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Medicine Education

A Smart Pillbox To Improve Medication Compliance 145

Posted by kdawson
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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A Smart Pillbox To Improve Medication Compliance

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  • by Nom du Keyboard (633989) on Saturday February 09, 2008 @05:04PM (#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?
  • Costs ? (Score:2, Insightful)

    by Romwell (873455) on Saturday February 09, 2008 @05:08PM (#22362904)
    "...costs the healthcare system $100 billion per year and $60 billion to the pharmaceutical industry"
    Did they want to say brings ?
  • by gotzero (1177159) on Saturday February 09, 2008 @05:09PM (#22362910)
    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...
  • by LearnToSpell (694184) on Saturday February 09, 2008 @05:14PM (#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 truesaer (135079) on Saturday February 09, 2008 @05:14PM (#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.
  • by lobiusmoop (305328) on Saturday February 09, 2008 @05:16PM (#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.
  • by Joe Tie. (567096) on Saturday February 09, 2008 @05:16PM (#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.
  • Re:Costs ? (Score:5, Insightful)

    by gEvil (beta) (945888) on Saturday February 09, 2008 @05:19PM (#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 nurb432 (527695) on Saturday February 09, 2008 @05:20PM (#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.
  • by stranger_to_himself (1132241) on Saturday February 09, 2008 @05:23PM (#22363052) Journal

    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 people with visual impairments or slight memory problems.

  • by pete-classic (75983) <hutnick@gmail.com> on Saturday February 09, 2008 @05:37PM (#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 Adambomb (118938) on Saturday February 09, 2008 @05:39PM (#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.
  • by AK Marc (707885) on Saturday February 09, 2008 @05:40PM (#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?
  • by Dunbal (464142) on Saturday February 09, 2008 @05:45PM (#22363284)
    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 off the meds). Not because they "forget".
  • by Original Replica (908688) on Saturday February 09, 2008 @05:55PM (#22363346) Journal
    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 use a Norplant [wikipedia.org] type delivery system for all antibiotics that are in danger of becoming useless due to resistant strains. In some ways the taking of a strong anti-biotic is using a public commodity, the effectiveness of that drug. If it is abused then the public commodity can be damaged when resistant strains develop. However, industrial livestock are much more problematic in this area than negligent patients. [abc.net.au]
  • A Smart box (Score:3, Insightful)

    by mangu (126918) on Saturday February 09, 2008 @06:05PM (#22363448)
    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.
  • by Scrameustache (459504) on Saturday February 09, 2008 @06:32PM (#22363720) Homepage Journal

    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"?
  • by Scrameustache (459504) on Saturday February 09, 2008 @06:34PM (#22363746) Homepage Journal
    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 @07:28PM (#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.
  • Re:Costs ? (Score:2, Insightful)

    by Captain Vittles (1096015) on Saturday February 09, 2008 @07:31PM (#22364232)
    Keep in mind that the pharmaceutical industry isn't just the rich guys in suits that head those massive companies which are raking in obscene amounts of money. There are plenty of smaller companies as well, cranking out the everyday drugs that people take for granted and making very little money in the process.

    The cost being talked about could largely be opportunity cost, as the people who aren't taking their doses of well-established, off-patent, one-dollar-per-dose medications will many times need a new prescription, once the ailment that wasn't cured comes roaring back. Multiply that by many of these types of drugs and many people abusing them, and you see that manufacturers are forced to put out bigger orders of these low margin items. If people would just take their meds properly, then the resources opened up can be put towards products that might just turn a profit, and allow the business to grow instead of just survive.
  • by tguyton (1001081) <t_guytonNO@SPAMbellsouth.net> on Saturday February 09, 2008 @09:22PM (#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.
  • by canajin56 (660655) on Sunday February 10, 2008 @12:44AM (#22366708)

    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 trafficker, his two condos, car, and boat were all seized by the state and sold. Since they were auctioned for pennies on the dime, he still owes them a big chunk of the $500,000 minimum fine for drug trafficking.

    I think that's how House should end. He's at a conference in Florida. He gets busted with a bottle full of pills, in the proper prescription bottle. Doesn't matter. He had more than 50, he's guilty of drug trafficking. 25 years in prison. All his possessions are sold. According to their records he paid large amounts of money to Dr. Wilson, and received large amounts in turn. "But he was just paying me back, he borrows money all the time". Likely story Dr. Wilson, 10 years for money laundering, all your possessions seized too. The end. No opportunity for appeal, the law is clear.

  • by balloonhead (589759) <doncuan.yahoo@com> on Sunday February 10, 2008 @01:15AM (#22366908)
    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 done with good intentions but the manpower that would be required to review the original indication for a prescription, the ongoing need for it, whether (better or cheaper) more modern alternatives are there, new information regarding the safety of drugs and any other relevant factors makes it impossible on a large scale in practical terms. I am still waiting for an IT system in medicine that could semi-automate it (there are a number of things in medicine that could be revolutionised by proper IT but every system I have seen has been a kludge) as that would go a long way towards addressing issues like these.

Nature, to be commanded, must be obeyed. -- Francis Bacon

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