WEBVTT - The Digital Pill

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<v Speaker 1>In November seen the Food and Drug Administration of the

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<v Speaker 1>United States approved a pill that knows when it's been swallowed.

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<v Speaker 1>I'm Jonathan Strickland and this is text stuff daily. The

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<v Speaker 1>pill is called abilify my site. It contains a medication

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<v Speaker 1>called a rip of Result, which is used to treat

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<v Speaker 1>bipolar disorder, depression, Tourette syndrome, and schizophrenia. It belongs to

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<v Speaker 1>a class of pharmaceutical products called atypical antipsychotic drugs. The

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<v Speaker 1>FDA had previously approved the drug for such use back

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<v Speaker 1>in two thousand two, but this new pill adds something special. Namely,

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<v Speaker 1>it's a digital sensor. That sensor can detect when someone

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<v Speaker 1>swallows the pill, but the sensor is just part of

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<v Speaker 1>the overall digital ingestion tracking system. The sensor records when

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<v Speaker 1>a patient swallows the medication and sends a signal that

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<v Speaker 1>gets picked up by a wearable patch on the patient's

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<v Speaker 1>left side. The patch can then transmit data to a

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<v Speaker 1>mobile device with a customized app that can monitor the patient.

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<v Speaker 1>Patients also have the option to allow their physicians or

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<v Speaker 1>caregivers access to this information so that they can make

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<v Speaker 1>certain the patient is taking their medication regularly. Patients can

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<v Speaker 1>also revoke access to the data at any time that

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<v Speaker 1>they like. The sensor itself is tiny, According to a

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<v Speaker 1>press release published on the website for Proteus Digital Health,

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<v Speaker 1>which in turn creates the sensor for Otsuka Pharmaceutical Company Limited,

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<v Speaker 1>The sensor is about the size of a grain of sand.

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<v Speaker 1>The Verge reports that the sensor consists of silicon, copper,

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<v Speaker 1>and magnesium, and that it's the acid in a person's

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<v Speaker 1>stomach that triggers the sensor. The FDA's Director of Division

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<v Speaker 1>of Psychiatry Products, Dr. Mitchell Mathis, said the FDA supports

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<v Speaker 1>the development and use of new technology and prescription drugs

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<v Speaker 1>and has committed to working with companies to understand how

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<v Speaker 1>technology might benefit patients and prescribers. According to the I M.

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<v Speaker 1>S Institute, misuse of medication, including the failure to take

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<v Speaker 1>it regularly, leads to billions of dollars in healthcare costs.

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<v Speaker 1>The institute estimated a two hundred billion dollar cost back

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<v Speaker 1>in twelve. For example, if doctors or caregivers can quickly

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<v Speaker 1>determine if a patient has taken a dose or not,

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<v Speaker 1>it could save lives and money. Because the sensor only

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<v Speaker 1>activates after coming into contact with stomach acid. The time

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<v Speaker 1>recorded by the system is a few minutes after the

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<v Speaker 1>patient actually takes the drug. It's also not one successful

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<v Speaker 1>in registering when a patient takes a dose. For those reasons,

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<v Speaker 1>you aren't supposed to rely upon the pill to give

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<v Speaker 1>real time feedback on when a patient takes it. Not

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<v Speaker 1>everyone is super on board with this approach. Some civil

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<v Speaker 1>rights advocates have warned that digital pills could compromise a

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<v Speaker 1>patient's privacy. There's also a fear that digital tracking could

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<v Speaker 1>lead to scenarios in which doctors punish patients for failing

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<v Speaker 1>to stick to a medication schedule, or not just doctors.

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<v Speaker 1>Arthur Kaplan, who is a bioethicist at New York University,

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<v Speaker 1>suggested in two thousand fifteen that digital pills could lead

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<v Speaker 1>to ethically questionable situations in the courtroom. Kaplan created at

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<v Speaker 1>a hypothetical situation in which a judge would require, as

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<v Speaker 1>part of sentencing that a convicted person go on a

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<v Speaker 1>regimen of medication, miss a dose and get your chance

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<v Speaker 1>for parole taken away from you. Being legally compelled to

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<v Speaker 1>take a medication is problematic. There's a concept called the

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<v Speaker 1>right to refuse treatment. Barring a court order, healthcare professionals

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<v Speaker 1>can't treat a patient against his or her will. In

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<v Speaker 1>all but the most extreme cases, patients have the right

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<v Speaker 1>to decide what happens to their own bodies. In some implementations,

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<v Speaker 1>the use of a digital pill could be really helpful.

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<v Speaker 1>For example, elderly patients who find it difficult to keep

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<v Speaker 1>track of their medication use might rely on pills with

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<v Speaker 1>digital trackers to do it for them. They can do

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<v Speaker 1>a quick consultation with the app to see if they

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<v Speaker 1>had remembered to take their medications, thus avoiding either over

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<v Speaker 1>or under medicating themselves. But there are other scenarios to

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<v Speaker 1>get more invasive. For example, requiring patients to use such

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<v Speaker 1>a system to track their use of pain management drugs

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<v Speaker 1>could help prevent overdoses and opioid abuse, but it comes

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<v Speaker 1>with a lot of tough privacy questions. There's also concerned

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<v Speaker 1>that insurance companies could start creating incentives for patients to

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<v Speaker 1>use such drugs, and those incentives could be so extensive

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<v Speaker 1>as to tread into coercion. That's the concern of Dr

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<v Speaker 1>Eric Topol, the director of Scripts Translational Science Institute. If

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<v Speaker 1>the incentives reach a point that it seems as if

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<v Speaker 1>patients who do not choose to be tracked are being penalized.

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<v Speaker 1>That's a potential ethical quandary on its own. Some experts

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<v Speaker 1>don't necessarily have an issue with a digital tracking approach wholesale,

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<v Speaker 1>but rather for this particular instance. Dr Paul Applebaum, who

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<v Speaker 1>is a director of Law, Ethics and Psychiatry at Columbia University,

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<v Speaker 1>said this to The New York Times. Many of those

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<v Speaker 1>patients don't take meds because they don't like side effects,

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<v Speaker 1>or don't think they have an illness, or because they

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<v Speaker 1>become paranoid about the doctor or the doctor's intentions. A

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<v Speaker 1>system that will monitor their behavior and send signals out

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<v Speaker 1>of their body and notify their doctor, you would think that,

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<v Speaker 1>whether in psychiatry or general medicine, drugs for almost any

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<v Speaker 1>other condition would be a better place to start than

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<v Speaker 1>a drug for schizophrenia. We're waiting on evidence to see

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<v Speaker 1>if this pill is actually affected in the way it

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<v Speaker 1>is intended. In the meantime, make sure you subscribe to

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<v Speaker 1>the Tech Stuff podcast, where we explore ethics and technology

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<v Speaker 1>along with all other aspects of tech. Shows published Wednesdays

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<v Speaker 1>and Fridays, I'll see you against him.