A recent opinion essay in the New England Journal of Medicine argues that physicians have less reason to fear a potentially “creepy” innovation, than they might have thought.
But the author’s main point was that pills embedded with sensor technology, while they may be helpful, can’t replace physicians’ own efforts to understand why patients aren’t taking their medications.
Last month, the FDA approved a formulation of the antipsychotic drug aripiprazole with a sensor, Abilify MyCite, made by Japanese drugmaker Otsuka Pharmaceuticals. The sensor detects contact with gastric fluids, sending a signal to a patch worn on the abdomen. That signal is then passed to a cell-phone app which lets the receiver know the pill has been swallowed.
NEJM‘s national correspondent Lisa Rosenbaum, MD, a cardiologist at Brigham and Women’s Hospital, summed up her initial reaction in one word: “creepy.”
“[L]ike many people, I puzzled over the irony that the technology was being piloted in a drug used for paranoia,” she wrote in a perspective article published Wednesday.
But,”I think that what became clear to me, as I dug in a little bit, is that people can choose to do this, and if they don’t want to, they don’t have to,” she told MedPage Today.
Patients download the tracking app to their phone and determine who else sees the information, she explained.
The monitoring pathway, known as a digital health feedback system (DHFS) is already being tested in clinical trials and “will probably soon be combined with other chronic disease medications,” she wrote in the article.
This kind of technology has the potential to be most effective in the subgroup of people who “just need a reminder,” explained Rosenbaum — the ones who want to take their medications, but forget and are scared of taking a double-dose, she added.
For others, however, the problem isn’t forgetfulness, nor is it costs or side effects.
“A lot of people just don’t want to be sick, don’t want to carry a diagnosis. You think that would mean they would want to take a medication to make it go away, but that’s often not the case,” Rosenbaum said.
She see this “identity shift” and a “sense of shame” with her own patients who have coronary artery disease, and that’s something she believes needs to be addressed.
Ira Wilson, an adherence expert at Brown University told Rosenbaum it may take at least two years for a person to accept that change in identity from “an invincible 18-year-old to being 48 with two chronic conditions.”
Unfortunately, in a 15-minute clinic visit, physicians don’t have time to ask patients what it means to them to have a serious condition that requires medication, Rosenbaum said.
“The most effective thing we could do is just give doctors more time with patients.”