UAE doctors discuss pros and cons of the concept
If administered correctly and for the right reason, it should be a positive step
Dr Arun Kumar Sharma, consultant neuro physician at Medeor 24/7 Hospital, and Dr Paul Macnamara, consultant orthopaedic surgeon, Medcare Hospital, Dubai, offer their perspective on the issues surrounding the digital pill.
How does the medical fraternity in the UAE view such technology? Do they see it coming here?
Dr Sharma: The medical fraternity in the UAE is a highly qualified and experienced group of professionals owing to the rigorous licensing procedures of the regulatory authorities. We are continually striving to keep abreast of the latest developments in medical science. Although the digital pill has been released by the FDA only a few days ago, we are assimilating the news and its practical implications for its future usage.
The composite opinion is still in the process of coalescence. It is one thing for FDA, a governing body of the US, to release a new medical technology basing on its effectiveness and safety profile and yet another thing to foresee its acceptance by health-care providers and care givers which are by and large driven by utilitarian concerns.
To cite a few examples, different types of patches used in Parkinson’s disease, Alzheimer’s disease, Vagus Nerve Stimulation implants for management of epilepsy, subcutaneous infusion pumps for diabetes, although released decades ago by FDA, have not yet found popularity in this part of the world.
Dr Macnamara: Having discussed this with my colleagues, on the whole, the reaction was positive. This technology will almost certainly come here. It would most likely be welcomed here.
Is there data available on the level of compliance with dispensed prescription in the region or the UAE?
Dr Sharma: Compliance is a variegated issue. It depends on the inherent quality and its adverse effect profile of the medicine itself, the disorder for which it is being administered and the awareness of the patient.
There is one study about diabetes published from Ajman some years ago in Malaysian
Journal of Medicine that showed compliance to be about 86 per cent, another from Cairo which showed compliance for blood pressure medications to be about 88 per cent, and yet another one from London School of Pharmacy showing compliance to be only about 2.4 per cent in psychiatric patients belonging to Middle Eastern region. Therefore, in a way, by choosing Abilify, a drug indicated for bipolar disorder, the first digital pill manufacturers have exhibited a significant sagacity.
Dr Macnamara: I am not aware of any data regarding compliance. The overall tenet must prevail that the patient has a right to choose whether or they receive the treatment.
How does such technology alter the patient-doctor relationship?
Dr Sharma: Doctor-patient relationship is a moral enterprise. Therefore, administration of a digital pill will necessarily involve cost-effectiveness of the technology, an all-pervasive issue of approval by insurance companies in the region and of course, a consent by the patient himself. The relationship will not be affected unless there is obfuscation on the part of the doctor or the industrydoctor fiscal alliance comes into play.
Dr Macnamara: I do not think this will alter patientdoctor relationship as long as the patient feels they are working in their best interests. Patients quickly sense this and if explained in the right way, it can have positive effects. Most doctors do not administer any form of treatment unless they feel they are working in their best interests.
How will the medical establishment address patients’ privacy concerns?
Dr Sharma: There is no clarity offered by either the manufacturer or FDA on this issue. For obtaining any reasonable perspicacity about the privacy concerns of the consumer or someone who ingests the digital pill, in addition to a well-constructed interview with the patient and the family, the topic has to be debated at the various doctorpatient forums at the world level commencing with potential Abilify-digital pill consumers.
Dr Macnamara: As stated in the article, one can choose who views the data and thus address privacy issues, particularly regarding the number of family members who see the data. If the data is breached, then the patient must be informed as soon as possible.
The composite opinion is still in the process of coalescence. It is one thing for FDA, a governing body of the US, to release a new medical technology basing on its effectiveness and safety profile and yet another thing to foresee its acceptance by health-care providers and care givers which are by and large driven by utilitarian concerns.” Dr Arun Kumar Sharma | Neuro physician
I do not think this will alter patient-doctor relationship as long as the patient feels they are working in their best interests. Patients quickly sense this and if explained in the right way, it can have positive effects. Most doctors do not administer any form of treatment unless they feel they are working in their best interests.” Dr Paul Macnamara | Orthopaedic surgeon