Slashdot Mirror
A Smart Pillbox To Improve Medication Compliance
Roland Piquepaille writes "A major challenge in public health is that people do not take their medications, a phenomenon known as 'medication non-adherence.' In the US alone, it is estimated that this accounts for 10% of all hospital visits and costs the healthcare system $100 billion per year and $60 billion to the pharmaceutical industry. Now, an MIT research team thinks it has a solution to this problem that will save lives worldwide. They've developed the uBox, a convenient, palm-sized, intelligent pill dispenser, 'which reminds a patient when it is time to take his medication, records when a patient has taken a dose, and prevents a patient from double-dosing.' The first large-scale trial with 100 uBoxes is scheduled to begin in May in Bihar, India, in a 6-month long tuberculosis treatment program."
And how does the pillbox know that you actually took the pill, as opposed to taking it out of the pillbox so that it will quit nagging you?
"It's the height of ridiculousness to say for those 9 lines you get hundreds of millions."
Unless a court has ordered it, you can't be forced to take your medicine. Pretty much all they can do is bad vibe you. This is a terrifying little idea because I could easily see the insurance companies lobbying for laws requiring that you take medication.......
Why uBox? They should call it the iBox and everybody would buy one.
It is dangerous to be right when the government is wrong.
Maybe this will stop certain people I know from taking others unused antibiotics when they get a cold. Much easier than unsuccessfully trying to explain the difference between viruses and bacteria.
Libertarian Leaning Political Discussion Forum.
"...costs the healthcare system $100 billion per year and $60 billion to the pharmaceutical industry"
Did they want to say brings ?
Or what if you take the pill out intending to take it, but due to arthritis (or the shakes) you drop it, and then due to dementia you forgot what you were doing to begin with... Box wouldn't know what became of the pill.
I'm sick of following my dreams. I'm just going to ask where they're goin' and hook up with 'em later.
In response to: it is estimated that this accounts for 10% of all hospital visits and costs the healthcare system $100 billion per year and $60 billion to the pharmaceutical industry
My grandmother is going into assisted living this week, and up until now, I've had to nag her twice a day to take her pills. They'll administer her meds, but it's $21/day.
Haida Manga
Soon we have machines bitching about our eating, drinking, oversleeping, computing.. And those machines are controlled by corporations and run "without costs" with advertising. Advertising that MAKES you go out and buy. Oh I cant wait!
I can imagine this will only be made available to third-world patients. The liability lawsuits arising out of things like battery failure on the unit in the medical/legal minefield of the USA don't bear thinking about.
"I bless every day that I continue to live, for every day is pure profit."
But there's times when I think some people just don't deserve the benefits of modern healthcare. It's just amazing how common a situation it is for people to have a deadly illness and simply stop taking their medication. It's pretty rare for them to even know the actual name of the drug, or anything about how it works. I almost died when I was just a kid, and even at that age I learned the hell out of the drugs I was on. And I certainly learned to check my watch, or at least just set an alarm. I wouldn't have cut myself any slack for not doing so at 11, and I wouldn't for any adult not suffering from a mental disorder.
Everything will be taken away from you.
To alert the patient that it's time to take the medicine, the box flashes its lights and sounds a buzzer. When the compartment is opened, the uBox records the exact time and prevents double-dosing by refusing to open again until the next treatment is due.
I like that it can prevent double-dosing. Not only do some forgetful folks miss a dose, they sometimes take that dose multiple times because they believe, each time, that this is there first dose.
http://www.busyweather.com/
How is this different then those 25 cent plastic pill boxes that have compartments for all your drugs, all nicely labeled and sorted for each day? They easily show you what you need to take, and if you missed anything. No batteries either!
If we cant make it an 'i-something or other' and give it an IP address its of no value? Sure, technology has its place, but sometimes just common sense is all that is needed. When a hammer is all you need, bring a hammer, don't re-invent it just for the sake of inventing.
---- Booth was a patriot ----
How is this better than the already-in-trials Cypak box, which also reminds the patient to take the pills, registers the time/date taken per pill, transfers results over RFID to doctors, etc, has the added advantage of looking exactly like an ordinary pharma blister pack?
There will be plentiful disclaimers that the manufacturer can point to in those cases. Take a look at the legal disclaimers on average household appliances. I can imaging they'll be even more amusing for medical devices.
If your logic held true, we wouldn't have electronic blood sugar meters either.
Sometimes people don't take their pills because they either (A) don't have time, or forget to refill them at the pharmacy, and/or (B) can't afford them.
-- "In order to have power, I must be taken seriously." -Mojo Jojo
The problem with this is not an issue of people needing to be reminded of the doses they've taken, or should take. The biggest issue I see is WILLFUL non-compliance with a doctors advice. Now granted, doctors are only human as well so they can make mistakes but the number of people I hear tell me that "oh well i have a pill for this, but i do not take it" because they think they know more than the doctor (which sadly is SOMETIMES the case when one looks at it in a 'knows more about this situation' issue).
..., n(st|th|rd) opinions are for. Self diagnosis is about as reliable as the Mitch Hedburg round-about aids test if you have no background in biochem.
This mentality is a lot more prevalent than I would have thought prior to working in travel medical insurances. The number of people who would get angry because we had to count them as treating a condition because they had a specific prescription on their history but they refused to take it was staggering. Somehow, it then becomes our fault that they have an exclusion because they were not complying with the prescribed treatment.
To get Dickens on it: Given that non-compliance is generating these costs, i'm guessing its also generating casualties, which means the tendancy will eventually be minimized across the gene pool.
Wish that helped my generations health costs though.
Protips: If you disagree with your doctor, that is what second, third,
Ice Cream has no bones.
Based on my understanding of US law, carying a controlled substance (anything that requires a prescription) in anything other that the official bottle it came in is a federal crime. All such daily and weekly pillboxes are illegal. My father was stopped and threatened with arrest when one such item was disovered, he had to rummage through his cary on luggage to find enough pill bottles with appropriate names and descriptions such that they let him through (though they noted that just having them out of the appropriate container was illegal). How do such pill boxes deal with the legal issues? If you take one on a trip and don't bring the bottle with the appropriate documentation, should you be subject to arrest?
Learn to love Alaska
Great idea, really. But I forget to take my PDA with me VERY often, and that device is significantly handier, that that robotic pill box; at least, from what I can tell by viewing the images (http://web.mit.edu/newsoffice/2008/itw-india-enlarged.jpg). I don't know how exactly the device works, but it hast to have some sort of battery in it, what happens, when that battery drains? I forget to recharge my PDA about as often as I forget to take it with me... This box may be of great use in the well developed world, where people are used to electronic medical devices, like electronic blood sugar testers, for instance. What if people treat the device like I treat my alarm clock sometimes: Throw it at a wall when I can't find the snooze button. And I guess the box behaves much like an alarm clock...
EOF
Take pill. Throw in trash. Box fooled.
Engineering is the art of compromise.
If you are being treated for Parkinson's disease, it will give you another pill. If you are being treated for Alzheimer's, it will beep to remind you.
Nothing helps if people refuse to take their pills but for many it's a very real problem to remember to take them. I suffer from epilepsy and must take pills twice a day and despite having done that for over 10 years, I still sometimes forget to take them on time. I have a box that I fill weekly and it has slots morning/evening for every day of the week so I can then check it if I get unsure whether I've remembered to take my pills as I should. I also have my cell phone set to alert me whenever it's time but despite those measures I sometimes have difficulties. It happens quite easily if I'm in a hurry in the morning - e.g. if the pill alarm goes off when I'm in the shower and thus can't take them precisely when it sounds. And in the evenings it has happened simply because I've turned off the alarm when the phone has rang and then been interrupted by something when I was on my way to take the pills from the box. Now, I don't think that this is anything revolutionary but simply having the alarm and the pills in the same location, would be an improvement.
Another issue is that it's a bit troublesome to carry along such a box and thus I have a matchbox-sized one with only one day of pills that I carry with me everywhere and keep the big one at home - an ideal solution would let me check remotely whether I've taken the pills from it or not (some bluetooth thingy in the box that would let me login remotely to my home server and check it that way, or something....). It is an awful feeling when you're unsure whether you've taken the pills and contemplate whether you should go home and check or stay and assume that you have taken them. It may sound like a trivial problem but just imagine if you had to always carry around a ~5x3x1 box with pills just to be able to confirm that you've taken them. And unfortunately it is also true that people react strangely if they seem someone taking or having pills with them. It shouldn't be any of anybody else's business but in practice, I must always visit the bathroom or something similar if I'm not at home at 8 am and 8 pm.
Oh yeah, that's not doomed to failure!
The batteries will never run out, the thing will never be badly programmed, the patient will never ignore it, nor forget it, and the workers checking up on them will always be diligent and honest. That's why it's gonna work!
You can't take the sky from me...
Now if we only had national health care so I could afford the pills...
I fear that the way health care operates, this will be used to punish patients who have forgotten to take their pills by refusing them cover for further medication.
"I'm sorry Mr Jones but we can't supply you with more blood pressure medication. It says right here you missed a dose 3 months ago. Now what's the point of giving it to you if you won't take it? Next!"
These posts express my own personal views, not those of my employer
'medication non-adherence.' In the US alone, it is estimated that this accounts for 10% of all hospital visits and costs the healthcare system $100 billion per year and $60 billion to the pharmaceutical industry.
I assume the latter is not the least concern.
Some quack must have been watching TV and recently put my mother on Vytorin. Pick your favorite Google result on how worthless that drug is.
Already been done: http://compumed.com/ Comes with strobe lights for deaf people, audio alerts for blind people, I think it can even phone an emergency contact if the medicine isn't taken--very well thought out. And it's been around for several years.
when did the medical community begin using military terminology like "medicinal non-compliance?"
I've always thought it would be cool to have a candy box that would limit consumption. How big of a "pill" can this thing handle? And is it hard to break open if one is desperate for some chocolate?
I'd use this. I have ADD, and one of my problems is paying enough attention to take the meds at the right time. Years ago I actually wrote software for the Apple Newton to help me solve that problem. (Huh, I wonder how hard it'll be to port it to the iPhone? Dev kit comes out soon, right?)
Anyhow. Yeah. I'd actually use this.
This box could be a great new product, but could be even bigger overseas. Think a place like, oh, Africa. Few people have clocks, and not many can tell time in the remote regions. An automatic dispensing system could potentially revolutionize health care. This, of course, depends on people actually caring about Africa, not just listening to Bono spout off about erasing debt.
liesdamnedliesandstatistics $160 billion because people don't take their pills? I doubt that sounds right.
For those who seek perfection there can be no rest on this side of the grave.
Intelligent pillboxes are not a new phenomenon, and this will not be the final say on the matter - I should know, I started a company to try to produce one for the UK market.
The patent landscape is littered with numerous attempts to solve the problem of patient compliance with self-administered, even back to the 1960s. They all rely on a similar solution to this one - an intelligent alarm, an internal counter, and some form of interface for either the physician or the patient.
The problems my product was trying to address were these - noone wants to get their packs of medications and then dispense them into some special second device which counts them back out to the patient; and no pharmacist or drug company wants to issue a new pill box for each prescription.
Once these issues are solved, this idea may fly - but I don't think the MIT team are offering anything the marketplace hasn't seen before.
Old folks will recall that the plot of THX-1138 revolved around Criminal Drug Evasion.
There have been proposals for criminal control outside prisons through the use of mood altering drugs. Fun shit like Thorazine that reduces your atention span to less than the guy in Memento, so basically you can't get in to mischief because you'll get completely bored an move on before any harm happens.
The sick part of these proposals were to use RFID labeled pills, so that a relative simple compliance monitoring device could determine if the pill was inside you versus just inside your pocket or in the trash can.
In other words THX-1138. Busted for drug evasion.
Some drink at the fountain of knowledge. Others just gargle.
There are natural cures for Aids, Cancer, Heart Disease that save life's. This is no secret, but those natural cures won't make Big Pharma huge profits. I'm afraid this is profit above human life .. wake up folks.
http://naturalnews.com/
Bacteria are living single cell organisms whereas a virus is a particle containing a strand of viral DNA (they are larger) or RNA (much smaller and sometimes more deadly). Furthermore, the viral coat is a set of tight fitting protein molecules that protect the D/RNA payload. In addition, there is a mechanical structure to inject its code into the host cell. A virus exists at the edge of what is usually defined as a living system. It can only reproduce by taking over the machinery of an infected host that is then converted to spew out new copies of viral particles. Those may lie dormant for extended periods or in worse cases suffer irreversible damage that makes the new particles unable to infect new hosts. Others that remain infectious can carry new markers on the outer protein coat making them less liable to the host's immune response. There are still very few good anti-viral pharmaceuticals, and those tend not to have a broad range of effectiveness. Vaccination tends to be the more effective means to combat viral infections, however, in a rapidly mutating virus, albeit a frail one, e.g. HIV, with an insidious infection mode finding an effective vaccine can be a frustrating endeavor. Moreover, that vaccine will likely never meet the level of effectiveness sought in other common diseases.
Very different creatures. Indeed one is and the other perhaps should not even be characterized as such.
In my experience with patient concordance to prescriptions (NB: 'concordance' is the new PC term for 'compliance'), patients don't take their medicine because of poor communication on the part of the doctor.
With increasing patient loads, and consequentially reduced consultation times, doctors often don't take enough time to explain why the patient needs to take the medicine, how to take it, and how often. Also, by appearing to be rushed/stressed, doctors don't give patients the opportunity to ask questions about their medication regime.
Not a member of the General Public
Unbelievably, the idi0t California legislators made it illegal to carry rx medications in anything other than the original containers they were dispensed in. They probably were off their meds at the time.
welcome our new, drug dispensing overlords. Although I'm not quite sure what it says about us when the pillboxes are smarter than we are.
I've calculated my velocity with such exquisite precision that I have no idea where I am.
During my pharmacy study I received the weekly dutch magazine for pharmacists. A professor from my university had a column where he reevaluated case studies from random patients. He studied the pattern of drugs prescribed, knew the illnesses for which these are normally described, found that a lot of drugs were described against side-effects of previous drugs, and in most cases concluded that the 10+ drugs weekly should be replaced by nor more than 2-3 different drugs. If there would be a program that would do this systematically for you, the amount of money saved on both hospital visit because of wrong drug prescriptions and of course the costs of those drugs would be enormous! It would lead to less income for the pharma industries, but the wiser application of their drugs can also lead to less costs in legal and economical damages after their drug has proven dangerous when applied incorrectly. This is a long term win-win situation, but unfortunately no one is interested in doing the short-term investment to actually start such checks.
By the way, this actually made me understand why there is such an intuitive dislike against the roland piquepaille posts. He just places the standard PR messages from companies/universities as news, without taking a single effort of a critical evaluation of the message. It is certainly not journalism. You might call it blogging, I call it ad-farming. Or maybe he honestly believes that every single PR message he receives/reads is completely true,b as innovative as it claims, and faultless.
molmod.com - computing tips from a molecular modeling
...about this not being a solution for the multitudes of people who simply choose not to take their medications, but that's not the only goal of a system like this. It could go a long way towards helping people keep up with their doses. My mom died at 45 because one of the medications she was on gave her memory issues and one day she overdosed because she simply couldn't remember that she had already taken the drugs. If this helps anyone avoid that fate, it will be successful in my opinion.
Twice a day? Lucky you, I have to do it all through the day and heaven help me if she doesn't want to take it. $21/day isn't bad since Medicare picks up the tab.
Already done... http://www.remindcap.com/
The purpose of such a thing is not to make it impossible to miss pills. The purpose is to make it less likely that those who use the system will miss doses or take extra doses. You might as well argue that alarm clocks aren't worth buying because its possible that people either won't set them or will turn them off and go back to sleep. Nevermind that they work most of the time for most people. Lets focus on everyone else.
People forget that they have forgotten to remember stuff.
Mit der Dummheit kämpfen Götter selbst vergebens
I think a lot of non-complience is for the simple fact that consciously or not they don't want to take all those pills. Problem is is that their medical condition isn't so forgiving. I just got through arguing with my mother about her medicine were she's telling me she took fridays medicine today and I know better. So now she misses today and I have to move it to sunday to keep everything on track. If this device helps out, so much the better?
As a patient currently on a combination of oxycontin and percocet for pain following a disabling hip fracture, I've learned from experience that trying to time the dosages at set intervals isn't remotely as effective for pain management as an uneven, targeted dosing based on the degree of pain involved. What this means, is that instead of one dose every 4-6 hours for every single day, I take the degree of pain as a factor in deciding how much of a med I need to take and when in order to get the most optimal results. So, on some days, I may need to take twice as much in a 3 hour period one day and skip a dosage later on when conditions become more favorable. So long as I reach the end of the month without coming up short, the day to day dispersal takes a back seat to the larger time period.
So far I have had no ill effects in doing so over maintaining a daily schedule and the net effect on my liver and such remains the same in the long term picture. The only difference is that I have control over my own level of suffering vs some hack who doesn't allow any deviation from what the book says.
A smart dispenser that would prevent access to meds when I need them and report schedule deviations to those who could later cut off my access citing misuse would prove frustrating and extremely disturbing to the point that I'd be too tied to watching a clock instead of ever getting anything done reliably. It'd be even worse later on once my body has become significantly desensitized to the medication.
With the exception of helping senile old blue-hairs this could only have nasty consequences for those of us just trying to get by the best way we know how.
8==8 Bones 8==8
http://www.hommed.com/ makes a uPhone type device already. They have a smart pill dispenser, too, but I'm not sure if they still offer it.
If they're essentially charging you $21 to replace a five minute phone call twice a day, why don't you outsource this task? Seriously. Go to GetFriday.com or someplace similar and hire a nice young Indian lady to spend 1/5th of an hour a day (split into two chunks, about $3 a day and you would likely get a quantity discount) calling your grandmother at the appropriate times and saying "Hello, Mrs. LearnToSpell. I'm just calling to check up on you. Is everything going alright? That is great. Have you taken your pills yet? No? Oh, it's no problem. Could you take those right now please?"
Granted, I wouldn't use something like this to avoid talking to your grandmother, but that isn't the point of the excercise. The point is to take a simple, repetitive task and perform it simply and cheaply. Your nerves, and your grandmother's health, will thank you for it, and you'll save a few hundred dollars a month.
Help poke pirates in the eyepatch, arr.
Many modern medications have severe side effects. Many will cause more trouble than the original problem. There have been a number of recent cases where medications were either deadly to the user or ineffective.
Pharma spends a lot of money to get MDs to prescribe their latest and most profitable, and it works. The patient is on his own when deciding to keep on taking his meds. In this instance, Google is indeed your best friend.
I am not referring to the use of antibiotics, but to the myriad meds for high blood pressure, gastric distress, elevated fat levels in ones blood, etc.
And, there is the constant reformulation of effective meds to get patent protection, just to be able to charge a higher price. Prilosac and Nexium are good examples.
There is a huge difference between narcotics vs antibiotics and other types of medication here.
In the case of antibiotics, it is an example of "what doesn't kill you, makes you stronger", it's just the germs, which get stronger and antibiotic-resistant, if the patient stops taking the antibiotics, when (s)he feels better.
In the case of narcotics, the rule is mostly, "take what's needed, but to a limit".
In this case, the pillbox could be programmed to allow you to take what you need, put preventing you from inadvertently taking an overdose.
Of cause, you could cheat and take as many pills as allowed, and save them for a suicide. But if this is to prevented, then shoelaces and belts are to be removed too...
A pill dispenser is nothing new... google "medicine reminder"... there are thousands
So, mention "MIT" and now it's this amazing thing? From my experience with family members with this problem... trips to the hospital happen after a couple years...
Immediately after having an episode, everything is fine for awhile... but what happens 2 years later when the busy day-to-day of life sets in and you simply forget to bring your pill box to work... or forget to stock the pill box at home, work, or your car. What happens then? Basically, mistakes happen... and a pill box can't prevent that.
It's a great idea... but not the silver bullet.
I spent the past year and a half as a case manager for people with severe mental illness and HIV, and the biggest problem with HIV meds is compliance (psych meds, too, but the results are potentially less lethal w/ the psych meds). Once you go on meds you need to be 90% compliant for them to work reliably. If you go off then you are burned to those meds, those drugs will be ineffective for your treatment as you now have a resistant strain of the virus (In fact, how quickly HIV turns to AIDS is now thought to be correlated with how many different strains of the virus you've been re-infected with).
The specific population I was working with was African American women, which is a caretaker population (ie, they have people in their lives they need to take care of). We spent a lot of time reminding them that they HAD to make time to take care of themselves every day instead of their children, otherwise they wouldn't be around to take care of themselves. It can be a difficult case to make when their child has had two asthma attacks in one day and they have to go to a clinic or an ER to get them looked at. I believe if you added a regular sensory input (sound and light) it would help ingrain the habit of taking meds, to the point that when someone is running out of the house to get their kid to the ER, they might think "Oh, that darn buzzer is going to go off. I should grab my pill box".
Its an abstract concept which not everyone is equipped to deal with easily, that there is an invisible thing in your blood that is so lethal that you have to take time out to address it three times a day. Its especially easy to put it to the side when you have friends that tell you not to trust your white doctor, that pharmaceutical companies are getting rich off your illness, and the side effects of incontinence are so bad that you don't want to leave the house. Most of my clients didn't argue with the fact that they should take their medication. They all said they knew they had to, but with all those and other variables, people are pretty well primed to forgive themselves if they forget a dose. So we spent time with them on ways to remember taking your meds (attaching a note to your toothbrush, sticking a note to your front door. I even programmed the calendar on some of my client's cell phones for them). And those strategies helped.
Most people know they have to take their meds, just like most people know they need to work out, know they need to avoid fatty foods. Behavioral interventions like this aren't a panacea, but they help eliminate one of the very real factors in non-compliance. I know it would have made my job easier.