The self-tracking pill

by on October 15, 2015 at 1:30 pm in Medicine, Science, Web/Tech | Permalink

Some morning in the future, you take a pill — maybe something for depression or cholesterol. You take it every morning.

Buried inside the pill is a sand-sized grain, one millimeter square and a third of a millimeter thick, made from copper, magnesium, and silicon. When the pill reaches your stomach, your stomach acids form a circuit with the copper and magnesium, powering up a microchip. Soon, the entire contraption will dissolve, but in the five minutes before that happens, the chip taps out a steady rhythm of electrical pulses, barely audible over the body’s background hum.

The signal travels as far as a patch stuck to your skin near the navel, which verifies the signal, then transmits it wirelessly to your smartphone, which passes it along to your doctor. There’s now a verifiable record that the pill reached your stomach.

This is the vision of Proteus, a new drug-device accepted for review by the Food and Drug Administration last month. The company says it’s the first in a new generation of smart drugs, a new source of data for patients and doctors alike. But bioethicists worry that the same data could be used to control patients, infringing on the intensely personal right to refuse medication and giving insurers new power over patients’ lives. As the device moves closer to market, it raises a serious question: Is tracking medicine worth the risk?

That is from Russell Brandom.

1 IVV October 15, 2015 at 1:37 pm

Is tracking medicine worth the risk?

Sure! Just be ready to go to battle against those who would control you. But that’s nothing new. Eventually, we’ll likely have medicines fed by IV into our systems anyway, controlled by real-time blood concentration measurements. That is, unless the drug really should be delivered to a specific site, bypassing the blood entirely.

Pills will be outmoded.

2 RoyL October 15, 2015 at 4:05 pm

Everybody forgets how hard it is to keep a longterm port free of infection. Even without antibiotic resistant bacteria just having a port is a huge factor in mortality.

3 Harun October 15, 2015 at 4:08 pm

Have some grafted cells that produce whatever drug you need.

4 Ray Lopez October 15, 2015 at 9:35 pm

“As the device moves closer to market, it raises a serious question: Is tracking medicine worth the risk? ” – TC, you cannot be serious, you’re trolling your readers.

Coming next: a wireless drug delivery system, just beam the nanoparticles–remember the particle/wave duality–to the source. There’ll be an app for dat.

5 dearieme October 15, 2015 at 1:37 pm

I suppose it might have a purpose in ensuring that dangerous lunatics take their pills, but then “bioethicists” might have a fit of the vapours.

I wonder: if you popped the pill into an acidic solution (water and lemon juice?) and held the glass next to your stomach, would that fox the Spy In Your Stomach?

6 Nathan W October 15, 2015 at 1:51 pm

Awesome! Problem already solved.

7 anon October 15, 2015 at 11:29 pm

You’re assuming that the pills make them less likely to act. But sometimes the pills numb parts of their brain and make them feel more energized to do something crazy. There’s a reason some of them have suicide warnings. Contrary to popular belief, mass shooters tend to be calculated in their planning. They don’t suddenly decide at 8AM to pick up a firearm and go to town due to being off their meds.

8 Careless October 16, 2015 at 9:01 am

if you popped the pill into an acidic solution (water and lemon juice?)

Chemistry is my weakest subject, but I’m pretty sure you’re talking about many orders of magnitude difference in acidity, if that’s relevant

9 Nathan W October 16, 2015 at 9:51 am

I was thinking the same thing, but after your comment I decided to do a quick search. Turns out pH of lemon juice is about 2, compared to 1-5-3-5 for the stomach, in which case lemon juice might do the trick. But there are things other than just acidity which contribute to breakdown in the stomach, such as many enzymes, so probably a more specialized fluid would be needed to be effective.

10 Careless October 16, 2015 at 11:24 am

2+water makes what, 3? Compared to the 1.5 of stomach acid, well, it’s not “many” orders of magnitude, but it’s significant

11 Gochujang October 15, 2015 at 1:40 pm

Sure, why not. Note too that insurers will judge us against the patient population, deviations from the mean. Take your daily medication with normal dedication and you will be fine.

The bonus of course will be that the same data will highlight unexpected results in the population more quickly.

12 Don Reba October 15, 2015 at 1:47 pm

Just throw the pill into a glass of Coke.

13 Nathan W October 15, 2015 at 1:50 pm

I would maaaaybe support using this for drugs to keep pedophiles in check.

But this sounds very scary. The right to refuse medication is a pretty big deal. A very activist front would be needed to keep the slippery slope well gummed up.

Consider how civil rights activists in the 1970s were “imprisoned” en masse using BS psychological diagnosis of the “protest psychosis”. Wouldn’t it just be lovely if governments could force-medicate protesters into oblivion. It’s an extreme situation, but given it that would represent the end of freedom as we know it, I think it is worth considering how far this slippery slope could go.

14 Gochujang October 15, 2015 at 2:00 pm

Are you confusing the right to refuse medication with the right to lie?

15 Cliff October 15, 2015 at 2:08 pm

The very substantial costs and deaths resulting from failure to take medications as instructed vastly outweigh the downsides I think. Medication compliance is a huge huge healthcare issue.

16 JayT October 15, 2015 at 5:52 pm

This wouldn’t take away your right to refuse medicine, it would just let the insurance company know if you’re worth ensuring or not, which I see nothing wrong with. Why should the insurance company have to pay for pills the patient doesn’t take? Why should they have to sell insurance to a person that doesn’t try to get well?

17 ad*m October 15, 2015 at 8:05 pm

Given that I am being forced at gunpoint to pay for others’ healthcare, through Obamacare, they better take their tax payer funded medication. Yes, I want this for these patients, and proponents of socialized health insurance / care can suck it up.

18 prior_approval October 15, 2015 at 10:05 pm

‘Given that I am being forced at gunpoint to pay for others’ healthcare’

Well, yes, but Medicare is just one of those things that maybe government should get out of, right?

19 Nathan W October 16, 2015 at 10:02 am

It is not unreasonable to think that healthy people are better workers and better citizens.

20 chuck martel October 15, 2015 at 8:16 pm

For some years we’ve been indoctrinated that we can’t live without a healthy, vibrant banking/financial industry. Now you want the insurance industry to be at the same level of importance. With the acknowledged indispensibility of health care it looks like we’ll all be working to keep those parts of the economy in clover.

21 Jan October 15, 2015 at 1:54 pm

There are some very damn expensive drugs out there these days and adherence is a big problem. I can see insurers using this to make sure patients prescribed those very expensive drugs actually take them. If they don’t, there is no reason we should be paying for them. This is no more questionable than many other methods payors use to manage costs. In fact, this approach could actually end up making it easier for patients to access drugs, because it could eliminate other kinds of cost saving measures.

22 Gochujang October 15, 2015 at 2:04 pm

From a utilitarian perspective, truth in drug taking would save lives, at the only cost that you take the drugs you have agreed to take.

Public health benefits would accrue as treatment for infectious disease was completed.

23 Dan Weber October 15, 2015 at 2:16 pm

adherence is a big problem

It certainly is. I’m glad someone is thinking about the ethics of refusal, but this is simply making monitoring easier. If we can force drugs on people, this technology doesn’t change the picture too much.

There are plenty of patients who would be much better off if a nurse gave them a call to remind them to take their pill when the meter is missed.

24 Pshrnk October 15, 2015 at 4:58 pm

Yep!

25 Gochujang October 15, 2015 at 2:08 pm

Under old law, if you have high cholesterol and refuse Lipitor, could your insurance drop you? Raise rates?

Are droppers of pills in Coke counting on Obamacare?

26 Dan Lavatan October 15, 2015 at 2:36 pm

Under both old a new law they can drop you. They can be fined by the HHS secretary for doing so, but the secretary would only do this if in her political interest.

27 Gochujang October 15, 2015 at 2:45 pm

Thanks. Interesting.

28 Jan October 15, 2015 at 4:07 pm

So, under the law, they can’t drop you.

29 Jan October 15, 2015 at 4:08 pm
30 Gochujang October 15, 2015 at 4:20 pm

Thanks. x2

31 Urso October 15, 2015 at 5:16 pm

“Before the ACA an insurance company could find a small detail like a mistake on your application, or the omission of something simple like forgetting to report that you had chicken pox when you were two, and could [t]ake away your coverage”

What a hilarious hypothetical. It’s like saying the government can put you in federal prison for failing to report a $5 bill you found on the ground to the IRS. Both are technically true, I guess.

32 Dan Weber October 15, 2015 at 5:36 pm

There were actual incidents of people having claims for major procedures denied because the applicant forgot to mention they had acne treatment years ago that got significant coverage back in Obama’s first term.

The industry rejoindered that “rescission only happens one out a huge number of times,” and it turned out that that huge number of times was about 2x the number of people making significant claims. Or about half the people making big claims being told “sorry, it turns out you aren’t covered.”

The GOP could have done something about this to take the wind out of Obama’s sails, but they didn’t.

33 Bill Kilgore October 15, 2015 at 7:03 pm

Apparently Mr. Weber didn’t read the link which noted that the practice wasn’t widespread.

Is the link false Mr. Weber?

34 Dan Weber October 15, 2015 at 9:09 pm

Given that I already said “it only happened one out of a huge number of times” I see no reason to bore other people here with your lack of reading comprehension.

35 rayward October 15, 2015 at 2:10 pm

Wireless monitors (of vital functions and body chemistry) pose a similar risk, yet telemedicine (of which wireless monitors are a part) is the next big thing in medicine. Do people really want 24/7 medical monitoring? We already have 24/7 tracking (your smart phone is a tracking device), so I suppose 24/7 medical monitoring is just another step in the direction of comprehensive 24/7 surveillance. I would point out that the government has little if anything to do with this.

36 Dan Weber October 15, 2015 at 2:19 pm

Monitoring is oversold. And it will be a huge tarpit in the US for legal reasons, the same way radiologists have had to deal with mammograms. Just change “Dr Uncaring, why didn’t you notice this shadow on Ms Suffering’s mammogram 4 years ago?” to “Dr Uncaring, why didn’t you notice the blip on Mr Windbag’s hear monitor 4 years ago?”

If we were a decent society we could roll out monitoring in limited ways to see what actually useful information there is to be gained in an economical fashion. But we suck.

37 Ryan October 15, 2015 at 3:26 pm

Dispense monitoring has been around for a decent while now. Workarounds aside, this just gets us closer to ensuring that the user actually took the drug.

38 Bill October 15, 2015 at 3:09 pm

What was once a science fiction story-This Perfect Day-by Ira Levin has become close to reality. I wonder if the outcome will be the same?

39 Pshrnk October 15, 2015 at 5:03 pm

Check out INTRUSION by Ken MacLeod.

40 NZ October 15, 2015 at 3:25 pm

This is a cure for paranoid schizophrenics who believe they are being bugged via the pills doctors give them: if the thing you’re paranoid about is real, then it’s not a delusion.

41 Thiago Ribeiro October 15, 2015 at 3:43 pm

But what about people who are taking normal pills and now will think their doctors are bugging them? We will have created a new class of schizophrenics. The voices in my head tell me it won’t end well.

42 NZ October 15, 2015 at 4:56 pm

No, they won’t be deluded either.

The problem is people who refuse to believe their doctors are bugging them. THEY will be the deluded ones. But they won’t be paranoid schizophrenics…is there such a thing as naive schizophrenics?

43 Thiago Ribeiro October 15, 2015 at 5:27 pm

One whose voices tell him everything will be fine, I guess.
Is there a name for pathological optimists (other “voters”) without the modd swings and euphoria aspects of Bipolar Disorder?

44 ibaien October 15, 2015 at 3:52 pm

i could (grudgingly) support it in the case of antibiotics, where noncompliance increases the risk to society that the drug will become useless. I don’t think I can support it for the forced normalization of the mentally ill. but I doubt our lawmakers will choose to see such subtleties.

45 Gochujang October 15, 2015 at 4:21 pm

Noncompliance in psychiatric drugs has both societal costs and risks.

46 ibaien October 15, 2015 at 4:29 pm

i agree, I’m just saying that I find the idea of antibiotic-resistant bacteria to be much more terrifying on a personal and societal level than I do the potentially unmedicated schizophrenic guy at the library.

47 Gochujang October 15, 2015 at 5:24 pm

so sad that “schizophrenic guy at the library” is a thing any library user recognizes

48 Jan October 15, 2015 at 4:57 pm

I agree with the sentiment, but more evidence is coming out that not finishing antibiotics doesn’t actually increase resistance. The opposite may be true. http://theconversation.com/no-you-dont-have-to-finish-all-your-antibiotics-38774

49 Anon October 15, 2015 at 5:35 pm

The article is pretty disingenuous. It strings together some reasonable points (antibiotics are over prescribed and yes have some side effects) to create a nonsensical clickbaity premise. Yes some antibiotic course lengths are arbitrary but to imply people can decide to just stop taking a course of antibiotics halfway through is dangerous and stupid. No average person is likely to know which particular bacterial infections need the entire course or whether they are likely to relapse if they stop. Further antibiotic resistance is created by both over prescription and misuse.

50 Jan October 15, 2015 at 6:49 pm

I am not saying this is settled science, but really, the traditional view that if one doesn’t finish his prescription of antibiotics he is contributing to a global resistance problem is more than likely overstated, if not plain wrong. It’s not just some wackos talking about it.

http://discovermagazine.com/2014/oct/8-stop-taking-antibiotics-when-you-feel-better

51 TMC October 16, 2015 at 12:22 pm

Oh, it’s settled, you denier.

52 Dave October 15, 2015 at 4:27 pm

Who is going to remember to wear their belly monitor though?

I think external electronic monitoring of a person’s actions is more likely to be what’s used to help people take their pills on time. Through a variety of methods a program will monitor a person and learn their routines and then at the appropriate times will remind them to take their medicine. And all more or less perfectly voluntary. People will tell their smartphones or iTiaras or whatever to keep track of these things for them. Or failing that, their children or health professionals will.

53 Nikita October 15, 2015 at 4:45 pm

The domestication of the human cattle continues.

And frankly, you deserve all that’s coming to you.

54 Gochujang October 15, 2015 at 5:23 pm
55 MikeW October 15, 2015 at 6:00 pm

…and speaking of cattle, I thought this problem was already solved decades ago in a much simpler way. You load a medication capsule with titanium dioxide, a bright white powder that passes unabsorbed through the digestive tract. If the cow’s shit is white the next day, you know she ate the capsule instead of spitting it out.

56 ibaien October 15, 2015 at 6:02 pm

solved unless you’re the guy tasked with inspecting shit all day. though i guess it’s a living.

57 HL October 15, 2015 at 7:45 pm

Kein Mitlied Für Die Mehreit

58 Curt F. October 15, 2015 at 10:51 pm

But bioethicists worry

They never do anything else. Of all the professions created in my lifetime, “bioethicist” is the running for the dumbest.

59 Nathan W October 16, 2015 at 12:01 am

Let’s brainchip Curt, and then ask who stopped fighting for his hypothetical rights.

60 Careless October 16, 2015 at 11:10 am

I think his first sentence was absolutely spot on. What do bioethicists do but worry?

61 pushpa October 16, 2015 at 1:34 am

great

62 chuck martel October 16, 2015 at 6:42 am

It’s interesting that the same meatballs that are concerned with supposed global warming and the negative effects it will have on future generations are advocating the reversal of natural selection in the human species. Allowing, in fact encouraging, the survival and reproduction of genetic defectives will make future humans less intelligent, with poorer vision and other sensory attributes and more likely to carry chronic diseases. A future society composed of semi-invalids waiting in line for a handicapped parking space so they can receive robotic kidney dialysis before the doctor changes their insulin injector doesn’t seem like an improvement in the human race.

63 Nathan W October 16, 2015 at 10:05 am

You’re next.

64 TMC October 16, 2015 at 12:24 pm

Most of this will happen after breeding age, so will not affect human stock.

65 chuck martel October 16, 2015 at 5:16 pm

The most successful stock of humans will be the society of professional athletes, the males of which have their pick of the best, most healthy females. Their kids will be OK. Later generations will be better as well. Physical inequality will grow even more than inequality of wealth. For everyone else, even the would-be intelligencia, it’s going to be a downhill slide into thicker and thicker glasses, a rudimentary sense of smell, diabetes, hip and knee replacement, bad hearing, high blood pressure and so on. By the time New York Harbor is lapping at the front door of Macy’s the country will be inhabited by obese, limping, coughing, nearly blind caricatures of the once noble homo sapiens.

66 Nathan W October 17, 2015 at 2:49 am

I think the exact opposite will happen.

a) I don’t think many people with serious disabilities want to have children.

b) Earlier in history, people had lots of children before most genetic diseases become manifest, but now i) people are having children later and ii) we have better knowledge of how these genetic diseases are transmitted and people can make more informed decisions about how to enjoy parenthood without passing on genes which are likely to lead to serious disability.

c) You seem to assume that in the last 10,000 years people with genetic diseases didn’t reproduce, but that now they are. What leads you to make these assumptions?

67 arbitrary aardvark October 16, 2015 at 7:22 pm

I took part in a trial of some of this technology last month. Had a patch on my stomach that sent a signal to an ipad when I took my pill. Also the pill bottle kept track of every time it dispensed a pill. Still a few bugs in the system, but they are making progress. Obviously there are risks as well as benefits.

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