BIG BROTHER’S WATCH

BioSpectrum (Asia) - - Bio Edit - Milind Kokje Chief Editor milind.kokje@mmac­tiv.com

Among the seven coun­tries that ac­count for 64 per cent of the to­tal tu­ber­cu­lo­sis (TB) cases in the world, five are from Asia. With 45 per cent new cases in 2016, the largest num­ber of TB cases oc­curred in Asia. Ac­cord­ing to World Health Or­gan­i­sa­tion (WHO), out of the to­tal TB cases in the world, an es­ti­mated 4.1 per cent are multi-drug re­sis­tant (MDR) cases. The pro­por­tion is higher at 19 per cent, among pre­vi­ously treated for TB and some coun­tries have shown se­ri­ous epi­demics, par­tic­u­larly Cen­tral Asia and East­ern Europe.

MDR TB is con­sid­ered a pub­lic health cri­sis and a health se­cu­rity threat. In 2016, about 600,000 new cases with re­sis­tance to the most ef­fec­tive first line drugs were re­ported and out of them 490,000 were MDR cases. As all are aware, drug re­sis­tance to a dis­ease oc­curs mainly due to in­ap­pro­pri­ate use of medicines, in­cor­rect dose pre­scrip­tion, poor qual­ity drugs and most im­por­tantly dis­con­tin­u­ing the treat­ment in be­tween. Pa­tients stop the treat­ment pre­ma­turely with­out the doc­tor’s knowl­edge, in­creas­ing the risk of drug re­sis­tance.

Dur­ing the treat­ment of any dis­ease, ex­cept pre­scrib­ing medicines or mak­ing them avail­able to the pa­tients, doc­tors have very lit­tle or al­most no con­trol over the pa­tients es­pe­cially when they are not ad­mit­ted to the hospi­tal. Nei­ther the doc­tor, nor any of his/ her as­sis­tant can mon­i­tor if the pa­tient con­sumes the pre­scribed medicines and that too a right dosage at the right time. May be a dig­i­tal pill de­vel­oped by a pharma com­pany and ap­proved by US FDA in Novem­ber 2017 could be a so­lu­tion for this prob­lem. The pill uses an in­gestible sen­sor in­side the pill, which is ac­ti­vated by the stom­ach flu­ids. When the pa­tient takes the pill, the in­for­ma­tion is com­mu­ni­cated to a wear­able patch worn by the pa­tient. That patch fur­ther com­mu­ni­cates the in­for­ma­tion to a smart phone app. Doc­tors can ac­cess this data through an on­line por­tal with the pa­tient’s per­mis­sion. Thus, the doc­tors can do ef­fec­tive mon­i­tor­ing of the medicine con­sump­tion by the pa­tients even when the pa­tient is not ad­mit­ted to the hospi­tal.

Non ad­her­ence to pre­scribed medicines is a se­ri­ous is­sue and ac­cord­ing to An­nals of In­ter­nal Medicine, in US lack of ad­her­ence causes 125,000 deaths and 10 per cent of to­tal hos­pi­tal­iza­tions “cost­ing US health­care sys­tem be­tween $100 and $289 bil­lion a year.” The dig­i­tal pill tech­nol­ogy is thus ex­pected to save around $300 bil­lion that is wasted by pa­tients by not tak­ing their medicines.

In the first ver­sion of the dig­i­tal pill, the sen­sor tech­nol­ogy is em­bed­ded into an­tipsy­chotic medicines that are used to treat schizophre­nia, bipo­lar disor­der and de­pres­sion. Ac­cord­ing to the UK data, 60 per cent of pa­tients with de­pres­sion do not take their medicines as pre­scribed when tak­ing medicines prop­erly is par­tic­u­larly cru­cial for them. About half of the Asthma pa­tients also do not take medicines prop­erly. Sim­i­larly, about one third kid­ney trans­plant pa­tients and over 40 per cent heart at­tack pa­tients do not take medicines reg­u­larly. A fa­cil­ity to mon­i­tor the in­take of medicines will surely help such pa­tients.

Among the eight com­mon causes for pa­tients not tak­ing their medicines on time or get­ting re­luc­tant, long term con­sump­tion of medicines is one im­por­tant cause. TB is one such dis­ease in which long term treat­ment is gen­er­ally re­quired. Thus, pa­tients tend to give up the treat­ment half way, thereby open­ing the pos­si­bil­ity of de­vel­op­ing drug re­sis­tance. This can even­tu­ally lead to a grad­ual spread of the re­sis­tant bac­te­ria. Though the cur­rent dig­i­tal pill is only meant for men­tal ill­ness, one can hope that it would be adopted for many other dis­eases in the com­ing years.

How­ever, no in­no­va­tion comes with to­tal ac­cep­tance. Ob­jec­tions are al­ways raised. The pri­mary ob­jec­tion against the dig­i­tal pill is that it ex­poses pa­tients’ in­for­ma­tion and it may reach the wrong hands. Although the fear is gen­uine, all such in­no­va­tions have over the time helped the de­vel­op­ment of the field and sub­se­quently the pa­tients. ‘Big brother is watch­ing you’ was a term used with a fear in so­cio po­lit­i­cal con­text. In the field of medicine, the big brother’s watch through a dig­i­tal pill will even­tu­ally prove to be help­ful and eco­nom­i­cal in the long run. Its pres­ence should be wel­comed!

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