Customized Care & Precision Medicine in Psychedelic Treatments
Customized Care & Precision Medicine in Psychedelic Treatments
Sherry Walling - 0:00:00
Our phones, smartwatches, and social media platforms record all kinds of information about our daily activities. If you were to analyze all that data, you could get a really good picture of who someone is. Sometimes, the enormity and specificity of all this data can get a bit invasive, but it is also possible to put our digital footprint to good use. Fitness and sleep trackers like Fitbit and the Oura Ring can help users adapt their behavior in response to quantitative analysis of their habits. This biofeedback now offers new and exciting possibilities for those of us interested in improving health and specifically, those of us interested in psychedelic research and treatment.
Sherry Walling - 0:00:33
How could we use new technology and the associated data on human behavior to better implement psychedelic treatments? How can we pair the wisdom of ceremony and tradition with the most advanced scientific tools? Welcome to Mind Curious. This is a podcast for those looking to explore the potential of psychedelic compounds. I am your host and clinical psychologist, Dr. Sherry Walling.
Sherry Walling - 0:01:07
This podcast does not constitute medical or legal advice, and the perspectives of the guests are theirs alone. They don't represent me, my opinions, or those of our sponsor. Mind Cure Health. So, let's dive in. The technology companies of the Silicon Valley use our personal data to expertly tailor our online experience. They know if you like cat videos or if you're more of a sloth video person, but that's not the only way this data can be used.
Sherry Walling - 0:01:31
Precision Medicine is an emerging field that analyzes massive amounts of data to personalize medical treatments. Dr. John Brownstein is an expert on big data. He's a biomedical informatics professor at Harvard Medical School and the Chief Innovation Officer at Boston Children's Hospital. He is also an advisor to Mind Cure. Dr. Brownstein gives us a clearer picture on what precision medicine actually is and how it can it be applied to psychedelic treatments.
Sherry Walling - 0:02:09
So, I've listened to you, do a few interviews, and you used a term that I thought was really interesting, which is precision medicine, and I wonder if you would talk about what that is with these listeners.
Dr. John Brownstein - 0:02:37
Yeah. So, precision medicine is sort of the evolution of the practice of clinical sciences that focuses on the individuals, the recognition that every person is unique. And therapies or treatment plans can be tailored directly to the unique aspects of that individual and we don't do this necessarily very well in medicine. You know, we have large studies, clinical studies that tell you whether things are healthy or not, whether you know, drinking is healthy. You know, they're, you know, what you should be eating, whether caffeine you should be consuming, but we all know that everyone responds differently to the food they eat to exercise it. Yeah. And so, the idea that you can tailor as much as possible any type of treatment to the individual is sort of what is the basis of precision medicine.
Sherry Walling - 0:03:29
The way that I've heard you talk about it is really interesting. You are tailoring sort of medical recommendations specifically to an individual, but the way that you get there is by looking at these big, big datasets.
Dr. John Brownstein - 0:03:43
Sherry Walling - 0:03:43
So, walk me through the connection between like big data and millions of data points and one specific human.
Dr. John Brownstein - 0:03:50
Right. So, because you have large datasets, you can understand features at a very precise level. So, think about if you have data on an entire population, you know the nuances of various features that contribute to health outcomes. And so with that, you can study very nuanced details that can influence the care for a very small sample of people. And that's what we mean by precision medicine. So, what I work with in terms of big data, I spend a lot of time thinking about digital devices or how people spend their time on social media. All of that what we call digital exhaust has vast amounts of data about people sort of behaviors and health outcomes. And because the data is so large, you can actually get very sort of statistically relevant findings that can help sort of inform treatments that can help inform, you know, important population patterns at a very specific level.
Dr. John Brownstein - 0:04:31
And so, that big data, in fact, is informing very individual-level decisions.
Sherry Walling - 0:04:51
Yeah, very interesting. What about the Big Brother component of this? How do you think about the need for individual privacy and just the ways that we use data that are ethical and respectful of people's individual lives?
Dr. John Brownstein - 0:05:08
Yeah, no. There's definitely that concern. I mean, obviously, these companies are already collecting that data and we have to be thoughtful on how we... we utilize that data by individuals. In our research, we never collect data at, you know, in a way that we could reversely identify a person. So, we're always focused on, you know, aggregate data and learnings from the dataset rather than any ability to reversely identify people. But, you know, absolutely, we have to think about, you know, the... the negative implications of so much data about an individual being utilized. And of course, our purpose for collecting that data is to form care for that individual, and the view is more data that you can capture about an individual, especially passively, the more that we can create, you know, precision-based treatments at an individual level. And in clinical practice, we are so used to sort of one-off interactions where we collect only a very small sample about a patient's status.
Dr. John Brownstein - 0:05:58
But, imagine you can collect the vast amount of data that the person has through their day. And then, there's also, of course, you know, the opportunities for patients to interact with digital tools and provide better feedback. That has a real opportunity to have, you know, impact at an individual level and in a continuous way. And so, yes. We have to be very thoughtful about how this data is collected, how it's stored, how to protect it from misuse, but the opportunities are so significant with this kind of information.
Sherry Walling - 0:06:37
Are you for telling a world in which my doctor looks at my Facebook page?
Dr. John Brownstein - 0:06:41
I mean, they could get a lot of data from your Facebook page in your likes. So, yes. I mean, I think at some level, there is some value there.
Sherry Walling - 0:06:48
And sometimes, you use data like people's postings on Twitter or Yelp Reviews related to food poisoning, or you know, these data that all of us are interacting with on a regular basis.
Dr. John Brownstein - 0:06:59
Yeah. So, we've been very fortunate to work with a lot of the sort of large Silicon Valley companies like Twitter, Facebook or Google, and they have more data about you than basically anyone. And so, if you were trying to understand an individual, well, a good place to go is to understand their sort of online activities, what they search for. They might be searching for symptoms. What they tweet about might tell you a bit about their sort of mental health status. Their Facebook likes might tell you what kind of activities they're involved in. All that sort of digital trace information has some relevance to your real-world life, and a portion of those digital traces are health-related.
Dr. John Brownstein - 0:07:29
And so, by taking advantage of that vast amount of data, that data which is generally used do ad-targeting back at you. In this case, using that data for health-related research.
Sherry Walling - 0:07:52
So, how does that relate to the world of psychedelics and maybe where psychedelics bumps up against mental health?
Dr. John Brownstein - 0:07:58
Yeah, yeah... So, you know... Of course, these psychedelics and practice of medicine is an emerging field. There's a lot of opportunities to bring digital tools to support treatment. You know, broadly speaking, we're seeing a revolution in the use of digital tools to support mental and behavioral health. It makes so much sense to have digital companion tools that allow for better collection and logging of data. You know, people have a tough time describing their health status, but there's sort of digital biomarkers that you can leverage to get deeper insights. And so, you know, as Mind Cure is thinking about broadening the sort of tools in which we use to support patients and the sort of use of psychedelics as treatment, you know, we want to be able to collect as much valuable information to inform treatments.
Sherry Walling - 0:08:47
So, this data is living with tech companies. How do we get it from them to the clinicians, practitioners in a digestible format?
Dr. John Brownstein - 0:08:55
So, this is the big problem, and I think this is an area that Mind Cure is working on. There's so much data and often, that information sits out of the electronic medical record. And so, you can have incredible data, but if it's not informing care, then it's sort of not valuable. And so, you have to find ways to process that information, derive insights from that data, and that information is fed to the provider who can make informed decisions, but just a huge data set of a lot of data points about an individual are not going to make a big difference. And so, that processing, that visualization, that sort of conversion to decision-support tools is so critical.
Sherry Walling - 0:09:34
And what are the components of those tools that are most helpful?
Dr. John Brownstein - 0:09:38
Well, I mean, the reality is so if you have a device, a wearable that's streaming a ton of information about you, bunch of different metrics, activity, you know...
Sherry Walling - 0:09:47
Like your sleep, your heart rate, what you're drinking...
Dr. John Brownstein - 0:09:49
Yeah, what is that really going to do? But, if you have the ability to turn sort of sleep patterns into insights about how well the treatment is going and if someone is having improved sleep or their sleep is more disturbed, you know, what are those signals and the data? So, how do you turn that stream of information into important signals? And then, how do you turn those signals into actionable sort of clinical guidances, like what should you be doing differently to improve your sleep? And so, that processing and turning all that data into information, information into decisions, that's the sort of critical transformation of all that information.
Sherry Walling - 0:10:31
Effective precision medicine requires intelligent analysis and application. This approach is being pioneered by Mind Cure Health with the development of digital therapeutics and our new platform called iSTRYM. If you're scratching your head and wondering, "What is a digital therapeutics platform?" Then, I recommend going back to listen to episode two of the Mind Curious podcast once you're done with today's conversation. Dr. Ty Tashiro is one of the scientists involved in building iSTRYM. He's an award-winning professor of psychology and author of the book, "The Science of Happily Ever After." Dr. Tashiro is an expert in data science related to mental health and psychological well-being. I asked him to give me the details on how iSTRYM works and what it does.
Sherry Walling - 0:11:06
So, when you think about iSTRYM, which is this piece of technology that you and the team at Mind Cure are putting together, what are the things that are like most exciting from a technology-gadgety perspective?
Dr. Ty Tashiro - 0:11:39
Sure, yeah. Well, you know, one of the things from like a psychological-assessment perspective that I find so interesting is we always complain about self-report, and self-report is actually pretty good for a lot of things like no one has as much access to your private thoughts as you do. And so, how we just ask you about it and see what you have to say and maybe you rate yourself like on a zero to ten scale or something like that. We've all done those kinds of questionnaires for all kinds of things, but there's something unsatisfactory about stopping there. And so, what... Of course, psychologists have done over the decades they've adopted new tools. So, things like biological markers, whether it's like heart rate or heart rate variability, maybe muscle tension. There's things like natural language processing now that are really amazing where we can analyze people's speech and categorize maybe the tone of what they're saying.
Dr. Ty Tashiro - 0:12:21
We can categorize things like the amount of insight that they're producing at a given moment, and all of these technologies are really cool. Most of this knowledge though is tucked away in dusty shelves and library journals. And we have this opportunity to take this cutting-edge technology and this repository of really rich research and information that's accrued over the past couple of decades and put it into somebody's hand, whether that's a therapist or a client, and say, "Hey, we have the self-report. They say they're feeling seven out of ten for happiness. Let's say, but we also have this heart rate data. We have this activity data from how much they've been walking or exercising." We know from their natural language processing because they wanted to have maybe their journaling analyzed, kind of how they're feeling from that perspective, and then, use artificial intelligence to aggregate all of that information in a way that's meaningful so that we get a more accurate and reliable assessment of where people are at.
Sherry Walling - 0:13:48
What goes into natural language processing, like, what does that involve? What's the philosophy of that?
Dr. Ty Tashiro - 0:13:54
Yeah, I remember the first time I heard about natural language processing. I was so mad because as a graduate student and young professor, I had spent hundreds of hours going through cassette tapes, transcribing those until like some Word document, and then sitting there with other research assistants and coding these tax into categories. So, let's say we're coding for positive emotion where we're pulling out how they said happiness, they said glad, and then doing these tallies in these sheets with paper and pencil.
Sherry Walling - 0:14:32
I'm totally having memories of doing very similar things as a graduate student,
Dr. Ty Tashiro - 0:14:36
Right, such an arduous...
Sherry Walling - 0:14:38
Look at this transcript of a... of a therapy session and assess it...
Dr. Ty Tashiro - 0:14:41
Sherry Walling - 0:14:42
Based on the language, these keywords that get used...
Dr. Ty Tashiro - 0:14:45
Ah, and it's just arduous when you're the one doing it, and so you have these moments while you're doing that, and you think, "So, why am I taking the time to do all this?" And what you think to yourself in those situations is, "Well, it's because it's giving us a richness of understanding." It's because we're seeing what people are actually saying, and now we're extracting these themes from the texts that they provide, whether it's spoken or written. Natural language processing records, of course, with people's consent... records what you're writing or what you're saying, turns it into text, and then it goes in, and it finds the themes that otherwise would have been coded from people like you and me.
Sherry Walling - 0:15:29
An army of graduate students.
Dr. Ty Tashiro - 0:15:30
That's right... That's right, and so we can see, "Hey, how... how much positive mood is someone exhibiting in their journaling, for example? How much distress did someone share during the course of a therapy session?" Now, all of these things provide really rich and nuanced insights into what someone saying and the underlying themes that might be going on with them. You know, even the best psychotherapists, with great intuition and great experience, might miss certain things here and there, might miss certain consistencies that are operating and what somebody is saying. And so, I feel like natural language processing not only gives you this richness of data, but also helps work in concert with a therapist's intuition or a client's intuition to say, "Hey, we're also finding these things that you might not have noticed." As well as saying, "Hey, you picked up on this thing as an intuition that someone was maybe a little more upset than they were leading on." And in fact, the natural language processing supports that.
Sherry Walling - 0:16:40
It concerns that...
Dr. Ty Tashiro - 0:16:41
So, it's just yet another way to assess what's going on and improve the accuracy and reliability of people's insight.
Sherry Walling - 0:16:50
It's a little bit mind-blowing that you're building a piece of technology that really kind of has the potential to understand someone, maybe even a little bit better or accurately than they themselves can see themselves. So, one of the things that can happen with this tool is that with this data, it can help people better understand what conditions create thriving and what conditions might create distress. So, whether that's looking at physical activity or sleep data or heart rate data or subjective report, you know, you had this argument with your significant other, and now your... your anxiety is higher. But, the... the tool can then help, right, kind of give feedback that says, "Hey, a little more meditation." The days that you journal, the days that you exercise... These things really are the key ingredients of well-being for you.
Dr. Ty Tashiro - 0:17:46
That's right. Although we have some ability to have good insight into what we're feeling or what we're thinking, we're not always the best historians and record keepers of what we were thinking or feeling or what we did. We tend to have this revisionist memory that helps us feel better about ourselves. It happens to the best of us, and I think one of the great things about a tool like iSTRYM is that it can just gently track these different things going on with you and say, "Hey, you know, this is what was going on yesterday, the day before, the day before that..." And I think when technology works well with mental health. It's when it's working in concert with that person. So, it's not judging you.
Dr. Ty Tashiro - 0:18:22
It's not saying this was a bad thing. Rather, it's just giving you reliable information, accurate information, and then it gives you the freedom to use your free will to decide what you want to do with that. And I think that's the kind of relationship I like to have with other people. It's also the kind of relationship I think people want to have with their technology. They don't want to feel like they're being badgered, or you know, feeling guilty about things. All they want is factual information, and then you can use your wisdom to do as you see fit with that information.
Sherry Walling - 0:19:13
We've talked about large datasets and how they can be helpful in suggesting treatment options and tracking physical and mental health. Now, we are faced with the opportunity to interweave this cutting-edge technology with ancient, psychedelic medicine practices. How could we combine this healing power with modern data tools and artificial intelligence? You're taking this, I mean, really robust and extensive body of research and also introducing psychedelics to that conversation in some cases. So, iSTRYM can be... It sounds like really useful for people whether or not they're using psychedelics as part of their mental-wellness regimen, but it is also designed to be very supportive of people who are using psychedelics.
Dr. Ty Tashiro - 0:20:07
That's right, yeah. And so, that's kind of a difficult challenge to think about. How do we make this work for someone who's depressed, maybe? Maybe someone who has... struggling with PTSD, struggling with substance abuse, and how do you make a platform that gets them in a way that feels personalized and accurately gets them? And then, number two: How do you make it functional so that what you're recommending back is something that's actually useful for them and evidence-backed in the sense that we know this will be something that helps them get better? So, the system is being built with that in mind, so that we can take wherever someone is at, have the system adapt, and understand their specific problem, and then be adaptive again to suggest things that would be personalized or specific for their particular presenting problem. And I think that's where things like the measurement flexibility really helps. Having things like biometrics or natural language processing, and then being able to run that through artificial intelligence gives us the kind of range to be able to be agile across all of these different situations.
Sherry Walling - 0:21:27
You know, when we talk about psychedelics, sometimes we're talking about mystical experiences or things that feel sacred, are historically sacred, or even in the... the lived experience, for someone who's maybe going through these journeys as part of their healing context. Feels like there in this sort of magical, sacred, mystical spot.
Dr. Ty Tashiro - 0:21:47
Sherry Walling - 0:21:48
And so, how do you hold that with reverence? And then also say, "Okay, here's what your heart rate was doing. Here's... Here's what the data says..."
Dr. Ty Tashiro - 0:21:56
Right. Yeah, I think its data can be like scaffolding, right? And then, I think the situations I like the most are the ones where I can provide a bit of that scaffolding say, "Hey, this is what we know." And with something like iSTRYM say, "Hey, this is what we know from... from you and what's been going on." But then, allow the person to fill in the spaces on their own, and I've oftentimes found with... with most things in psychology, people have the wisdom that they need, and it might be in different parts and needs to be integrated. It might be the case that they're not allowing themselves for a lot of times very good reasons to fully access what that truth is, or what that wisdom is. And so you know, I think assessments and tools like iSTRYM, the job is to facilitate the synthesis of that natural wisdom that people have within themselves.
Sherry Walling - 0:23:00
What are you hoping a clinician will experience when they start using iSTRYM and you know, maybe invite a couple of their clients to be on the platform? What will be different in their practice or in their life as a result of having this tool available?
Dr. Ty Tashiro - 0:23:19
Yeah, one of the first reactions I'd like for therapists to have is a sense of relief that I have this tool, this partner that's going to help me do the things I need to do and be accountable. Yeah, iSTRYM's built to every single time with every single client be thorough about risk assessment, to be thorough about safety monitoring. It provides treatment protocols so that it helps kind of nudge folks to... to stay on the rails with delivering the treatment components we know are really beneficial for people. You know, a lot of people want to track client progress over time, and some sort of standardized way, iSTRYM just does that for folks. And so, you're seeing, "Hey, this is how my client is progressing over the course of time." So, if I'm using a product like that, I think there's a sense of relief. I don't have to worry about something may be slipping through the cracks and iSTRYM is just going to help me with that.
Dr. Ty Tashiro - 0:24:13
The second reaction I think I'd like for a therapist to have is like the sense of wonderment which I know is my sound overstated, but I would love for them to get into it and just have these "Aha!" moments where they see like, "Oh, you know what, I've never been able to track someone's progress or gain insights into somebody's difficulties in this kind of way..." And I know I have that with things like natural language processing, you know, biometrics, these other things. Sometimes, you see what comes out of that. And you have to kind of look twice and think, "I can't believe that." I sometimes I feel old saying this, but we have the technology to actually leverage these things into something that's insightful and meaningful.
Sherry Walling - 0:25:28
As individuals, each of us has different needs, habits, and struggles. Psychedelic therapies have the potential to treat some of humankind's most stubborn, pervasive illnesses, things that cause tremendous amount of suffering. That said, no one size fits all. That's why I'm so excited to see how precision medicine and digital therapeutic technology like iSTRYM can make psychedelic therapies more effective, more individualized. Thank you so much to Dr. John Brownstein and Dr. Ty Tashiro for joining me on today's show. If you want to learn more about iSTRYM and how it can support clients and practitioners, visit the website, "mindcare.com." You can even sign up to be an early access user. Thank you so much for joining the conversation and as always, stay curious.