News Article | April 6, 2016
Type 'depression' into the Apple App Store and a list of at least a hundred programs will pop up on the screen. There are apps that diagnose depression (Depression Test), track moods (Optimism) and help people to “think more positive” (Affirmations!). There's Depression Cure Hypnosis (“The #1 Depression Cure Hypnosis App in the App Store”), Gratitude Journal (“the easiest and most effective way to rewire your brain in just five minutes a day”), and dozens more. And that's just for depression. There are apps pitched at people struggling with anxiety, schizophrenia, post-traumatic stress disorder (PTSD), eating disorders and addiction. This burgeoning industry may meet an important need. Estimates suggest that about 29% of people will experience a mental disorder in their lifetime1. Data from the World Health Organization (WHO) show that many of those people — up to 55% in developed countries and 85% in developing ones — are not getting the treatment they need. Mobile health apps could help to fill the gap (see 'Mobilizing mental health'). Given the ubiquity of smartphones, apps might serve as a digital lifeline — particularly in rural and low-income regions — putting a portable therapist in every pocket. “We can now reach people that up until recently were completely unreachable to us,” says Dror Ben-Zeev, who directs the mHealth for Mental Health Program at the Dartmouth Psychiatric Research Center in Lebanon, New Hampshire. Public-health organizations have been buying into the concept. In its Mental Health Action Plan 2013–2020, the WHO recommended “the promotion of self-care, for instance, through the use of electronic and mobile health technologies.” And the UK National Health Service (NHS) website NHS Choices carries a short list of online mental-health resources, including a few apps, that it has formally endorsed. But the technology is moving a lot faster than the science. Although there is some evidence that empirically based, well-designed mental-health apps can improve outcomes for patients, the vast majority remain unstudied. They may or may not be effective, and some may even be harmful. Scientists and health officials are now beginning to investigate their potential benefits and pitfalls more thoroughly, but there is still a lot left to learn and little guidance for consumers. “If you type in 'depression', its hard to know if the apps that you get back are high quality, if they work, if they're even safe to use,” says John Torous, a psychiatrist at Harvard Medical School in Boston, Massachusetts, who chairs the American Psychiatric Association's Smartphone App Evaluation Task Force. “Right now it almost feels like the Wild West of health care.” Electronic interventions are not new to psychology; there is robust literature showing that Internet-based cognitive behavioural therapy (CBT), a therapeutic approach that aims to change problematic thoughts and behaviours, can be effective for treating conditions such as depression, anxiety and eating disorders. But many of these online therapeutic programmes are designed to be completed in lengthy sessions in front of a conventional computer screen. Smartphone apps, on the other hand, can be used on the go. “It's a way of people getting access to treatment that's flexible and fits in with their lifestyle and also deals with the issues around stigma — if people are not quite ready to maybe go and see their doctor, then it might be a first step to seeking help,” says Jen Martin, the programme manager at MindTech, a national centre funded by the United Kingdom's National Institute for Health Research and devoted to developing and testing new mental-health technologies. One of the best-known publicly available apps was devised to meet that desire for flexibility. In 2010, US government psychologists conducting focus groups with military veterans who had PTSD learned that they wanted a tool they could use whenever their symptoms flared up. “They wanted something that they could use in the moment when the distress was rising — so when they were in line at the supermarket,” says Eric Kuhn, a clinical psychologist and the mobile apps lead at the US Department of Veterans Affairs' National Center for PTSD. The department joined up with the US Department of Defense to create PTSD Coach, a free smartphone app released in early 2011. Anyone who has experienced trauma can use the app to learn more about PTSD, track symptoms and set up a support network of friends and family members. The app also provides strategies for coping with overwhelming emotions; it might suggest that users distract themselves by finding a funny video on YouTube or lead users through visualization exercises. In its first three years in app stores, PTSD Coach was downloaded more than 150,000 times in 86 different countries. It has shown promise in several small studies; in a 2014 study of 45 veterans, more than 80% reported that the app helped them to track and manage their symptoms and provided practical solutions to their problems2. More results are expected soon. Kuhn and his colleagues recently completed a 120-person randomized trial of the app, and a Dutch team is currently analysing data from a 1,300-patient trial on a similar app called SUPPORT Coach. Smartphone apps can also interact with users proactively, pinging them to ask about their moods, thoughts and overall well-being. Ben-Zeev created one called FOCUS, which is geared towards patients with schizophrenia. Several times a day, the app prompts users to answer questions such as “How well did you sleep last night?” or “How has your mood been today?” If users report that they slept poorly, or have been feeling anxious, the app will suggest strategies for tackling that problem, such as limiting caffeine intake or doing some deep-breathing exercises. Some apps help people to stay connected to health-care professionals, too. ClinTouch, a psychiatric-symptom-assessment app designed by researchers at the University of Manchester, UK, analyses users' responses for signs that they may be experiencing a relapse; it can even notify a clinical-care team. Small feasibility studies — which are generally designed to determine whether an intervention is practical, but do not necessarily evaluate its efficacy — have shown that patients use and like both apps, and a 2014 study found that those who used FOCUS for a month experienced a reduction in psychotic symptoms and depression3. FOCUS and ClinTouch are both now being evaluated in randomized, controlled trials. Some researchers see opportunities in the data that smartphones collect about their users' movement patterns or communication activity, which could provide a potential window into mental health. “Your smartphone is really this interesting diary of your life,” says Anmol Madan, the co-founder and chief executive of Ginger.io, a digital mental-health company based in San Francisco, California. Studies have now shown that certain patterns of smartphone use can predict changes in mental-health symptoms4; a drop in the frequency of outgoing text messages, for instance, may suggest that a user's depression is worsening. The Ginger.io app, which is still in beta, monitors these sorts of patterns and alerts each user's assigned mental-health coach if it detects a worrying change. The evidence supporting the use of such apps is building5, 6, 7. But this is a science in its infancy. Much of the research has been limited to pilot studies, and randomized trials tend to be small and unreplicated. Many studies have been conducted by the apps' own developers, rather than by independent researchers. Placebo-controlled trials are rare, raising the possibility that a 'digital placebo effect' may explain some of the positive outcomes that researchers have documented, says Torous. “We know that people have very strong relationships with their smartphones,” and receiving messages and advice through a familiar, personal device may be enough to make some people feel better, he explains. But the bare fact is that most apps haven't been tested at all. A 2013 review8 identified more than 1,500 depression-related apps in commercial app stores but just 32 published research papers on the subject. In another study published that year9, Australian researchers applied even more stringent criteria, searching the scientific literature for papers that assessed how commercially available apps affected mental-health symptoms or disorders. They found eight papers on five different apps. The same year, the NHS launched a library of “safe and trusted” health apps that included 14 devoted to treating depression or anxiety. But when two researchers took a close look at these apps last year, they found that only 4 of the 14 provided any evidence to support their claims10. Simon Leigh, a health economist at Lifecode Solutions in Liverpool, UK, who conducted the analysis, says he wasn't shocked by the finding because efficacy research is costly and may mean that app developers have less to spend on marketing their products. A separate analysis11 found that 35 of the mobile health apps originally listed by the NHS transmitted identifying information — such as e-mail addresses, names and birthdates — about users over the Internet, and two-thirds of these did not encrypt the data. Last year, the NHS took this apps library offline and posted a smaller collection of recommended online mental-health services. The NHS did not respond to e-mailed questions or make an official available for interview, but it did provide this statement: “We are working to upgrade the Health Apps Library, which was launched as a pilot site in 2013 to review and recommend apps against a defined set of criteria which included data protection.” The regulation of mental-health apps is opaque. Some apps designed to be used in a medical context can be considered medical devices and therefore may be regulated by the UK Medicines and Healthcare Products Regulatory Agency, the US Food and Drug Administration (FDA) or equivalent bodies elsewhere. But the lines are fuzzy. In general, an app that claims to prevent, diagnose or treat a specific disease is likely to be considered a medical device and to attract regulatory scrutiny, whereas one that promises to 'boost mood' or provide 'coaching' might not. The FDA has said that it will regulate only those health apps that present the highest risks to patients if they work improperly; even mental-health apps that qualify as medical devices might not be regulated if the agency deems them to be relatively low risk. But the potential risks are not well understood. “At the low end, people might waste their money or waste their time,” says Martin, “and at the higher end, especially with mental health, they might be actively harmful or giving dangerous advice or preventing people from going and getting proper treatment.” When a team of Australian researchers reviewed 82 commercially available smartphone apps for people with bipolar disorder12, they found that some presented information that was “critically wrong”. One, called iBipolar, advised people in the middle of a manic episode to drink hard liquor to help them to sleep, and another, called What is Biopolar Disorder, suggested that bipolar disorder could be contagious. Neither app seems to be available any more. Martin says that in Europe, at least, apps tend to come in two varieties, those that are commercially developed and come with little supporting evidence or plans for evaluation, and those with academic or government backing that take a more rigorous approach. The problem is that the former are generally more engaging for users and the latter take so long to make it to the market — if they even do — that they look out of date. “This is a generalization,” Martin says, “but it's broadly true.” Even well-intentioned apps can produce unpredictable outcomes. Take Promillekoll, a smartphone app created by Sweden's government-owned liquor retailer, designed to help curb risky drinking. While out at a pub or a party, users enter each drink they consume and the app spits out an approximate blood-alcohol concentration. When Swedish researchers tested the app on college students, they found that men who were randomly assigned to use the app ended up drinking more frequently than before, although their total alcohol consumption did not increase. “We can only speculate that app users may have felt more confident that they could rely on the app to reduce negative effects of drinking and therefore felt able to drink more often,” the researchers wrote in their 2014 paper13. It's also possible, the scientists say, that the app spurred male students to turn drinking into a game. “I think that these apps are kind of playthings,” says Anne Berman, a clinical psychologist at the Karolinska Institute in Stockholm and one of the study's authors. There are other risks too. In early trials of ClinTouch, researchers found that the symptom-monitoring app actually exacerbated symptoms for a small number of patients with psychotic disorders, says John Ainsworth at the University of Manchester, who helped to develop the app. “We need to very carefully manage the initial phases of somebody using this kind of technology and make sure they're well monitored,” he says. In a pilot trial published earlier this year, ten US veterans with PTSD were randomly assigned to use PTSD Coach on their own for eight weeks, while another ten used the app with the support and guidance of primary-care providers. At the end of the trial, seven of the ten patients using the app with support showed a reduction in PTSD symptoms, compared with just three of the patients who used the app on their own14. But if apps require medical supervision, that undermines the idea that they will serve as an easy and low-cost way to provide care to the masses. “People think there's an app for everything,” says Helen Christensen, the director of the Black Dog Institute at the University of New South Wales in Sydney, Australia, who has developed and studied mental-health apps. “It's actually about how we build systems around apps, so that people have health care.” Distributing mental-health apps in the developing world presents further challenges. Although mobile technology is spreading rapidly, there are many people who do not have — or cannot afford — smartphones or mobile Internet access. And the content of apps needs to be delivered in local languages and reflect local cultures. “The notion that you can take an intervention and just plop it down in a region where people might not even use the same terms for mental health as you're using is a little unrealistic,” says Ben-Zeev. “What we might call 'hearing voices' in the United States might be something like 'communicating with your elders' in a different region, depending on what label people attach to that experience.” At this point, the notion that apps can deliver quality health care in low-income regions remains largely theoretical. “This is generally where the mHealth field is,” says Natalie Leon, a scientist at the South African Medical Research Council in Cape Town. “It's a promise of potential effectiveness.” To make good on that promise, apps will have to be tested. Between 2013 and 2015, the number of mobile-health trials registered on ClinicalTrials.gov more than doubled, from 135 to 300. And the number of trials specifically focused on mental and behavioural health increased by 32%, according to a report by the IMS Institute for Health Informatics in Parsippany, New Jersey. One digital health company that has earned praise from experts is Big Health, co-founded by Colin Espie, a sleep scientist at the University of Oxford, UK, and entrepreneur Peter Hames. The London-based company's first product is Sleepio, a digital treatment for insomnia that can be accessed online or as a smartphone app. The app teaches users a variety of evidence-based strategies for tackling insomnia, including techniques for managing anxious and intrusive thoughts, boosting relaxation, and establishing a sleep-friendly environment and routine. Before putting Sleepio to the test, Espie insisted on creating a placebo version of the app, which had the same look and feel as the real app, but led users through a set of sham visualization exercises with no known clinical benefits. In a randomized trial, published in 2012, Espie and his colleagues found that insomniacs using Sleepio reported greater gains in sleep efficiency — the percentage of time someone is asleep, out of the total time he or she spends in bed — and slightly larger improvements in daytime functioning than those using the placebo app15. In a follow-up 2014 paper16, they reported that Sleepio also reduced the racing, intrusive thoughts that can often interfere with sleep. The Sleepio team is currently recruiting participants for a large, international trial and has provided vouchers for the app to several groups of independent researchers so that patients who enrol in their studies can access Sleepio for free. “We think this is the way forward for digital health,” says Espie. Mobile-phone-based treatments, he says, “should be tested and judged like any other intervention. We shouldn't treat people's health with any less respect because the treatment is coming through an app.”
News Article | December 23, 2015
Did you lose a day or two of work last year because you slept poorly the night before? You're far from alone, according to new results from the World Sleep Survey. The study, which was conducted by researchers at the University of Oxford in collaboration with U.K.-based health care company called Big Health, found that full-time employees in the U.S. lose an average of seven days of work per year due to poor-quality sleep. And those who report that their sleep is of "less than average" quality lose more than 13 days. More than 20,000 people participated in the survey. Widely cited research from 2011 prompted employers to take a closer look at sleep. Researchers from Harvard University interviewed more than 7,000 people by phone, and found that insomnia results in the loss of 11 days of work per year. As a nation, that represents a total loss of $63.2 billion. Poor-quality sleep can result can affect mood and judgment, and result in serious health problems. The Centers for Disease Control and Prevention recently declared insufficient sleep a "public health epidemic," with some 18 million people in the U.S. reporting that sleep troubles impacted their job performance. Noel Lindsay, a Bay Area-based sleep expert, is not surprised that exhausted employees are skipping work. "When you don't sleep well, you'll experience a serious degree of cognitive impairment," he said. Lindsay said some people simply don't allot enough time for a good night's rest; others aren't able to sleep well due to medical conditions, like insomnia or sleep apnea. For those who have persistent sleep troubles, Lindsay recommends paying a visit to a doctor. Some 72% of those who participated in the World Sleep Survey said they had not consulted a physician about their sleep troubles. Moreover, Lindsey has a few hacks to try at home: Avoid turning on electronics for an hour before bed, keep alcohol consumption to a minimum, and ensure the bedroom is a mecca for sleep— and not a glorified office. Historically, employer wellness programs have focused on fitness and healthy eating. But that's beginning to change. Some companies are developing programs to assess and treat employees with sleep apnea, a common disorder that disrupts sleep and often goes undiagnosed. More than 18 million American adults have sleep apnea, according to the National Sleep Foundation. Other large companies, like Google and Goldman Sachs, have brought in sleep experts to disseminate information about sleep disorders, according to the Washington Post. Johnson & Johnson offers its employees a digital coaching program that is designed to reduce insomnia, and involves relaxation videos. Corporate wellness company Ceridian now offers sleep coaches to teach employees about healthy habits for getting a good night's rest. "I think employers are interested in it because when you improve sleep, you improve productivity and potentially a whole host of health issues," says Jennifer Benz, a San Francisco-based health benefits expert with the firm Benz Communications.
News Article | November 30, 2016
Market Research Store report gives a complete, in-depth, and internationally proportionate statistics, analysis, and numbers on a broad range of services for the global Big Health Industry of Traditional Chinese Medicine in China 2016 - 2021 market. This report will help in the analysis of the main technological aspects and trends of the global market in the forecasted period. Detailed study of the financial ratios along with the projection of sales for the future is provided by this report. Big health industry was advocated because of the development, social demands and changes of disease spectrum. Big health industry of traditional Chinese medicine (BHITCM) proposed a healthy lifestyle that cured disease as well as the preventive treatments. Big health industry of traditional Chinese medicine obtained output RMB700 billion in 2009, and it reached RMB1 trillion in 2015. There were hundreds medicine companies in big health market at present, including around 30 listed companies. The big health concept simulated the social demand so that it brought opportunities for those companies. The new concept of big health industry was widespread, which included healthy food, health care instrument and leisure health care services. It not only provided products, but also the solutions of health lifestyle, therefore, it could create much more business profits. The output of big health industry of traditional Chinese medicine will catch RMB3 trillion in 2021. To provide readers with comprehensive and indepth understanding of Chinese big health industry of traditional Chinese medicine product industry; To analyze the market import and export of big health industry of traditional Chinese medicine product industry; To analyze the future trend of big health industry of traditional Chinese medicine product industry; To analyze industrial size of the industry; To reveal opportunities for big health industry of traditional Chinese medicine product industry in China. Obtain latest info of big health industry of traditional Chinese medicine product industry, such as market size, price, key players, etc.; Discover market potential in different regional markets; Find out how Chinese big health industry of traditional Chinese medicine market will change and how your business can be involved in; Keep informed of your competitors/their activities in China; Learn about key market drivers, investment opportunity ; The report will investigate Chinese big health industry of traditional Chinese medicine industry from the following aspects:
News Article | April 21, 2016
Millions of people with mental health disorders, including depression and bipolar disorder, are not getting the help they need. The World Health Organization (WHO) estimates that up to 50% of people in developed countries and 85% in developing ones lack proper access to treatment. But many of these underserved people do have access to smartphones. And a simple search on Apple's App Store yields hundreds of apps, which claim to do everything from diagnosing depression to treating insomnia. As you might imagine, these apps range in quality. Some are peddling pure snake oil (one app recommended that people with bipolar disorder drink hard liquor during manic episodes), while others have been been independently peer-reviewed by scientists and researchers. I asked three experts to weigh in on whether mental health app makers have an ethical obligation to back up their claims with clinical evidence. Here's what they had to say. John Torous, clinical fellow and senior resident in psychiatry at Brigham and Women's Hospital in Boston, Massachusetts: How would you react if your doctor told you the medication she is recommending for your life-threatening infection has never been actually tested, studied, or evaluated? The foundation of health care is trust. So why should the standard be any different for mental health technologies, like smartphone apps that claim to offer either diagnostic or therapeutic guidance? We have clear evidence that some apps can cause harm, or are ineffective; and many make boastful claims that are simply not true. While opponents may claim that clinical studies take too long to generate evidence, there are new models of research like Agile Science that can facilitate rapid results. And there is the simple truth that if you want to claim an app is effective for long-term care, then you simply have to study it in the long-term. Instead of science and evidence-based information from which patients and clinicians can make informed decisions about mental health apps, there is currently a lack of clinical outcomes data and a world rife with bold claims and promises. Thus the real question is not should we have evidence for these apps, but why is it currently acceptable to make claims about mental health outcomes with no supporting data? Is it stigma against mental health, belief that patients and clinicians will accept low standards, or a drive for commercialization that has created a landscape where many are making bold claims about mental health that resemble snake oil rather than science? I believe that smartphone technology for mental health will likely grow and evolve into useful clinical tools as we begin to better study and understand them, rather than sell them. Peter Hames, CEO of digital medicine startup Big Health: Here’s the simple fact: Evidence in health care is non-negotiable. Be it drugs, talking therapies, or even homeopathy, if we're claiming an outcome we owe it to the people who use our services to give them things that work. This is more than an eye-rolling meeting of regulations. It’s our ethical duty. As a founder, I all too frequently hear the view that the time and resources required to conduct controlled trials and publish the evidence are beyond the reach of startups. This is junk. Our first randomized, controlled trial was conducted and published while we were bootstrapped. If you have a promising innovation and believe in the importance of evidence, there are people out there desperate to help you; every clinical academic department I’ve ever had contact with is hungry for novel digital solutions to test, often with funding secured and at the ready. "We need to behave like grown-ups to win the trust of patients, clinicians, and payers." But this evidence-ducking is more than just lazy—it's dangerous. For the first time ever, we have an opportunity to get evidence-based non-drug health care to the millions of people who need it. And in the process we can create a huge new industry that operates under that rarest of things—a strong code of ethics aligned with the interests of the end user. In short, this is a golden opportunity to create a better type of medicine, and if we’re not careful we’ll blow it. If we’re serious about fulfilling the potential of digital therapeutics then we need to behave like grown-ups to win the trust of patients, clinicians, and payers. That means doing the hard work, getting the evidence, making it available for scrutiny, and publishing it. Or digital therapeutics will forever be treated like toys, footnotes at the fringes of health care. The stakes are too high, and the need for change is too great. Let’s not shrug our shoulders—let’s roll up our sleeves, meet our ethical responsibilities, and create a better type of medicine. Thomas Goetz, cofounder and CEO of Iodine: Medicine often works at a glacial pace. Besides the 17-year lag between research and practice, there’s also just an everyday gap between what we know health care should do—the platonic ideal that’s often been proven in clinical trials—and what health care actually does—the day-to-day practice of usual care. Mobile technologies offer us a true opportunity to speed up this cycle and to put effective interventions to work at scale. Apps, in other words, are a chance to "fork the code"—to turn well-proven but manual interventions into automatic, algorithmic interventions that leverage software to bring best practices to the many, rather than the few. This is a huge shift, and a huge chance for medicine to improve the speed of practice. This doesn’t mean doing away with proper validation studies that vet mobile apps for real effectiveness. But we should take advantage of the rapid, iterative, launch-and-fix-bugs pace of software. And we shouldn’t expect software to stand still for one or two years while academic validation works its way through review and publication. At my company, Iodine, we’ve taken the approach of building upon years of well-researched interventions, validated measures, and guidelines from the Institute for Clinical Systems Improvement, and seeing if we can turn that into something real people will actually find useful in their daily lives. Having proven that on the battlefields of real life, we’re now moving on to academic validation studies that will help us sell our products to the real customers: providers, insurers, and employers. It seems to me that to take the opposite approach would fail to take advantage of what technology is so good at—iterative development—and succumb to what medicine still suffers from—a timeline driven by publishing deadlines and peer review, rather than the pressing needs of real people in the real world. What do you think? Please share your views with me on Twitter (@chrissyfarr) or via email (email@example.com)
News Article | December 8, 2016
ClearlySo, Europe's leading impact investment bank, announced today that it has launched ClearlySo ATLAS, an impact assessment solution for private equity and venture capital investors. Octopus Ventures, a London based venture capital firm, focused on backing unusually talented entrepreneurs, is the first customer to go-live and is in the process of rolling out the solution across its portfolio. ClearlySo ATLAS helps private equity and venture capital investors assess the social and environmental impact of their investments and provides practical suggestions for action. Research increasingly shows that there is a positive correlation between impact and financial return, and lack of awareness about negative impact is a risk. The methodology ClearlySo ATLAS uses to assess impact combines current best practices, industry-wide expertise and years of in-house experience developed at ClearlySo. Private Equity Reporting Group, Principles for Responsible Investment, European Union Directives and Red Line Voting are all considered and the results are mapped to the UN Sustainable Development Goals ensuring investors engage with the latest market expectations. Luke Hakes, investment director at Octopus Ventures commented: "We are delighted to be working with ClearlySo to assess the social and economic impact of the companies we back. We are incredibly proud of our portfolio companies which include Antidote and Big Health and the brilliant work they do in their respective sectors. We know that High Growth Small Businesses have a disproportionately high impact on our domestic economy and we are excited to be able to work with ClearlySo to analyse the impact of our venture capital investments." Further commenting, Lindsay Smart, head of impact innovation at ClearlySo said: "The launch of ClearlySo ATLAS marks a new chapter in assessing the role of impact and sustainability in the venture capital and private equity sphere. We spent 18 months collaborating with industry experts to develop a solution at a time when corporate and financial action continues to garner much scrutiny. We look forward to working with our customers, including our first, Octopus Ventures, renowned for leadership in innovative thinking, as they seize the opportunity to be standard setters for private equity and venture capital investment." To learn more about ClearlySo ATLAS please visit http://www.clearlyso.com/ATLAS. ClearlySo is Europe's leading impact investment bank, working exclusively with businesses and funds delivering positive social, ethical and/or environmental impact along with financial return. It supports capital raising activity through financial advisory work. Originally founded in 2008, ClearlySo has helped over 100 clients raise more than £100 million in impact investment from its extensive network of high-net-worth individual and institutional investors. In addition, ClearlySo ATLAS helps investors assess the social and environmental impact of their venture capital and private equity investments and guides them towards choosing sustainable businesses that deliver long term benefit to people, planet and the bottom line. Octopus transforms industries that really matter - like investments, healthcare and energy. We do extraordinary things so that our customers see change for the better. Octopus is a fast-growing UK fund management business with leading positions in several specialist sectors including smaller company investing, healthcare property, energy and property finance. Founded in 2000, Octopus manages more than £6 billion of funds on behalf of 50,000 investors - both retail and institutional. Over the years we have invested in more than 500 SMEs including household names such as LOVEFiLM, graze.com and Zoopla Property Group. Our investments have helped these businesses to create thousands of new jobs.
News Article | September 17, 2014
Index Ventures-backed UK health startup Big Health has launched its first app, extending its inaugural web product, Sleepio — a cognitive behavioral therapy program for sleep disorder sufferers — onto the iPhone and iPod Touch. The app integrates with Apple’s HealthKit in iOS 8 so it can import sleep data from fitness tracking devices such as the Jawbone UP, giving users a quick way to flesh out their sleep profile within the app. Update: The Sleepio app will be on the App Store later today, once iOS 8 has rolled out. Stay tuned. Update 2: The app’s launch was disrupted by a bug in Apple’s HealthKit developer tool which caused Cupertino to lock down HealthKit and remove apps with HealthKit integration from its store entirely. Apple has said it’s working on fixing the bug by the end of this month. Until then there’s no active HealthKit integration. So the version of Sleepio currently on the App Store has had HealthKit integration removed temporarily, until Apple fixes the problem. Big Health itself is on a mission to invent a new category of healthcare called “digital medicine” — offering an alternative to pharmaceutical interventions by scaling CBT programs to large numbers of people via the medium of digital technology. The premise being that not everyone can get face-to-face access to a flesh and blood therapist, even when that might be preferable to taking drugs. But an automated digital CBT can be inexpensively scaled to anyone with Internet access. The startup has conducted what it says is a “world first” placebo-controlled randomized trial of the effectiveness of Sleepio — in a bid to set the product in a rigorous, medically valid category of its own, i.e. rather than have it rubbing shoulders with generic lifestyle advice apps and services. Proving the effectiveness of its “digital medicine” will therefore be key to scaling this business as big as its sizable ambitions. The startup is backed by some $3.8 million in funding, from investors including Index, Forward Partners and Esther Dyson. It’s spent some of that money on today’s mobilizing of its virtual therapist, The Prof, so that it can make its digital CBT product portable. That’s an obvious boon, given that insomniacs are more likely to be able to reach for their phone when they’re unable to sleep in the middle of the night than have a laptop or desktop handy. The Sleepio app offers users immediate help when they’re trying to sleep — via a ‘Help me now’ button, that will generate advice from The Prof contextualized to the user’s location and time of day, as well as personalized based on their sleep data. It also acts as a repository for that sleep data. Users can either input the data themselves (into the app or the Sleepio website), or import sleep data from third party tracking devices. The app then generates various visualizations of the data, including a sleep efficiency score, based on time spent in bed vs time spent asleep in bed. “You can now do the full evidence-based CBT program from your iPhone, and the help you get is now tailored based on data from HealthKit, as well as Jawbone UP,” Big Health CEO Peter Hames tells TechCrunch. “Given that we’re likely to see a bunch of apps and devices writing sleep data into HealthKit then we act as the missing link — actually making that data useful.” The only feature the app lacks vs the Sleepio web product is the social network element. Online, Sleepio offers a forum type environment that links insomniacs with fellow sleep disorder sufferers so they can get some (human) advice and support, as a supplement to The Prof’s digital ministrations. “For now, the community is web only – but this is better suited to long form communication in any case,” adds Hames. The Sleepio App will be a free download on the App Store. Users get seven days free access to trial the full product, after which they will need to pay a subscription to access the full CBT program — either $4.99 per month to get access to instant sleep tips, or $149 for a personalized, 12-week ‘Long Term Sleep Improvement’ program — or they can carry on using the app’s Sleep Diary and Your Schedule features for free.
News Article | February 2, 2015
It’s our favorite time of year, when frogs from around the world examine the state of technology’s future. Below you’ll find 15 declarations and projections from experts whose work continually advances the human experience. This compilation forecasts a few of our expectations for the future, and we look forward to your feedback as we collectively consider what is to come. Fitness technology startups are primed to shake up the health and fitness wearable industry, offering true insights and recommendations for athletic training. 3D, pressure, and motion sensors are being integrated to assess form, movement quality, and muscular exertion to automatically log your workouts and provide real-time recommendations to prevent injury and improve training. Companies to watch: Sensoria, Moov, LEO, GYMWatch The introduction of Amazon Echo is just one of many examples of ambient intelligence. We’ll see a surge in products and services that quietly pay attention to what’s happening around them — learning what people do, how they sound, and what they’re interested in — all in the service of making better guesses as to what people might need or want. Prepare for a very smart, ambient world. Companies to watch: Amazon Echo, Google Now, Microsoft Cortana What if our bodies could tell us we were sick, even before we felt symptoms? Nano particles, designed to live within the human body, are opening up opportunities to monitor the health of a person in real time with extreme accuracy. This emerging technology, along with other advanced diagnostics techniques, will enable instant disease detection, enabling much faster treatments and better outcomes. Companies to watch: Google[x], Danny Hillis “Ubiquitous (or pervasive) computing” has become the norm as microprocessors, sensors, and cloud services made their way into almost everything in our homes, cars, offices, and beyond. It is becoming too burdensome for many connected product and service companies to deliver software that can anticipate use cases and integration points of thousands of new connected products coming to market. A shift is underway in software and service design where the command and control of this complex connected world around us will rely on “casual programming” experiences — giving every day, non-programming people the tools, services, and APIs usually reserved for the hackers and technology elite in friendly and accessible forms. Companies to watch: IFTTT, Wink, Zapier Recently, cutting edge technology has been pushing its way into the food chain. In 2015 it will finally make its way to the dinner table. From 3D printed meals to data-derived diets to efficient home farming, technology is poised to revolutionize the dinner options in a 21st century home. Companies to watch: ChefJet, Mellow, 3D Robotics 2015 will see a new roster of connected kitchen devices that will profoundly change the way we produce, consume, and interact with food. Don’t be surprised to come home to a robot cooking pizza from original Italian recipes available on the Internet, or by making coffee (almost) out of your smartphone. Companies to watch: My Vessyl, LG Mobile is transforming developing markets; opening access to critical services like education and healthcare, improving financial inclusion and improving the efficiency of trade. frog is at the forefront of this transformation, researching and designing mobile solutions for the underserved in a diverse range of markets. With over four billion people yet to connect to the internet, the opportunity to create meaningful impact is immense. Companies to watch: Internet.org, Google Project Loon, GSMA mAgri Secure messaging had the reputation of being for shady people. But ever since a series of high-profile hacks in 2014 laid bare the private lives of several celebrities — as well as thousands of civilians — there has been massive interest in messaging (voice, text, photo, and video) that is meant to be fundamentally secure from snooping. A new set of products emerged to take up this challenge, including everything from personal data vaults, to secure encrypted calls, to video chats. Expect to see even more platforms that make it easier for you to live anonymously online. Companies to watch: Silent Circle’s Blackphone, SpiderOak Cloud Storage, Geeksphone, DarkMail Alliance Imagine a factory in the future where the parts of a product assemble themselves, or where physical objects can adapt to a user over time. For instance, a 4D-printed chair could become more comfortable over time, or become stronger at stress points, instead of breaking. What if? This is the aim of 4D printing, a field popularized by MIT’s Skylar Tibbits and his self-assembly lab. We’re on the verge of seeing explosive progress in the world of 4D printing. Expect to read about advancements in the field in the near future. Companies to watch: Nervous Systems, Stratysys Digital currencies, including crypto-currencies, will thrive. Governments are exploring frameworks and systems to regulate and manage digital currencies, which will make their ubiquity in our everyday financial vernacular more profound. Ecuador’s Congress recently approved a reform to create a digital currency, and the New York State Department of Financial Services is considering establishing virtual currency exchanges. The UK government is calling for information about the benefits and risks of digital currencies. We can expect digital currencies to be used interchangeably with legal tender, giving birth to a frictionless, agile, universal payment system that will expand beyond the current banking ecosystem. Companies to watch: Government of Ecuador, The UK Government, New York State Department of Financial Services What if your app and wearable device could not only diagnose your sleep apnea, stress, and anxiety, but also provide clinically proven treatments? While wearable health activity trackers were all the rage in 2014, the future will see the rise of therapeutic solutions: data-tracking hardware paired with clinically proven software that simulates cognitive behavioral therapy. These new solutions will address chronic behavioral conditions, from sleep disorders to stress and anxiety. Companies to watch: Big Health, Lantern, Olive Your everyday items will be getting an upgrade. More and more companies and designers will create innovative smart textiles embedded with new technologies and sensors, which will impact everyday lives by monitoring health, behavior, and the environment. This year the hottest wearable device might just be the shirt on your back. Adaptive technologies will become omnipresent both in and out of the classroom, providing students with the ability to learn content at their own pace and potentially test out of areas when they are ready. Real-time data will lead to more actionable items for students and teachers—allowing for a personalized path to success. Companies to watch: Knewton, Aleks, Alt School, Dreambox, Kidaptive Hiring is time-consuming. To save time during the hiring process in 2015, more companies will turn to video games to evaluate job candidate nuances such as creativity, problem solving, and collaboration. Candidates’ game scores will be measured against scores of successful employees, making hard data — alongside subjective opinions from hiring managers — an asset to predict success. Companies to watch: Knack Everyone will grow their own organic lettuce and trade it on a local social network for other types of vegetables. Our habits around food production and consumption are undergoing a radical shift, from wider adoption of CSAs to the prevalence of organic food, consumers are taking control of how and what they eat with new smart food technologies. Several companies are designing easy-to-use and aesthetically pleasing hydroponics and aquaponics systems for the home, which will allow anyone to manage a mini-farm with a smartphone. Greater food autonomy is on the horizon.
News Article | July 6, 2015
The NHS has selected 17 healthtech innovators to join the Innovation Accelerator, part of its Five Year Forward View commitment to transform the culture of innovation within the organisation. Participants include AliveCor with its mobile heart monitor, the Patients Know Best personal health data platform, the Sleepio digital sleep improvement system and peer-to-peer social network HealthUnlocked. “The NHS stands on the cusp of a revolution in innovation,” said Sir Bruce Keogh, NHS England’s national medical director. “At its heart, innovation is the will to better, to find solutions for existing needs or new problems through more effective products, processes, technology or even the way we deliver services. “Today we increase the opportunity for improving patient care by creating new conditions for ideas to thrive.” Peter Hames, CEO and cofounder of Big Health, creators of Sleepio, said: “It’s an honour to be appointed as an NHS Innovation Fellow, and a unique opportunity to get evidence-based digital medicine such as Sleepio to the millions in the UK who would benefit.” Participants, many of whom are professional clinicians, get mentoring, a bursary and support through the Academic Health Science Networks, and could see their products rolled out across the entire NHS.
News Article | August 6, 2015
Q: What do you get if you cross seasoned psychological cognitive behavioral therapy (CBT) techniques with modern app design? A: Moodnotes: aka the lovechild of London-based digital product studio ustwo — maker of minimalist mobile game Monument Valley, among other apps — plus LA-based m-health app maker Thriveport. “Moodnotes is a health journal for you to capture your feelings and improve your thinking habits,” says Alana Wood, ustwo UX designer. “It couples positive psychology with CBT and off the back of logging your mood it acts as a catalyst to get you into journaling and then it’s through the journaling that we tailor the content, in quite a simple way, whether your mood is more up or down… to prompt users to think more in depth about the situations that they’re facing and how they’re feeling and thinking whilst they’re in those situations.” The other half of this joint venture, Thriveport, was set up by a pair of U.S. psychologists with the aim of building “scientifically sound” apps for the emergent m-health space. Their first app, MoodKit, has been in the market since 2011. And has gained users from the mainstream, as well as attracting utility as a tool clinical psychologists recommend their patients use, according to co-founder Edrick Dorian — although he won’t disclose exact user numbers, saying only that it’s in the “tens of thousands” and demand for the app has “held steady for the past four years”. Moodnotes, launching today on iOS (iPhone and Apple Watch) also as a paid app (costing $3.99/£2.99), extends Thriveport’s reach into the m-health app space with a second iOS app focused on promoting emotional and mental wellbeing, but this time incorporating the interface and UX design pedigree of ustwo via a partnership that’s initially agreed to run for two-years. Moodnotes is an intentionally more streamlined experience than MoodKit, says Dorian (he describes the latter as a “Swiss Army Knife of mental health tools”), with a more fixed focus on mood tracking and journaling as a way to help users understand and modify their thought processes with the aim of promoting general emotional wellbeing. It’s being launched as an MVP at this stage after eight weeks dev time (with no iCloud integration as yet, for instance), and content and feature-set aligned with its $3.99/£2.99 price-tag — allowing the team to get an app launched within a tight delivery timeframe, test the market, and then iterate based on future usage, says ustwo’s business director Nicki Sprinz. “We put together the maximum content that suits that price point that people feel they are getting value… but there’s enough revenue for us to be able to support the maintenance, growth and design of the platform,” she says, explaining why they’ve steered clear of a subscription model at this point. Moodnotes has a playful interface that lets users quickly log their mood by swiping up or down on a face to move from neutral to happy or sad. From there they can do a quick save and leave it at that if they just want to do mood tracking. Or there’s a button to tap to add more details — at which point the app prompts them to start journaling to flesh out the feelings behind the mood they just recorded, including the ability to tag entries with positive or negative feelings (such as ‘anxious’ or ‘content’). “Depending on how much time or motivation the user has, they can progressively go deeper with their journaling practice. And we thought… to frame it as a tangible journal was quite important because it’s a social norm, journaling, so essentially we wanted to also get around this kind of stigma associated with mental health and focus it on emotional health and just simply the act of journaling,” says Wood. The flow of the app changes depending on the emotions the user expresses — so if they start tagging their day with more negative emotions they will unlock different prompts than if they are expressing positive feelings. “Depending on if you’re feeling low then it will start to bring in that CBT content to help you to unpack in more detail how you were thinking and approaching the situation — and then it will kind of give you an antidote in terms of how to think about things differently for the future and what to look out for,” says Wood. “But then if you’re feeling more positive then what we found through testing is when people are in a more uplifting mood they don’t want to spend too much time in analysis. So then we limit the questions simply to more positive psychology type of questions around the kind of gratitude journaling, and that kind of thing.” The app also charts mood logging so users can get an overview of their emotional state over time. “It’s quite interesting because it has a lot of versatility around it. It’s simply a facilitation experience, and so people make from it what they put into it,” she adds. Content is stored locally on the device, to preserve user privacy of such sensitive personal information. “It’s quite different to your average quantified self logging tool,” notes Wood. “It’s really personal… so for now we wanted to keep it quite self-contained.” ustwo has been beta testing the app with around 500 users before launch, and has found people are using it in a variety of different ways — although most people are using it two to three times per week, rather than (as it had expected) multiple times per day. “There’s some people we’ve noticed that they use it just when they’re facing situations where they need to break free of the thinking habit or the style that they are stuck in… and then some people are using it daily to log their mood but they don’t go that deep in terms of their journaling habit,” says Wood. “And then some people are using it to figure out what makes them more content, day to day.” “It was quite an interesting design challenge because there’s legacy ways of doing something within the psychology space, so we wanted to be true to the kind of scientific roots of that discipline, but at the same time we were really pushing the boundaries in terms of how could we make this a customer facing application that was slightly playful but not too playful, simple, intuitive but not patronising, not too academic but still intelligent,” she adds. “We were constantly trying to strike the right notes.” While there are quite a few apps in a similar space — from journaling apps like Momento to life tracking apps like Expereal — ustwo reckons Moodnotes has something a little more well-rounded to offer than what’s already out there. “It’s more than a mood tracking app, it’s a journaling tool,” says Wood. “I would say it’s on the cusp between the two. And the benefit of this one is it can provide value to the user depending on whether they are encountering a negative situation or a positive one. They can still learn something about themselves and grow their self awareness. “A lot of the mood tracking apps or the apps that target more anxiety or depression… tend to go a bit more towards unpacking those negative situations and then I think it’s done its jobs. Our app is giving something to people on both sides.” For ustwo, the m-health space is a brave new world. Its main focus to date, aside from commercial work building apps for other companies, has been games — with the aforementioned Monument Valley and other in-house efforts like Whale Trail, plus other consumer apps such as messaging apps and then last year another joint venture project for the fan-focused Dice mobile gig ticketing app. Efforts with Dice are ongoing, but ustwo’s Sprinz said the company was keen to diversify its output further — hence the push into m-health, and the partnership with Thriveport. “The background is that most of the studio is really interested in doing some work in the health and wellbeing space, and we’re aware of the fact that unlike, for example, finance or retail where we have a huge amount of experience in those areas, health is more of a passion point — but we have less on the ground product development experience. And so we were looking for ways, as part of our investment projects and internal research, to uncover more work that we could do and put new lenses on problems that we were aware were affecting the industry,” says Sprinz. “When we formed some interesting proposition ideas we were aware that in order to really make a difference in the health space we needed to convene the right kind of partnership,” she adds. Thriveport’s Dorian says the focus of the partnership is about “enhancing the design element to make it more engaging, more accessible, have even broader mainstream appeal”. “You can have a delightful or pleasant experience with the app and yet be exposed to content that is normally found in therapy, or through clinical self help books but in a way that you don’t normally find cumbersome or dry or boring,” he adds. “With Moodnotes it’s a return to the basics but given how the technology, including design knowledge, UI advancements and understanding has evolved over the past five+ years [since MoodKit launched] it enabled us to take a fresh look at how we would deliver this sort of content with high design but a very focused objective for the app.” How much hard science underpins Moodnotes (and MoodKit)? No random placebo-controlled trials as yet, but Dorian, who is a board certified clinical and police psychologist, argues this is largely down to the newness of the m-health space. “This area of research is in its infancy but a fair amount of research has emerged over the past half-dozen or so years pertaining to the feasibility, usability, and, more recently, efficacy of such apps — with findings that are generally quite encouraging, albeit limited,” he tells TechCrunch. MoodKit is also now part of a “large-scale controlled efficacy trial” currently taking place in Australia, adds Dorian. There are other m-health startups using apps as a delivery mechanism to scale up access to CBT. Big Health’s Sleepio, for instance, which uses CBT methods to help insomnia sufferers get a better night’s sleep. That startup has conducted a placebo-controlled randomized trial to support its claims that digital sleep interventions can be helpful, but it’s unusual for doing so — and claimed it as the world’s first such trial for a digital health product. One thing is certainly true: m-health apps can be lower cost way of delivering CBT vs going to therapy, although Dorian also argues they can work well as a therapy supplement (but of course not everyone can afford full-time therapy). When well designed, apps also hold out the promise of a more accessible way in to CBT techniques vs the other low-cost alternative of self-administering CBT from a book. So MoodKit and its ilk are effectively the digital forerunners shaping the next generation of self-help tools — aiming to build on the size and success of the very large (and lucrative) self-help book market by leveraging the power and ubiquity of smartphones to deliver CBT content in new ways. “I’ve had so many patients tell me in my direct work with them they just so appreciate not having to pull out a pencil and paper, that they can just write onto their phone,” adds Dorian. “More importantly, if they’re reading content that they wouldn’t normally want to be seen reading in public — like ‘overcoming your personality disorder’, or something — they don’t want that book exposed on the bus. And so it’s discreet. “For all people know you’re simply texting or writing an email or what have you. In reality you’re probably selecting feelings or evaluating your thoughts or making a journal entry. So I think that’s probably it’s biggest win over self help books, among many other reasons.”
News Article | August 14, 2015
Peter Hames was born in the northern English city of Leeds, educated at Oxford, and founded a digital health startup in London in 2010. Six months ago, he and his company moved to San Francisco. Hames had the backing of doctors, patients and venture capitalists for Sleepio, an online insomnia treatment. But he couldn’t see a way to sell the idea to the U.K.’s National Health Service, which controls virtually all medical spending in Britain. In California, by contrast, he’s marketing to companies that self-insure their employees. “The bigger opportunity was here,” Hames, 35, said by phone from San Francisco’s Mission District. “I wanted to see it happen in the U.K. but it was clear it wasn’t going to.” Venture capital investors plowed more than $4 billion into digital health startups in the U.S. last year, more than twice the total of 2013, according to Rock Health, a fund in San Francisco. Though no directly comparable data exists for Europe, the total is likely less than 100 million euros, according to the European Private Equity and Venture Capital Association. The gap means fewer opportunities for European entrepreneurs in one of the fastest-growing areas of technology, so there’s less likelihood that a startup might grow into a major employer. And it means any health benefits and cost savings from digital initiatives will take longer to reach the region’s medical systems and taxpayers even as the NHS -- projecting a 30-billion pound ($47 billion) shortfall by 2021 -- says it’s counting on innovation to cut costs. Index Ventures, a fund with offices in London that was an early investor in Skype, Soundcloud and Dropbox, backed Hames and encouraged his move to the U.S. The firm has looked into another half-dozen or so digital health companies in Europe, but could never envision a market, said Ophelia Brown, a principal at Index. “We see so many great ideas, but health-care solutions don’t have a great revenue model,” Brown said. “You need to see who will pay for it.” The problem is particularly acute in the U.K. In Germany and France, not all medical services are free for consumers, so they’re willing to pay for online products. In Britain, by contrast, the NHS covers virtually all health expenses, so entrepreneurs can’t avoid dealing with its bureaucracy. To sell to the NHS, a vendor must first become an approved supplier by getting on one of the lists the government maintains. The lists, called frameworks, cover everything from pacemakers to office shelves to ambulances, and can expire after three to five years. Figuring out how to get on them can be baffling for startups, particularly those with technologies that don’t fit into neat categories. Once approved, a supplier must convince buyers at each of the NHS’s 209 regional units or one of dozens of other groups that control health-care spending. “The complexity is massive,” said Mark Doorbar, chief executive officer of Safe Patient Systems Ltd., a company outside Birmingham that makes software for monitoring vital signs via mobile devices. In 2011, Doorbar got his company onto a national framework for mobile health providers, and started signing up local NHS units. When the framework expired last year, his sales stalled and while he has a few existing contracts, he’s struggling to find funding. After months of talks with venture capitalists in 2013, he came away empty-handed. “It was frustrating and disappointing,” Doorbar said. “We got fairly consistent feedback: ‘How can you penetrate the market?’” Simon King, a manager at Octopus Investments in London, said his firm evaluated Safe Monitoring Systems for several months. While the technology might save health systems money, “we just couldn’t get comfortable that they could” win enough contracts with the NHS, King said. The agency is aware of the obstacles faced by startups and wants to work with them to improve both care and efficiency, said Michael Macdonnell, who oversees NHS strategy in England. The service this year started a program to test innovations to determine whether they can back up their claims of saving money or improving health. Technology “is absolutely central to making the transformation that’s required,” Macdonnell said. “We just must have the right sort of innovation, value-added innovation. We can’t just be a route to market for people who want to sell the latest version of a scanner with a few more bells and whistles.” James Wise, a principal at Balderton Capital, a venture capital firm in London, says the NHS has gotten more open since centralized attempts to re-organize its computer systems failed about a decade ago. For entrepreneurs “the prize is big,” Wise said. “When you prove to a 100 billion pound organization you have something, companies can go from zero to very successful overnight.” Hames came up with the idea for Sleepio after developing insomnia. Frustrated that the only available treatments involved drugs, he read up on cognitive behavioral therapy and improved his sleep. Seeing the business potential, he formed a company called Big Health and recruited an Oxford sleep medicine professor to give the project scientific rigor. Sleepio, which costs about $10 a week, includes a sleep diary, online support groups and an animated therapist that guides patients through relaxation techniques. Hames rolled out the program in the U.K. in 2012 and began to attract paying customers. Last year, he got $3.3 million in funding, but he couldn’t crack the NHS and moved to the U.S. last February. “We assessed it and it was just not feasible,” Hames said. “We could waste years with no impact.” The NHS, though, hasn’t given up on Hames. In July, he was named one of 17 “NHS Innovation Accelerator Fellows” in a program designed to guide promising entrepreneurs. Hames is optimistic that the service can change, but still sees barriers for companies like his. “The NHS is optimized for people with large sales organizations, and/or specific knowledge about how the system works,” he said. “Although U.S. health care has its problems, and there are some messed-up incentives, at least there are incentives.”