Leading Neuroscientist Dr. Adam Gazzaley Talks Drug-Free Brain Health Treatments Using Virtual Reality and Video Games

Dr Adam Gazzaley - UCSF Gazzaley Labs

( Music )

Mark Masselli: This is Conversations on Health Care, I'm Mark Masselli.

Margaret Flinter: And I a m Margaret Flinter.

Mark Masselli : Well Margret , another year has flown by and to say it was tumultuous
would be an understatement.

Margaret Flinter: Yeah t hat is what I call pretty safe to say , and certainly at least in
terms of health care we ’ re ending this year with more uncertainty and unanswered
questions.

Mark Masselli: Well it ’ s pretty sure to say that there will be some form of repeal and
rep lace . Our most recent guest, the honorable Michael Leavitt feels that the
administration really has no choice but to deliver some form of what was promised
on the campaign trail.

Margaret Flinter: And if it ’ s repealed much of the progress that’s been mad e in
i nsuring more than 20 million Americans may be lost . Many likely to lose their
coverage in the wake of repeal which will certainly impact not only the i r access to
health care but it really impacts everybody on the frontlines of care as well , and
faci ng some very real challenges at the same time at the start of 2017 certainly
continuing to look at opioid overdose deaths as a huge problem across the country ,
just a devastating p ublic health crisis for which there just is no simple fix.

Mark Masselli: N o , there really isn’t Margaret , and something that our guest think s a
lot about , Dr Ad am Gazzaley is a neuroscientist and founder of the Neuroscience
Imaging Centre and the Gazzaley Lab at UC San Francisco.

Margaret Flinter: He has been doing some really fascinating and groundbreaking
work , developing 3D brain imaging technology that allows researchers to observe
brain function in real time and we a re really looking forward to that.

Mark Masselli: He is also developing virtual reality systems already prov ing highly
e ffective in helping treat such conditions A DD , PTSD and even addiction. What’s so
exciting about this is that it offers a non - pharmaceutical approach to treating a
number of brain disorders. Really looking forward to that conversation Margare t.

Margaret Flinter: And L ori Robertson will stop by, the Managing Editor of
FactCheck.org . You can hear all of our shows by going to www.chcradio.com .

Mark Masselli: And as always , if you have comments please e - mail us at
www.chcradio.com or find us on Facebook or at CHC radio on Twitter , we love
hearing from you.

Margaret Flinter: We’ll get to our interview with Dr. Adam Gazz a ley in just a
moment.

Dr Adam Gazzaley - UCSF Gazzaley Labs

Mark Masselli: But fir st here is our producer Marianne O'Hare with this week’s
Headline News .

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Marianne O'Hare : I’m Marianne O'Hare with the se Healthcare Headlines . 2016 was
a bad year for the res urgence of the mum p s with more than 4000 cases reported by
the Centers fo r Disease Control and Prevention; t hat’s nearly triple the number of
cases reported in 2015. College campuses seem to be a hot bed of infection. Most
of the se students who contracted the mum p s had been vaccinated , leading to
discussion of whether there ne eds to be a new approach to the vaccine booster
protocols. Two doses of the vaccine is the standard protocol for immunization but
experts at the C D C are looking at the efficacy of recommending a third booster shot
in areas where out breaks are underway.

Eb ola took a devastating toll on West Africa , the out break starting back in 2014 and
leaving more than 11,000 people dead . And there is good news from the lab, an
experimental vaccine has proven to be 100% effective in blocking the virus. The
new vaccine h as some flaws experts say , it may not give long - lasting protection.
Lab test s w ere so successful 300,000 doses have been produced and preserved
should another out break occur. Bird flu is also on the rise across parts of Asia and
even Europe. Hong Kong r eported its first death from bird flu , an elderly man who
had contracted the H7N9 virus w hile in China. Officials in Germany where bird flu
w as also detected are doing the same , the H7N8 strain known to be highly
contagious , and in India a strain H 5 N 1 has shown up as well .

And pregnancy and women’s brain s, a study has shown a link between women’s
pregnancy and growth in the part of the brain wired for responding to social and
emotional cues. A r ecent study showed many of these changes appeared to last at
least two years after giving birth. Mothers who had the most pronounced alterations
in their brains also scored higher on tests of emotional attachment to their babies
th an women whose brain s underwent more subtle changes . And being a single dad
seems to have an impact on brain health as well. According to a Canadian study
single dads are twice as likely to report poor physical and mental health as father s
with partners d o. Study found that single mothers generally had more stresses due
to financial cha llenges , whereas men experience more stress a s lone caregivers.
Researchers suggest m e n are less likely to ask for help when they are in trouble and
urge better screening of single dads in the primary care s etting . I’m Marianne
O’ Hare with these Healthca re Headlines .

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Mark Masselli: We’re speaking today with Dr Adam Gazz a ley , Founding Director of
the Neuroscience Imaging Center, Neuroscape Lab and Gazzaley Lab at UC San
Francisco. Dr. Gazzaley is also Cofounder of Akili Interactive Labs, a digita l
medicine company. He ’ s authored over a hundred scientific papers and delivered

Dr Adam Gazzaley - UCSF Gazzaley Labs

over 500 presentations around the world , including the PBS Special and
accompanying book The Distracted Mind. He earned his MD and his P hD In
neuroscience at Mount Sinai Sch ool of Medicine and completed his internship in
internal medicine and his clinical residency in neurology at the University of
P ennsylvania . Dr. Gazzaley , welcome to Conversations on Health Care .

Dr Adam Gazzaley : Thank you , p leasure to be here.

Mark Mas selli: Yeah . You are among a handful of notable cognitive neuroscientist s
who are helping to forge a path to a new frontier of brain scientists . You know I think
over the last probably 15 months we’ve had a number of interesting figures in the
brain wor ld . We had Dr. William Newsome who wa s co - directing the BRAIN Initiative
w h ere the y are mapping out the brain. Your lab has been developing technological
and gaming interventions for the development of healthy brain s and also treatment of
a number of com mon and debilitating brain disorders. I w onder if you could share
with our listeners some of these new technologies that you’re developing and the
potential to usher in a new era of brain health.

Dr. Adam Gazzaley : Sure . Well as a neurologist I ha ve fel t frustrated with our
current tools that we use to treat conditions of the mind , from attention problems to
mood like depression and anxiety , but certainly aging - related impairment and
cognition so things associated with Alzheimer’s disease and other
neuro degenerative processes. Medications that we use which are really small
molecules , a re not well - targeted and they a re not well - personalized to the individual
and so we either wind up with only modest effe cts or lots of side effects . And so the
idea that I had pushed into practice almost eight years ago now was to use
experiences to help re wire neur al circuits and strengthen different neur al process es .
And the experiences that we ha ve really latched on to as being very powerful and
interactive , we deliver in the form of video games . So in our center here at
Neuroscape at UCSF , usually working with professionals in the video game industry
very interactive challenges that push one of our participants to engage in an activity
for long periods of time and then record carefully how that type of interactivity
improves the ir brain function.

Margaret Flinter: Well Dr. Gazzaley, that is totally fascinating and th ere’s about a
million steps between what you just said and where my mind goes to in terms of
some of the things that we a re trying to gra pple with. Let me pick one that’s so much
on our mind s these days which is the opioid cris i s , managing chronic pain which ha s
so often led to addiction, treating conditions like post - traumatic stress disorder.
These are j ust huge issues that we have terrible outcomes for too many patients .
You have spoken of your grand vision of the f uture of brain health where we will
have this f ar more personalize d as you say and specifically targeted approach. Can
you talk about how t echnologic interventions that you are exploring might make a
dent on some of the just seemingly almost intractable problems?

Dr Adam Gazzaley - UCSF Gazzaley Labs

Dr. Adam Gazzaley : Because these experiences can be constructed in a very
precise way to challenge an individual just on those abi lities and most need to be
optimized , we can direct our medicine, our digital medicine as we like to think about
it , much more precisely . We use this close d - loop system of a game to ad just its
challenge in a way that’s appropriate to their abilities , and when someone gets better
overtime , because our brains are plastic so that’s the natural process , the game
gradually pushes these processes into a more optimal state just being there pushing
the system . And so we’re already s ee ing impact across the wide ra nge of
conditions, things that seem almost counterin tuitive for a video game to be
therapeutic on such as addiction and attention disorders which many people blame
on this ( cross talk) . We think it can have a positive impact , now it ’ s just doing the
hard work and proving that.

Mark Masselli: So tha t i s counterintuitive, video games doing good work as
somebody who has two adolescent boys, but you actually see the same ve hicle but
you see it in a different way and you a re seeing some real progress on treati ng
A D H D or PTS D beyond that realm so tell us about how all this works.

Dr. Adam Gazzaley : Sure . So video games are this interesting beast where they
have been many ways thought of as the enemy , but that’s tru e of everything . You
know there is always yin and yang and video games are certainly very clearly in that
category . You know the y are a genre. They include many , many different types of
interactivity and challenges and how we think about it is that if you create this type of
interactivity and the c lose d - loop and while you’re playing, your accuracy , how fast
you are . We even feed other physiological information for example your heart rate
into some of our games , that they can be used to create this very personalized
challenge s uch that it’s not too difficult where you just give up and you a re frustrated ,
or too easy where it’s boring and so you just put your play right in that sw eet spot in
that flow state where they are most susceptible to change.

Now our first big study was on a game that we crated called Neuroracer and we
studied health older adults and what we were able to show that not only were they
able to improve their ability to multitask on the game , but that other skills that were
related t hrough common brain networks but were not directly trained by the game
itself. This is something we call transfer . So their ability to do a face memory task
over short period of time, or a very boring sustained attention task, that they also
im proved significantly. So this is the very methodical rigorou s approach that’s
necessary to take this concept that an interactive game can improve your cognitive
abilities. Now we’re stepping into clinical domains looking at populations such as
A D H D, post - traumatic stress disorder, traumatic brain injury, anxiety d isorder,
multiple sclerosis, Alzheimer’s disease, all of those studies have started mostly by
our colleagues which then you know express ed interest in our games and we help
guide them , and data i s al ready now being yield ed that we a re really , really excite d
about . So you will hopefully be seeing many publications in 2017 across those

Dr Adam Gazzaley - UCSF Gazzaley Labs

conditions showing that we can make a positive and a meaningful and what we will
show i s a sustainable impact in improving the lives of those individuals.

Margaret Flinter: W ell during the recent holiday shopping season it was just about
impossible to avoid virtual reality products. You ha ve said that the combination of
virtual reality and artificial intelligence hold just incredible promise , th e n you’ve
conducted so much res earch on how these technologies work together. What
excites you about the potential for these interfaces?

Dr. Adam Gazzaley : This is the year of virtual reality . We have seen from the big
platforms like the Oculus Rift and the Vive , the Play S tation VR , even Sony has one
and then all really exploding into the consumer space this year , we wi ll see more of
that next year and then we will start seeing augmented reality devices that are going
to be quite powerful where you overlay the digital world on top of the real world. I
mean right now they are all really largely being targeted for entertainment purposes ,
but we see great potential for these to be powerful tools to help improve the human
condition in many different ways. We think there will be focuses o n education but
also on medicine and mental health. We already have seen virtual reality advances
for pain relief and for anxiety disorders . In our own group here at U CSF we are now
taking our video game platforms that we have developed th at focus on med itation
type practices, physical fitness and now we’re looking at how they might have an
even greater impact if they are placed inside virtual reality domains , and the reason
for that is that it is just a much more real world immers iv e setting to be i n and we
think that it will create more powerful experiences and th us have a more powerful
influence o n improving brain function.

Mark Masselli: We’re speaking today with Dr Adam Gazzaley, Founding Director of
Neuroscience Imaging Center at the U niversity of C alifornia San Francisco and
principal investigator of a cognitive neuroscience laboratory at UCSF. Dr. Gazzaley
also c o - founde d Akili Interactive Labs, a digital medicine company. He’s co -
authored over a hundred scientific papers and has delivered over 5 00 presentations
around the world on his research. I am wondering about the group that you partner
with. Are there folks in the industry who are making video games engaged in your
work?

Dr. Adam Gazzaley : I think scientists often assume that because the y are deeply
involved in understanding the brain they would be able to create video games on
their own. We’re not in that camp, we really respect the video game professionals,
artists, musicians, storytellers, the programmers . We realize that there is gr eat
expertise and we want to help leverage that to ac comp lish this higher or der goal of
building th e s e games a s valuable tools , and so we teach them our understanding of
the brain and close d - loop algorithms and then work with them on creating these
environ ments and the reward structures. Akili Interactive which is the company that I
cofounded based on our research here at UCSF is pretty much a 50 - 50 team of
video game professionals and others from science and business and health care.

Dr Adam Gazzaley - UCSF Gazzaley Labs

Some of the highest level people from the game industry that might be feeling you
know as my colleague from LucasArts once told me he spent his entire career
teaching teenagers how to kill alien s and now he is ready to advance to something
else . And so we often find like the best people in the industry that have been doing it
the longest, that have already made their names and they a re on the other side of it
and then they a re like I want to take these skills and really reapply them . So it
creates a new type of dynamic when you spend enough time with video game
professionals and scientists and people from medicine that create products that
people have never seen before , so we a re really excited about that particular
element of this whole journey.

Margaret Flinter: Well Dr. G azzaley , you recently hosted a riveting presentation
where you had a Wall Street Journal reporter on stage with you fi tted with one of
your lab ’ s head caps and what was so remarkable about it is that one was able to
watch a large 3D image of his brain on t he screen as the neurons were firing away in
real time while he interacted with a video game. How are these advance d imaging
technologies enhancing our understanding of how the brain actually works?

Dr. Adam Gazzaley : So you are talking about a technolog y that we create d with
many othe r partners called the Glass Brain, and the goal is to create a real time
visualization that is able to detect different brain rhythms and h ow brain areas are
communicat ing with each other essential ly in real time . So the Gl ass Brain is a
combination of an MRI and a mob ile EE G that operate upon that data very rapidly to
create that visualization . And now we’re proceeding along two path way s with this
technology , the first is to see is there any value in real time brain inform ation in this
format as a diagnostic to o l . So we also have a virtual reality version of this which is
quite remarkable to put it on and fly inside your own brain . If you are a physician or
a therapist let’s say, flying inside someone else’s brain, watchi ng it evolve in real
time and let ’ s say you have a dash board and you can increase the challenges in a
game that they’re playing and then look at how their brain responds , where we are
spending most of our time is on the therapeutic aspects of this.

We have another game where your heart rate drives it so that’s a physical fitness
game where we want to maintain you at this perfectly challenging heart rate for you .
With the Glass Brain what we can do is take neur al information , actual brain data in
real time while you’re playing the game, feed that into the game engine and now the
game is challenging you and giving you rewards not just based on your performance
but based on what your brain is doing , and we think this is going to be a much more
targeted way , al most like a surgical way of optimizing brain function , b asically
consumer friendly technology like mob ile E E G caps and video games and VR and
artificial intelligence and wearable physiological devices all coming together to create
this close d - loop to impro ve your function.

Mark Masselli: You are a health care provider, you a re a researcher and you a re
doing the bend science right now and you a re trying to get F D A approval for several

Dr Adam Gazzaley - UCSF Gazzaley Labs

of your therap eutic games . I am wonder ing if you could talk a little bit about the
approval process, what do you expect we will see .

Dr. Adam Gazzaley : So the stage that we a re at with Akili in terms of taking video
games to that true clinical level which requires regula tory approval , we’ve pre -
submitted to the F DA who have a pproved not the game for clinical use yet but a full
multi - site clinical trial which is as far as we know the first time that we’ve seen this
type of trial being conducted. The first trial that ’s underw ay now is as a therapeutic
device to treat attention disorders in children with A D H D . Then we could be looking
at the first non - drug treatment for A D H D and as far as we know the first video game
as a prescribable. That’s a big one and we will see the results of that study in 2017
as we will start many othe r clinical trials , but there are other things that have to
change . It ha s to be essential almost like a para digm shift in terms of physicians
thinking about medicine not just as pills but as interactive video games . There has to
be a shift in how payer w ill help support this field as prescribable therapies . But my
hope is that we will see physiatrists , neurologist s reach into their pocket s, p ull out a
prescription pad and not just write down a drug but write down like two months of
iPad and a whole new t ype of medicine will be born , that’s what I hope.

Margaret Flinter: We ha ve been speaking today with Dr. Adam Gazzaley , Founding
Director of the Neuroscience Imaging Center , Neuroscape Lab and the Gazzaley
Lab at UC San Francisco. You can learn more abo ut his groundbreaking work by
going to g azzaleylab. ucsf.edu or follow him on Twitter at a dam g azz @adamgazz .
Dr. Gazzaley , thank you so much for joining us on Conversations on Health Care
today.

Dr. Adam Gazzaley : My pleasure , it was lot of fun.

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M ark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about health care reform and policy. Lori
Robertson is an award - winning journalist and managing editor of FactCheck.org, a
non - partisan, non - profit consumer advocate for voters that aim to reduce the level of
deception in U.S. politics. Lori, what have you got for us this week?

Lori Robertson: We looked back at the most noteworthy false claims about science
in 2016 and several concern ed health issues . For instance , during a Congressional
battle over funding to combat the Zika epidemic Senate Minority Leader Harry Reid
fals e ly claimed that Zika “ affect s everyone ,” because recent research found that it
“ causes people to go blind. ” Tempora ry vision impairment is a symptom of Zika but
no adult has gone blind because of the virus. Democratic Presidential Candidate
Hi l lary Clinton said that you can’t do any research about m arijuana because it’s a
Schedule 1 drug . That’s false . Schedule 1 cl assification makes it difficult to conduct
research on a substance but not impossible. Senator Jim Inhofe falsely claimed in
November that a new report confirms that fracking has not impacted drinking water

Dr Adam Gazzaley - UCSF Gazzaley Labs

in Wyoming . The industry funded report couldn’t reach a firm conclusion due to a
lack of water quality data before oil and gas exploration. Louis iana representative
Ralph Abraham claimed in June that thousands of studies refute the US
Environmental Protection Agency’s conclusion that ground level ozon e exacerbat es
asthma attacks. That’s false too. A link between ground level ozone and asthma
exacerbation is well - documented in the scientific literature which both the American
Lung Association and the World Health Organization acknowledge . And that’s my
fact check for this week. I am Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players, and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked, email us
at www.chcradio.com . We will have FactCheck.org’s Lori Robertson check it out for
you here on Conversations on Health Care.

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Mar garet Flinter : Each week, Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. When long time IBM
executive Sharon Linder left the left the corporate world she thought she would ease
into semi - retirement , but then breast cancer diagnos e s for her mother and two
sisters shifted her focus. She watched as all three of them went through multiple
surgeries and treatments we aring the ubiquitous Johnny, the hospital gowns that tie
in the back and leave patients often feeling vulnerable and exposed.

Sharon Linder : The hospital gown was never meant to close in the back , it was
meant to make it easy for you to go to the j ohn . So when you put it in the front it
really doesn’t close . You know I thin k that the traditional hospital gown takes away
your identity and comfort , t wo things that are really important when you are
advocating for yourself.

Margaret Flinter: The former corporate executive decided that the one in eight
women going through breast cancer treatment needed a power suit of their own to
navigate this challenging experience and she launched her own research project into
which fabrics and which designs might provide a better alternative to the standard
hospital gown.

Sharon Linder : We c ame up with a fabric that you know you would throw in the
washer and drier for like two weeks nonstop and it came out beautifully. So the
fabric we came up with isn’t a [ inaudible 23:27) fabric but it’s a knit so the feel of it is
very much like a c otton cashmere that is just so soft you just don’t want to take it off.

Margaret Flinter: She called her invention Janes as opposed to John n y , creating a
gown that thousands of users have called comfortable, stylish and a vast
improvement from their predecessor s.

Dr Adam Gazzaley - UCSF Gazzaley Labs

Sharon Linder : And they fit people in a comforting way. You are totally covered. It’s
a little V - neck crossover at the very top and it goes all around your body.

Margaret Flinter: And she developed a gown in time for her own cancer diagnosis
and was able to see her invention put to her own good use.

Sharon Linder : Ja n es did give me really a leg up . I think that I felt better about all of
my treatments j ust feeling like I looked better . When you think you look better you
feel better.

Margaret Flint er: Dozens of hospital systems across the country are adopting her
gown design , which you can also order online for women who have received a
recent diagnosis of breast cancer , and even nursing mothers are using her product.
Janes, a hospital gown d esign ed for enhancing the female patient experience ,
providing comfort, dignity, easier access during challenging procedures , or just
providing an easier experience for newly breastfeeding mothers, now that’s a bright
idea.

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Margaret Flinter: This is Co nversations on Health Care . I a m Margaret Flinter.

Mark Masselli: And I a m Mark Masselli , p eace and health.

Conversations on Health Care, broadcast from the campus of WESU at Wesleyan
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