Akili CEO Gives Inside Look at Startup’s Therapeutic Video Game Play

Xconomy Boston — 

Akili Interactive Labs is a medical device company that makes mobile video games—and not the other way around.

That’s an important distinction for co-founder and CEO Eddie Martucci.

“We’re not a consumer company, nor do we want to be,” Martucci told me recently, as we chatted in a conference room at Akili’s new downtown Boston headquarters. “You have to be pretty focused as a company to do something well. And medical is a huge area to focus on.”

Akili has grabbed headlines over the past few years for trying to become the first company to receive FDA approval to sell a video game as a medical device capable of assessing, and treating, a variety of cognitive disorders. The startup positions itself as an “electronic medicine” company whose experimental diagnostic and therapeutic software is delivered in the form of interactive games that look and feel like something you might download from an app store or play on your Xbox.

Akili is conducting clinical trials of its software in patients with autism spectrum disorder, depression, Alzheimer’s disease, traumatic brain injury, and ADHD. The company is furthest along in ADHD. It announced positive results from an 80-patient, open-label pilot study in October, and it’s planning a larger trial involving children with ADHD that could give Akili the evidence needed for FDA clearance.

But here’s the thing—Akili probably could be a consumer video game company if it chose to go that route. Who knows if its games would lure enough players to be successful, which is a tough nut to crack. Akili, which has 14 employees in Boston and San Francisco, has the right kind of expertise on staff, though. Members of its team have worked on major games like “Star Wars: The Force Unleashed” and the “Medal of Honor” franchise.

“We have people who spent their careers in high-quality consumer video games,” Martucci said. “They could do anything they want in the consumer world. But they want to have a medical impact.”

He didn’t rule out marketing Akili products to consumers, but he said the company would only entertain the idea “years down the road” if it successfully established itself in clinical settings. “We know the demand is there in many other markets outside of medical, but it’s not a primary focus for us right now,” Martucci said.

I can’t attest to the health benefits, but what Akili created is fun to play. During our interview, Martucci let me test a demo version of Akili’s flagship product on a tablet. In some ways, the tasks and feel of the game transported me back to third-grade sleepovers spent playing “Mario Kart” on the Nintendo 64, and rocking out with friends on “Guitar Hero” in my freshman dorm room. (Who am I kidding, I still play those games.)

In the Akili demo, I chose a “volcano” level (pictured above) that required me to tilt the tablet left or right to steer my character’s hover board along the path, doing my best to avoid potholes of fire. At the same time, various small orbs were flying across the screen. Before the level started, the software asked me to keep an eye out for a particularly shaped one, and every time that type of object flew by, I was supposed to tap the screen. When I got on a roll, I would enter a sort of hot streak mode that reminded me of “star power” in Guitar Hero.

I finished the level in about five minutes, according to Martucci—I was more focused on keeping my character and the vehicle free of scorch marks. That level corresponds to one segment of a patient’s daily “dose” of the software, Martucci said. I would’ve happily played longer if he and I didn’t have to get back to work that afternoon.

Perhaps it’s no surprise, then, that in early clinical trials, many patients have been disappointed to give back the device after the four-week testing regimen. “It’s become part of their routine,” Martucci said. “They want to keep playing it, and they want to keep conquering it.”

But some patients are “happy to be done with it” at the end of the trial, Martucci said. “It’s hard.”

Eddie Martucci, co-founder and CEO of Akili Interactive Labs

Eddie Martucci

Martucci and his team play the games regularly, he said, “mostly for testing purposes”—finding bugs, trying to improve the experience, and so on. That’s an advantage for Akili, Martucci said. “Rarely do you get to test your medical device, traditionally. The large majority of medical devices are implantable or things like that. You don’t get to simulate the patient’s experience or understand it.”

But when an autistic child, for example, gives feedback on Akili’s gameplay experience, employees can empathize better. “You won’t experience the device in the same way, but it gives you a more intimate understanding of how they’re experiencing it,” Martucci said.

What Akili built is more advanced than a typical video game, in some ways. For example, the software automatically adjusts the level of difficulty based on the patient’s ability. And the software constantly measures about 60 variables tied to the player’s reaction time and other neural indicators, Martucci said. “The device sends us data 30 times a second,” he added.

Akili is still exploring what it can do with all that data. But at a high level, the company intends for doctors and other healthcare providers to use its products to measure patients’ cognitive control, track their conditions over time, and potentially boost brain function.

Despite the progress Akili has made, plenty of questions remain as it tries to achieve its goals:

—Will the large clinical trial it’s planning be enough to convince the FDA that its flagship game has real therapeutic benefits for children with ADHD?

—If it gets the green light to start selling the product for that purpose, will many doctors prescribe a video game for patients?

—How big of a difference will the software make for patients?

—If Akili has a positive impact in ADHD, can it do the same with other conditions?

Those questions will be answered in the next few years. For now, Martucci, who holds a doctorate in biochemistry and molecular biophysics, is excited he’s working at a company mixing medicine and software in new ways. “What fascinated me when we founded Akili was you could apply this scientific method and this experimentation and rigorous process that you do in discovery-based biochemistry, you could apply that same method to things that people didn’t think could be studied in that way,” he said.

“People generally think software testing is qualitative,” he continued. “You put it out in people’s hands and get feedback. And they think of biochemistry as ultra quantitative. I think there’s a hybrid where we can bring these types of products—iPads and software—much closer to what we do quantitatively.”