Digital pill targets patients fibs, forgetfulness

Ingestible sensor opens window into health, behavior.

When his chemotherapy patients leave the hospital to continue treatment at home, Edward Greeno faces a new challenge.

He can no longer ensure they’re taking their medicine.

Greeno, the medical director of the Masonic Cancer Clinic at the University of Minnesota, has come to realize that some patients, like children hiding naughty behavior from a parent, will fudge the truth to avoid his disapproval, even when their health is at risk.

To combat patients’ fibbing and forgetfulness, Greeno has begun deploying a new tool in recent months: a pill embedded with a tiny, ingestible sensor. The sensor transmits data from inside the patient’s body to a wearable patch placed on their abdomen, which then connects to a mobile app that patients and doctors can access.

That data offers a new window into patients’ health and behavior, Greeno said, allowing doctors to remotely monitor someone’s heart rate, activity level and sleep cycle. The sensor, which is about the size of a grain of sand and dissolves in the gastrointestinal tract, also tells doctors when a patient has ingested their medication. The information is compiled in a database that doctors can access from their devices.

At the Masonic Cancer Clinic, as part of a pilot program, doctors have begun pairing the sensor — made by a California company called Proteus Digital Health — with a common chemotherapy drug used to treat stage 3 and 4 colorectal cancer patients.

“When we give people chemotherapy in the clinic with an intravenous drug, we’re able to assess the dose and timing and make sure they’re well enough to continue getting the treatment,” Greeno said. “But when you send them home with a bottle of pills, you don’t know when they’re taking them or if they’re well enough to take them.”

“You’d think for cancer treatm e nt that patients would be pretty diligent, and that’s not always the case, for a variety of reasons,” he added.

Ingestible technology has raised a variety of concerns among experts and ethicists since the Food and Drug Administration approved digital pills in 2017, from how physicians will use the wave of new data created by the technology to whether that data may be vulnerable to hackers.

“The health industry is behind the curve when it comes to cybersecurity,” Jason Christopher, chief technology officer at the cybersecurity company Axio, told Forbes last year. “Forget health record databases — how do you patch a digital pill?”

Despite the concerns, many experts have pointed out that the technology will help doctors ensure patients are taking their prescribed medication. Not taking medicine — or “medication nonadherence” in the healthcare world — is a “common and costly problem,” according to a study cited by the National Center for Biotechnology Information.

“Approximately 30 percent to 50 percent of U.S. adults are not adherent to longterm medications leading to an estimated $100 billion in ing factors. Greeno agreed, preventable costs annually,” pointing out that his patients according to the 2013 study. aren’t always lying about their

Comparing medication behavior. Sometimes older nonadherence to weight patients have trouble open- loss, NCBI researchers say ing pill bottles. Other times, the problem is more com- he said, they’re so fatigued plex than it might seem and and foggy that they strug- often has multiple complicat- gle to adhere to a rigorous schedule that requires them cost between $10,000 and to ingest multiple pills each $20,000 per month. day. And sometimes, he said, “I had one patient whose they struggle to deal with a hands hurt and she couldn’t medication’s side effects. open her pill bottle,” Greeno

The problem, Greeno said, said, noting that when the is that chemotherapy drugs patient’s daughter was can have a very narrow ther- around she would take her apeutic window and often pills, but when her daugh- ter was gone, she wouldn’t. “Normally, I might not find out about it until weeks later when she comes to the clinic. But now, the app is telling me in real time that she didn’t take her pills and I get that message in clinic the next morning.”