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Video Game Therapy for Cognitive Impairment: A Conversation with the CEO of Akili Interactive

Insight by

Charles Rhyee, Cowen Health Care Technology Analyst, speaks with Eddie Martucci, Co-Founder & CEO of Akili Interactive. In this episode of TD Cowen’s FutureHealth Podcast Series they discuss how Akili Interactive provides immersive action interactive video game experiences to treat cognitive impairments including ADHD.

They speak about how this treatment augments the current standard of care and how it targets cognitive function and strengthens neural connectivity. In addition, they also discuss focusing on distribution rather than volume, current patient interest, and payer coverage.

Press play to listen to their conversation.


Speaker 1:                           Welcome to Cowen Insights, a space that brings leading thinkers together to share insights and ideas shaping the world around us. Join us as we converse with the top minds who are influencing our global sectors.

Charles Rhyee:                  Hello. My name is Charles Rhyee, and I’m Cowen’s healthcare technology analyst, and welcome to the Cowen Future Health Podcast. Today’s podcast is part of our new monthly series that continues Cowen’s efforts to bring together thought leaders, innovators, and investors to discuss how the convergence of healthcare, technology and consumerism is changing the way we look at health, healthcare, and the healthcare system.

                                                And today I’m honored to have Eddie Martucci, co-founder and CEO of Akili Interactive, a leading digital therapeutics company, creating prescription treatments for people living with cognitive disorders that are delivered through immersive action video game experiences. Akili has received recognition from numerous entities, including the number one health company and Entrepreneur Magazine’s 100 Brilliant Companies of 2016 Award and the CNS Summit Innovation Award, among others.

                                                Eddie is a founding board member of the Digital Therapeutics Alliance and frequently serves on discussion panels for industry and academic events related to the digital therapeutics industry and healthcare innovation. Prior to starting Akili in 2011, Eddie helped launch PureTech Health’s digital health initiative and co-founded two other health focused startups. He completed his graduate work at Yale University in the departments of pharmacology and molecular biophysics and biochemistry, where he received both his master’s and PhD. Eddie, thanks for joining today.

Eddie Martucci:                 Thanks, Charles. Happy to be here.

Charles Rhyee:                  Yeah. Great. So to start, can you walk us through the background of Akili? Because I think there’s a pretty neat story there on the development and the underlying science.

Eddie Martucci:                 Yeah. I’m happy to. I love to tell the origin story. So I was part of PureTech and we were looking at new ways to impact the CNS field. So brain conditions, neurology, psychiatry. And this was, at this point, nearly 10 years ago. And so it’s right around the time where two things were happening. Essentially the traditional medicine world, the pharmaceutical world in CNS was pulling out of neuroscience. They were shuttering divisions and making statements that they’re probably not going to go after psychiatry and behavioral health anymore in a innovative way.

                                                And we were seeing this technology explosion of smart phones and smart devices that were being used for everything beyond communication, including the first early entrance in healthcare. And so what captured myself and my founding team, what captured our imagination was the idea that could you combine these two, this gap in CNS treatment and this just explosion growth and how digital devices are coming into our lives and potentially have a brand new mode of treatment.

                                                And as we started looking out in the world, we found that the neuroscience of engagement and the neuroscience of sensory stimulus, I think had gotten to the point where it finally came of age. And we started talking with dozens and dozens of neuroscientists in academia and small companies to understand the technologies that could be out there that could be amazing.

                                                And I got just enamored of the fact that if we did this right and got the right technology, we could code in a treatment that could be the first to directly impact neurocircuits or cognitive circuits through digital means and could actually be amazing and immersive and beautiful because you could leverage the best of technology. So that’s how the idea happened before we even had a technology.

                                                And then it turns out by chance in Boston, I met Dr. Adam Gazzaley, who was at the time and he still is the founding director of the neuroscience imaging center at UCSF. Now he’s extremely well-known thought leader in the field. At that time, he was kind of embarking middle of his career. And it turns out he had been approaching our problem from the exact opposite vantage point, where starting at neurology first principles, how can you use sensory stimulus in more engaging ways to activate the brain? And we hit it off.

                                                It turns out he had already had a concept forming in his head of maybe thinking about how this could be commercial. And that was exactly what we were looking for. So after looking at dozens of technologies, it turned out this technology from UCSF was the most powerful. We thought it could be “prescription grade,” and that really kicked off our whole path.

Charles Rhyee:                  And if I’m not mistaken, I think Dr. Gazzaley that he was maybe starting from Parkinson’s, right? Kind of help…

Eddie Martucci:                 Aging generally, not Parkinson’s per se. You’re right. He was starting at the older end of the age range. His research had been in what cognitive networks are essentially deficient as you start to go through an unhealthy aging process and it’s early stages of cognitive impairments. But it turns out that those functional deficits that appear are actually very consistent across ages and across diseases.

Charles Rhyee:                  So that was where I was going to kind of go to. What made you choose in the end pediatric ADHD as sort of the starting point then?

Eddie Martucci:                 Yeah. I mean, I think it’s multi-component, two strongest components. The first is the science. So we actually invested in the earliest days to do a number of different small proof of concept trials with the first technology we built off of this, or rather first product prototype we built off of this technology, because the technology is really an algorithm technology.

                                                And we had done a few different types of sponsored research and tests in a few patient populations. The beauty of digital therapeutics is you cut out the first five years of cell work and animal work and you can go right to humans. So we had done some proof of concept human studies and the cognitive benefits that were showing up, and you can see this in Dr. Gazzaley nature paper and others that we’ve published since, were in sustained attention, selective attention, minimizing gaps in attention, speed of processing.

                                                So basically it overlapped perfectly with the core cognitive deficits in ADHD. The second was really a market dynamic, which is, this is a population that is extremely high need, which is to say the vast majority of families are looking for new options. They’re not satisfied with the current options. And in our quest to really redefine cognitive medicine, it’s hard to find a better population than ADHD that everyone understands and has a relation to. So those kinds of market and science factors is what drove us to start there. I guess, to your point, to the opposite end of the age spectrum than the technology originated from.

Charles Rhyee:                  Absolutely. And to your point, I mean, I was looking up some statistics here and it looks like CDC is estimating roughly 6 million kids to the age of 17 are currently diagnosed with ADHD, obviously a big area. And to your point, families have obviously challenges in managing their children through and helping them with it, given that oftentimes these kids also have additional mental or other behavioral disorders. Maybe, Eddie, continue here to walk us through, what is the current standard of care for kids with ADHD today?

Eddie Martucci:                 Sure. Yeah. It’s a great question. The short answer, the one word answer is it’s long. So the process, the journey of families who have children with ADHD, and quite frankly, for adults as well, is really long and circuitous. So what tends to happen, and this is the most amazing stat that continues to wow me in this space, is families tend to have a journey of between 18 and 24 months from the time they first know there’s really an issue.

                                                And it tends to show up either at home or usually at school. So a teacher and the parents have together identified, all right, there’s really something we need to do and focus on here. 18 to 24 months from that point until they’re in a doctor’s office and finally getting a treatment that can help them. And there’s a lot of reasons for that. There’s stigma. There’s an aversion to thinking about medication as first-line for your child.

                                                There’s guilt and denial and other things that relate to stigma on the part of the parents. And there’s, unfortunately, still this part of society that brushes aside conditions like this and says, “Oh, it’s no big deal. It’s just kids.” And so all of that leads to this really long upfront journey. And I think that’s, quite frankly, an area that needs attention and innovation.

                                                And I believe that with approachable digital treatments, we can actually address that and draw people into talking with their doctor potentially even earlier. Once a child is with a doctor, has a diagnosis, and is considering a treatment, there’s really two main options today. There’s medication, and medication does very well for about half of ADHD families. It’s focused much more on the behavioral manifestations of ADHD.

                                                So what people tend to notice immediately is the hyperactivity, the behavioral disorder piece of ADHD is pretty well controlled by medication. Or there’s behavioral therapy, finding a therapist and working through behavioral occupational therapy. And then the journey from that first treatment course tends to be a long and repeated journey, where they’re coming back every month or two looking for either a new medication or a new dose or a new therapist.

                                                And it takes a long time for families to land on something that works for them. About half of families drop out of treatment a few months after they start. Totally. And one of the theories there is that the treatments today are not addressing some of the core issues and that’s where we think we can play.

Charles Rhyee:                  And I want to touch on that in a second. I mean, so EndeavorRx, your lead product here was recently approved by the FDA for treatment of children with ADHD. And you brought the point here that maybe 50% of kids respond to medication, but in a sense, it seems like what medication’s really doing is just treating the symptoms, which is sort of the outward expression, the hyperactivity, whereas EndeavorRx, it sounds like your thesis here is that it’s actually changing something different. Maybe walk us through what’s different with EndeavorRx and what it’s doing hopefully for children versus medication, and then combine that with therapy, let’s say.

Eddie Martucci:                 Sure. And the first thing to be aware of our product EndeavorRx, and I’d say this for the digital therapeutics landscape generally, is I think these products can be new pillars. They don’t have to be an either/or. So we have data that EndeavorRx has the same types of benefits with or rather alone or on top of medication And it’s really meant to be part of a total treatment program that a doctor decides to use this on top of other things.

                                                So this is a really good example of an orthogonal mechanism, to your point, that now just amplifies the number of choices that a physician has. So the way our product works, very different than medication, which is essentially saturating certain neuro receptors in the brain, dopamine, norepinephrine, et cetera. We actually target the functional cognitive networks.

                                                So what our technology does is based on sensory and motor stimulus, it’s activating the midline prefrontal cortex specifically. And so we have four different peer reviewed publications in medical journals and a fifth that’s going to be coming soon that we’ve shown in children and adults we can activate midline prefrontal cortex specifically. So there’s a specificity to this, and we increase efficiency between prefrontal cortex and posterial parietal regions of sensory processing.

                                                A very different mechanism that can be complimentary to medication. In terms of the outcomes that people would expect, it’s the easiest to look at our label. So our FDA label is indicated to specifically treat attention function in children with ADHD. And to your point, a lot of times, the reason that families are showing up for medication is more for the behavioral and hyperactive control because it’s become emergent. And our product has some effects there, but actually is indicated that it may not improve some of those issues.

                                                So what we’re doing is really focusing on something that hasn’t been as directly targeted in ADHD. And quite frankly, a good segment of ADHD population has languished because it’s not as disruptive as some of the symptoms of ADHD. The way cognitive issues manifest is children just fall behind. They have a harder time with work. They have a harder time making friends and social, but they’re not significantly disruptive.

                                                So we think it’s a really important new add to the treatment paradigm, where we’re going to help children who are on medication, and then for a big chunk of this market that is really struggling to find any effective therapy, we can potentially be a help there.

Charles Rhyee:                  Can you talk about targeting really the cognitive function? I mean, is the idea that it’s the plasticity of a child’s brain, particularly children, I guess, that you can strengthen neurons and the connectivity around areas that were maybe previously deficient? Is that sort of the idea here?

Eddie Martucci:                 That’s exactly the idea. Yeah. We have a beautiful publication in PLOS ONE from a couple of years ago from the lab of, I believe, Dr. Elysa Marco at UCSF. And what it shows is that a typical ADHD brain, when it’s processing a stimulus that it’s supposed to pay attention to, has general low-level activation to everything, but not specific heightened activation to what the child is supposed to or wants to pay attention to, which is to say the child is lacking top-down control.

                                                The ability to say, “I want to pay attention to this. Even if I don’t like it, I have to pay attention to this.” What we see after a month of treatment in multiple publications now is that front part of the brain that in typically developing children lights up to allow them to decide how and where to apply their attention now lights up within a few hundred milliseconds after a stimulus.

                                                So yes, it’s really allowing the brain to process information in a different way, in a more concerted and controlled way without having to dampen or target the rest of the brain or other things about the children. So what we like to say is we’re trying to give it power, and this is more marketing than scientific. But we want to empower families and empower the child without necessarily dampening the quirks of who they are. We want to give power and allow them to have a stronger ability to pay attention and to really remediate those cognitive issues.

Charles Rhyee:                  That’s exciting. Yeah. And we didn’t mention it before. I mean, you’re delivering this therapeutic through what from the front end looks like a video game experience. And I’m sure sometimes people look at it and say, “Well, couldn’t my child play something on the Nintendo or something and get something similar?” Maybe quickly just talk about sort of what is happening in the experience that is creating the therapeutic effect.

Eddie Martucci:                 Yeah. That’s a great question. And you’re right, that still happens sometimes. You’ll get a minority of people who say, “Even if it’s FDA approved, I don’t understand. Is this just any video game?” And the truth is, this is a patent to technology that had been worked on for over a decade at UCSF. The patents are to deploy a very specific order in adaptivity of stimulus that challenges the brain where it’s weakest.

                                                So we are constantly giving you stimulus, the patient, and the algorithms assess how the patient’s doing and adapt it second by second and adapt it to where the patient is weakest. And so we’ve spent years building those algorithms. It’s very different than any other consumer game, where consumer games are actually doing the opposite. Consumer games are giving you choice so that you can have fun doing what you like to do best and what you’re best at.

                                                Ours is a very different experience. So it’s not built to be a consumer video game. It’s fun, but it’s also very hard work. It can be exhausting. It can take serious effort and needs a commitment from families and the child. But what we’ve shown over time is that those engagement, after a month, we see these neurological changes that correlate with outcomes.

                                                Engagement after two months, which is data that we just made public at the child and adolescent psychiatry meeting back in October, after two months, 70% of families are clinical responders in day-to-day life benefits. So this is very different than playing the average video game, although some of the interactions and some of the art will remind children of some of the games they play. And we do that purposefully.

Charles Rhyee:                  Yeah. I might have to get my kids trying it at some point. So product’s been approved, maybe talk us through how the launch is going and sort of what the strategy there is.

Eddie Martucci:                 Sure. Yeah. Our strategy we’re really happy with so far. We’ve had a ton of interest. Our strategy right now is not to maximize volume. We have decided to invest in the end-to-end distribution of our products. I’ve been pretty vocal about this. While we have pharmaceutical partnerships outside the US, in the US we decided long ago that we want to own and be able to iterate this model, because what we deliver, which is the first video game based treatment.

                                                But on top of that, a care program of digital applications for parents. This is new. No one’s gotten a prescription for a video game before. It’s an activation code. It goes right on your phone. And we want to own every aspect of that. So our strategy in the early days is actually to maximize the experience. And so right now we’re kind of in earlier access or managing availability, where we’re keeping numbers small, and we’re highly iterating our systems, our entire teams.

                                                Our entire groups of teams that touch commercial and distribution and patient service are essentially looking to learn, adapt and iterate the model because we’re building it fresh. We anticipate going up into scale and broader availability in 2021. So far, I’m really pleased and I think it shows the need that is out there in the marketplace. We have about, at this point, over 30,000 families that have kind of reached out, signed up their information to a general interest list to be notified when there’s wide availability.

                                                So I think there’s a hungry and needy market that we can hit and we’re really excited to get to that point. But I think one of the obligations of digital therapeutics companies is to get all the patient interactions right in the early days. Because it’s not as streamlined as we have in pharmaceuticals, which have essentially been ironed out over the last few decades.

Charles Rhyee:                  Yeah. That makes a lot of sense. So as we look to maybe next year when you get this iteration all set up, what do you think the model looks like? Is it more like drugs or typical pharmaceuticals where there’s a salesforce that’s detailing physicians, or do you envision it given sort of the general interest that you’re already getting coming into you a direct to consumer type of model? How do you envision that in the future?

Eddie Martucci:                 Yeah, I think it’s both. I think it has components of patient pull and provider awareness. To your point, we haven’t spent a dollar in marketing and there’s tons of organic interest already. So both the provider and patient community are talking about this because they’re always searching for options in ADHD. But our model is to have both. We’re a prescription medicine.

                                                Contrary to what some people think about digital therapeutics, at least that Akili, we’re not looking to disintermediate the physician. We’re looking to actually directly engage the physician. With novel technology, many times physicians have been cut out of the loop. We want to do the opposite. We want to really allow this to be a new tool that a physician can use.

                                                So we absolutely will have and already do have some physician education work. We can do this remotely through webinars. We have discussions and calls with physicians. The difference here is I think we have the potential with digital to be far more efficient than the typical pharmaceutical model. The first is we want to meet physicians and patients where they are and be highly virtual and highly remote.

                                                And actually, what we hear more and more in the pandemic has helped this. Everyone wants to be more remote and virtual and that’s our bread and butter. And the second is our product is so novel and stands out so much and the data are so clear to physicians that this is not a 5 or 10 sales call cycle, where you’re trying to compete in a dispersing and diluted marketplace.

                                                This is the only prescription treatment to target attention or cognitive functioning. And so docs really early on, once they’re aware, they know exactly how to use this with their patients. And so we’re really focused on the awareness. But there’s a big patient component to this because they’re just already out there searching.

Charles Rhyee:                  Maybe switching gears a little bit up, payer coverage. I’d imagine right now payers obviously cover current treatment for ADHD. Maybe you can help fill us in just the current size on the pharmaceutical spend in the US on ADHD medications. Maybe start there and then, how have those discussions with payers been maybe gauge their current interest in covering Endeavor?

Eddie Martucci:                 Sure. Yeah. The spend on the medication side is the ADHD pharmaceutical marketplace is around a $10 billion marketplace right now. It’s harder to get those numbers on behavioral therapy, but it’s estimated to be in the billions as well, behavioral therapy for children more generally. We do think that payer coverage and insurance is really important for the broadest access and really what we’d call the top end of our business model.

                                                Meaning at scale, as you mentioned, there are 6 million children with ADHD. At least a good chunk of those children we know we can have a good potential to help. And so there’s a need to get to scale. Also, you have about 30% or more of this marketplace would qualify in the Medicaid paradigm. And so there’s state and other coverages for lower-income families.

                                                So yes, insurance, both government and private is very important for this, for ADHD, but also we think for the industry, for all of our products and for the industry. It’s really important to me and to the companies that are paving the way here that when something goes through FDA, has a prescription, has a clinical impact in patients, it shouldn’t matter the form factor. It should be covered by insurance.

                                                So far we’re having great conversations. Obviously we’re just through the FDA process and early prescriptions are coming in. So it’s not covered yet. But we anticipate that based on our conversations, there’s a couple of different ways to go. There’s pharmacy benefits, there’s medical benefits. And it looks like payers are split, but flexibility is a good thing.

                                                So I would anticipate that both pharmacy and medical benefits you’ll see some uptake here in the future. And the important thing is I think if we’re doing the right thing on staying responsible on cost and not doing the new technology thing of trying to charge thousands and thousands of dollars just because it’s new, but fitting into the cost that patients and payers are used to paying, I see no reason why this shouldn’t be covered. And that’s definitely a focal area for us in 2021.

Charles Rhyee:                  Yeah. And especially, I think when you just mentioned a third of kids probably are qualifying under Medicaid. Maybe talk about the government payer side of it a little bit more because it seems like… Obviously, states are struggling with everything pandemic, et cetera. So even at the first glance, someone might say, “Well, do states really want to add an extra cost here.” But really, I mean, you can think about total cost of care and discussion could probably help.

Eddie Martucci:                 Oh, absolutely, I think that’s the case. One thing we’re learning from the pandemic is, and I believe most people are reporting this, we’re going to incur, I believe this strongly, we’re going to incur down the road massive costs based on loss of services, loss of treatment, undertreatment of mental health and behavioral health. If you even take our markets of children with ADHD, we’re usually getting through both their physician, but also at school, a whole realm of supportive services that they’re not getting right now, or at least it’s greatly diminished.

                                                Whereas in adults you’re seeing really scary numbers of things like depression, anxiety, suicidal ideation. I think you’re going to see parallels in the pediatric markets as well with the ramifications of loss of treatment. So I do believe there’s tailwinds there. I believe states and the broader government are actually looking for ways to make sure they’re getting good, accessible, cost-effective treatments to patients as quickly as possible. So I think that’s going to help.

                                                The issue with Medicaid, as you’re aware, is without broad policy, it can be state by state, which just takes time. We and a number of digital therapeutics companies are supporting a few different legislative efforts that look to categorize digital therapeutics within CMS, so that there’s better ability for Medicare and Medicaid to be able to pay for and categorize these treatments. And so that’s something I also hope to have some traction on in ’21.

Charles Rhyee:                  That’s great. And you kind of touched on it, and maybe this is a good segue then. If we think beyond just pediatric ADHD, obviously clearly right now a lot of mental conditions and cognitive issues that are probably not being adequately treated more broadly in the general population. Maybe talk about where Akili can help in those regards, kind of ties into how the technology can be applied more broadly, and maybe [inaudible] then as a result.

Eddie Martucci:                 Yeah, sure. I mean, our approach, it’s interesting. We’re using the current medical system, which is diagnostic classification codes to fit in here. But the basis of our technology and our product approach is in some ways independent of diseases. So our technologies are not designed for ADHD or depression or autoimmune disorders. They’re designed for cognitive impairments.

                                                And what turns out is that independent of the maybe neurochemistry or neurochemical impairments that are unique to these different conditions, the functional cognitive impairments are very, very similar. And so we’ve spent the last eight years investing in clinical research across a number of these areas. We’ve looked at cognitive impairments in depression, cognitive impairments in multiple sclerosis, impairments resulting from injuries like traumatic brain injury.

                                                What a lot of people don’t realize is that the specific cognitive impairments are extremely similar to what you see in ADHD. They’re attention related. The highest prevalence complaints of a multiple sclerosis patient after successful immunomodulatory treatment actually can’t sustain attention to do my work. And so half of people don’t return back to their full work status even a year or two after treatment.

                                                We’re even now seeing reports from COVID suffers, people that have had COVID. It’s been in The New York Times and Washington Post called COVID fog. And the number one complaint there is attention and concentration. So the resulting functional impairment that millions and millions of patients across these diseases experience is actually similar in nature. And because our treatments work at that functional neurological level, we believe we have the ability to help many of them. We’ve seen positive data from randomized controlled studies already in depression and in multiple sclerosis looking at those cognitive issues.

                                                So we have plans and it is very much in our mandate and mission. And every one of our Akilians, our employees are excited by the potential of not only really delivering big time for the ADHD market who’s in need, but starting to tell that broader story and help people across these different areas. And the similarity across these different areas is the patients themselves are recognizing it, the medical system may or may not. But patients themselves are finally starting to become empowered and talk about their brain health. And so we see that as a trend that we and other companies will hopefully fit into and be able to deliver on.

Charles Rhyee:                  Yeah. And what’s exciting to me about all this really is we’re looking at it seems like finally something where software itself acts really on the physiology. And that differs, right? If we think about a lot of digital health today, which is really kind of delivering sort of analog therapies, like known therapies, but it’s delivered through software. Maybe expand on this a little more because I think this is a unique distinction that should be made here.

Eddie Martucci:                 Yeah. Thanks. And we’ve obviously been one of the loud companies talking about the fact that we love the part of the digital health industry that is taking human based therapy approaches and putting into an app or teaching patients strategies through an app that can help them cope in daily life. Those are massively powerful and I think they’re much needed in healthcare.

                                                We think it’s only half the story. So what gets us excited and certainly how our treatments work is by being based in mechanistic biology, in our case, mechanistic neurophysiology so that when you’re using the treatment, you’re actually directly and rationally targeting physiology. You can hear in my verbiage my biochemical background coming out. It’s rational design and rational mechanistic targeting. But I think it’s been the lower percentage of kind of companies in this space who have been applying these approaches because quite frankly, they’re hard.

                                                They take more scientific data upfront. They’re more likely to miss in the early days of scientific discovery than known human approaches. But I think they really just open up the imagination of what could be possible. I truly believe that what we do with our sensory motor stimulus is just one of a very broad spectrum of examples, where through motor or sensory or immersion, or even audio, there’s some companies doing music and audio stimulus now, you can be tapping into physiology in ways that we never really imagined it 5 or 10 years ago or even today.

                                                So my hope is we’re going to see actually flourishing two categories of digital therapeutics. We’re going to see really good app based approaches for delivering behavioral therapy and we’re going to see a whole spectrum of really unique ways to target physiology directly through the software itself. And I think both can and should be successful alongside today’s medicine.

Charles Rhyee:                  Yeah. And as we kind of close out here, just circling back to the start, 10 years ago almost you were looking around and you saw this convergence where pharma was getting out of… The neurology technology was exploding and you saw this opportunity. Where is biopharma then today? As we see all of this has developed, do you see them looking back and saying, hey, look maybe we exited because from the chemical side or the biological side, there was limited options or limited opportunities it looked like in terms of research and development. But now digital offers a whole new venue. Do you see more activity there? Obviously you have the partnership in Japan that shows you there are forward-thinking pharma companies out there, but maybe more broadly in the space. And is that important for the development of this space as well?

Eddie Martucci:                 I think it can be important and certainly we’ve played both sides of the coin there. I think it can be important. I think partnership with the pharmaceutical industry provides a potential lever and expertise that depending on the market, and most importantly, depending on the company and their approach, can be valuable and a value add. So our partnership with Shionogi, I’m really proud of the partnership that we’ve done.

                                                I believe they are great partners because they are transforming the business all the way at the top. So they had their mid-year meeting this past year. Shionogi highlighted that they are transitioning from being a pharmaceutical company to a healthcare delivery company. And part of that’s going to be medicine pills, part of that’s going to be digital, and part of that is going to be services.

                                                That’s the type of commitment that I think is a massive lever because you take the expertise and the in-country girth, if you will, and force that Shionogi has in Japan. But it’s evolving and we can be part of that evolution. But on the flip side, I think if it’s partnering just for partner sake, because it feels like pharmaceutical companies have scale, but there’s not really the commitment to actually innovate the commercial model, I think we’re left kind of with a lot to be desired because this field is going to take innovation and business model experimentation.

                                                So am I seeing pharmaceutical companies and others start to embrace this? Yes, in certain instances. Others are still playing a little bit here and there. You might’ve heard me say this before, but I think we’re evolving hopefully from digital therapeutics being the toy and the happy meal that’s kind of like, oh, a cool fun add-on, to actually being an asset. And those companies that invest in the asset I think are going to see big returns.

                                                But I don’t think it’s necessary for the digital therapeutics industry to thrive. The example I like to use a lot is think of Amazon in the early days and think of Amazon not as any one company, but representing an industry. And imagine if we said, well, gee, how are Barnes & Nobles and Borders going to help Amazon really create a business here? And obviously the truth was that Amazon made a business in books and continued to innovate there and did partnerships and had a much broader transformative business model for society.

                                                I think that’s the potential for digital therapeutics. And so I’m cautious of deals that are quick, easy money when they’re not backed by commercial vision. But I think we’re going to get to the point where you’re going to see medications and digital therapeutics intermingling. You’re going to see certain pharmaceutical companies really embrace innovative technology as a core strategy and I think that’s great for patients.

Charles Rhyee:                  Yeah. Maybe just to close out here, you touched on multiple sclerosis, depression. Maybe just touch a little bit more on the pipeline. For this long, what are you kind of most excited about right now?

Eddie Martucci:                 Sure. Yeah. And we’re excited about everything. That’s the problem. It’s a blessing and a curse that we invested in our early life to do lots of clinical research across different populations and now have a lot to choose from. We haven’t made any public statements around the exact products that we’re promoting up to get on path for later stage development. But the way we’re thinking about it today is there are two big groups of populations that we want to go after.

                                                The first is people with chronic cognitive impairments that are adults. So we definitely want to move into the adult market in chronic, which means ADHD, where we can leverage our work that’s already happening, but also beyond to some of these areas, like mood disorders, where people are having chronic impairments and need a chronic treatment paradigm. And the other area we’re very excited about is the incidents population of injuries or insults to cognitive function.

                                                This is an area that honestly has received even less attention than the chronic diseases and disorders like ADHD. So people coming out of hospital care, ICU, surgeries, oncology treatment. There’s a wide swath of populations that are coming from an acute injury, if you will. And experiencing on average two standard deviations below the norm or where they used to be cognitively, it’s a big, big deal and it’s not addressed at all today. And so that’s an area that you will probably see Akili playing in, in some specific ways over the next 18 months.

Charles Rhyee:                  And clearly COVID fog, right? Now we’ve got to add that to the list.

Eddie Martucci:                 Yeah. It’s been amazing, sad, but I’m glad unlike some other areas like chemotherapy, where it took decades to finally recognize it, people are already recognizing that this pandemic and this specific virus are really playing havoc with people’s cognitive function. So yeah, that’s a big, important area for the future.

Charles Rhyee:                  All right. Well, so Eddie, if people want to know more about EndeavorRx, where can they look to get that information?

Eddie Martucci:                 Sure. Yeah, there’s a product site that’s And that’s where you can see everything about how the product works, the science behind it, early patient testimonials and all of that, which hopefully it gives a good snapshot of this new product in action.

Charles Rhyee:                  Yeah. Well, hey, Eddie, thanks so much for joining us today and really always great to talk with you.

Eddie Martucci:                 Thanks Charles. Appreciate it.

Charles Rhyee:                  Yeah. And thanks everyone for listening today and stay tuned obviously with Cowen for future podcasts. And thanks everyone for joining us. Thank you.

Speaker 1:                           Thanks for joining us. Stay tuned for the next episode of Cowen Insights.

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