Can Health Technology Replace Our Need for Drugs?

Can Health Technology Replace Our Need for Drugs?
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Pharmaceutical drugs have an important place in modern health care. In all sorts of cases, they bring us relief from ailments and improve our quality of life. However, in the United States, we seem to be reaching for medication faster than ever before. For instance, although patients report unchanged levels of pain from years past, the sale of prescription opioid drugs continues to increase.

Finding alternative ways to manage different health conditions, therefore, is a valuable endeavor.

Different technologies are now being developed that could potentially reduce the need for pharmaceutical intervention and, in many cases, help make disease management easier. Often medication reduction through digital health is about using these tools to stimulate and modulate our body's systems to achieve the best balance possible. Health technology is also being used to provide symptom tracking, treatment management, and data collection. But are these innovations really helping us get better?

New Digital Therapeutics

Investors and startups are exploring how to replace medication with digital interventions delivered through smartphones. The so-called digital therapeutics or “digiceuticals” are provided in different forms—from online therapy programs to digital health tracking sensors. The advantage of digital therapeutics is that they usually do not require FDA approval (which can be a lengthy procedure), are generally low in cost, and do not inherently have side effects.

Digital Insomnia Treatment

Big Health is a startup that promises “good mental health without pills or potions.” Backed by science and evidence, their online therapy program aims to heal insomnia. Their program, called Sleepio, was designed by Dr. Colin Espie, a professor of sleep medicine at the University of Oxford.

The program starts with an online test to establish the user’s baseline with an overall sleep score. A personalized program is then designed for the user. Those who have severe sleeping problems get access to a full cognitive behavioral therapy (CBT) program as well as support from a virtual assistant, The Prof (and his narcoleptic dog Pavlov).

A review of the Sleepio program that was done at the University of Houston’s Sleep and Anxiety Center of Houston showed that after six weeks of treatment, outcomes were comparable to face-to-face CBT therapy. Moreover, the online program was assessed as offering a personalized experience and could be used as a stand-alone intervention for those lacking sleep.

Digital Management of Asthma

In some cases, digital companies are also starting to build alliances with the pharmaceutical industry. For example, Propeller Health—a company specializing in digital solutions for respiratory medicine—has been cooperating with GlaxoSmithKline (GSK). Propeller and GSK are combining their approaches and using the Propeller’s clip-on sensor in conjunction with GSK’s asthma medicine.

Patients can attach the Propeller sensor to their inhaler to monitor the inhaler’s use.

The feedback they receive from the Propeller app can help them reduce their medication intake.

A study published in The Journal of Allergy and Clinical Immunology that looked at the effectiveness of Propeller found that patients using the Propeller Health Asthma Platform reduced their intake of short-acting β-agonist (SABA), a medicine that provides quick relief of asthma symptoms. Moreover, they had more SABA-free days and generally managed their condition better when compared to those using traditional care. The study also showed that digital tools like this can encourage self-management, which can make an important contribution to treatment outcomes.

Digital Pain Relief

According to the National Academy of Science, approximately 100 million Americans deal with chronic pain that can last anywhere from a few weeks to years. Different health tech innovations are being promoted to reduce the need for painkillers.

Digital Help for Back Pain

Lower back pain is the most common type of chronic pain. When searching for ways to improve their condition, many people look for a good mattress that can support their back. Now, sleep technology has been used in an innovative way to design the first smart bed, the ReST Bed, which is aimed at people who experience back, neck and shoulder pain.

This mattress automatically changes the firmness of five distinct areas of the bed to ensure spinal alignment and optimal support to different parts of the body. As you move in the bed, the ReST bed senses pressure and adjusts in real time by inflating and deflating. You can also use the accompanying ReST app to customize the level of support you require. The mattress is equipped with sensors for almost 2,000 pressure points and collects data on your sleeping patterns, which you can review and learn from.

Radiofrequency Pain Relief

Another non-pharmaceutical treatment for chronic pain that is becoming increasingly popular is radiofrequency ablation. A high-frequency electrical current is used during this procedure. The current runs through an insulated needle, which is inserted in the region responsible for the pain with the help of a fluoroscope, a special X-ray. This ensures the needle goes to the right location. A small burn or lesion is created within a nerve, so the pain signal doesn’t get transmitted to the brain anymore.

Different studies have shown the procedure can offer efficient pain relief, for example, in people with lower back pain and knee osteoarthritis. The positive results of the procedure can last between 9 to 24 months.

More Non-Pharmaceutical Pain Relief Options

Virtual reality (VR) and augmented reality (AR) are also being increasingly used for non-pharmaceutical pain management. While VR promotes behavioral engagement in a virtual environment, AR adds digital information and augments the real world. Two strategies usually employed when using VR and AR in health care are distraction and feedback. The first technique is about shifting your attention, so your pain threshold and tolerance increase. This can happen when playing an interactive game, for example.

Feedback-based VR/AR, on the other hand, has been mostly used for the treatment of complex regional pain syndrome and phantom limb pain, which occurs in approximately 75 percent of people who have had an amputation.

For years, mirror box therapy has been a common intervention for phantom limb pain. To change the amputee’s bodily representation and alleviate pain, this method builds on the principle of visual illusion. Now, virtual reality mirrors can also be used to create an illusion of an intact limb in a very realistic way.

For instance, Dr. Kenji Sato and his team from the Okayama University Graduate School of Medicine and Dentistry in Japan used a computer screen and a special CyberGlove embedded with 18 sensors when performing high-tech VR mirror therapy. The participants wore the glove on the unaffected side and completed different movements, such as grasp and release of an object. The affected arm and the target appeared in the virtual environment. Patients were instructed to focus on the virtual hand as seen on the screen. Finger motions on the unaffected side were simulated by the CyberGlove, while a special magnetic sensor simulated arm motion on the affected side.

Due to the VR component, the movements patients completed with the unaffected arm were perceived as being completed by the affected arm, creating an illusion that is the basis for the traditional form of mirror therapy. This type of regular high-tech practice reduced the pain by half in the sample participants of Dr. Sato’s study.

Digital Diabetes Management

With almost 10 percent of the U.S. population diagnosed with diabetes, it is not surprising that there have been many innovations in this field. In fact, there is enough that technology designed for patients with diabetes has been given its own name: D-tech.

An example of this advanced technology includes systems that help users achieve better insulin delivery. The Insulet's Omnipod is one of the latest innovations in diabetes treatment. It consists of a small, wearable Pod and a handheld Personal Diabetes Manager. The two-component system is tubeless and can provide a person insulin for up to three days, making it more convenient than traditional insulin injections and pumps.

The Omnipod’s cannula inserts automatically with the push of a button; there are no needles. As an added bonus, users do not need to take the pod off when swimming or taking a shower, as this device is waterproof for up to 25 feet (for up to 60 minutes at a time). The pod and the Personal Diabetes Manager communicate with each other wirelessly, and users can customize their insulin delivery settings whenever they need to. There is also an accompanying app that allows users to follow and manage data on their insulin delivery and blood glucose, as well as their fitness data and health information from other devices.

Another helpful D-tech innovation is a continuous glucose monitoring system that makes fingerstick blood draws redundant. For instance, Dexcom G6 is FDA-permitted and allows users to always know their glucose number.

When patients use Dexcom G6, a tiny sensor is inserted just beneath the skin using a simple auto-applicator. The sensor continuously measures glucose levels and sends this information wirelessly to a data repository. The readings are displayed on a compatible smart device in real time, making the whole monitoring system a lot more convenient than traditional methods.

A study of patients with type 1 diabetes published in 2016 in the journal Diabetes Technology and Therapeutics confirmed the benefits of continuous glucose monitoring. Sixty-five patients were followed over a year and the results showed that continuous glucose monitoring in conjunction with insulin pump therapy reduced the patients’ A1C (a blood test that measures the average blood sugar over two to three months and indicates how well a person is managing his or her diabetes) and risk of hypoglycemia.

WellDoc has also launched a digital tool that might be very useful for diabetes patients. Their BlueStar app has been FDA-cleared as a Class II medical device. The app provides tailored coaching messages that support users throughout the day in their lifestyle and diet choices. For instance, if BlueStar detects that blood glucose was high before breakfast, it advises the user how to choose his or her next meal. The company’s data suggests that users interact with the app on average between 13 and 24 times a week. Its use has also been linked to A1C improvement.

Reversing and Preventing Chronic Conditions

A number of startups are now taking things a step further, going beyond curative care. Some promote tools that could prevent chronic diseases from developing in the first place, while others talk of the possibility to reverse certain health conditions.

Omada Health, for example, is offering an online coaching program aimed at pre-diabetics. The idea is that by losing weight and exercising more, you could avoid developing the disease. Omada’s digital diabetes prevention program even qualifies for Medicare reimbursement. The company also targets other chronic conditions through digital behavior change, including cardiovascular diseases and stroke. Their intensive online programs are all grounded in science, which makes them more likely to receive approval from the medical community.

At Omada, they are constantly updating their software based on what they find works and what does not seem to work for people. To boost credibility and trustworthiness, the company’s research team is publishing its results in various scientific journals.

For instance, one of its peer-reviewed studies indicates Omada’s diabetes prevention program Prevent showed that people who were using Omada software lost a meaningful amount of weight within 12 months — more importantly, they kept the weight off 1-year post-intervention. An exciting finding of this study, conducted by Dr. Cameron Sepah of the University of California, San Francisco, was that prediabetes did not progress to diabetes over time in those following the online program. The participants’ average A1C levels regressed from a prediabetic range to a normal range.

Virta Health is another digital therapeutics company that has been pushing boundaries. Their digital products are focused on reversing type 2 diabetes. Clinical studies conducted by Virta show that most people (94 percent) following their program can either reduce insulin use or eliminate it. Virta also offers programs aimed at other chronic conditions. Purportedly, its users can be coached to reduce inflammation, lower triglycerides, and improve liver function. The program involves not only personalized dietary guidance and coaching but also physician supervision, biomarker tracking, and private community engagement.

A Word From Verywell

Although all these technological advances are a viable option for many people and bring hope of a better life, medications have their place in many people’s health care. Often, the best results can be achieved when combining different approaches, including lifestyle changes, pharmaceuticals. and digital tools. What is becoming clear, however, is that many conditions once considered chronic and progressive can now be managed in a better way through technology, giving patients and their families an opportunity to live a more relaxed and carefree life.

Sources:

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Leggett LE, Soril LJ, Lorenzetti DL, et al. Radiofrequency ablation for chronic low back pain: A systematic review of randomized controlled trials. Pain Research & Management: The Journal of the Canadian Pain Society. 2014;19(5):e146-e153.

Merchant R, Inamdar R, Quade R. Effectiveness of population health management using the Propeller Health Asthma Platform: A randomized clinical trial. The Journal of Allergy and Clinical Immunology: In Practice. 2016;4:455-463.

Sato K, Fukumori S, Morita K, et al. Nonimmersive Virtual reality mirror visual feedback therapy and its application for the treatment of complex regional pain syndrome: An open-label pilot study. Pain Medicine. 2010;11(4):622-629.

Šoupal J, Flekač M, Petruželková L, et al. Comparison of different treatment modalities for type 1 diabetes, including sensor-augmented insulin regimens, in 52 Weeks of follow-up: A COMISAIR Study. Diabetes Technology and Therapeutics. 2016;18(9):532-538.