The Washington Post - USA (2022-05-24)

E4 EZ EE THE WASHINGTON POST.TUESDAY, MAY 24 , 2022

er’s diagnosis. “The problem is there are a lot of ways you don’t know that it’s really objective. For instance, when you play games over and over, you get better at them. So are you measuring symptoms or are you measuring gameplay? “We can’t even treat many can- cers right now,” he said. “And the brain is arguably much more complicated.” It’s unclear whether Thymia execs ultimately intend for the tech to become a diagnostic tool all on its own. While Molimpakis and Goria take pains to empha- size it is meant as a supplement — “all we’re doing is extracting all this information that would come naturally to a clinician and pro- viding it back to them,” Goria said — the founding story involving Molimpakis’s friend suggests that the company is premised on the idea that the tech sometimes just may be able to do the job better. Thymia executives foresee a future point when results could be shared with primary care physi- cians and possibly even patients. Such decentralization makes phy- sicians like Doraiswamy wary. The panic over Googling a physi- cal condition is bad enough, they say; mental health information for patients could be that much more dangerous. “If you were trying to treat someone with a phobia, would you really want an app that spot- ted 40 different ones going off at all hours of the day?” he asked. The battle over Thymia and related tech is part of a larger conflict between an industry that says it resists technology not out of stodginess but human skillful- ness, and a group of disrupters who believe the machines in some cases may simply be more effec- tive. “Many psychiatrists have the strong feeling they should trust their own instincts,” Molimpakis said. “I understand that. But I think objective measurements can be very important. We should be fighting to make them better.”

health could deter insurance companies from paying for human doctors. Thymia founders say that this is one of the reasons patients will not be allowed to use the service themselves and in- stead must go through their clinician. Molimpakis says that Thy- mia does not share data with third parties, including insurers. Thymia has 12 employees but aims for 17 by summer; it has raised $2.6 million in early-stage funding, Molimpakis says, and will conduct a seed round later this spring. About 2,000 people have used the product in preclini- cal trials, with all-important clinical trials expected to begin at a number of U.K. medical institu- tions in the coming months. Executives have already begun working with British regulators to have Thymia games approved by the end of the summer, hoping to classify them as a medical device that would allow formal usage in doctors’ offices. Europe and the United States, Molimpakis said, should follow soon after. Backers say they see a big social upside. “As investors we asked ‘is there a massive problem to be solved and is this the right team to be taking it on?’ ” said Patrick New- ton, a principal at the London venture-capital firm Form Ven- tures, which has invested an un- disclosed sum in Thymia. “We answered yes to both. The idea of giving a clinician the ability to remotely and regularly check in and understand how someone’s condition is performing could be huge.” But some say they worry about the pitfalls in the move from a first-person to third-person — or, third-machine — approach to diagnosis. “Objective markers can provide better scores than self-re- ported scores in a lot of cases, there’s no question about that,” said Liam Kaufman, co-founder of Winterlight Labs, a Canadian start-up that uses AI to detect voice changes and aid in Alzheim-

patient’s mental health specialist, not a primary care doctor. (Pa- tients choose the data to be shared via a pop-up opt-out every time recording will be used; they can allow voice but not eye-track- ing, for instance, or vice versa.) The doctor then makes treatment decisions — even, in emer- gency situations, sending people to the hospital. Data is not shared with the patient. In doing things this way, Thy- mia execs say alarms are sounded that would have remained silent in a traditional office-visit struc- ture. “It’s increasingly hard to get in to see a psychiatrist because it’s so expensive,” Molimpakis said. (In the United States, the average psychiatrist makes $105 an hour, according to the Bureau of Labor Statistics, although that number is usually much higher for private consultations.) “Even then you may only go in to see them once every four weeks or six weeks. And who knows what’s really hap- pening to you in that time?” she said. Some doctors familiar with depression and technology, however, ask if the service will really provide all the information that a clinician needs. “There’s no doubt that generally speaking AI and technology hold promise for mental health and are really the future of it,” said Murali Doraiswamy, a professor of psychiatry and professor in medicine at Duke University School of Medicine. “But psychiatric disorders like depression are very personal- ized,” he said. “Symptoms are ex- tremely variable. ... I’m not sure that I’ve seen the evidence that a computer can be programmed to understand all this the way a person can.” Mental health advocates also worry generally that cheaper app- based approaches to mental

nority” of gamers “can become truly addicted to video games and as a result can suffer mentally, socially and behaviorally.” Thymia execs, however, say that the game works well because it creates a natural setting for a subject to spin off data; a person immersed in a video game is less likely even to think they are taking a test. (Thymia is, in this regard, a distant cousin to En- deavorRX, the prescription video game used to treat attention-defi- cit/hyperactivity disorder in children.) Such a tool also won’t have trouble attracting users — 68 percent of American adults now play video games, according to the trade group the Entertainment Software Association, up 6 percent over the course of the pandemic. The Thymia games, available free for clinicians from its site, are minimalist. They involve simple tasks in whimsical natural set- tings; in one, a player tries to track bees buzzing around sets of flow- ers. But the machine is gathering critical information. As a player swipes in the game, or moves their eyes, or changes their expression or speaks, the AI is recording the data. It is measuring for markers like agitation, anxiety, attention and working- memory. (Agitation might seem a difficult metric to gauge in the stressful confines of a video game, but can be done, Molimpakis says, via jumps or dips in areas like psychomotor speed.) The algorithm processes this data and compares it both to baselines for a given user and the expected reactions for a user’s demographic. If, say, it perceives working-memory degrading over time, or eye movements too rapid for a person’s age group, this is factored in. It calculates all it tracks and produces a score for each symptom, which it sends to a clinician — at the moment only a

but they can also be the person least likely to hold a clear view on the subject. Traditional psychiatry has tried to crack this by combining a subjective firsthand report with ostensibly objective questions. The long-running standard for depression diagnosis is the “PHQ-9,” a set of nine questions about how a patient is feeling. Do they have “little interest or pleasure in doing things?” “Poor appe- tite or overeating?” The patient ranks themselves on a scale of “not at all” to “nearly every day.” If five of the nine answers are positive, they are clinically diagnosed with depression. The creators of Thymia say there’s a better way. “There’s a rich body of mathe- matical tools that we haven’t been using,” said Stefano Goria, who co-founded the company with Molimpakis and serves as its chief technology officer. “What we can do is extract information that we may not understand naturally so we can put objective numbers on it and make a more informed decision. We can get a lot more information.” There is an urgent need for fresh approaches: Americans’ mental health has worsened in the past several years as technology, seeking to aid humans with communication, has increased their atomization. The isolation brought on by the pandemic has only deepened the problem. The Boston University School of Pub- lic Health recently found that rates of depression among Ameri- cans — at 8.5 percent before the pandemic — now stand at nearly quadruple that, at 32.8 percent. Video games are an unlikely solution. While many gamers have no noticeable positive or negative psychological effects from playing, a landmark Brigham Young University study revealed that “a significant mi-

entrepreneurship, and artificial
intelligence, to fill in gaps in men-
tal health treatment. She rea-
soned that since a limited supply
of doctors didn’t have the time or,
possibly, even the raw processing
power to solve a growing depres-
sion epidemic, perhaps technol-
ogy could step in.
And in the most unusual twist,
she decided to use video games for
the task.
The result is Thymia, a simple
set of mobile video games that
Molimpakis and her co-founder
say might, with the help of AI,
pick up on depression signals as
well as any office examination.
When it begins clinical trials in
the summer, Thymia will try to
improve and even save lives as it
alerts doctors to warning signs
they might otherwise miss.
According to the founders, the
tool — which comes as part of a
larger movement to deploy AI to
address mental health — could
revolutionize how society cares
for depression. The start-up joins
a host of related start-ups using
digital tools to broaden access to
mental health care, including
wearables company Fitbit, which
recently filed for a patent on a new
mental health detection system,
and TalkSpace, which primarily
uses a data-driven approach to
match consumers with therapists.
But some experts who were
asked about Thymia worry that
machines are an inadequate and
potentially risky replacement for
a profession that requires high
levels of human interpretation,
echoing broader concerns of doc-
tors that the “app-ification” of
mental health could sacrifice
quality for the sake of cost and
easy access.
Psychiatric evaluations pose an
innate paradox: The only way to
really know how someone is feel-
ing is to ask the person directly,

GAMING FROM E1

Using video games to detect signs of mental illness

all the bugs back home — black widow spiders. I was nuts. “So all those kids, Rebecca in- cluded, when they get all excited, I see me.”

Hissing cockroaches When Varney posted her story on Twitter, many people got in touch with UC-Berkeley. It took a while to identify the professor, Lewis said, because the meeting happened in the days before email. Everyone was trying to “rack their brains” to figure out who could have been working at the Essig Museum during that time, he said. Two of them aren’t alive anymore. Another said it wasn’t him. Lewis wasn’t sure until he read Varney’s comment about how she got to pick up hissing cockroaches and scorpi- ons, and thought, “Oh, that was me, I always had those around.” It was Varney’s mom, Mary Jo Grothman-Pelton, who con- firmed it. She didn’t remember that the professor was Black, but she said when she heard his voice on a video, she knew it was Lewis. Grothman-Pelton was a substi- tute teacher and her husband, Varney’s father, fixed computers. Neither of them was a big out- doors person and didn’t know anything about bugs. When Rebecca was 3-years-old,

“I just remember her coming in with this thing, and she opened her hand it was this huge cricket, one of the really big ones, perhaps a Jerusalem cricket, and she was so excited to show me,” Groth- man-Pelton said. “I didn’t want to show her I was afraid or that I wasn’t happy about it, but I did say it would probably be happier outside.” After visiting the museum and meeting with the professor, whenever someone would ask Varney what she wanted to be when she grew up, she would tell them she was going to get a PhD and be a scientist and study bugs. And she did, getting her PhD in 2021 from the University of Alabama in bio- logical sciences and now working with aquatic invertebrates such as crustaceans as a postdoctoral researcher at the University of California at Santa Barbara. “What I remember most from that visit was that the professor really talked to Rebecca, he took her very seriously,” Grothman- Pelton said. “That made such an impact, and encouraged that love of nature and science.”

Similar stories Nearly 13,000 people on Twit- ter noticed her post and tried to help Varney track down her earli- est mentor. As they did, many scientists shared similar stories — moments when some adult took the time to talk about the wonder of science and answered their questions seriously. Sometimes they were that person who showed “dinosaur poo” to a class and changed someone else’s life. Varney, in addition to keeping walking sticks in her room growing up, had millipedes and a corn snake named Beverly Crusher. “She used to sit on my head when I got home from school because my head was warm from walking from the bus stop,” said Varney, now 33. She contacted her childhood mentor through email, and he told her that now that she has a PhD., it was her turn to pass on that love of bugs. She was a little disappointed that he didn’t remember her personally, but said it felt “incredible” to be able to thank the person who started her on her career journey. “I think for any of us who are scientists, and perhaps for any of us who do something we love, there was some formative experi- ence with another human being that kind of brought us to be the people that we are,” said Varney, who now has a crawfish named Clawdio. “The thing that I’ve enjoyed the most is having hundreds of people reaching out to me to tell me their own stories of a visit with some person who took the time to talk to them when they were a child, and it totally changed their life.”

Although the envelope was
only addressed to “University of
California-Berkeley,” it made its
way to the entomology depart-
ment. A professor replied and
invited Varney and her mom to
visit the Essig Museum of Ento-
mology. He let her hold a hissing
cockroach and a live scorpion,
and explained how walking sticks
have knees, Varney recalled. He
told her that college had “whole
classes” where she could learn
about bugs, and that she could get
something called a PhD and
spend her life researching them.
“And then he shook my hand
and said ‘It’s been a pleasure to
meet another scientist,' ” Varney
said.
This spring, she posted her sto-
ry on Twitter and asked if people
could help her find the professor
who took her young scientist self
seriously.
Twitter did.

A love for all things bugs

It was Vernard Richard Lewis,
the first Black entomology profes-
sor at UC-Berkeley and one of
several faculty members who gave
tours of the Essig Museum. Now
retired, Lewis, who received a
PhD in entomology from Berkeley
in 1989, has clearly not lost his
love for teaching and for all things
bugs.
“Do you want to see some live
insects? I have them right here!”
he said over a Zoom video call,
showing off a termite display at
his home office in Hayward, Calif.
He said he still finds himself
catching one insect or another
several times a week and keeps
live hissing cockroaches at hand.
Lewis, 71, grew up in Minne-
sota but ended up at UC-Berkeley
or “Cal” in 1972 as an undergrad
student because, he says, a high
school teacher told him it was the
best school in the country. From
undergraduate to graduate school
and then to becoming a professor
and now a retired adviser, Lewis
has been there since.
As a termite specialist, he has
fond memories of a 30-foot ter-
mite mound in Australia, and he
was a founding member of the
United Nations’ Global Termite
Expert Group, which traveled
around the world helping people
grow food without being affected
by termites.
But despite his busy schedule,
Lewis said he made sure to find
time for children such as Rebecca.
“Do I remember meeting her
specifically? No. I talked to thou-
sands of kids, and I visited
schools, and made sure to give
them time,” Lewis said. “Why?
Because my grandfather was the
one who instilled in me the love
and passion of nature. He had that
infinite patience, he never told me
‘no,’ and I was a wild kid, bringing

BUG-MAN FROM E1

She finds professor who encouraged her love of science

ROBIN TABUCHI

MARY JO GROTHMAN-PELTON

STEVE FOSSUM TOP, CLOCKWISE: Vernard Richard Lewis, then a professor of entomology at the University of California at Berkeley, teaches students how to conduct bug races at an elementary school in 2006. Despite his busy schedule at the time, Lewis says he made sure to find time for children. Rebecca Varney, then age 5 with her pet snake. After meeting the professor, whenever someone would ask Rebecca what she wanted to be when she grew up, she would tell them she was going to get a PhD and be a scientist and study bugs. And she did.

The Washington Post - USA (2022-05-24)

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