Featured Post

I don’t wanna takes my medicine!!

The Internet of Things could help make sure that patients actually do what their doctors recommend
Pills at the Teva factory in Har Hotzvim, Jerusalem (illustrative photo; credit: Nati Shohat/Flash90)
Pills at the Teva factory in Har Hotzvim, Jerusalem (illustrative photo; credit: Nati Shohat/Flash90)

I apologize for not posting yesterday. I really am trying to keep to a 6 posts/week schedule. Actually tomorrow and Friday will be very hectic as I will be taking part in a “start up helper” course. I hope to share some of my experiences from this course, next week.

I have previously spoken about the importance of adherence to a prescription for medication. Far too many patients do not follow the instructions as told to them by their doctor, or as reviewed with them by the pharmacist or as written on the bottle. It is no surprise to anyone that failure to take medication as prescribed, will lead to unpredictable results. There are cases where taking a medication for a shorter period of time than recommended, can cause complications, worse than if the patient had not taken the medication at all. Proper adherence is a critical element of proper care, but somehow, it still does not get the attention it deserves.

In the following article, the authors speak of the problem of nonadherence to a medical regimen during clinical trials. A clinical trial is a very expensive and time-consuming process that requires of the test patients that they follow instructions as closely as possible. For example, if one group being tested fails to take the medication as it was given, while the comparison group takes the medication without permission, you could literally end up with results that make no sense whatsoever. When the patients are interviewed, they may simply lie about their compliance, because it would be embarrassing to say that they did not follow instructions. In cases where the patients are paid for participating in the study, they would be concerned that they would lose the money they were given, if they admitted to not following instructions.

Clinical trials are the foundation of evidence-based medicine. We count on such studies to teach us what medications and what treatments and what devices actually work. If noncompliance with trial instructions is in fact commonplace, then it puts into question a great deal of research that has been done to date. The obvious question is how to enforce compliance, not only during clinical trials but also during day-to-day medical care.

Considering how significant an issue this is, it should again be no surprise that there are a number of startups trying to find a solution. Smart pill bottles have actually been around for a number of years. The idea  is that when the pill bottle is opened and a medication is removed, the pill bottle is able to record this event. This information is then sent to the patient’s smart phone or to the cloud, and is then available for review, ideally by the family physician.

You could ask: what stops the patient from removing the pill from the bottle and then just throwing it out? The answer is, absolutely nothing. Also, there is the assumption that the patient’s physician will review compliance records from the pill bottle. But if the doctor has hundreds of patients in his or her practice, reviewing compliance for each and every one of the doctor’s patients would take more time than the doctor has in a day. Still, smart pill bottles are a step in the right direction, and solutions can be found for automating the review of the data so that the doctor is only bothered when significant noncompliance happens. But the situation is still not ideal, and people are still looking for solutions.

The new industry that is called the Internet of things [IoT] is attempting to label and track anything and everything in our environment. Right now, as I dictate this blog to my computer, I am staring at six computer screens. When I am asked why I have so many, I answer that there is no such thing as “too many”. But the more honest answer is that having so much screen space allows me to virtually spread out documents and my development tools. The result is that I can work much more quickly and much more efficiently. In fact, there are times that I wish I had at least two more screens.

Sometimes, one of my screens stops functioning. It burns out or the screen gets damaged. When that happens, I call the person who manages my home computer system and he sends a technician to replace the screen. If you go through the steps, you realize that a lot of work has to be done in order for that technician to come to my home. Firstly, I need to be in my home office to notice that the screen has died. Then I need to contact the person who handles my hardware. Sometimes he is unavailable, so I send an SMS and an email. Even though he is extremely reliable, the person who cares for my system is also extremely busy and sometimes he can only get to my request after a couple of days [which leads to more emails and SMSes]. Finally, a message must be sent to the technician who finally comes to my house to replace my screen.

In an IoT reality, each screen would be “smart”. My IoT screen would be able to identify its own problem and would automatically notify myself and the company that handles my system. The request for fixing the problem would be automatically recorded onto a task list, and I would receive automatic updates as to the status of my upcoming repair. The technician who will eventually fix my screen would be notified of my request, via a system that tracks ALL requests and ALL technicians and  that makes sure that all repairs are scheduled in the most efficient way. In the end, I might wake up in the morning to find that one of my screens is not working, but the technician is already on his way to repair it. Multiply this by all of the repairs that must be done to all types of equipment in the world. The time savings and improved resource management would be worth a tremendous amount of money. And the secret to all of this, is a set of IoT technologies that provide the smallest and largest items with the ability to communicate with other technologies.

In the case of improving compliance for taking medication, one solution would be to have each pill augmented with an IoT device. This tiny device could inform the smart pill bottle that the medication pill is now inside the patient. If the patient throws the pill into the garbage, the system would know. Yes, this is the ultimate in big brother technologies. Yes, the IoT device would have to be minute to become part of the pill. Yes, there would need to be a whole new means of manufacturing medications to get these IoT devices embedded into the pills. But all of this would be worth it, for the benefits it promises.

There are a lot of people who are frightened by such a technology and who do not want their refrigerator to automatically inform them when they are running out of milk. But technology marches on and IoT will find its way into every aspect of our lives.

Using IoT to increase compliance could revolutionize healthcare. When patients do actually take all of their medications as prescribed, physicians will experience new success in the care they provide. Patients will stop being misdiagnosed with unresponsive diabetes or high blood pressure, and will be spared additional medications that the doctor prescribes to achieve clinical success.

Swallowed devices will also have the opportunity to test the entire environment within the body. If the patient’s stomach is producing too much acid, an IoT device will be able to detect this. If the patient has a problem with movement through their bowels, this will be detectable. All forms of tests will be possible as more and more IoT devices become available.

I won’t even try to deny the invasion of privacy that is inherent to such technology. As I have said before, I am personally willing to sacrifice privacy in order to benefit from these medical technologies. But, at least for the near future, it will be an individual’s choice to use IoT. But the day will soon come when the only way to test for a given issue, will be to use IoT based tools. Sometimes, the benefits of the system are so dramatic that it is effectively impossible to stop it from progressing. Let’s all hope that these technologies really do dramatically improve our lives, rather than being a way for some people to take advantage of their capabilities to be used to hurt us.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
Related Topics
Related Posts