Mental and Behavioral Health Weekly - Week of February 10, 2020Read more...
Taking pills may one day seem 'barbaric'; Can we learn from depressed robots?
For our next SplashX Invent Health salon on June 21 at HP headquarters in Palo Alto (save the date!), we'll be focusing on the future of behavioral health and mental health. Some of you may be wondering why we're combining both behavioral and mental since they can mean two entirely different focuses.
One focus is the promotion of wellness among mentally healthy people, while the other focus may be the treatment of serious disorders among schizophrenics or the mentally impaired, due to a chronic illness. They're on the opposite ends of the mental health spectrum. At the same time, there are countless studies that show bad behaviors are the root causes of chronic diseases.
Additionally, the lines are blurring on this spectrum as more and more people find themselves experiencing some level of mental disorder, whether it's mere anxiety to overwhelming stress and sadness.
To this end, the meaning of 'mental' health is evolving and broadening. And, sadly, it's on the rise. So we want to focus on mental health at all levels.
As stated above, our behavior has a significant impact on our mental well-being. Often disease can stem from behavioral problems. Hence these problems may be prevented by or treated with behavioral modifications. If our behaviors aren't properly guided and directed by family, friends and our community, then there are behavioral health services that can be solid alternatives. We'd also add digital therapeutics into this bucket as these software-based solutions are also seeking to change behavior to get to outcomes, without taking expensive pills or hiring expensive doctors and coaches to tell us how to behave.
We find this a fascinating and timely topic. Hence why my co-hosts at HP - Dr. Archana Dubey and Fran Ayalasomayajula and I are hosting this salon. Join us!
As with our past salons, I'll collect what I see as interesting stories in this space and share in a weekly post. Some are recently published, and some are older, but worth reviewing.
Depressed robots? AI and the human brain share a vital feature
It's logical that stress and consequently depression can come from change and unmet expectations. If we're flexible and adaptable to these changes, we're likely to be healthier mentally. But failure to adapt to adversity/change may "be one of the main reasons" why humans get depressed, and it's one of the reasons why machines may malfunction, according to Zachary Mainen, neuroscientist whose research focuses on the brain mechanisms of decision-making. For humans, increased levels of serotonin - a chemical produced by nerve cells which can affect mood and motor skills - can create more plasticity, or flexibility to adapt and react to change. If AI is to learn, it will need some flexibility component. Yet a good point Mainen makes is that a lot of flexibility may not be good, as the machine might forget all its learnings faster, if it's constantly absorbing new information with change, and hence it might never build up knowledge.
At the same time, if we build machines to have multiple goals (hence if circumstances change, they can focus on the best goal for that situation), the machine may become rudderless. Knowing how flexible to make a machine is an unknown, but it is key, and without it machines may experience some sort of depression, probably not suffering, but depression, says Mainen. If this is the case, Mainen asks whether we will be able to learn from machines about our own depression.
"Susceptibility to depression is one of the costs of the ability to adapt to an ever-changing environment," Mainen observes. "Today’s AIs are learning machines, but highly specialised ones with no autonomy. As we take steps toward more flexible “general AI”, we can expect to learn more about how this can go wrong, with more lessons for understanding not only depression but also conditions such as schizophrenia."
Preventative care to avoid upstream costs
Here's an April 2018 report on the attributes of behavioral health and preventative services, conducted by a Massachusetts special commission, named Promote Prevent. A big finding was that the state spends about $6-$7 billion annually on direct spending on behavioral services and prescription drugs. But spending on prevention pales in comparison. The Department of Mental Health and the Department of Public Health's Bureaus of Substance Addiction Services direct less than 1 percent of their combined budgets to prevention or promotion, spending about $14.3 million annually. The Department of Education spends about $10 million out of a $6 billion budget.
The bottom line: "Underfunding behavioral health promotion and prevention contributes to dramatic downstream consequences." Three action items from this report are:
1) Act early. Half of chronic mental health conditions begin by age 14 due to poor self-regulation and understanding of harm from substances. But protective factors can counteract those later risks, such as family stability and positive school environments. Behavioral health services seek to integrate these protective factors.
2) Apply an integrated behavioral health approach. Realize that half of people with psychiatric conditions actually have two or more conditions and mental illness and substance misuse often go hand-in-hand. These issues are deeply intertwined and exacerbate the symptoms.
3) Build a community or coalition. The report proposes spending a third or $10 million in cannabis revenue to fund community-based prevention coalitions.
Raw fruit, vegetables better for mental health
University of Otaga researchers find that raw vegetables and fruit are better for your mental health. This is a pretty significant finding notes Dr Tamlin Conner, Psychology Senior Lecturer and lead author, since he says that prior public health campaigns have focused on the quantity of vegetables and fruits (one apple a day, etc). This report compares cooked vs raw. "Controlling for the covariates, raw fruit and vegetable consumption predicted lower levels of mental illness symptomology, such as depression, and improved levels of psychological wellbeing including positive mood, life satisfaction and flourishing. These mental health benefits were significantly reduced for cooked, canned, and processed fruits and vegetables. This research is increasingly vital as lifestyle approaches such as dietary change may provide an accessible, safe, and adjuvant approach to improving mental health," Dr Conner says.
* The top 10 raw foods related to better mental health were: carrots, bananas, apples, dark leafy greens such as spinach, grapefruit, lettuce, citrus fruits, fresh berries, cucumber, and kiwifruit.
There are limits to pills
Vijay Pande is a partner at Andreessen Horowitz. In a blog post, he's interviewed about his thoughts on investing in general. But he also shares his thoughts on digital therapeutics. Below are quotes from this interview.
"The other huge area of interest for us is digital therapeutics. It’s a term pioneered by Omada [which we’re investors in] and others. The way I like to think of it is this: If the first phase of medicine was about small-molecule drugs delivered intravenously, and the second phase (then led by biotech companies like Genentech) was about protein biologics, then the third phase is about digital therapeutics.
"It seems like the holy grail of medicine is to take a pill, wait a bit, and then get better — just like magic! But there are real limits to this, especially when it comes to depression, PTSD, smoking cessation, type II diabetes, insomnia, and other behavior-mediated conditions. I’m confident that 10-20 years from now when we look back on this phase of medicine, it’s going to seem backwards and even barbaric that our solution to everything was just giving out pills.
"Digital therapeutics treat what are really behavioral problems with a behavioral solution. To give you an example of what a digital therapeutic would actually do: Let’s say I’m borderline for type II diabetes. I could pay someone $100,000-$200,000 a year to follow me around 24/7, like a personal trainer, making me do pushups to build muscle mass and knocking doughnuts out of my hands every time I reach for one. And sure, that would work. It’s just really expensive for most of us. Behavioral therapies essentially do the equivalent type of motivation and coordination — and still have a human-touch element through coaches, messaging, social networks — but do so in a way that can scale such that costs are dramatically lower.
"Because there are existing approaches that have already shown quite good efficacy in this space — they’re just expensive and don’t scale. A great example is Stanford’s sleep clinic or its pediatric obesity clinic, both of which do amazing things but cost a lot and can only take in a small number of (often privileged) people a year. Yet there are millions of people with type II diabetes …it’s an epidemic.
"Digital therapeutics allow such successful approaches to become cheaper and to scale. And they have no toxic side effects, which is very appealing from a drug point of view; what we don’t like about investing in traditional biotech is the risks due to side effects, additional regulatory issues, and so on."
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