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How Playing Games Improves Health: Ryan Douglas
81 Plays5 months ago
My guest is Ryan Douglas, co-founder and CEO of DeepWell Digital Therapeutics. Ryan is a therapy designer, previously – a top executive and board member in several med-tech companies, deeply experienced in creation of smart medical devices, neurosurgical robotics. Now with his team he creates an industry of immersive medicine, developing games and mechanics that help people treat mental health issues. Ryan believes such games need to be available both over the counter for self-assessment and can be recommended by your doctor as part of immersive medicine concept.
Find out about Deepwell DTx: https://www.linkedin.com/company/deepwelldtx/
Ryan Douglass: https://www.linkedin.com/in/ryanjdouglas/
Check the first Deepwell DTx game on Meta Quest – Zengence: https://www.deepwelldtx.com/zengence
Please, enjoy our conversation, subscribe, rate the show and share your thoughts with us at monthsandmillions@gmail.com!
Alex Babko: https://www.linkedin.com/in/alexanderbabko/
This is a personal podcast. The views and opinions expressed here are only those of the author and do not represent those of any organization or any individual with whom the author may be associated, professionally or personally.
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Transcript
Introduction to 'The Month in Millions'
00:00:14
Speaker
Hey, welcome to The Month in Millions, a practical and inspiring show about innovators and immersion tech practitioners. I'm the host of the show, Alex Povko. In
Parental Concerns on Video Games
00:00:24
Speaker
my childhood, my parents and aunties did not allow us to play video games as much as me and my siblings who wanted.
00:00:31
Speaker
They said that TV lamp would die because of Super Mario, or I would have to wear glasses all the time, play because of playing Sonic the Hedgehog. Luckily, none of them materialized. On
Video Games in Therapy
00:00:43
Speaker
the contrary, it evolved so much that in 2024, gaming world collides with therapy. Who knew?
00:00:51
Speaker
But this is actually a reality now, with the rise of gaming studios and publishers who not only embed gamified mechanics for medical treatment, but even integrate therapeutics mechanics into video games. My
Meet Ryan Douglas
00:01:04
Speaker
guest today is Ryan Douglas. Ryan calls himself a therapy designer. Previously, he was a top executive and but board member in several companies, including Nextern, and now deeply experienced in creation of smart medical devices, neurosurgical robotics, and most recently, a co-founder of Deepwell Digital Therapeutics, an S-Gen company that has an ambitious goal. Create video games that your doctor can officially prescribe to you.
Deepwell's Mission and FDA Collaboration
00:01:33
Speaker
Hi, Ryan. Hi. Hey, um we first met with you at South By in Austin, initially at Deep Well launch party. And most recently, ah this year, when you took part in one of the key sessions at South By, can you briefly introduce the concept of what are you doing at Deep Well?
00:01:56
Speaker
and why it's a game changer. Sure. I mean, the at the core concept, what we're doing is we're using video games to deliver therapeutics at a level that really hasn't been done before. It needs to be distinguished from gamification or edutainment. It is a different process. It's recognizing that the play mechanics, the games themselves and the engaging mechanisms within video games can be a therapeutic delivery mechanism and actually themselves are therapeutic. 70% of folks that are managing their mental health are doing it on their own. So it does something different than that. We very much want prescriptions in the future to be something that are happening, but we're working with the FDA to make these available over the counter. So you can self-assess, jump in and get involved with one of these products in a way that is probably more honestly how you're treating your mental health today. if you're
00:02:50
Speaker
70-80% of the people who don't have a doctor aren't necessarily getting access to managed care. So that's a very different approach than just write a prescription necessarily because there isn't anybody to write those prescriptions yet.
Economics of Therapeutic Game Development
00:03:04
Speaker
And if there is, there's nobody to reimburse them. So it meant building the games and using the game development and the game development platform in a very economically accessible way to not thinking, oh, we're going to get paid $1,000 a month to do this or something like that.
00:03:18
Speaker
How do we do this in a way that's safe and effective and can be you know doable for 1995? No medical device exists very well in that place. We had to rethink and we've been working with the agency to reimagine how those games stay safe, are effective, and are economically viable at a video game. rate All right, yeah, well, that sounds very ambitious and very promising. ah From what I know, are you your career started already with a quick takeoff. So you started as a pilot in Canada back in 1994. Yes, yeah. yeah i Making making the the highly required connections with local communities. Now you help other studios to lift off and help people around the globe
00:04:08
Speaker
to live a better life. So what lessons you learned ah following this career trajectory? Yeah, I mean, I think the starting as a pilot, I mean, I did it through a formal program through Mount Royal College, that's now ah Mount Royal University, a phenomenal facility in Calgary, that it means community based college, and they take you up to the next level, folks end up being doctors from there, so that they'll transfer to other universities, but they got a great starter program, I mean, and I was the kind of person that needed a starter program, because, you know, as a someone who dealt with ah neurodiversity in a time when people didn't know what it was, formal education, some of that was was trickier for me. So, you know, starting in that college, um they really did a great job of teaching us technically how the plane worked as well. So we had as many, what I'd say near engineering, tons and tons of meteorology courses,
00:04:59
Speaker
ah calculus, calculus based physics, and we had to fly the planes and this kind of stuff as well. So it gave me this mix of sort of engineering, science, and, you know, this very practical skill of of flying, in my case, small planes and and doing that in northern communities for for a period of time. So it was and like a resourcefulness that was needed. and I mean, the folks that taught us to, you could never get these instructors now. The vast majority of the people that worked in that program had actually been wartime pilots and they you know took us very young folks and there was a whole bunch of discipline and there was a whole bunch of bravery and there was a whole bunch of ah perspective that you know you don't really get in ah and a normal program because you know they very clearly
00:05:43
Speaker
every time one of the students took off and we had to fly solo as well as we had to fly with instructors, every time you could do something wrong and something catastrophic could happen. That's very different than a lot of university and programs. It's very real world, right? And so they did a lot to to instill in us a lot of practicality, how to use technology to your advantage, thinking about why you're doing the things you're doing and thinking about whether or not you should do it. So there's a lot of go-no-go conversations around the mechanics of an airplane, around the the weather that day and and you know predictive analytics at a time when those words weren't really used. Yeah, that's fascinating. and After your pilot career, ah it was very short.
00:06:25
Speaker
very sure You somehow got to the idea of digital pharmaceuticals. What do you think were the defining milestones between that point of time, point of career and self-development,
00:06:40
Speaker
to where you are now and while we are like recording this podcast. Yeah, I mean, restlessness, first of all, and the idea that there wasn't one thing that I wanted to do, I mean, that my brain got pulled in various directions. And I actually punished myself pretty hard for that. Why couldn't I stay particularly focused? Why couldn't I do one thing? And it's funny, um in a career,
00:07:02
Speaker
If you're going to live within sort of a given construct, that is a terrible thing. But if you're actually going to try to build new things from scratch, that then becomes a very positive thing. So my guess is a lot of my career trajectory was about finding a place where I felt good about me, about the way my brain works, the way I think about things to land in a place where I could be comfortable.
00:07:23
Speaker
being what I am. you know And so you know that and this overarching need to help. Health, wellness, and safety seem to just keep grabbing onto me in in various ways.
00:07:34
Speaker
you know it it you know started after kind of coming out of the the flying, um I went back to school for medicine. But again, it was too constrained. It wasn't exactly what I wanted. And it wasn't long until I was pulled. you know It was right around that time, late 90s, where everything was going on. kind of The internet was burgeoning and that kind of stuff. And I was pulled into media for a while and ended up with a group of folks. And we solved a ah a problem for a product called Macromedia Flash. We got the audio to sync with the visuals, which was the only way you could truly do animations or really
00:08:05
Speaker
um you know Prior to that, the ah the visuals were vectorized, which was great. You could load them once and use the mini, but the audio just streamed in and you couldn't time anything. So in solving that, getting involved ah with that community, the Flash community, with Macromedia, and eventually with Adobe, ah that was a chance for me to see media and and its reach and the power when it was kind of just burgeoning on the next level. when you know We already knew media was big from up.
00:08:31
Speaker
music standpoint from a video standpoint. But it was standing there at what was going to be the largest medium ever you know in in digital media and and video games. And and i mean Flash was used to build those games. I didn't stay in that for very long because that's kind of how I worked. And I started bouncing my way through after that product. I actually went into an educational product. So we built one of the first reading programs for struggling readers. and It was my ability to use Macromedia Flash allowed us to build this thing at individual learning and we we actually re-educated the entire Houston School District for one year. Anybody that was a struggling learner, they were in the back of a classroom with a computer and we got them up like 1.2 grade levels on average in six weeks. And so right then it started to help.
00:09:18
Speaker
you know and everyone of those kind of steps along the way if you look at the next things in my career there was there was no this health wellness and safety this idea that we could that we can improve somebody and use technology smartly you know just and that kind of snowball while i.
00:09:34
Speaker
figured out I was, I guess, an entrepreneur without knowing what that was or maybe even sometimes being ashamed by that word back in the day, too, right? It meant someone who couldn't hold down a permanent job, you know, or couldn't stay focused for too long in any one place. So but that, you know, that trajectory kind of made its way through from from media. I was I was drawn into robotics and ended up working eventually on something called the recon robot a robot that was deployed in theater in Iraq and Iran.
00:10:02
Speaker
And um this was a great little thing. It was the size of a Popcat and you pull a pin and you throw it and you had a Gameboy-like controller that was designed like a Gameboy-like controller because everybody we were teaching to use it was an 18-year-old kid, you know, running around scared for their lives. And we wanted to solve for a problem, which was that, you know What were we going to do about these incendiary devices and all the things that were going on in in a different kind of warfare in a different time? So, you know, we went through and we're part of that ah really interesting thing. And there are also physical things we are making are making really big changes. We're getting letters from people that are saying.
00:10:39
Speaker
you know, my son didn't blow up because of your product, things like that. Super exciting. And, you know, that really there was about 20 of us and we got banded up together and we were just super excited about how we could utilize technology to change things. And that set a trajectory. And there was a real defining moment where we were asked to be involved with making that robot ah blow up.
00:11:01
Speaker
something it didn't do. And we made a decision to to step away, to move in a different direction. um you know And the 20 of us that had kind of been doing this at that point had also been helping out with, we were in the in the Twin Cities, so there was tons and tons of medical device going on. And we've been helping out with automation or robotics in the beginning of home-based therapeutics and stuff like that. And we just latched onto it.
00:11:25
Speaker
And for 17 years through a company called Nextern, we put 27 medical devices in the field in various ways. Everything from, and I shouldn't even say, some of them were just wellness devices, but they had tons and tons of impact. That included white therapy. ah We ended up winning the white therapy market from Phyllis by making an accessible product and and partnering with Costco so we could get deep reach. And that's really informed a lot of what we're going to talk about today with with deep well right and uh worked on neuro stimulation for pain and we had this organization when that grew and grew and grew filled with really purpose driven folks and we would get folks doctors and companies coming to us and they were saying look um
00:12:03
Speaker
We have these ideas. We can't get them implemented or we've tried to get them into the market and we could take what we were really good at, um which was designing all the way through commercialization and get these products in the field. And it just, we got opened up and more and more and I got more and more exposed to how technology could make big differences. And we got super, super, super engaged and super, super wrapped up.
00:12:25
Speaker
and map So that trajectory landed at you know the the chance to sell that company and actually four exits along the way. So a lot of luck and privilege to see that work translate into value in a way that we had choices. And then you know a bigger exit when next turn was sold, and but some unresolved situations as well. um especially in mental health, realizing that even with the light therapy work that we had done, the reach was you know we could see millions and millions in need. The product was very accessible and sold very, very well, but we were just scratching the surface of what could be done.
00:13:03
Speaker
and and you know as the you know we kind of We transacted right during the beginning of the of the pandemic, and as the pandemic was rolling on, you know it became really, really clear that the mental health emergency, which has been around for 50 years, it was not started by the pandemic,
00:13:19
Speaker
Uh, was getting worse. It was getting worse fast. And some of the folks that I knew, some of the people I had been connected with had been really successful in, uh, indie video games. And they were seeing their games being used as therapeutics and pinging me like, Hey,
00:13:35
Speaker
you know Could these be medical devices? This was not my idea at all. And if anything, I pushed back and like, um as I knew these folks, I knew how unregulated and how they ran their worlds. I was like, I don't really want to see video games meet the FDA. i you know So I said no early on to to being too involved, but then There was compelling enough and there was enough going on in the environment that and the summer hit. this and Me and my boys, we didn't have a specific thing to go do. I've got a ah couple of boys that are 20 years old now and another one who's 16. We all started, and and my partner ah Emily, who's a biotechnician and really great at at reading like through studies and and all this other stuff, so we started going backwards and reading all these studies.
00:14:24
Speaker
And I mean, thousands of them, Alex, were out there. There was a really cool independent movement where researchers had in various times where video games had been pigeonholed as being very, very bad for you. And that was usually if you look deeply at the sponsorship behind a lot of that research, it was a little nefarious. Like people were had their own motivations for positioning games this way. But then all these indie researchers, smaller budgets, of course,
00:14:49
Speaker
smaller ends, less people in the studies, but they were over and over and over and over again systematically showing the various elements that games were good for you. And they weren't doing these big holistic studies because they couldn't afford them, but one would be like, well, look, at this helps you learn in this particular way. Look, at this helps you change your perspective in this particular way. This can make you feel happy. This can reduce your worry. This can help you sleep. This can help you think better. And we started putting them all together and we were like, well, there's something here.
00:15:19
Speaker
And the accessibility is off the charts. That's also when I learned that there was over 3 billion people gaming. I did not know that. But once you hear that, I mean, in the medical device world, you know this from what you do. If we can reach 100,000 people with a device, we feel like we have really smacked it on the park. When light therapy hit millions, that was my i mean my biggest seller because it was the most accessible. And because, interestingly enough,
00:15:42
Speaker
It didn't need a prescription. It was available over the counter and the price was in the right place. We could get a lot of reach. So when I saw the potential here, I, you know, I thought I got to dive in. I got to see if I can do something with this. That's kind of how you get pulled all the way through from flying planes to making video games.
00:16:01
Speaker
I love that. I love that. And especially ah the key highlights that you said, health, ah wellness, and safety. Well, listen, and I want to be really clear about a couple of things too. I am not a businessman by nature. I'm a creator and a creative. But after a few rounds in business, this desire to help people um took me heavily into business. And I got to tell you, it wasn't really safe for creatives in business is what I found. And so I had to start representing myself.
00:16:29
Speaker
And and even even when I pick partnerships and things like that, I'm amazing at being part of a thing and a part of a group. And I should say that when you say my trajectory, the only way I could have done this trajectory was, you know I keep saying there's about 20 of us that were always core to this. There's no doing it without them. I mean, these were really mixed.
00:16:47
Speaker
um medium, right? So, I mean, electrical engineering, mechanical engineering, chemical engineering, ah we needed lots of physiological understanding, lots of medical understanding. So it was like, this was a place that this pack of folks, you know, could nod to and all felt really good about. And then, you know, from the business perspective, I was great at picking people like that to work with, always have been able to be part of or put a team together that that was purpose driven that wanted to do a thing.
00:17:13
Speaker
But on the business side, I had to learn that because um you know there's a lot of there's a lot of difficulties in translating creativity into something that's economically viable. And the more economically viable it is, the more interesting folks that turn up to help you.
00:17:32
Speaker
yeah Yeah, I totally relate to what you're talking about, so that it always takes a team ah to or actually leverage different competencies and make some very good collective ah progress and results. Moving onwards, so from from what I know, from what you told me, ah you have your twins are diagnosed with the autism,
00:17:58
Speaker
And then to yourself to a certain degree, um dealing with that as well. And ah do you think digital experiences and video games can help ah treat this diagnosis or like minimize its impact on a day to day life? I don't think neurodivergence is a disease.
00:18:18
Speaker
Matter of fact, I think that most likely more of us are neurodivergent than not. And then on the boundaries of it, as you get farther and farther out to it, we give it a name. Neuronormative is going to end up being a 3% to 10% of the population. They just happen to be the folks that often make the rules that make us feel like the rest of us need to be in a conformative place to be fitting into society. And I think this could be one of the reasons we see so much anxiety and depression is we're being asked to be something that we're not, to fit into something that we don't really understand why we have to fit into. I think society is fighting its its way through that. So I wanted to be clear about that. That being said, um as soon as you get to that, it points to the idea that much of the population has a divergence to it, right? And as a result of that, do I think that video games are good for that population? Absolutely, they can be. I also think they can be devastating for a population. It depends when you say video game, what you're talking about, but the pure play elements of it
00:19:15
Speaker
play. the The play loops, the game loops, those sorts of things, they're amazing for us. they The simulation is something that makes our brain work on a level that is out of this world. And then when you can combine it with narrative and perception of a story, that's how we work. We're not fact-based machines. We're perception, not precision-based machines. And these games set that up on a level that are is unlike anything else. and you know So the more immersive that that experience is, the higher likelihood that we can get the stimulus going in the brain in the way that we're going to adopt new thoughts about ourselves, new behaviors, new reaction to stimuli. All of that is amazing. Unfortunately, when you say video games, you get all sorts of different things bundled in there with it, including monetization schedules.
00:20:02
Speaker
socialization tactics that lead to monetization schedules, right? And those mechanics, some of those that are really driven to um get you to stay engaged beyond a time that you want to be there or get you to spend when you don't have any more to spend both emotionally, physically, monetarily, ah those mechanics are are not good for, you know, for vulnerable populations or neurodivergence necessarily. And the more neurodivergent you are in some ways the more they can hook you and that can be tricky too. So yes, there's a ton of value there. um It's been mixed up or confused with some of the ways that things get sold and that's different than the thing that it is in its entirety.
00:20:42
Speaker
And I think that that's really important. and That's why you see us talking a lot about violence in video games, which has been proven over and over again to not be a problem versus loot boxing, which has been proven over and over again to potentially be a problem. But again, it's nuanced.
00:21:00
Speaker
could a loot box be in a game and could it be perfectly okay? But then could you also be designing it so the neurological hook has you at the highest rate of dopaminergic response where you're also socially driven to push the button five more times to spend money you don't have?
00:21:17
Speaker
And that's definitely a problem and for a neuro divergent who may be very socially motivated and trying to get part to be part of something and has nothing else to do but push that button to try to fit in. Is that a big problem? Oh, yeah, that's a big problem. hey Yes.
00:21:33
Speaker
So how do you think the games that you and your teams are designing, um how they could incorporate the principles that are applicable for all audiences that play and make ah their life ah better? Sure. I mean, at the base level.
00:21:49
Speaker
and When we go all the way down to the base level we know that there's like five things that really drive us you know in that gaming environment so we have like a biofeedback mechanism which is more rare in gaming we can talk about that we have social constructs right we have distraction based.
00:22:07
Speaker
things we have something called visual spatial interference which is uh you know is distraction based and it's all right but it kind of it's the idea that we get you busy enough sort of the Tetris factor like how we get you doing a thing where you're still able to be cognitive but you're really the cognitive load is has been balanced to a place that you're not overthinking or metacognating in a way that you could be making negative memories or negative connotations and then there's the play element itself which is the most fascinating of all of it and the one that takes the most study to understand in most has the greatest level of neurological hooks. Because the learning science is showing us without question, we learn most effectively when we play. We always have. And we know this intrinsically, but we lose track of it as adults. So if you're given a child and say, hey, here's this child, it's your job to get this child to be socially competent, to speak, to walk, and and to relate to the world, you do that all with games.
00:23:04
Speaker
intrinsically you just know and and and that deep reward mechanism that is emulated within a video game that heavily sort of like, well, I want this positivity to happen, the child is wired. So the big bonus is the smile on your face, not everybody's face, but the parents face. And so you've got this, you got an economy in place and you've got this mechanism of play, you've used it, you've seen it done, you can buy a million toys,
00:23:30
Speaker
When the interesting enough we get the merani around five years old or gonna send them off to school and certainly after the kindergarten ages what is kind of a work hard play hard mentality and that just grows and grows and grows and grows and grows and as adults.
00:23:44
Speaker
we start to think of play as recreation and and work as as the way to learn, and then our neuroplasticity drops like a rock. So for a long time, people thought, oh, yeah, you're more neuroplastic when you're a kid. Now it looks like you are always neuroplastic if you can re-engage the play element. Oh, wow. So Dan, the question is how to regenerate this neuroplasticity? You play.
00:24:11
Speaker
And you play as authentically and as deeply and as immersed as you can, and then it starts to become really clear, well, where can you do that? You know, it's that play element that matters. And but accessibility to what matters too, I get a little frustrated when I hear about the Well, we should be all out but running around at the beach or running around in the forest. It's like, well, that is the privilege for those that have the economic viability for it, that those that are physiologically wired and strong enough to do that. And so gaming starts to get really smart because it's this ubiquitous accessibility to that neuro stimulating model.
00:24:50
Speaker
Right? We all, and when I say we all, we got to be careful there too, because there's still a socioeconomic thing where, you know, there's 3.5 billion or so people gaming. My guess is it would be damn near seven to eight of the eight billion if we weren't talking about the fact that you have to have a piece of electronics and connectivity to get there. But, you know, when we look at least at the democratization that can occur today,
00:25:13
Speaker
with the equipment that's available, gaming has this accessibility that is broader. and And if you understand how to use it, you think of media nutrition the way you think of food nutrition, it's an educational process to go find media that can spark this in you without exposing you to the things that could be harmful.
00:25:38
Speaker
Yeah, speaking about playing, playing the games can improve and improves lives of our kids, of us playing, can regenerate this neuroplasticity. What do you think are the frontiers and Pandora's boxes that can open if we start playing with that?
00:25:59
Speaker
mental health game design because it's so it's like very sensitive area that we step into that um we need to be 100% sure that whatever we do with our games and mechanics leads to the better but not to the worst because it's just that you get this access to people's brain to certain extent like to their mental health and the perception and what might be like the challenges that it opens and how to navigate it. So I think that's a I think it's great that you positioned it that way because I've been hearing this all the way since light therapy. You're talking about people's mental health, you have to be so careful.
00:26:47
Speaker
everything we do is people's mental health. The video games already had access to mental mental health, as does the press, right as does our leaders, as does our friends, our family. I mean, and on whole, if we measure it, we're not doing very well. So we have to be really careful about painting the idea that when we go out to do a therapeutic a treatment, that we're exposing people to something that is so different than what they've already been exposed to.
00:27:15
Speaker
So, a big part of making medical advice is you know that this is doing a risk analysis. If you sit down and you do a serious risk risk analysis about the use of video games and media to reach people from a mental health perspective, what you start to find out is the risk is already way high.
00:27:33
Speaker
you're waiting into a place where people are already doing really poorly. And where, you know, I recently talked to a woman who has worked for years at the VA. She's one of the suicideologists there and she's helped design their response programs at the VA where you see suicides are four times higher, five times higher than the general population, okay? These are all US stats, by the way. And so, you know, what she said is, look, six out of seven people are going to attempt suicide and never tell anybody and if it isn't successful for the vast majority of them that will be such a resetting event that they will never try again because at that moment people come to find value in their life in ways that is incredible and we've seen that all the way to extremes where people have shot themselves and lived and horribly disfigured themselves and then fight really hard to live because these are catalyzing events where your brain shifts and where you get really new neurological pathways built really really quickly that go holy smokes I want this in my way I want this world I want this thing I want this that so six out of seven people are doing this on their own so I started the place of what
00:28:42
Speaker
is the damage or danger or threat to not helping six out of seven people who are doing this on their own. That changes the risk assessment considerably. When you realize people are already dealing at this level and they don't have the support, then you start to look at it differently. This is no different than going through a pandemic. We're in a pandemic of mental health and loneliness right now.
00:29:06
Speaker
As a medical device guy, and you're a medical device guy, I don't always love pharmaceuticals. Some of them are amazing, but that industry for me has been one of the reasons I made medical devices was to reduce the reliance on drugs. But along came the pandemic and I lined up my neurodiverse kids and walked them in and they stuck a mystery, you know, material into their arm that had only been tested by the FDA for one year. When I have done that under any other conditions, absolutely not.
00:29:35
Speaker
and I believe in the process, I believe, but we were in a place in time and this is what's going on right now. We're in a place in time. We're six out of seven folks who deal with suicidality. So imagine when we're talking about mental health in general, right most of us are truly dealing with this alone on some level. So when we talk about mitigating this risk, we should be realistic about where the risk is sitting.
00:30:01
Speaker
right The risk is more in the fact that we haven't recognized and regulated the things that are already harming us than the idea that you would come in with a well-designed therapeutic that is you know built by some of the best. I mean, if you look at Deepwell's medical advisory team, it's nine of the best neuros I mean all the way from neurosurgeons to neuroscientists to physiologists who are doing risk analysis and are driving themselves through and are controlling this thing in a way that is I mean you don't see that happening in the day to day media or the day to day interactions we're having so where is that risk right and where does that what does that look like versus the risk of not trying not treating
00:30:43
Speaker
All that being said, all of this needs to be cleaned up. For the world to work right, everything should be running up with more levels of honest, not politically motivated or financially motivated regulation, but true regulation to strike around media. Some things are going to hurt us and they're going to hurt that they need to be controlled for. So making something like this is about balancing the reality of what it is you're trying to do.
00:31:08
Speaker
with the fact that you could do more harm than good and making sure that's not where you're going. And a lot of that then has to do with the delivery of the media in a way. It's what your intent is when you build it. right And so when you look at the use of these mechanics and those sorts of things, the nice thing about video games is that the therapeutic elements are actually fairly safe. So I take things to the boundary conditions. I learned this over 25 years ago when we started working on light therapy.
00:31:37
Speaker
On the boundary conditions of anything with therapy that's therapeutic, you're going to find harm. And that's because you're wielding power. So light therapy is a really good example of this test that works really well on this test. Light all the time is a torture.
00:31:51
Speaker
no light ever will mess with your circadian rhythms to the point that your body will not function appropriately. So much so that the way that we found the melanopsin in the eye that controls circadian rhythms or puts the input in for circadian rhythms was because there was two kinds of blind people. Some had the melanopsin and some didn't. And the ones that did could run on a regular pattern and the ones that didn't got up at three in the morning and and couldn't function on the same level. Then the next question is, is it a functional therapeutic? And that's like how much spaces there until it ceases to be therapeutic. And if you get a wide margin, and light therapy has that, you get a wide margin of therapeutic where before it becomes useless or dangerous.
00:32:39
Speaker
Right? On either one of those conditions, you've got ah you' got a really good therapeutic you can wield. Games, playing, have a huge boundary condition. Not monetizing or social aspects of gaming that are devised to do things other than connect people in a positive way. Free and unmoderated chat does not have that big boundary.
00:33:00
Speaker
And when you combine it, for instance, with a game, when someone's playing, if you're heavily dopaminergic, let's say you're playing a game like Call of Duty and you're shooting like crazy, are you becoming a shooter? No. But are you highly dopaminergic in that moment? Yes. Are you highly suggestible in that moment? Yes. And if the wrong thing is coming into your ear, especially while you're socially isolated, isolated heavily socially motivated, could you be radicalized?
00:33:22
Speaker
Absolutely. And that's why you're seeing the folks at Call of Duty recently put in a filter system. So if you start saying the wrong things while we're playing this, that free and unmoderated chat, that has to be controlled. But the play elements themselves actually have a very nice boundary. You know, you can't think of too many times that you played with your child, earnestly played a game, and that game was harmed.
00:33:45
Speaker
The intent was to play, the the play was to learn, right? I mean, unless you're talking about material again that is socially bound in a way that it's trying to create harm on its own, you don't have a lot of mechanisms that can harm somebody, even a kid running around with a stick pretending to shoot.
00:34:02
Speaker
that does not have your kid next day, you know, getting to the Walmart trying to pick up a shotgun. You know, it's never been that way, you know, kind of thing. So I think we have to look, when we do the risk analysis and we look at these playing mechanics, we then spend a lot of time thinking about where is it that we can be effective without hitting the boundary conditions of harm. And games have a lot of that to offer.
00:34:28
Speaker
Yeah, that totally describes the picture and outlines the the proper approach ah that that you and your team are following um when dealing with the ah such sensitive things. That's very important to do that.
00:34:44
Speaker
ah responsibly, right? So you already started to tell about the mechanics or examples of such games. And ah in many of your interviews, ah you explicitly, like, avoid the word of gamification. And you rather refer to, like, a building games with medical effects.
00:35:04
Speaker
When we were doing the early research of how games could be so effective as therapeutics, we also did this, we then hit this head-scratching moment, and we did what it was called counter-research or adverse research or oppositional research, and we were saying to ourselves, then why hasn't the early gamification movement worked, really? right Everything from you know putting a Fitbit on your arm and these sorts of things, most of them now are in people's drawers which is where i'm afraid many of my medical devices are too right so i was like okay i'm not saying that i'm more special than everybody else but this was supposed to make adoption easier and it hasn't necessarily hit yet.
00:35:45
Speaker
What we found through series of experiments and reading, like our own experiments of trying to do things and failing is that um under the concept of gamification, there were ways in which this was already being done. And so we needed to differentiate from it. Experts were showing up wanting something from gaming without letting gaming do what they know how to do. We all want the power of video games. We want to reach as many people as possible with deep levels of engagement.
00:36:14
Speaker
But we weren't using the people and the processes that knew how to do it in gamification. What we were mostly doing that I could see was showing up with this thing that said, look, this is a here's a mechanic. This mechanic is really good for you. Now, I want you to gamify it. And if you go all the way back even to the intellectual property around gamification, nobody defined what that meant. Just said,
00:36:37
Speaker
So they grabbed people, they often didn't get the best of them because the best of them were busy making video games and and maybe you weren't willing to be drawn into a process like this. And those folks would take this kernel, this thing, and they'd adorn it with secondary game mechanics, badging, scoring, social, these sorts of things, but they didn't have a primary play loop in it. That was something that could hook you and bring you in.
00:37:00
Speaker
When you went and then talk to the people that built games, they were like, well, we don't even start in the virtual environment. We start, you know, we build card games and dice games or we go outside and play or we, you know, come board game and something like that. And we play that thing until we're having so much fun that we just love this core play loop.
00:37:19
Speaker
We can't stay in it. We're having such a good time. At that point, we digitize it or we take it up a level in the digitized world. And usually what happens is it gets less fun. And then we go through this process of finding fun, which can be, there's this saying in games, it's hilarious. How far is your game? It's 90% done, which means you got the next 90% to go, which is this process, this magic making process.
00:37:44
Speaker
Right? And in mind that, what you saw Deepwell's been working on, we only have one game coming out so far. What have we been doing? Well, outside of building tons of tools and a tech stack on the backend that allows us to turn video games into medical devices while they stay compliant and in working with the agency to get them to understand everything you and I have been already talking about today, we've been redefining roles within the game development environment, right?
00:38:06
Speaker
Now the game designer has to be the game designer and they have to be in control. They can't be so far in control that there's nothing medical happening or that the game loses its potential for medical application, but they still have to be in control in the way that that meant all these scientists and doctors that work on my team who are very used to telling people how it is, had to start working in service of the game developer. We had to reverse all of this around.
00:38:32
Speaker
and culturally it took a lot of time honestly i like sometimes it took a lot of pain we lost people added people there was you know big turmoil in the in the organization it's already so scary to build a video game you're so exposed to put a piece of media out there that you know some game designers think they just couldn't do it they couldn't release even a little bit that said i have to go back and deal with with you know a whole team of regulatory and quality and and the specific therapy designers so we some of them could do it any other way around we couldn't work
00:39:06
Speaker
We had to change out some of our doctors and stuff like that too. Some of them just couldn't have the patients or weren't willing to be the people that worked in service of the play element of the game and to trust in you know these professionals, which I believe the game designers, the good ones, the masters.
00:39:22
Speaker
are probably the top observational behavioral scientists of our time, and they needed to be treated as such. And that's a lot more like making a medical device. If you think about it, like when we did light therapy, we needed electrical engineers, we needed mechanical engineers, we had the phosphors because it wasn't LED, so we had chemical engineers to get exactly the right, we wanted consistency in the color temperature, a long-term burn in the In the lamp, we needed psychiatrists, psychologists, we needed folks that understood the eye. They all had to be in the room together, but then we did have to figure out how to stack the priorities. Medicinalization of games stacks the priorities in the weight of the game designer, but still balances this in a way that the therapeutic is key is element. Risk analysis is completed, that a quality system is running in the backend, that we are watching for these things.
00:40:12
Speaker
It took a new culture. It took special people. right It took people, not everybody just like not everybody in medical device, not everybody in gaming is truly was truly in it to help.
00:40:25
Speaker
and so but and yeah And then think about it. And then you need really talented people. I mean, it's already hard to make a really good game. Now you're putting mechanics into it that people actually don't want to do and you're going to try to make them want to do it. Imagine how good you have to be.
00:40:38
Speaker
So it also was about finding people in industry who had been very, very successful and who were willing to go wading into a world that, I mean, is not yet all that lucrative, right? And so they had to be able to afford to do it, they had to be willing to do it, and they had to be willing to kind of come into this new process, work together to do it. So all that needed a title.
00:40:59
Speaker
Right. And that's why we, and it needed a defining moment. And so we started pulling away from gamification, edutainment, and kind of traditional ways of talking about this so we could attract the right people and have the right conversations and also get prepared for the most important part of this. It was going to be hard and it has been.
00:41:21
Speaker
right Harder than making a good video game, which is crazy because that's so hard. Harder than making a well-adapted medical device because that's so hard. The second generation of the team that developed the game that's going to be coming out that took the first generation's beautiful work and kind of pushed it to the next level, they were very key. I was actually very bought in. there There's been more than one version of the game that's come out. and The first version was my favorite game I've ever played, but it wasn't reaching enough people. It wasn't everybody's favorite game.
00:41:51
Speaker
And so when the the next generation of the game developers came in, when Jeffrey Sang came in, who's this amazing game developer who has had like who has a history of finding new audiences and finding what they want out of the medium, he's very willing to... he says you know and He figured this out his own way years ago. He's like, I had to stop making games for me. I had to start making them for the audience. When he came in, he changed a lot of things. And I was like, a lot of us were like, no, no, no, those are so important. but When we started testing it, more people could do the things we wanted them to do and were attracted to. Very, very interesting drawn out process of building what we're calling immersive medicine. And you know this is the idea, and I want to be really clear about this. For all the medical devices I've done, everything from you know the neural work and and all of the um
00:42:45
Speaker
I mean, all of the 27 therapeutics, that you you know, automation of of surgical, you know, and surgical robotics and compression therapies, all of which have been some pretty bleeding-edge stuff that's made some real interesting differences. I've been really lucky to be part of some very cool things. I've never seen anything as powerful as this ox. Not even close. It's going to take a while to get there.
00:43:08
Speaker
it's going to disrupt pharmaceutical markets, it's going to disrupt device, but unless you know but it's not necessarily going to be the most lucrative thing, and therefore it's probably going to even take longer to get there, which is true of almost everything that's super great for society. If you asked me to make a medical device that was a game and gamification hadn't happened, I want to be really clear. I would have gamified it.
00:43:33
Speaker
As a matter of fact, if you look all the way back to the work I did at Individual Learning in 2000, we gamified reading. And it worked really well, but it worked on a different society that was so enamored to just be on the computer in the first place, that attraction mechanism. And it was making its work, it was doing its work in a six-week jolt.
00:43:52
Speaker
And now we've got people that are so media savvy, their expectations are very, very high. Attention economy might be different. We're still trying to figure that out. And so we have to figure out how to make this work. And that has been such a cultural exercise. It's been great. Yeah, I can imagine. I can imagine. Because all the challenges, as you mentioned, and all the cross-disciplinary approach of your team, um and the regulatory aspects,
00:44:23
Speaker
multiplied by the huge opportunity and at the same time making it making games that are appealing to wider audiences. It's like it's super hard. So huge kudos to you and your team for um pushing this forward and bringing closer the reality checkpoint when more and more people can have access to to that kind of therapy.
00:44:50
Speaker
The FDA has been a really good partner on this. on so i mean they They too are like, whoa, what are we talking about here? What is this? and that's Their nature is skepticism and that's not wrong. I used to get quite frustrated with it. you know Whatever happened here, the regulation came in response to some pretty bad behavior around some really important things. We can't make stuff up about people's health.
00:45:14
Speaker
That's really important. We can have a hypothesis. We have to have a hypothesis because when we talk, Alex, about how the brain works, none of us know. All of us are guessing whether you're building you know a SSRI or whether you're building a neurostimulator or whether you're building a late therapy product, you don't know exactly the mechanism of action in the brain. there's no We don't know that and we're not going to know it in my life.
00:45:38
Speaker
right We're not going to know it in my lifetime. So you're you're running on a hypothesis, but that's different than a guess. And that's certainly different than then ah positioning something for monetary reasons versus for what we think is is best. That makes and makes sense. So we we have to do our best.
00:45:54
Speaker
to you know focus in and figure out how to how to get this done. And so the agency does their best. right they they They are setting precedents, and they have to be careful about what they let into the market. And we're asking them to let us do you know these things again. And that's why I'm so passionate about this environment. The agency did a really good job on this. They put out an emergency order really fast three years ago that said, hey, if you've got some psychological benefit and a digital therapeutic, and you can do all the stuff in-house that we would expect you to do, you can put that on the market.
00:46:23
Speaker
The good and bad of that is 20,000 digital therapeutics were launched in a three year period. About 12 to 20 of them have been cleared for mental health. over the counter, zero yet. And they did a really great job of suggesting where safety could be managed within those environments. And we utilized that early on. We quietly had stuff running around in the market, very small usage rates, because we just wanted to see what was working and what wasn't working. But we also applied all of their suggested labeling, all of their suggested um
00:46:58
Speaker
access points for additional care, making sure that the patient understands that if this isn't working for you in a short period of time, maybe you should be seeking other care, which is a really important thing that accessibility to care can do. If you were going to go it on your own and then you decide to use a video game to treat your mental health, if that video game doesn't help you assess whether or not If it's working, then there's a problem there because you know you might just not seek the care you should be seeking. On the other hand, if that video game says, hey, if you're not feeling better in X days based on this research, based on that, you and you should probably push this button here and get more help, now you've actually bridged a gap where people that were going to do it on their own and going on their own might get a level of realization on their own that they need help, more help than they can get from a video game or something.
00:47:48
Speaker
The agency's not ready to have these conversations about combinations of mechanics and play and games and all this stuff that's understudied. They need to look at the core mechanics behind these games that make sense that have already been studied.
00:48:01
Speaker
So we focused and leaned heavily on biofeedback, because it's one we know. And it's one that our game designer, starting with our first game designer, felt like they could pack into a game and could make it make sense. So we were looking at vagal nerve stimulation, and we were looking at that in combination of other motion constructs, which are another really important thing that games can do. Getting you to move.
00:48:23
Speaker
is very good for your mental and physical health. What's really cool about doing it in a game, and this has been well measured. VR does this best, but it happens in video games. Dance Dance Revolution does this too. We lose the perception of the work that we're doing when we're immersed, which means we push harder. Which means we work out more, and we do it more frequently because we don't perceive it as work.
00:48:47
Speaker
that's like games that's supernatural have kicked butt on this, right? they've Now folks are out there losing more weight and doing more things than they've ever done before because they needed that distraction quotient. They needed that that combination with the visual spatial interference that that drove them to a motion to a place where the emotion was most impactful, right? If anything, when we get really good at this, Alex, alex my guess is we're gonna have to be careful that we don't overexert, especially in rehab type situations, because people aren't feeling it the same way.
00:49:18
Speaker
we could talk about motion with with the fda yeah We can talk about We can talk about
00:49:27
Speaker
right? That's been something. I mean, if you look at these amazing games that are out right now, our kids are getting injections and they didn't even know they were injected. Oh yeah. yeah or Kids are having, kids are prepping for surgery and they're not going through the roof. And as a result of that, and this is why I'm saying it's going to change the pharmaceutical industry. When those kids aren't freaking out, they don't need as many pain meds, like 30% less pain med. And that's something as a therapy designer and someone who's worked in pain that I know.
00:49:53
Speaker
where How you environmentally perceive or how you perceive your safety level at the moment changes therapeutically what it means to reach you. All of these perceptions change the reality of how much drug we got to pump into you to get the same net result of like managing pain, which changes the threshold of risk considerably for the therapeutic, especially when you're talking opioids.
00:50:14
Speaker
They've actually asked people to have their quality system to be completely risk-driven in the next two years. Those constructs of motion, biofeedback, right and distraction, social elements, i mean there they're amazing first steps.
00:50:31
Speaker
All right, Ryan. So here we are at the end of August with just a few weeks before the release of the episode.
FDA Approval for Therapeutic Games
00:50:38
Speaker
And I know that you have a very big and important update. So what's new? Well, we're super excited because all the things we were talking to you about a while ago that I know will be out on this podcast that's coming up, we've just managed to be able to get cleared through the FDA. So we've had an amazing collaboration.
00:50:55
Speaker
with the agency and we've landed with ah the ability to transform interactive media. into medicine, into a digital therapeutic that is really focused on mental health. and We got indications for ah stress and hypertension. And so we're going to be able to use this kernel. You're going to be able to place this adjacent to other media, and it becomes part of this medical device. And that's going to allow us to bring access to reimbursement for many, many folks that are building interactive media.
00:51:27
Speaker
And it really does start that idea of immersive medicine and media being on the forefront of digital therapeutics, especially for mental health. We're not just talking about video games here. This is all sorts of forms of media. We can be working with video. We can be working with audio. We can even be working with some social channels in various ways to put it together as interactive media. And then in combination, you get this this therapeutic. So that can be as a standalone game or interactive. It can be on a platform that already has aggregated.
00:51:56
Speaker
ah things like a Netflix kind of platform or within our own platforms as well. So there's a lot of different ways to be involved. The media doesn't necessarily have to be altered, just associated. So that brings a lot of opportunity for folks to do the work that they've already done and and kind of attach it here for mental health use. And it also brings this reimbursement code in. So there becomes a whole new monetization available to people who are making this media.
00:52:23
Speaker
And the great thing is it's for people that are massive storytellers, really talented, and who can really get you into a flow state and and catch you with a narrative. That's the kind of stuff that's really effective for mental health. And you don't have to worry about the monetization schedules anymore. You don't have to think about free to play and microtransaction because there's a reimbursement stream coming.
00:52:43
Speaker
And it's going to be really interesting because they've set it up through Medicaid and Medicare where the physician is also going to get compensated for initiating this with the patient and then following along their at home use. So this is a really big breakthrough.
00:53:00
Speaker
When we're here in the States, we're dealing with mental health issues on the highest level. These are going to be very accessible, over the counter media based solutions that work on the devices you have now and can be downloaded from the stores you're used to and can start helping you with your mental health and potentially can get reimbursed for or paid for in various different ways.
00:53:19
Speaker
um to help people you know get the the help that they really need. This
Future of Immersive Medicine
00:53:23
Speaker
sounds absolutely incredible and huge kudos to you and your team to shooting this milestone. It was seen really impossible back then a few years ago, but sir I know that that's been like a very big journey.
00:53:40
Speaker
so our Speaking about the evidence-driven prescriptions, or like the and ah do you plan like any kind of test drives, test to stages for doctors so that they get familiar with your games, with the mechanics?
00:53:58
Speaker
or how you see that as a separate library for mental health practitioners who actually say, hey, for that for I see like that diagnosed, you should play this game. Or based on what I observe in your history, and like on your clinical history, you should play like that game like twice a day. we like How do you see that? Alex, you've just defined immersive medicine. That's where we're going to go. It's not just going to be your disease state. It's going to be who you are,
00:54:28
Speaker
hey What equipment you have access to, right? That sort of level. How you play. So another really interesting example why why this isn't so clear cut. Let's say both of you you and I have a diagnosis of anxiety. Yours is based in loss. You lost somebody really important to you. Mine is is based in in a very direct trauma. If we put you into the same game you put me into,
00:54:54
Speaker
At best, it may not have impact. At worst, it might actually make you worse. Or if you think that on another level, if you think about those broader diagnosis, we're both diagnosed with depression. Well, one of us might be anxious while the other one might be really dealing with sorrow. Can you imagine if you flip-flopped those situations?
00:55:09
Speaker
So here's where I think we've seen another part of gamification that we really wanted to to disentangle with. The first people to commercialize were trying to win markets, you know go public, do these things. And so they were convincing us that they had the answer in their game. Because they didn't slow down and work with the agency in a way that they could agree on what they could change. It was so expensive to make one game that they had to convince you that that one game was the holy grail of you know therapy for all these people. It's not going to be one game.
00:55:39
Speaker
it's going to be thousands of games. Immersive medicine needs to be an industry, not a company, right? And that's, you know, what Deepwell is doing, we're not clearing games. We're trying to clear mechanisms of action in a way that they could be reutilized over and over and over again. So many, many, many, many people could do this. So we can build a big US pot of media. And so we can learn to classify it over time so people can find the right solutions for themselves. Will people will be choosing that for themselves? Will doctors will be choosing for their patients? Or it will be like, I don't know, the AI suggesting that based on your search history, based on the places you've been to, based on the tags in your emails, you play this game tonight. Step one, you're going to have to figure it out for yourself because there is no doctors are reimbursed with it. And the problem is here now.
00:56:33
Speaker
Step two, we want immersive medicine to exist in a way that it's a discipline and there are experts that know how to marry you up. I also hope we're building our drugs and our medical devices with integrated in immersive medicine components to them, lowering the dosage, ah reducing the time to therapeutic value. I mean, these sorts of things are are all coming.
00:56:54
Speaker
But right now, what we're capable of doing with the knowledge we have and the infrastructure we have, World Health Organization says by 2030, mental health is going to be the leading cause of morbidity and mortality.
00:57:08
Speaker
Yet today we spend 2% of our dollars on it and we and it's so linear. It's one doctor for one person, for one hour, for, you know, and the accessibility just, it can't scale when, you know, 40, 50, 60, 70, 80% of your population is having a particular problem. How do you scale that?
00:57:29
Speaker
Right. And that's where the technology here, I think can be super, super important. So I think we're going to see over the counter first from mild to moderate. We're going to see more severe things and that's going to be physician driven. And then eventually the AI, but the AI, I mean, AI.
00:57:45
Speaker
is not artificially intelligent in its entirety. It is relational databases of human intelligence. that's It's not intuing yet. It's not intuitive. it's you know It may be able to see patterns that we can't see when it connects enough data, but it's not like, oh, you know.
00:58:01
Speaker
It's knowing you in your background and looking at how you're responding at the moment. I mean, that's people that do that level of work, that level of work, and it's a while, I think, until we can do that. That doesn't mean AI won't be amazing for gathering the data, finding those relational points, helping us be more effective at figuring out what is the best thing for you. I see that that coming, but in that order is is my guess.
00:58:28
Speaker
I remember like when I led special projects at Wargaming, we got like tons of feedback from the World of Tanks community stating that, hey, I played this video game and it helped me overcome PTSD. Or the wives claiming that their husbands and partners played the game, it helped them to overcome certain addiction to certain like alcohol or like ah other stuff. So, our what do you think, like from your perspective, is the top five list of addressable mental health issues that you would see in the nearest future addressed by video games?
00:59:12
Speaker
Yeah, in in order and I think in order that the agency would be comfortable to stress anxiety right behind that depression which gets you know, we start to get more complicated as right anxiety based disorders post traumatic stress disorder, we're already I mean, you see there's some VR applications that are really doing very very great with this so stress anxiety depression then these comorbidities that kind of run along with them pain. We gotta get off of these opioids we have to get to the place that we have mechanisms of action we can use to manage and numb. That pain in our minds in a way that we just don't get it you know addicted to drugs i mean that's so i mean mental health if you at the back end of mental health you'll find addiction all over the place so.
00:59:54
Speaker
pain and that then leads itself to levels of addiction. Rehab is also amazing and we talk a lot about prehab too which I think is really smart. Can we get you in a better place to receive the therapeutic? To have a surgery? To take a pill? I mean these are things that I think that to be healthier of mind, healthier body at the moment that you walk into the therapeutic. So, pre-hab you, therapeutic rehab is also like you look at stroke recovery and stuff like that. Some folks are building amazing games that get you to do these things to re-utilize your limbs and and, you know, to have less of a self-conscious thing. That's the beautiful thing about visual-spatial interference.
01:00:32
Speaker
If I've put you in a mech suit and I'm shooting at your head, and one of that things means sometimes you got to move an arm that you normally wouldn't move, you stop being so aware of the fact that you can barely move it, especially if in the game that actually looks like a real defensive mechanism. We're making this be this, and then next week we're making this be this, and next week we're making that be that, and you know, I'm accelerating it in weeks, but that in rehab, I think, is another super powerful place where games can play.
01:01:00
Speaker
When then you think about also augmenting the usability of medical devices and augmenting the therapeutic dosage of of pharmaceuticals, the answer could be considerable. Immuno diseases that require Jack inhibiting and those sorts of things. If we can reduce those doses while getting the same level of response, wow, right? And so I think you're going to see that kind of stuff too, where games are going to be studied in conjunction with other therapeutics. And that's immersive medicine as well. and So we've been talking today already about the hardware and that enables those experiences and ah we might be talking more about screens and platforms and eventually as the time goes by, we see those screens coming closer and closer to our brain.
01:01:49
Speaker
and starting with the huge like TV screen that I referenced at the beginning and all the way to Apple Vision Pro that was recently introduced. The first titles that you um push out to the world, to the market. So what do you think the platform ah would be um initially for for the launch? And speaking onwards, what do you believe would be our the best fit ah hardware to deliver that content these is like wearable airports or like other wearable devices or consoles, mobiles, or Elon Musk's Neuralink. So what's your take on that?
01:02:32
Speaker
I think most people know that DeepBowl's first title will be in VR. um it was a bit It's been a good partnership with Meta who has has been a very open partner to figuring out how we can do more and reach more folks. Our game has been cleared into the game store. There's never been a therapeutic put into the Oculus game store. So um we're coming in and we're coming in as a game. And I love that. I love that message. um VR also was a choice for us because But this has less to do with the human factors. It's probably going to be more reimbursable. It seems that the first reimbursement codes are headed more towards durable medical equipment, less about software as a as a medical device. And so you know we had to point ourselves where where where the market would potentially be. We also believe that folks like Meta will continue to invest in accessible levels of technology. so mean But our thing is accessibility.
01:03:26
Speaker
In the end, accessibility to care. And so where do I want to see this? I want to see this in mobile. I want to see this in ubiquitous platforms. And so what you'll notice too about our mechanisms of action is we don't use additional hardware. So we're looking at the things the cameras.
01:03:42
Speaker
the microphone, the screen itself, the accelerometers. We actually have a lot at our disposal. What can we do with that's already there to reach as many people as possible that also then that ubiquitous nature of the hardware allows the agencies to be more calm about verification and validation requirements. They allow us to reach more You know phones if we're if we're putting slapping on like specific things and working at these very specific nitty little Processes within the hardware. Imagine what happens every time that someone changes one of the platforms. Remember we're using commercial means to deliver these medical things So, you know, this is why the FDA doesn't love cell phone delivered stuff because what if android changes this and ios changes that we have to work really smartly
01:04:29
Speaker
around things that if Android changes this and somebody changes that, it actually works really well still and doesn't you know get bounced around all over the place so as far as its therapeutic value. So you know mobile is the most ubiquitous platform and therefore it has the greatest reach. And so for what we're trying to do,
01:04:48
Speaker
especially in mental health, in mild to moderate, we just want to get as far as we can get to help as many people as we can at a price point that isn't prohibitive for them being successful. That's one of the people that works at our company has a lot is a neurodivergent like me and she fights a lot with anxiety. So she works on this thing for us right now. How do we get you to put the headset on when you're not feeling very good?
01:05:12
Speaker
And the answer is probably, in some cases, we don't, we need a companion app. So you can just do it on your phone for a little bit too. Like this, you know, this is the things that that we're looking at. So, I mean, VR has its challenges that are still getting solved, not the least of which is um people don't always wanna, you know, once they're in there, they wanna, but you know what it's like to get the headset on somebody, right? Like it could be a thing.
01:05:33
Speaker
So our speaking about VR, one of the highlights it's out by, for me, was a VR experience that leveraged the Gen AI, recreating the custom 3D world from my memories that I typed to chat GPT-ish solution that it took and depicted um a a virtual world based on what I typed in.
01:06:00
Speaker
so I don't know if you're familiar with the TV series Devs, D-E-V-S Devs. So they were like trying to um recreate and enable like the time travel machine within your memories. And and i actually like it's out by so they're just like, it's already here.
01:06:23
Speaker
So and it's good to see like how Gen AI enables all that. So how do you envision or maybe you practice we with your ah mechanics ah the use of Gen AI in therapeutics? The really interesting thing about traveling through time off your memories is that our memories are plastic.
01:06:42
Speaker
And we're not used to that yet. Like our whole judicial system is that I'm going to bring you into court. You're going to tell me exactly what you saw. And then we're going to find somebody guilty, not guilty based on those things. And we're figuring out to our own detriment and now positively that your memories are dynamic and that they can be shifted over time. That's really important for things like trauma.
01:07:00
Speaker
If you're going to always feel as traumatically or traumatized about a thing as you really had it, you're never going to pull out of it. so you know It's interesting to think about that. When we start pulling from your memories, if we remember if something so positively remembers what you used to think about it, are you going to still feel like they were your memories later? Or are you going to have to re-dynamically generate them based on how people are feeling now if you want a true relatable?
01:07:24
Speaker
And I think that's true if you've ever gone back and read your own writing. If you've ever journaled or anything like that, you know you do that. I can't believe I was thinking that. i can't you know That kind of stuff. So it it's interesting on what level you want to use it for. If it is to really help people therapeutically understand where they were to where they're going, you would do it one way. If it's to be as relatable as you possibly can be in that moment, it would be more dynamically generated from the way people feel.
01:07:51
Speaker
in that time, and it would be done fairly differently. And that could be both positive and negative. It also could be a feedback loop that convinces you of things that you shouldn't be convinced of. So there's a lot there you know that we need to be careful. We are very inward-looking, self-motivated individuals. And that mechanism of of ah seeing yourself as a movie or as a 3D environment of you is very intriguing. And what you could do with that um is both, I think, therapeutically off the charts and diabolical. And that's why I feel like, ah you know, we're going to need balance ethics. And the only way we really truly get ethics when money is involved in business is we're going to need regulation around those things. But but I see a lot of therapeutic power there. So do you see already some examples on the market that are
01:08:46
Speaker
are starting to integrate that kind of capability into into gaming, into something that people actually can interact with. Yeah, I mean, I think if you go all the way back, the idea of injecting yourself, the first place you've been seeing this from the beginning is to build an avatar. Anything by which where you can have a representation of yourself is where you get to be who you most want to be in that world.
01:09:09
Speaker
That's why, I mean, I did a post on this I think last week about avatars that are most flexible from the aspect of you being you or the you you want to be, whether that represents, you know, who you are from a sexuality standpoint, who you are from a neurodivergency standpoint, what color you are, what species you are. These are all I think that that's what's really interesting. And there's been a lot of proof that using those avatars um Does help people you know in in defining roles and then it allows them to run through these games in simulation as the person they want to be or the person they think they are and that. Creates really real memory so just cuz we're in simulation doesn't mean that we're not impacting our reality.
01:09:53
Speaker
And I think that there's a lot of power. in that and And I think it's only going to be more exponentially so over time. I'm super fascinated with peopleometry as well, because it's something, again, it's quite complicated the way the eye is reacting to the things that that you're seeing and doing at the moment. But it can be picked up by a very simple sensor. It can be done by a camera and stuff like that. And so that's sort of how engaged are you? How much do you believe what you're seeing at the moment? And then how much that can inform your environment, I think, is is a really, really, really cool thing.
01:10:22
Speaker
I'm not so aware outside of the art space that you're talking about. I've seen it used in art, which is typically where we first you know see these things come out. ah The other thing I did itself by that I love, maybe you did, it was like a three screen interactive ah storytelling and you'd come in and you'd you'd write these really crazy things and it wove it all into this beautiful story. I had a hard time believing that one. you know um that was I found that really, really interesting.
01:10:49
Speaker
Speaking about months and millions, are how do you think, ah how doctors prescribing video games or like the games having therapeutical effect, how does it change the business behind the video games? Will it make
Business Impact of Therapeutic Games
01:11:03
Speaker
it more profitable? ah More studios will go in that direction?
01:11:09
Speaker
um ah Or like it will take longer to develop such video games or faster, considering the Gen. AI applicability and so on. So what's your take on the economics of all that? I think that it's going to change the economics of gaming considerably. And not all studios will go there. And I think someone will very much say, we're not this. Once you find these mechanics and build these games that help people, there's a different reason to play.
01:11:38
Speaker
And that different reason to play changes the economics and it takes you out of a hit driven environment. That hit driven environment has behaviors that we don't like everything from the higher layoff cycles that people are very uncomfortable. with There's always like, why do games work like this? i'm like Well, because the company's economics work like this, right? In my world, like when we build a light therapy product,
01:11:57
Speaker
we built for years and years and years and years and years and years and years, a positive ramp. And that, especially if you then give ownership in the organizations to the Dev, something that that um I'm adamant that we do. And in some cases, I mean, some folks at Deep Well, because we haven't been super funded, have taken nothing but ownership. Then that ownership translates into long-term payment over time, dividend level payment.
01:12:23
Speaker
different kinds of ways that we can live and different motivations for what we build, and that can really change how we position the industry. I think Nextern did really well when I was there, and I think it still brilliantly does it now, is it built a model that the innovators were safe, that there was enough back-end dollars and push over time that we ah could try again.
01:12:47
Speaker
And if we were wrong, we were still making decent dollars off the tail of the last thing that we had done. And we built cultures that way too, where failure with good intent for the right reasons was acceptable. It wasn't amazing. We didn't throw a party over it. Sometimes we actually did.
01:13:03
Speaker
But you know we we recognized it as part of the process right of having this culture that started with a deep belief mechanism around you know individual passions being driven into purpose and then working through collaboration, iteration, or risk management. I don't mean product risk. I mean the individual innovators risk and driving these things to completion. and we But we get to live in that world because there's an economic safety net.
01:13:30
Speaker
You take away that economic safety net and you know you get order of the flies pretty quickly. So I think I have one more question, Ryan. Ryan, what's next?
Deepwell's Future Plans
01:13:40
Speaker
The thing is we have so much of this cleared and only so much of the technology built. So we go into heavy building mode, heavy partnership mode. We've been talking with some wonderful folks on the highest levels of of med device, on the highest level of pharmaceuticals because it looks like we could be really helpful.
01:13:57
Speaker
and keeping people compliant and and maybe even more available for pharmaceutical treatment. And then, of course, we're working with the media agency to kind of connect everybody together and make this all work. So it's pretty exciting. That's fascinating. That was Ryan Douglas, co-founder of default digital therapeutics, a man behind the concept of video games for mental health. Thank you for coming, Ryan. Thank you very much, Alex. Great seeing you again. and Likewise.
01:14:26
Speaker
Hey, thank you for tuning into the show. You've been listening to The Month in Millions, a practical and envisioning show about innovators and emerging tech practitioners. Please subscribe to make sure you don't miss a new episode. I'm Alex Babko and you've been listening to The Month in Millions. Goodbye.