“Dear Future” is a monthly column that explores the rise of transformative entertainment and how it can be a foundational pillar, alongside psychedelics, in the field of mental health and wellness.
Shel Mann is the CEO of Firefly VR, a digital therapeutics company whose mission is “reimagine behavioral health and digital therapies” through biosensor technology and immersive virtual environments.
Since launching in 2016, Firefly VR’s has worked closely with neurologists, scientists and healthcare professionals to develop virtual reality therapies. The company is currently focused on building a platform for mental health alongside the emerging psychedelic industry.
Mann is passionate about channeling the unique engagement of virtual and augmented realities towards making the world a better place. In this interview, we discuss how immersive technology can help prepare patients for psychedelic therapies and the integration of virtual tools into mainstream healthcare.
Immersive technology in medicine and the psychedelics industry seem to be on a similar growth curve. Early adoption, regulation, and publicly traded companies are happening in both spaces. Do you see this as a coincidence, or is a sign of pent up demand for innovative healing tools?
For the last four years, we’ve been working with United Health Group and Optum Labs on immersive technology. To me, the obvious two categories are virtual reality and augmented reality. They’ve been doing some work with HoloLens, for example. Their research has shown that because of this technology’s ability to create an immersive visual narrative that’s non-distracting, it has moved the needle in terms of higher comprehension of things that come in visually, and go around the sides of your brain, to the visual cortex in the back of your mind. You use your hands to do exercises and get into that multimodal, kinesthetic learning state. It creates a deeper imprint on the subconscious mind. That’s well-accepted now in the healthcare space, and why immersive technology is something the medical world is leaning towards.
The big issue for payers is prevention versus cure. Many people think it’s more of a disease care system now, rather than a preventive or preemptive model. But thought leaders within healthcare, including chief mental health officers, are looking at the potential power of prevention. To that end, both VR and psychedelics offer great hope.
Psychedelic research is going on at Johns Hopkins. Schools are bolstering the science behind psychedelic medicine, and the fact that it’s not addictive, but creates lasting memories and rewires the brains, synaptogenesis, is something the healthcare industry is taking notice of.
At the same time, there is a tipping point on VR software and hardware. The prices keep coming down. Products are getting better. There’s a strong belief that where VR will be most relevant isn’t medicine, but other areas, like education.
There’s more mainstream awareness around psychedelic medicines. Most people are unaware of the rise of digital therapeutics (DTx) and that the DTx industry is actually getting FDA approval much faster, with over 40 digital wellness tools now being FDA cleared or approved, and hundreds more on that path. How do you feel a similar cultural shift in perception can occur for video games and VR as healing tools over the next few years?
If one thinks of video games as creating engagement, as opposed to just fun, there’s a lot of ways you can use that engagement. It can be preparation for using a psychedelic. Our beachhead product is ketamine. Many people lack education about it, and are anxious and fearful of that first session. By creating an engaging space through VR, people can learn mindfulness techniques, how to let go of old barriers and create new intentions. Let’s say you have treatment resistant depression. Through VR you can explore what you would like to come out of your ketamine experience, so by the time you have it, you’re leaning forward. You’re hopeful instead of anxious.
As digital medicine begins to lock arms and walk in tandem with these other healing modalities that are gaining popularity, that will give more gravitas and momentum to the industry.
VR can be awe inspiring, especially if you haven’t been in VR before. And it’s different than any other digital therapy. Mobile games are cool, but they’re not immersive. The immersive world of VR creates that sense of wonder and engagement for the user, making them feel like they’ve been inside for 10 minutes, when they’ve actually been in for thirty. That’s partly what’s unique about VR.
FDA approval is only one piece of the puzzle for both psychedelics and DTx (digital therapeutics). How do you see payers, providers, and patient adoption happening at scale with digital experiences? How should companies look at navigating this ecosystem?
We know there’s about one therapist for every 1600 people in the U.S. And that’s not nearly enough. Certain countries don’t have any. There’s a huge problem right now with not having enough therapists to handle issues like depression or PTSD.
Payers want to see a standard of care that increases the possibility of the best results. There’s everything from high end clinics with expensive therapists all the way to people doing it on their own, without therapy. The right angle is to work more on the inside of healthcare, and create the standards of care. As far as FDA approval, it depends on what it’s for. For preparation and education, it may not be necessary to have that approval. However, if you’re building a risk evaluation mitigation strategy along with a drug to get FDA approval, it becomes very important that healthcare companies and the digital therapeutic partner are working in tandem.
There is a lot of fear around digital medicine, from pharmaceutical companies to psychedelic therapists and consumers. What would you tell these groups about the products you are creating, and what inspired you?
When we made video games, the idea was to get people to want to keep playing it. Make it addictive. Now we’re taking everything we’ve learned about creating engagement and applying it to something that can make the world a better place. We think games can do that.
Most people in the DTx world talk about “drug plus,” the idea that digital therapeutic apps essentially function as companions for the drug that you’re ingesting. How do you see that landscape playing out? Will pharmaceutical companies be incentivized to keep selling the traditional pharmaceuticals while adding digital therapeutics to help either reward people for taking them, or create more lasting outcomes? Or do you imagine pharmaceutical companies, understanding it’s the wave of the future, will buy out a lot of these digital therapeutics companies, and transition their business model into digital medicine?
There’s definitely an understanding now that you need to provide more than a drug. What are you going to do to make extra value for the patient? The acceptance now of digital tools is pretty well in place. Maybe not as far with VR, which is still coming down in price, but it’s ubiquitous with mobile apps now. There’s an emerging view that digital therapeutics can either reduce the need for medication, or help affect its efficacy.
Over a billion people are suffering from mental health issues. The need is so vast, and there’s not enough therapists. What a therapist can do with an individual to personalize their experience and help them could be augmented by these. Let’s face it, we have a problem. There’s more people who are suffering and we also have to lower the cost. A lot of therapists are very expensive. Therapists can cost several hundreds of dollars an hour. A lot of people can’t afford that. There’s a way we can use digital therapeutics along with therapy that’s helpful for all.
There is a vast array of digital tools that are starting to hit the ecosystem, with over 200,000 health and wellness apps available through Apple. How do you envision such a new industry with so many companies pursuing the same health indications and communities? Will there be too many software solutions for patients and doctors to choose from in the emerging DTx landscape?
It’s similar to what’s happening now with streaming services like Netflix, Amazon, and Disney Plus. There’s great content fueling an enormous amount of creativity. I’m delighted that the rising tide raises all boats. There’s going to be a lot of people doing creative things, and that’s a positive. We all learn from each other. Some will do better than others.
We’re excited about our approach because we’re taking a very specific angle. Our success has been with heart rate variability and changing environments. We’re looking at a future where everyone has a low cost, biosignal device that can measure your pupils, facial muscles, heart rate, vagal tone, and other potential signals. We see this as a huge piece to our larger roadmap.
Like every industry, there’s an aggregate of approaches. Some fail, some succeed. I hope others achieve theirs, which will be unique from ours.
What’s Happening in Transtech
Games can be good for you. Led by video game publishing legend and co-founder of Devolver Digital, Mike Wilson, DeepWell plans to develop therapeutic video games. As Wilson notes, the medium is often “harshly judged” for its perceived negative impacts. “DeepWell is bringing entertainment and medical science together to build upon the proven fact that video games can be good for you,” he says.
Will OpenAI and the GPT chatbot put Google out of business? As AI sweeps through the mainstream, it is fascinating to think about the implications. What if AI succeeds? “Garry Kasparov suggests that AI could replace a surprising number of white-collar college-educated employees, much in the way that globalization crushed manufacturing employees previously,” writes Logan Kane for Seeking Alpha. “On a bit of a darker note, Twitter users have been able to seek advice on committing burglary and hacking the Pentagon by convincing the computer it’s just for a screenplay.”Rx Health and Wise Therapeutics partnership A care coordination platform and digital therapeutics company are collaborating to provide game-based therapy. As the landscape grows, partnerships like this will be crucial to provide a foundation for the industry, similar to the development of standards and training within psychedelic medicine.