In our GERO meeting this month we discussed a new FDA approved sensor (by Proteus Health) that can be embedded in a pill in order to track each pill taken by a patient. This sensor relays the information to a patch worn on the patient’s skin which then relays it to a tablet or smart phone. The patient can decide if they would like their doctor or family member to also have this information.
For the CBC interview discussing the technology CLICK HERE
Currently, this sensor has been approved for an antipsychotic drug but we discussed the pros and cons of using this technology in medication taken by patients with dementia. Medication adherence can be an issue in this population, as patients can forget to take their medication or have a complex medication load that can be overwhelming to maintain. Although potentially beneficial to patients, physicians and family members, this technology is not without its ethical issues and possible problematic complications.
We also discussed generally the implications of “digital medicine” as it was described in an article in Nature: Elenko E, Underwood L, Zohar D. Defining digital medicine. NATURE BIOTECHNOLOGY. 2015;33:456-461.
We talked about how some medication can have harmful effects for the patient if pills are skipped or taken as a double dose so if a physician or family member can be alerted immediately this would potentially be very helpful. We also discussed how currently physicians rely on self-report from the patient regarding their medication and this isn’t always accurate. Being able to properly track medication use could help physicians and family members determine what strategies actually work for aiding the person with dementia to remember to take their pills (ie. reminder phone calls, written reminders etc.). In addition, we also discussed how family members often are the ones to make sure that their loved one takes their medication properly and how stressful this can be for them and additionally how some people are isolated or don’t have family members to help them.
We discussed several limitations to the technology and ethics issues inherent in this type of tracking. We talked about two issues around privacy. As this information is sent to the “cloud” and although generally we are assured that this is secure there is always a potentially for this information to be hacked. Additionally, this information could in the future be used by third party companies who have a vested interested in understanding big data drug consumption or tracking individuals. We also discussed patient autonomy and their right to refuse to take medications if they decided they didn’t want to continue. In terms of limitations of the technology we discussed that although this allows the tracking of each pill ingested it doesn’t track other details around the consumption. Some pills need to be taken with specific conditions (ie. enough water, in an upright position etc.) in order to not cause detrimental side effects. This tracking might give a false sense of security without actually checking on the person taking the medication. We also talked about how technology can be a useful tool as long as it doesn’t divorce health care providers from face to face interactions from patients (ie. home visits from nurses in the community) and how this social interaction alone can have a positive effect on patients. We also talked about how important it is for health care providers to not be so reliant on the technology that they can no longer do their job if it is not present. As well as our cultural tendency to believe the technology is always giving us valid data and that there are no errors.
Lastly we discussed generally the issues around medication coverage in Canada and how some medications with less side effects/complications are not always covered as they are can be more expensive and how this type of technology can be seen as a solution to medication adherence even though possibly making other (more costly) medication available to the public could address the reasons for non-adherence.
All in all it was a very interesting, lively discussion – let us know what you think!