SWALLOWING A SPY: A CREEPY WAY TO KEEP YOU ON MEDS
First of all, guys, pat yourself on the back. Study after study shows that men are better than women at taking prescribed medications as directed. Explanations for this gender difference have ranged from women being too busy caring for other family members to a belief that females are less prone to ailments such as heart disease, so they don’t need to worry.
Failure to adhere to prescribed medications exacts a huge toll in Canada, in both health and dollars. According to the Canadian Society of Hospital Pharmacists, “drug non-compliance is the cause of 10 per cent of all hospital admissions, 25 per cent of hospital admissions for the elderly, and 23 per cent of all nursing home admissions.” An industry source estimates that it costs Canada between $7 billion and $9 billion per year.
For some people, money is the problem. A study published in the Canadian Medical Association Journal found that 1 in 10 Canadians who receive a prescription say they don’t fill it for cost reasons. Those with lower incomes, and people who lack insurance coverage for prescription drugs, were most at risk.
But why do people who can afford their medications fail to take them? Sometimes, it’s lack of knowledge.
A fascinating article in the New England Journal of Medicine describes a man seen by Dr. Ira Wilson of Brown University. Wilson asked the patient what hypertension means to him. The man explained “I’m kind of a hyper guy. And sometimes I get tense.” He went on to say he takes his prescribed medications “only when he feels both hyper and tense.” While most doctors would say “that’s not how it works” Wilson sagely replied, “May I share another perspective?”
That same article, by Dr. Lisa Rosenbaum of Harvard Medical School, discusses the possible future of medication adherence. She notes that the U.S. Food and Drug Administration recently approved a pill with a built-in sensor. As it dissolves in the patient’s body, the tablet sends a signal to a patch worn on the skin, which relays it to a cellphone app. This can tell your doctor if, and approximately when, you have taken your pill. The patch can also monitor heart rate and activity levels.
The first approved use of this technology is Abilify MyCite. That’s aripiprazole, a drug used to treat schizophrenia and bipolar disorder. There is a certain irony in testing a creepy new technology on a population that is prone to symptoms which may include paranoia.
Still, in a U.S. study of 12 adults with bipolar disorder and 16 adults with schizophrenia who tried the digital pill, 24 thought the technology might be useful to them, and 21 said they would like to receive reminders on their cellphone if they forgot to take their medications.
A Health Canada representative says there is no application to approve this product, or any digital health feedback system (DHFS), in Canada. Yet one can easily envision a future where health-care bill payers require evidence that you’re actually taking your meds, not selling them on the street or flushing them down the toilet.
Proponents of the system point out that it is completely voluntary. You can simply rip off the patch. Of course, then your doctor would stop getting messages that you’ve taken your medicine.
It’s worth noting that more is not always better when it comes to taking medications. The Canadian Deprescribing Network (deprescribing.org) is working to optimize medication, especially for senior citizens. This may involve backing off doses or even stopping some drugs. All this needs to be done carefully and in partnership with a health-care provider.
Unpleasant side-effects are another cause of skipping pills. Rosenbaum’s article describes a woman who was having diarrhea. “This is what happens when she takes all her medications,” her son reported. Somehow, that side-effect was never discussed with her doctors; they simply lectured her to take all her medications.
A digital pill won’t make the side-effects less severe, but the data it produces could provide an excellent doctor/patient conversation starter.
Digital pills raise a fundamental issue that permeates all modern technology. We can obtain some important benefits, but may also put our privacy at risk. Experts feel the downside can be managed, and that at least some patients will benefit.
Rosenbaum gives the DHFS a qualified thumbs-up, writing that “feedback might well help the patient with diabetes who often forgets whether he’s taken his sulfonylurea and who’s had hypoglycemic episodes after an unintentional extra dose.” She doesn’t think it would do much for a guy with high blood pressure who has no symptoms and might just find the system annoying.
My take is that your doctor is probably too busy to pay much attention to alerts that you missed a pill. On the other hand, your employer or your insurance company or even law enforcement might be keenly interested in getting their hands on that kind of data. Maybe you’d be wise to stick to one of those plastic pill boxes with the nice non-digital compartments.