Big Brother Watching Your Meds

A huge problem in medicine today is patient “non-adherence” to their medical regimen. Years of poor or non-adherence to medications leads to bigger costs down the line for many chronic diseases like diabetes and high blood pressure.

 

This poses a problem for the individual patients and their quality of life—but it’s also a serious cause of our rising health care costs on the whole.

 

One estimate by IMS Health Informatics found that $105 billion was wasted due to medication nonadherence in 2012. The biggest illnesses responsible for this high number? Diabetes and high cholesterol – two chronic diseases that, if untreated, often lead to numerous hospitalizations, more expensive acute care, tests and ER visits.

 

With a number as big as $105 billion, it’s no surprise that the technology world is trying to get in on this problem.

 

The newest invention? Ingestible pill sensors. Your medication coated with a sensor, made out of safe elements, like copper and magnesium, which sends a message via radio wave or electronic impulses to an app on your phone or a receiver nearby.

 

Sounds out of this world? Nine health care systems across the country are now using encapsulated sensors with medications for patients with uncontrolled hypertension!  

 

The newest FDA approved pill sensor is Abilify’s “Abilify Mycite,” the digital version of the antipsychotic medication most often used to treat schizophrenia.

 

The pill has a sensor which generates an electrical signal when splashed about by stomach fluids. That signal is then picked up by a patch worn on the rib cage by the patient.

 

The patch then transmits the date and time the pill was taken via Bluetooth to a cellphone app.

 

The obvious aim of this is to increase the likelihood the patient takes their medication, thus giving them better health overall. Since this is such a new technology, the jury will be out for a while as to whether this aim is actually achieved.

 

This is part of medicine’s future: sending signals directly from our bowels to our doctors to let them know if we are taking our medication properly. Pretty amazing indeed, but while we wait for the proof that these “digital pills” increase our adherence to medications, maybe we should consider what this means for us in terms of ethics and privacy.

 

For schizophrenics who may not be able to monitor their medication intake, especially after missing a few doses, this may be a natural recourse. It’s no coincidence that Abilify came out with this drug before one for diabetes or high cholesterol.

 

Abilify’s digital version gives patients the ability to input how they are feeling at different times on the app, which is also sent to their physician. This is a great feature that should come with any medication tracked digitally. If a doctor is going to review your data, they may as well know how you are feeling with varying doses or times of dosing.

 

Should the same apply to our non-mental medical issues? What if we take too much pain medication after surgery? Will we get a call from our physician scolding us?

 

No one can force you to take the digital version of the pill, but what happens when health insurances deem it the cost saver they hope it to be and start penalizing patients who take the “old” version?

 

What happens when your only choice is to pay $100 for a month of your cholesterol medication because you refuse the digital sensor version that your insurance company prefers?

Technology has a big place in medicine and I’m all for advances like this. When it comes to an issue as complex as non-adherence, this may not be such a simple answer.

 

There are many reasons why patients in the U.S. fail to adhere to recommended medication regimens.

 

One reason is medication cost; yet prices of many drugs have been dropping over the past decade as drugs have gone off patent and several companies make the same drug force competitive pricing. For example, the cost of many medications that treat diabetes, high blood pressure and high cholesterol have decreased by more than 50% since 2001.

 

Another reason patients don’t take their medications is that they just aren’t informed about the long term health effects of their chronic condition being untreated. Educational campaigns like those TV commercials showing poorly controlled diabetics with foot amputations are working towards eradicating this issue with education.

 

Another reason people don’t take their medications is simply fear—of both the medications and the establishment of doctors and pharmaceutical companies seemingly “pushing pills.” Mistrust is a major obstacle to adherence and this likely won’t be helped by sending signals out of their body to their doctor.

 

Even this passive way of getting information from patients still requires some of their participation. If a patient doesn’t wear their sensor or have their bluetooth turned on, the sensor won’t work.

 

My point? Problems of non-adherence aren’t fixed with digital pill sensors. We still need to work toward patient education as the centerpiece of getting patients to adhere to their medications!

 

Our skyrocketing costs of healthcare due to poorly controlled chronic diseases is a problem we can solve. It’s the how that isn’t so easy.

 

This doctor just isn’t sold on ingestible pill sensors being the answer.