now ubiquitous biotech industry with the approval of the first synthetically-manufactured human insulin, back in 1982.

Some could contest his claim that in time every therapeutic intervention will be digitally-enabled, and time will tell whether Proteus remains the leader here, but it’s hard to ignore the paradigm shift happening in front of our eyes. Based on what I saw in Berlin at Frontiers Health here are my three key conclusions on where digital medicine is heading.

1. Digital therapeutics are the new biosimilars

The phrase ‘beyond the pill’ has been around a while, referring to digital applications that complement traditional chemical and biological medicines to help ensure the right patients take them as intended.

However, a new wave of technologies is emerging that can act alone, potentially even replacing existing pharmacological therapies. The Digital Therapeutics Alliance (DTA) is spearheading this market by working on industry definitions and looking to focus minds on industry-wide challenges – such as interoperability, plus collaborating on different industry partnerships, including one focused on producing drug monographs for digital therapeutics (or DTx) and mapping them to the drug industry.

It’s already a big space. More than 170 companies are developing digital therapeutics, with over $1.7 billion invested in the area and it’s certainly a field that has piqued pharma’s interest, with at least 15 companies having backed it financially or formed partnerships with digital therapeutics firms.

Sophie Park, chief strategy officer at Bayer’s G4A programme, used Frontiers Health to proclaim the emergence of digital therapeutics as an exciting expansion of the medical landscape, stating “it’s changing the way that we deliver healthcare and changing what healthcare can be”.

A key moment arrived in December when the UK’s National Institute for Health and Care Excellence (NICE) issued its guidance on how local commissioners can better assess digital therapeutics, which is sure to be read closely by the rest of the world. How payers perceive the new digital therapeutics industry remains to be seen and the devil will be in the detail when it comes to how they and insurers assess value here, but they will have to find a way.

On a digital therapeutics panel at Frontiers Health, when Sandoz’s head of digital André Heeg was asked about the digitalisation process at his company he said: “Sandoz has made a strategic decision to pursue digital therapeutics. We have a history of making bold decisions and we envisage a similar future for DTx as biosimilars have had.”

It is indeed a bold claim, but there are distinct parallels between digital therapeutics and biosimilars in combining high levels of innovation and personalisation with faster development than novel medicines.

2. Digital health innovation happens everywhere

To reflect further on Andrew Thompson’s opening remarks, digital health is not far behind biotech, judging from the breadth and depth of start-up talent on display at Frontiers Health.

We’re also starting to see similar partnership ecosystems for medicines licensing and acquisition spring up everywhere within big pharma for dealing with digital. It feels a lot like a dating game between big and small companies, all chasing the aim of bringing the coolest tech to market.

For example, Bayer’s G4A brought this year’s cohort of start-ups from its programme to the event. This included Canada’s proteome screening firm Cyclica, which has an AI-augmented, cloud-based platform for drug discovery that looks to solve the problem of small molecules interacting with anything from 30 to 300 separate ‘off-target’ drugs. The potential for accelerating an R&D process practically unchanged for decades is massive.

The second day of the event saw even more start-ups pitching their business to the assembled pool of health tech investors, with far too many to mention individually here so I’ll just provide a taste.

Amicomed is addressing what is often called the ‘silent killer’ of hypertension, which is responsible for a high level of morbidity, through its multimodal platform to monitor and help manage it in a manner personalised to each patient. Asked about scalability, CEO Giangiacomo Rocco di Torrepadula said his firm is moving more and more towards data and analysis – a common focus for many start-ups.

Positioned as “a gorgeous watch designed to save lives”, Embrace from Empatica has been developed for use in epilepsy management. Co-founder and CEO, Matteo Lai, explained how they crowdfunded the device to run a clinical trial before it was approved by the FDA and only then sought Series A funding. The aim for the device is for it to be able to detect and eventually predict/avoid seizures.

In oncology, Savor Health is addressing nutrition in cancer patients, with the claim that tackling this can reduce hospitalisation, improve adherence and help patients better cope with treatment.

Several start-ups are aimed more broadly at helping patients manage the healthcare process. Medbelle allows patients to book procedures and pay online while the platform books rooms and schedules treatment for them, combining consultation, education and diary management in one interface. Similarly, Vivy is billing itself as a smartphone-based personal healthcare assistant, helping patients access their medical data 24/7.

Eugene Borukhovich, global head of digital health incubation and innovation at Bayer, talking about how the company franchised its G4A programme around the world, summed up the talent on display in Berlin very succinctly: “Innovation happens everywhere.”

3. AI is unlocking the power of healthcare big data

There has been a lot of hype about healthcare big data and it’s a subject that, in its many forms, loomed large at Frontiers Health 2018. However, the conversation seems to have moved on to artificial intelligence (AI) and its power to unlock insights from data.

Manish Marotkar, head of global strategy and business development for med tech company Siemens Healthineers, spoke about turning data into insights with AI, and noted that “the industry has been speaking a lot about AI, what it can do and how it can change the rules of the game”. While traditional machine learning is not a new concept, he acknowledged that the rapid evolution of processing power is now changing the game.

Data really has the potential to save lives, noted Dr Maximilian Kerz, chief technologist for digital health at Bayer’s G4A. He believes that smart data analysis can help both pharma companies manage increasingly expensive drug development and patients receive better outcomes: “We believe real-world data is the key. It can allow evaluation decisions to be made quicker.”

So how does this data-hungry healthcare start-up ecosystem fit in with the technology giants? Time will tell, but the medical industry is also keeping a close eye on the major players, including Apple, which has signalled serious intent here.

What is clear is that historically the generation of health data has moved more rapidly than the ability to know what to do with it – but that appears to be rapidly changing with AI and other problem-solving computing techniques.

It’s a testament to the concentration of digital innovation minds at Frontiers Health that even these three trends just felt like they scratched the surface of how technology and traditional healthcare is converging.

To leave the final word to Andrew Thompson: “This is the healthcare opportunity of a lifetime.”

After two days of cutting-edge healthcare innovation at Frontiers Health it’s hard to disagree with him – the age of digital medicine is here.

Dr Paul Tunnah is pharmaphorum’s CEO. He founded pharmaphorum in 2009 and is a respected expert in healthcare social media and content-based engagement.

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