Medication Compliance Chip

The article:

Call them tattletale pills. Seeking a way to confirm that patients have taken their medication, University of Florida engineering researchers have added a tiny microchip and digestible antenna to a standard pill capsule.

"It is a way to monitor whether your patient is taking their medication in a timely manner," said Rizwan Bashirullah, UF assistant professor in electrical and computer engineering.
Such a pill is needed because many patients forget, refuse or bungle the job of taking their medication.

One part is the pill, a standard white capsule coated with a label embossed with silvery lines. The lines comprise the antenna, which is printed using ink made of nontoxic, conductive silver nanoparticles. The pill also contains a tiny microchip, one about the size of a period.

"The vision of this project has always been that you have an antenna that is biocompatible, and that essentially dissolves a little while after entering the body,"

Read the article, it's interesting:

Engineers design pill that signals it has been swallowed

Shall we file this one in the technology with a reasonable purpose premise but with nefarious potential category? I think that we should.

Other than the sinister "forced medication compliance" aspect, I draw your attention to the "biocompatible" element of the discovery ...

In the past, as I understand it, were any rfid chip to be clandestinely appropriated into someone's body, one could, at the very least detect it. Not necessarily easily detected it, but I'm thinking with strong enough x rays, cat/pet scans, mris and the such, or with radio frequency detectors.

With the biocompatible element in play, one could "chip" you for a time and let the evidence dissolve away. Not saying they will, just saying they could.

Anyhoot, I thought the whole idea of a disappearing chip was interesting so I shared.

Well, it is one way to make sure the "patient" takes their pill.

Now, what defines patient?

I wonder how much this would cost to say each pill?

I thought a major problem was costs nowadays in health care.

Sometimes scientists need to ask "should we", instead of "can we".

I am working on a pill that reduces the IQ at 10 point levels each dose. I never thought to ask, Should I". Should be a HUGE success.

Thanks for the article SD.

This would be a great tool in cases where you have a patient who is obviously non-compliant, but swears they stick to their regimen and wants to know why you aren't "helping them". I had a patient who promised, everytime I saw her, that she was monitoring her blood sugar and taking her metformin, but her feet kept swelling and she was tired all the time. Lo and behold, when she was faced with having her foot amputated, she admitted to me she had never taken the metformin beyond the first pill because she "doesn't like taking pills" and never checked her blood sugar because she "doesn't like needles". Lying to your physician about chronic disease management can lead to horrible consequences from the disease they are doing their best to treat.

reply to post by VneZonyDostupa


Mmm, I understand non-compliance in the context of a clinical trial, after all the subject signs a contact (I presume) committing to take a medication/placebo.

Not quite sure of the ethical consequences in regards to treatment though ... doctors aren't in a position to "force" someone to take their meds if they don't want to and suffer the consequences.

We have mothers for that.

Originally posted by VneZonyDostupa
This would be a great tool in cases where you have a patient who is obviously non-compliant, but swears they stick to their regimen and wants to know why you aren't "helping them". I had a patient who promised, everytime I saw her, that she was monitoring her blood sugar and taking her metformin, but her feet kept swelling and she was tired all the time. Lo and behold, when she was faced with having her foot amputated, she admitted to me she had never taken the metformin beyond the first pill because she "doesn't like taking pills" and never checked her blood sugar because she "doesn't like needles". Lying to your physician about chronic disease management can lead to horrible consequences from the disease they are doing their best to treat.

Straight up honest reply ,
Blood test much?
If you knew what you were treating and prescribed said medication, the levels would have been obvious in any follow up blood testing, Should you have requested any testing.
Long enough to allow for the foot to be considered removed tells me you checked what? Nothing? Nothing!
Patient instruction and education on treatment?
Common sense?
Do this and this happens!
Dont do this and this happens!
Was this a roll of the dice chuck a luck wheel diagnosis?
Transfer of blame or just a dumb story to share.
Yes she's responsible for her health,
once youre involved as a primary care giver so are you, as an authority figure.
Got anymore stories like this?
I wouldnt share them.

Originally posted by schrodingers dog
reply to post by VneZonyDostupa

 

Mmm, I understand non-compliance in the context of a clinical trial, after all the subject signs a contact (I presume) committing to take a medication/placebo.

Not quite sure of the ethical consequences in regards to treatment though ... doctors aren't in a position to "force" someone to take their meds if they don't want to and suffer the consequences.

We have mothers for that.

It's not at all about forcing anyone to take a treatment. It's about figuring out WHY a medication with an amazing track record, like metformin, wasn't working for the patient. I had no reason to believe they *weren't* taking it, given the woman's emotional appeals for information about why she wasn't getting better. If I had some method of knowing if and how much she took reliably, it would help immensely. Of course, this is a last ditch effort.

Originally posted by HappilyEverAfter
Straight up honest reply ,
Blood test much?
If you knew what you were treating and prescribed said medication, the levels would have been obvious in any follow up blood testing, Should you have requested any testing.

Metformin is rapidly metabolized. Additionally, you can't just "do a blood test" for every drug. The rate of drug degradation varies based on every patient's CYP profile, so a plasma level would be useless without knowing when and how much the patient took the drug.

Long enough to allow for the foot to be considered removed tells me you checked what? Nothing? Nothing!

The patient was given a Pgluc test on every visit, as well as HbA1C every 3 months. They problem wasn't that there was a lack of testing, it was that the testing showed either an intolerance to metformin, or a lack of administration of metformin. The patient "swore" she took it, even to the point of tears, and was started on al alternative plan of diet modification and blood sugar monitoring, which she "swore" she followed despite her test results saying otherwise. It was at this visit, the 3 month follow-up after being given the health plan, that pitted edema was noted up to her ankle. She was advised that continuing on this path would lead to possible loss of the foot within 6 months. Admittedly, it's likely to take longer, but if could happen very quickly, as well. It's best to give the worst case scenario in this sort of situation.

Is that thorough enough for you, or do you want to continue to question my patient care abilities further, not being a physician yourself?

Patient instruction and education on treatment?
Common sense?
Do this and this happens!
Dont do this and this happens!

All of this was presented to the patient at every visit, following standard pre-diabetes and diabetic counseling. She was also referred to a nutritionist (whom she failed to meet with) and a nephrologist (whom she failed to meet with).

Was this a roll of the dice chuck a luck wheel diagnosis?
Transfer of blame or just a dumb story to share.

How, exactly, am I making a "roll of the dice" with this diagnosis? I'm amazed that people with little to no knowledge of medicine are always the first to make such accusations.

Yes she's responsible for her health,
once youre involved as a primary care giver so are you, as an authority figure.

I'm neither responsible for her health nor am I an authority figure. My job is to do my absolute best to treat her and educate her to the best of my abilities about how to care for herself. If she chooses to disregard my advice and treatment plan, there is nothing I can do about it. It's tragic, and I hate it, but I can't force the metformin down her throat, nor can I force the fork out of her hand.

Got anymore stories like this?
I wouldnt share them.

That depends. Do you have any more nonsensical ravings and baseless accusations like this? I wouldn't share those, either.

[edit on 3/31/2010 by VneZonyDostupa]

Originally posted by VneZonyDostupa

It's not at all about forcing anyone to take a treatment. It's about figuring out WHY a medication with an amazing track record, like metformin, wasn't working for the patient. I had no reason to believe they *weren't* taking it, given the woman's emotional appeals for information about why she wasn't getting better. If I had some method of knowing if and how much she took reliably, it would help immensely. Of course, this is a last ditch effort.

I understand and appreciate where you're coming from ... must be rather frustrating to see a patient get worse whilst on the assumption that they're taking their medication regimen, struggling to figure why this is happening, perhaps even questioning your own diagnosis and prescription, all the while the patient is deceiving themselves and their doctor.

However, it seems to me that if thought through, this particular technology will not remedy the above circumstance you described unless it is incorporated into every single medicine/pill. The reason for that is, that until the denouement of the situation you had no reason to suspect that anyone would be so irresponsible as to not take their medication in light of such dire consequences. Such behavior is presumably the result of rare and deep seeded psychological/emotional problems and at best difficult for a doctor other than a psychiatrist to diagnose.

So without warning signs that a person might not take their vital medication the only way to prevent such action is as I said to have them in every single pill to catch the few that are so predisposed.

That in turn brings us back to the original ethical question of whether it is up to the physicians (other than in clinical trials) to enforce medication compliance.

I hope I'm making sense.

EFSpelling

[edit on 31 Mar 2010 by schrodingers dog]

reply to post by VneZonyDostupa


Nope
Not an MD
Still, could have caught it with blood tests.
There was no support around the patient to insure compliance?
Chipping meds or people isnt the answer.
Doesnt like taking pills?
Liquids also?
Raving not!
And yes in case you didnt notice MD's are viewed as authority figures,
sit on the other side , as I'm sure you have in the past, doctors are viewed with awe and you know it, or else you'd only be charging $8.00 a hour.
Youre trusted and yes you are responsible for giving the best care, thus youre responsiblities even though limited, do exist.
Yes I will question you, youre not taking the standard elevated stance of above not needing to answer that seems to be held by some who attach capital letters after their name are you?
The business of keeping the exam table occupied sometimes causes rushed care doesnt it?
I would probably suck at making money as an MD because I'd get to involved and spend too much time.
And you DIDNT make a roll of the dice in diagnosis did you? testing provided the details you needed, the same way it could have provided continued details.
You had a difficult patient, that it seems required more focus and attention then the norm.
Did you end up fixing it, did she comply or die?
Did you learn anything from it? create a new care plan so when you encounter this again youre prepared?
It's okay if youre upset that "someone" who's not formally trained questions and prods, the entire industry needs questioned and prodded.
That's where true reform will come from.

Originally posted by HappilyEverAfter
reply to post by VneZonyDostupa

 

Nope
Not an MD
Still, could have caught it with blood tests.

Please tell me which blood test would have detected these levels, when it should have been administed (fasting, non-fasting, day or night), which test code it is, and the required blood volume needed for testing. Obviously, you've created a new test that is capable of measuring raw levels of fast-metabolizing insulin activity modulators. I bet there's a Nobel in it for you, too.

There was no support around the patient to insure compliance?

Her husband is an enabler, and never came to appointments.

Chipping meds or people isnt the answer.

I never said it was. I just thought it was an interesting take on the problem.

And yes in case you didnt notice MD's are viewed as authority figures,
sit on the other side , as I'm sure you have in the past, doctors are viewed with awe and you know it, or else you'd only be charging $8.00 a hour.

The level of "awe" or "authority" (misplaced or not) people view my profession with has nothing to do with my salary. In fact, I prefer to view my salary as directly related to the fact that I have up the large majority of my twenties working, studying, or both for 100+ hours per week, providing free care during my last two years of school as a means of gaining clinical experience, and then being saddled with over $200,000 in debt, the cost of a medical education.

Remind me again where "awe" enters into that equation?

Youre trusted and yes you are responsible for giving the best care, thus youre responsiblities even though limited, do exist.

My responsibilities end at my profession. I am not responsible for a patient wanting to eat themself to death, despite offers of therapy and counseling. I am not responsible for forcing a pill down a patient's throat other than in emergent, life-threatening situations, and I am not responsible for behaviour modification if the patient makes it very clear that they are not interested and unwilling to the point of lying to myself and my colleagues.

Yes I will question you, youre not taking the standard elevated stance of above not needing to answer that seems to be held by some who attach capital letters after their name are you?

I have no problem with being questions. I DO have a problem with being accused, as you have done. There's a big difference.

The business of keeping the exam table occupied sometimes causes rushed care doesnt it?

I work in an academic public health center. We aren't in any rush to fill the exam beds. I get paid the same salary if I see 100 patients a week or 10.

I would probably suck at making money as an MD because I'd get to involved and spend too much time.

There are plenty of physicians who do this and make a lovely salary. It's called speciality work.

And you DIDNT make a roll of the dice in diagnosis did you? testing provided the details you needed, the same way it could have provided continued details.

Testing can provide confounders, rather than answers, as in this case. That's something you learn as a medical professional that most people don't understand.

You had a difficult patient, that it seems required more focus and attention then the norm.
Did you end up fixing it, did she comply or die?
Did you learn anything from it? create a new care plan so when you encounter this again youre prepared?

I've created five "plans" for her, ranging from daily mettformin to behaviour modification to weight loss programs to group counseling. She has lied and/or refused all of them. She isn't dead, no, but she certainly isn't going to be coming to my clinic again if the next 3-month follow-up shows advancing edema and noncompliance. I've already told her that, in that event, she'll be referred to another clinic with a doctor who is specifically interested in diabetes, partially because she needs it and partially because she clearly doesn't care about anything I do or say to her.

It's okay if youre upset that "someone" who's not formally trained questions and prods, the entire industry needs questioned and prodded.
That's where true reform will come from.

Again, questioning and prodding is fine. Accusing is not. You need to learn the difference if you truly want to "investigate" the industry. You catch more flies with honey than vinegar.




[edit on 3/31/2010 by VneZonyDostupa]

reply to post by schrodingers dog


Oh, I agree entirely. The usefulness of the technology hinges on what medications it's conjugated to. I imagine they are most interested in HIV medications, as the consequences for not taking those are usually AIDS or death.

In the case of my patient, it would have been an interesting option about the second time I noticed her irregular blood sugar. The first time I saw it, I chalked it up to the metformin either not being taken the past few days due to her script running out, or maybe some level of metformin resistance. The second time, it was clear she just wasn't taking it, especially when compared to her HbA1c. Of course, this new "monitor pill" will probably be restrictively expensive, so I doubt it will be a realistic option for cases like mine anytime soon.

reply to post by VneZonyDostupa


Indeed ...

I don't know, obviously discoveries are interesting for their own sake.

From an outsider's pov it seems that this technology is driven by pharmaceutical companies to force compliance in clinical trials, for which I bet they are willing to bear the above mentioned high cost. For reasons already agreed to it seems unlikely for this technology to be available to the lay person any time soon ... except perhaps for the elderly/alzheimer patients, for which they may modify the technology slightly as a reminder vehicle.

There is however, as referred to in the OP, also considerable Dr. Evil potentiality inherent and to be considered ... after all, we're at the ATS no?

Metformin has an oral bioavailability of 50–60% under fasting conditions, and is absorbed slowly.[95][96] Peak plasma concentrations (Cmax) are reached within one to three hours of taking immediate-release metformin and four to eight hours with extended-release formulations.[95][96] The plasma protein binding of metformin is negligible, as reflected by its very high apparent volume of distribution (300–1000 L after a single dose). Steady state is usually reached in one or two days.[95]

Metformin is not metabolized. It is cleared from the body by tubular secretion and excreted unchanged in the urine; metformin is undetectable in blood plasma within 24 hours of a single oral dose.[95][97] The average elimination half-life in plasma is 6.2 hours.[95] Metformin is distributed to (and appears to accumulate in) red blood cells, with a much longer elimination half-life: 17.6 hours[95] (reported as ranging from 18.5 to 31.5 hours in a single-dose study of non-diabetic people).[97]

Yes Sir seems even though its life is short it is still detectable,
And I didnt accuse you of anything.

And that's great you made the choice to help people,
choice
Please dont compare your choice to loss and sacrifice.

Enabler husband, yes sir that's a bad deal too.

See, this is where we all need to live with our choices,
and if she valued gluttony and lying over health, then her end is her responsibility.

I dont want a nobel,
but it can still be found if she's taking it in a test.
And the test can be scheduled.

Urine or blood. Metfomin would be present.

Initial benchmark levels of B12 and folate could be compared to follow up samples.
Metformin Depletes Vitamin B-12 and Folate
Metformin has one more significant side effect. It depletes Vitamin B-12 and Folate and increases homocysteine, a blood chemical associated with increased heart attack risk.
This makes it important that anyone taking Metformin take supplemental vitamin B-12 and Folic Acid. Because a low carb diet may not provide enough of these important vitamins, extra supplementation is advisable for people on a low carb diet. If you have been taking Metformin for a while, you should ask your doctor to test your blood vitamin B-12 level.

I'd rather see the human interaction remain or become elevated with care,
a traveling LPN on a daily route administering the meds as opposed to some biometric tracking device seems more obvious,
and a plus is it creates jobs for people.

covering the cost? adjusting crazy glue used in ER's as liquid bandage from $900 to $3.
And then I'd continue down the list of over priced insanely priced labor and supplies and find even more $$$$$$.

to answer your first question I would schedule the first blood test for 1 hour after her dosage time in the morning,
and several days later another test an hour after her dosage time again.
the code? no i dont know it yet.

And I'd probably be a little pissed if I found out she was undermining my care plan.

ADD:
insertion of an inert trace monitor agent that would be revealed in a urine sample.



[edit on 31-3-2010 by HappilyEverAfter]

HappilyEverAfter, you fail to comprehend the reality of healthcare. How can I schedule her to have a bloodtest performed "an hour after her dose", if the dose can be administered at anytime at her own discretion? If I tell her to take it at 8am for the initial test and the follow-up tests, how can I know that my baseline measurement is correct? What if she took it at 6am for the initial, and 9am for the follow-ups? The higher levels of metformin would cause me to think that she was developing metformin resistance when, in reality, she merely changed her dose time.

As for your link saying metform "isn't metabolized", that's a load of crap written by someone who doesn't understand medical biochemistry. Metformin is a biologically active compound that increases activity of insulin and delays glucose uptake. The phrasing in your text (which was copied from wikipedia, try getting a better source next time) is referring to the end-result of unused metformin. Of course it's excreted.

I'm finished responding to you, HappilyEverAfter. You obviously came into this thread with a pre-conceived notion of how patients should be treated, despite having no experience working with patients, compliant or otherwise, and then you make disgusting accusations about my character. All I did was offer a difficult patient-care situation that this sort of pill would be an interesting option, and you decide to accuse me of not doing imaginary, and quite frankly clinically useless, blood tests for my patient. Get a life.

reply to post by VneZonyDostupa


Yep,
It still can be found and monitored in blood tests and or urine tests.
Too bad you had to put up with her lying to you.
Sounds like a difficult one.
I wont post the 5 sites I got the same info from since youre bailing.
A human is needed, not chips.
It's not even something that should be entertained.
Youre too sensitive Doc, I never character attacked you, stop stamping your feet.