Digital Pills and Other Medical Adherence Technology
The Future of Medicine
The future of medicine may have arrived, and it has its benefits — but it might also create an Orwellian, Big Brother culture.
All medical developments are meant to solve a problem. It is estimated that as often as 80% of the time, patients fail to use medication as directed for some diseases. According to The Atlantic, nonadherence (or noncompliance), in general, costs Americans between $100 billion to $289 billion a year. That has led to considerable research focusing on how to improve patients’ compliance.
Noncompliance is a problem throughout medicine, including the treatment of chronic pain. Most other areas of medicine are concerned with patients who are not using the medications they are prescribed.
However, when people in chronic pain are noncompliant, they tend to overuse, not underuse, prescribed drugs. They may take medication too frequently, or use it in the wrong way. Some people may even use the medication for the wrong reason and, if it is an opioid or a drug with the potential to be abused, they may develop a substance use disorder (SUD). In the worst-case scenario, they may even become an overdose statistic.
The First Digital Pill
If you’re a science fiction fan, you might recall Dr. “Bones” McCoy’s fictional tricorder, which was featured on the original “Star Trek” television series, and that seemed to be capable of analyzing everything. Bones could certainly use a tricorder to determine whether or not the patients in sick bay were complying with his directions. We may be decades away from development of that type of device. Yet such technology is inching closer to reality, and some of the latest developments are worthy of notice.
The New York Times recently covered the story of an antipsychotic medication, developed by Proteus Digital Health, called ABILIFY MYCITE®. It is the first digital pill to receive approval from the Food and Drug Administration (FDA). Designed to monitor compliance, each pill contains an ingestible sensor that lets doctors know how frequently, and in what amounts, the patient takes the medication.
Proteus Digital Health is not alone in pursuing this type of medical technology. Other companies are developing their own visions, although not all of them relate to medication adherence. A company called Vivonics, for instance, “has developed several novel systems for noninvasive sensing and physiological monitoring.” The New York Times reports other companies are focused on advancing medication adherence technology. Cutting-edge companies are developing their own digital pills with ingestible sensors, technology that can recognize when a patient swallows medication, and more. There’s currently a study underway to study how eTectRx’s digital pill, with its ingestible sensor, can help doctors better understand their patients’ “opioid adherence.”
Other devices to foster medication adherence use biometrics such as a pupil or fingerprint to identify anyone who tries to access the medication. Once it recognizes the user, it “unlocks” the packaging and provides access to the drug, similar to the way some smartphones work. The medical device also may release a drug only at a specified time or if the vitals of the subject fall within a predesignated range.
Patients often welcome — or at least, they are tremendously aided by — medical technology such as apps and patches. These devices can benefit forgetful patients, including the elderly who live alone and those with Alzheimer’s, by reminding them to take their medication or that they have already taken their medication. Other technologies might prevent patients from taking more medication, even at the appropriate time, if they show signs of having already reached a toxicity limit.
Medical Technology Is Controversial
Technology that monitors patients’ behavior is controversial, even though it can save lives. Although the technology supports a doctor’s intentions, the fact that it does so by figuratively looking over a patient’s shoulder may raise ethical issues. Should doctors be playing Big Brother with their patients?
Is the new technology an invasion of privacy?
As the New York Times points out, the fact that insurance companies might pressure doctors to prescribe digital pills and use other medical adherence technology raises the stakes. Does the technology compromise the trust that doctors and patients share? If so, should insurance companies push it, anyway?
However, this may be asking the wrong question. Insurance companies might resist the technology rather than require physicians to implement it. Digital pills and the like would probably be more expensive, so insurance companies might push back against the technology even if manufacturers could demonstrate improved outcomes.
Perhaps we should be asking this: What is the value of new medical adherence technology? The answer might depend on whether you are paying for it or benefiting from it.
