Tuesday, November 14, 2017

When Paranoia Meets Reality: Your Medicine Snitching On You

Medication non-compliance is a problem: patients don't take their pills.  We hear about it all the time in psychiatry: people don't take their medications and they relapse.  Sometimes they decide they don't need them when they do, sometimes they don't like the side effects or risks of the medications, but mostly, they just forget.  You may hear about this problem as if it belongs to psychiatry, but it doesn't.  Patients don't take their cardiac medications, either; in fact humans are only randomly compliant with all types of meds.

Swoop in technology, here to solve the problem.  Now sensors placed in tablets can notify the doctor and up to four other people to inform them if and when a patient has taken their pill!  And what pill was was the first to be approved for the use?  Abilify: an anti-psychotic medication used to treat schizophrenia and bipolar disorder, and also used to augment anti-depressants.  Was that the wisest choice?  To have a tattle-tale system in a medication used to treat paranoia?  I'm thinking there could be a better place to start.

So the patient swallows a medication and his stomach acid signals the sensor.  He also has to wear a skin patch on his abdomen, under his ribs.  A notice goes out to an App on his doctor's phone, and to anyone else he wants notified (presumably himself).  He has to consent to this, but questions have been raised about whether the courts will require patients to do this in terms of release from incarceration, for mental health courts, or if it will be priced in such a way to incentivize it's use.  Will people be coerced?  Will they like it?  Will they remember to check their App to see if their loved one took their medication?  Do doctors really want to be notified every time a patient takes their medications?  Will EMRs now have boxes to check to verify that the doctor has looked to see if the patient has swallowed his pill, as directed, daily, at the correct times? Will doctors be liable if they fail to check results and take action when patients aren't taking their medications and if there is a bad outcome? Will sensors work to improve medication adherence?  And then there is the Creepiness Factor.   You can tell I'm a bit skeptical of this, but that's not new.  ClinkShrink will happily tell you that I was wary of the Internet the first time I went surfing: too slow, it will never catch on.  I was wrong. 

Want to read more? Here's the New York Times article: First Digital Pill Approved to Worried About Biomedical Big Brother.

Your thoughts?


David J. Littleboy said...

You wrote:

"To have a tattle-tale system in a medication used to treat paranoia? I'm thinking there could be a better place to start."

This would be the most hilariously funny thing of the day were it not so completely and perfectly and painfully spot on. Ouch. Really.

Somewhat seriously, caregivers (especially MDs) seem to not understand how incredibly hard it is to take meds. Even simple things. Three times a day with meals. But taking meds gets repetitive and if your concentration is even slightly distracted, whether or not you took your pills doesn't make it into memory. (I'm lucky: my meds are all once a day. At 12:00 midnight I take my pills and measure my blood pressure. Real easy. Anything more complicated, and I'd be in trouble. And that's someone with 7 years of graduate school in three completely different fields.)

Joel Hassman MD said...

Again, why does Psychiatry allow the profession to be used as an extension of correctional issues? I think there are a lot of colleagues who genuinely resent this, and yet, their silence only reinforces complicity. Besides, once we learn that the recent shooter in California was likely someone with a primary psychosis, and most likely comorbid substance abuse, well, someone has to be the scapegoat for this recent heinous atrocity...

And equally so, why is it people scoff at the mention that patients have choice? I know that if I make poor, reckless choices, I will have to deal with consequences. And yet, psychiatric patients continue to be allowed break after break after break...

Gee, sounds equally like what this society is doing for addicts these days as well.

I guess I should have just abused drugs in college, screwed up my brain, and gotten onto disability so I could ride the gravy train into my 50s. That is what I see over and over in my Locum Tenens travels these past 6 years...

Joel Hassman, MD