BIG BROTHER’S WATCH
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!