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A Smart Pillbox To Improve Medication Compliance

Posted by kdawson on Sat Feb 09, 2008 04:02 PM
from the you-talkin-to-me dept.
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."
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  • by Nom du Keyboard (633989) on Saturday February 09 2008, @04:04PM (#22362858)
    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?
    • Re: (Score:2, Insightful)

      I would be much more impressed with some method of administration that would be able to overcome purposefully missed doses in certain patients. I think a lot of the problems with missed dosages are people thinking that they are feeling better, and therefore do not need the medicines they are taking. That said, I think a huge proportion of prescribed drugs are unnecessary, and that practice should be looked into more...
      • Given that you have to take the pillbox to get refilled and reset every two weeks any how, I'm not sure, other than education, there is any good way to encourage people to finish their antibiotic prescription once they are feeling better. If it wasn't for the development of resistant viruses, I wouldn't even try to solve that problem beyond pointing out the story of someone who stopped taking their TB meds and died because of it. But with resistant strains developing because of this I would be tempted to us
        • Re: (Score:3, Insightful)

          I am a doctor. It is a given that of all the medication courses I prescribe:
          - one-third of people will take it correctly
          - one-third of people will try and take it correctly, but will get it wrong
          - one-third of people won't even try to take it correctly (e.g. not finish a course, not pick up the prescription)

          I am sure the numbers are not so round but this was the repeated teaching at medical school and beyond.

          As you say, unnecessary prescribing is a pain in the arse too. Often it is d
    • by dotancohen (1015143) on Saturday February 09 2008, @04:09PM (#22362912) Homepage

      And how does the pillbox know that you actually took the pill
      It should wear a condom if it's not sure.
    • by truesaer (135079) on Saturday February 09 2008, @04:14PM (#22362954) Homepage
      Medication non-compliance is usually due to forgetfulness rather than intentionally not taking it (they can't force you anyway). So really just alerting/reminding you is probably all they want to do.
      • Indeed.. I'm as absent minded as they come especially if I'm thinking through a solution for a client or an interesting programing puzzle. My problem is that I just can't remember if I've taken my meds or not. I usually figure it out eventually when I start having trouble breathing but that's not an optimal method of discovery.

        I would buy one of these devices in an instant if it handled inhaled meds.
      • You're damn right they can force you, just not physically.

        Non-compliance with a condition is grounds for exclusion of coverage with most insurances. You can not take the pills all you like, but if it jibbers you up you're paying the bills.

        I'd say thats a bit of motivation, although a problem is sleazier insurances will avoid mentioning this fact when people mention "oh my doctor has me on this, but I don't take it".
      • Medication non-compliance is usually due to forgetfulness rather than intentionally not taking it

        I'd be interested in statistics on this matter... I know one — otherwise meticulous — elderly woman, who only takes the prescribed medicines, when she has acute pain (the prescription is for regular use). I have heard of others...

        I'm sure, some people just forget (especially, if they are on anti-memory loss medication, ha-ha), but I'm not at all certain, they represent the vast majority of "nonad

    • The same way it knows if the correct person actually removed the pill from the pillbox.
    • 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?

      And how does it know that the pill you just took out didn't fall in the sewer and that you need another one right now?

    • Re: (Score:2, Insightful)

      I agree. And they are going to start with TB patients. Wonderful. Yes, TB patients "forget to take their meds". Right. TB patients stop taking their meds because a) they don't want to be orange colored anymore (Rifampicin) and have can barely eat because of their medication-induced gastritis.

      Lots of people stop taking their meds because they don't like the side effects (but can't be bothered to mention it to their doctor because after all they don't feel so bad from their original condition when they are of
      • 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.
  • Why uBox? (Score:3, Funny)

    by dotancohen (1015143) on Saturday February 09 2008, @04:07PM (#22362888) Homepage
    Why uBox? They should call it the iBox and everybody would buy one.
  • Costs ? (Score:2, Insightful)

    "...costs the healthcare system $100 billion per year and $60 billion to the pharmaceutical industry"
    Did they want to say brings ?
    • Did they want to say brings ?

      No, they mean costs. Did you really think that pharmaceutical companies could make profit off healing and saving people? Of course not, but they do it anyways, because if they weren't there, then who would make all these medicines for us? That's right, they do it all because they care about us and they want us to be alive and well, even if it's going to cost them hundreds of billion dollars every year.

      Think about it next time you consider buying Pfizer stock [google.com].

    • Re:Costs ? (Score:5, Insightful)

      by gEvil (beta) (945888) on Saturday February 09 2008, @04:19PM (#22363016)
      I wouldn't be surprised if this was RIAA-style math. What it possibly means is that the pharmaceutical industry would make an additional $60B a year if people took all the pills they're supposed to. But since people forget to take some of them, pharma considers it "lost revenue".
  • by LearnToSpell (694184) on Saturday February 09 2008, @04:14PM (#22362950) Homepage
    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.

  • by lobiusmoop (305328) on Saturday February 09 2008, @04:16PM (#22362974) Homepage
    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.
    • 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.
    • What do you need a smart dispenser for when you lack the meds you need to fill it with?
      • Re: (Score:3, Interesting)

        Oh ... the Third World gets plenty of pills. Of course, not all of them work, and the ones that do maybe haven't been tested as thoroughly as one might like. Heck, some might qualify as downright experimental. So they get plenty of pills. The thing is, what those people really need is a box to remind them not take them.
  • by Joe Tie. (567096) on Saturday February 09 2008, @04:16PM (#22362976)
    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.
    • by pete-classic (75983) <hutnick@gmail.com> on Saturday February 09 2008, @04:37PM (#22363206) Homepage Journal
      The story is about initial deployment in very poor areas of India. They probably aren't missing doses because they are having so much fun playing Wii. They just may have things going on that seem larger than a pill in the context of their lives.

      And even if we stipulate that certain people don't "deserve" treatment, does that mean that the rest of us deserve the antibiotic-resistant strains of TB that result from people missing their doses?

      -Peter
  • by nurb432 (527695) on Saturday February 09 2008, @04:20PM (#22363020) Homepage Journal
    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.
    • Re: (Score:3, Interesting)

      You obviously have never seen a person of diminished capacity who's on a lot of meds struggle with taking their medications. I just visited my 91 y/o grandmother who takes about 10 pills a day from 5 different medications. She's still with it (doesn't need assisted living yet), but can be forgetful. There are a couple of problems with the "25 cent plastic pill boxes" you describe that she currently uses:

      1. First, SHE is the one that has to fill them, and with so many different meds it's easy for her to make
    • For one thing, because giving someone one of those in absolutely no way means that they will actually use it. For another, it doesn't discourage the, "If one is good, three must be three times better!" mentality.

      There are probably a zillion different solutions if you personally want to make certain you take pills when you should in the proper quantity.

      But this is meant less to be an electronic counterpart to a pillbox, and more an electronic counterpart to a conscientious mother.
  • Already exists (Score:5, Informative)

    by CrystalFalcon (233559) * on Saturday February 09 2008, @04:25PM (#22363084) Homepage
    How is this better than the already-in-trials Cypak box [cypak.com], 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?
    • Well, the MIT one is cooler because it beeps and squeaks. It also has a reminder function (something any PDA, computer, wristwatch, kitchen timer can do).

      If this is all they're doing at MIT these days all I can say is that in my days....

  • 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.
  • by Adambomb (118938) on Saturday February 09 2008, @04:39PM (#22363226) Journal
    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).

    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, ..., 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.
    • Son of a...comment writing by parts between cases all afternoon makes for my original post.

      My apologies to the grammarstapo.
  • by AK Marc (707885) on Saturday February 09 2008, @04:40PM (#22363232)
    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?
    • The smart pillbox would most likely be dispensed by the pharmacy, thus rendering it the official bottle. This would be a non-issue.
    • Re: (Score:2, Informative)

      This is only partially correct. It's only illegal if you do not have the original prescription information from the bottles in your position. So yes, if your father didn't have his scripts with him then he would have been in trouble, otherwise the security guards that questioned him were on their typical power trip.
    • 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.
      WHAT!? Damn!
      How come you people don't break out in derisive laughter when you hear your country described as the "land of the free"?
    • Re: (Score:3, Insightful)

      In Florida a man was given the minimum sentence of 25 years for having 56 viccodin, of the 80 he was prescribed, in a valid bottle. Because, in Florida at least, any more than 50 is automatic guilt in drug trafficking. Having a valid prescription is not an exception, and the defense attorney was not permitted to even mention his valid prescription to the jury. The judge ruled that since the law does not mention prescriptions, that knowledge would be distracting and irrelevant. As a convicted drug traff

  • 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!
  • I'd use this. (Score:3, Insightful)

    by DdJ (10790) on Saturday February 09 2008, @06:28PM (#22364200) Homepage Journal
    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.
  • by tguyton (1001081) <t_guyton@nosPam.bellsouth.net> on Saturday February 09 2008, @08:22PM (#22365258)
    ...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.
    • Usually not, and in any case it can be a long time before anybody realises what the problem actually is, by which time damage may have been done. Also over medicating, or taking pills at the wrong frequency is also a major problem that this thing is trying to address.

      Having said that, I don't think a hi-tech solution like this is a necessary answer for most people. We'd go a long way towards preventing these problems simply by printing readable labels on med boxes that are easily distinguishable for peo

    • I wonder if they used the logic that 10% of hospital visits = 10% of the healthcare industry, because wouldn't that be neglecting the nature of the visits? I would assume that the 10% of hospital visits resulting from forgetting to take pills would have a greater chance of being taken care of fairly easily... Like, "ok here are your meds and a cup of water". Sure, some problems will be more serious, but still.

      You can't be serious. many medications have dire consequences if missed.

      Forgot your heart med

    • Whats funny is how by the time they're teens, most people start bitching and whining that they don't need any kind of supervision, their parents are too much, they're smart enough to take care of themselves...yet most people really don't. They need machines to be their parents.

      Oh the irony.
    • This is a terrifying little idea because I could easily see the insurance companies lobbying for laws requiring that you take medication.......

      A law requiring you to do what's best for you, after you have paid insurance exactly for that purpose. Why is it that this law doesn't seem such a bad thing?
      • A law requiring you to do what's best for you, after you have paid insurance exactly for that purpose. Why is it that this law doesn't seem such a bad thing?

        Why is it that you can't see what's wrong with that scenario?
      • Just let me write you a prescription for some personality-altering drugs which you are required by law to take. Then maybe you'll see why it's a bad thing. But if you do, we'll just increase the dosage until your mind is sufficiently numbed that you don't notice any more.
      • Re: (Score:3, Interesting)

        Because we don't know what is best. MDs are hardly infallible, can't always be on the spot, and are under enormous pressure to overmedicate. Sell more pills that way, and keeps them covered in case of a lawsuit. We still have much to learn about medication. For instance, grapefruit magnifies the power of a great deal of medicine. It is quite possible for half the dosage with grapefruit to be as good as a full dose without.

        I'm wondering if the pharmaceutical industry's "losses" are because people aren

      • Re: (Score:3, Informative)

        Yeah, they stop when they feel better. If there was ever a need for a public information campaign this is it.