The Digital Pill

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Episode Transcript

Speaker 1 (00:03):
In November seen the Food and Drug Administration of the
United States approved a pill that knows when it's been swallowed.
I'm Jonathan Strickland and this is text stuff daily. The
pill is called abilify my site. It contains a medication
called a rip of Result, which is used to treat
bipolar disorder, depression, Tourette syndrome, and schizophrenia. It belongs to

(00:28):
a class of pharmaceutical products called atypical antipsychotic drugs. The
FDA had previously approved the drug for such use back
in two thousand two, but this new pill adds something special. Namely,
it's a digital sensor. That sensor can detect when someone
swallows the pill, but the sensor is just part of
the overall digital ingestion tracking system. The sensor records when

(00:52):
a patient swallows the medication and sends a signal that
gets picked up by a wearable patch on the patient's
left side. The patch can then transmit data to a
mobile device with a customized app that can monitor the patient.
Patients also have the option to allow their physicians or
caregivers access to this information so that they can make
certain the patient is taking their medication regularly. Patients can

(01:13):
also revoke access to the data at any time that
they like. The sensor itself is tiny, According to a
press release published on the website for Proteus Digital Health,
which in turn creates the sensor for Otsuka Pharmaceutical Company Limited,
The sensor is about the size of a grain of sand.
The Verge reports that the sensor consists of silicon, copper,

(01:34):
and magnesium, and that it's the acid in a person's
stomach that triggers the sensor. The FDA's Director of Division
of Psychiatry Products, Dr. Mitchell Mathis, said the FDA supports
the development and use of new technology and prescription drugs
and has committed to working with companies to understand how
technology might benefit patients and prescribers. According to the I M.
S Institute, misuse of medication, including the failure to take

(01:58):
it regularly, leads to billions of dollars in healthcare costs.
The institute estimated a two hundred billion dollar cost back
in twelve. For example, if doctors or caregivers can quickly
determine if a patient has taken a dose or not,
it could save lives and money. Because the sensor only
activates after coming into contact with stomach acid. The time
recorded by the system is a few minutes after the

(02:19):
patient actually takes the drug. It's also not one successful
in registering when a patient takes a dose. For those reasons,
you aren't supposed to rely upon the pill to give
real time feedback on when a patient takes it. Not
everyone is super on board with this approach. Some civil
rights advocates have warned that digital pills could compromise a
patient's privacy. There's also a fear that digital tracking could

(02:41):
lead to scenarios in which doctors punish patients for failing
to stick to a medication schedule, or not just doctors.
Arthur Kaplan, who is a bioethicist at New York University,
suggested in two thousand fifteen that digital pills could lead
to ethically questionable situations in the courtroom. Kaplan created at
a hypothetical situation in which a judge would require, as

(03:02):
part of sentencing that a convicted person go on a
regimen of medication, miss a dose and get your chance
for parole taken away from you. Being legally compelled to
take a medication is problematic. There's a concept called the
right to refuse treatment. Barring a court order, healthcare professionals
can't treat a patient against his or her will. In
all but the most extreme cases, patients have the right

(03:24):
to decide what happens to their own bodies. In some implementations,
the use of a digital pill could be really helpful.
For example, elderly patients who find it difficult to keep
track of their medication use might rely on pills with
digital trackers to do it for them. They can do
a quick consultation with the app to see if they
had remembered to take their medications, thus avoiding either over
or under medicating themselves. But there are other scenarios to

(03:47):
get more invasive. For example, requiring patients to use such
a system to track their use of pain management drugs
could help prevent overdoses and opioid abuse, but it comes
with a lot of tough privacy questions. There's also concerned
that insurance companies could start creating incentives for patients to
use such drugs, and those incentives could be so extensive
as to tread into coercion. That's the concern of Dr

(04:10):
Eric Topol, the director of Scripts Translational Science Institute. If
the incentives reach a point that it seems as if
patients who do not choose to be tracked are being penalized.
That's a potential ethical quandary on its own. Some experts
don't necessarily have an issue with a digital tracking approach wholesale,
but rather for this particular instance. Dr Paul Applebaum, who

(04:32):
is a director of Law, Ethics and Psychiatry at Columbia University,
said this to The New York Times. Many of those
patients don't take meds because they don't like side effects,
or don't think they have an illness, or because they
become paranoid about the doctor or the doctor's intentions. A
system that will monitor their behavior and send signals out
of their body and notify their doctor, you would think that,

(04:54):
whether in psychiatry or general medicine, drugs for almost any
other condition would be a better place to start than
a drug for schizophrenia. We're waiting on evidence to see
if this pill is actually affected in the way it
is intended. In the meantime, make sure you subscribe to
the Tech Stuff podcast, where we explore ethics and technology
along with all other aspects of tech. Shows published Wednesdays

(05:16):
and Fridays, I'll see you against him.