Experts say smart pills reduce medical care

Smart pills, or digital pills, are prescription drugs equipped with electronic edible sensors that send wireless messages to devices, such as patches and smartphones or tablets, outside the body when they are not in use. they are ingested. The first of its kind, which is used to treat patients with schizophrenia, bipolar disorder and major depressive disorder, was approved in 2017 by the US Food and Drug Administration.

Some hope that the technology will help patients and doctors monitor compliance with drug regimes and increase patient adherence, which could save between $ 100 billion and $ 300 billion a year in the United States. United.

Eric Swirsky, an expert in legal and ethical issues related to health technologies, says both groups have valid arguments, but neither of them poses the right question.

"We need to know if smart drugs will actually improve the lives of patients, which is much more complicated than compliance or confidentiality," said Swirsky, an associate professor of biomedical sciences and information on the topic. health at the College of Applied Health Sciences of UIC. "It's naïve to think that this type of supervised monitoring of drug treatments recommended by the provider will work as a magic pill.More likely, this will challenge the ingenuity of patients."

Swirsky says that there is simply no evidence to suggest that smart pills benefit patients and that the use of technology outside of clinical trials "contradicts current research, which shows patients receive care from providers. many issues related to membership. "

"Smart pills are a dangerous reduction of the provider-patient relationship and there is no shortcut to improve patient compliance in a broader setting of home, work and clinical environments. , not to mention perceptions and emotions ". "This technology negates a problem that is often very complex in the hope of quickly solving a costly medical challenge."

For example, the first FDA-approved smart pill is used in patients with schizophrenia, who often suffer from paranoia about their surveillance and mistrust of drugs or caregivers. Swirsky said that the intention to improve medication adherence in this group of patients is understandable, since many patients have remarkable benefits through regular use of medications, but it can be said that they are contrary to ethics given their unique symptoms and vulnerabilities.

Researchers warn that smart pills should be evaluated based on their clinical effectiveness over standard drugs, like any other intervention, not just compliance or cost savings.

Swirsky co-authored the paper with UIC colleague Andrew Boyd, who said that, with respect to health information technology, "we have to think about the long game".

"It's not just about ROI – it's about using technology and data in a way that enhances life," said Boyd, an associate professor of biomedical sciences and information on the subject. Health at the College of Applied Health Sciences. "There is nothing more personal than our health, and as health care is aimed at high-tech innovation, we can not do it at the expense of trust between the provider and the patient. "

According to Boyd, the use of this type of data-driven technology should also not override public policies and legislation by properly regulating how these data are shared, used, or purchased by businesses.

"Health information technologies work best when they are implemented jointly with physicians and patients in a collaborative way," the researchers write. "Without a magic pill to cure the ills of the modern doctor-patient relationship, patients would be better served by providers who seek a global understanding of compliance than those who use technology that they do not understand. "

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More information:
Eric S. Swirsky et al, Adherence, Surveillance and Technological Hubris, The American Journal of Bioethics (2018). DOI: 10.1080 / 15265161.2018.1498953