November, 2017 //
For mental health patients, the combination of personalized treatment alongside a digital sensor to track medication uptake could drastically improve compliance and save lives. Yet, uncontrolled access to confidential, personal information could be harmful for doctors and patients.
Last week, the FDA approved the first mental health pill containing a digital sensor to track use compliance. On the one hand, this novel pill will help doctors’ better address non-compliant behavior – a real issue with mental health patients, while on the other hand, this “biological Big Brother” pill raises some real ethical issues.
Since establishing Taliaz, I am driven with a clear mission to innovate artificial intelligence tools to improve the way we cope with mental health disorders. Seeing a new product with a unique approach is both exciting but also raises some concerns.
So let me explain more.
Abilify – the new sensor-tracking medication
The FDA has approved a drug called Abilify for the treatment of schizophrenia, acute treatment of manic and mixed episodes associated with bipolar I disorder, and for use as an add-on treatment for depression in adults. However, unlike any other standard pill, this pill contains a tiny sensor that transmits to a wearable patch, which in turn can transmit to a smart phone. Luckily, for us, the sensor is the size of a grain and easily swallowed – so no worries there!
The idea is that the pill will provide objective information on a patient’s medication taking patterns to help inform the patient’s illness management and personalized treatment plan.
Dr. John Torous, a psychiatrist at Beth Israel Deaconess medical center and Harvard Medical School goes even further saying “This could be used as an early warning system to help provide small corrections to help patients before they go too far off.”
Addressing the compliance issue
Compliance is a real challenge for any treatment plan. For mental health patients, non-compliant behavior can be life threatening.
Statistics wise, up to 50% of depression sufferers and as little as 20% of schizophrenia patients adhere to their medication [http://mhc.cpnp.org/doi/full/10.9740/mhc.n132973?code=cpnp-site ]. For doctors and their loved ones, this can be highly frustrating and in some cases harmful, when patients suddenly stop taking their medication, or altogether avoid seeking a prescription.
The good thing is digital solutions, like Abilify, are helping us approach traditional challenges in new ways. However, using sensors to follow patient’s compliance is one way of tackling this problem, but it must not be the only one.
A sensor is one part of the compliance puzzle
Whether a patient takes their treatment on time and as prescribed (compliance) is a highly complex topic. Tracking their medication taking patterns in my opinion is only part of the puzzle. Ultimately, we need to help patients actively decide to stay on their medication, by finding the right treatment for their individual needs sooner.
In this respect, personalized medicine is an important missing piece of the compliance puzzle. Tailoring the right treatment to each individual has the potential to significantly improve patient satisfaction and quality of life, meaning patients may be happier and more in control of their day-to-day life. As a result, I believe patients will be both more capable of and also more motivated to continue taking their medication. The “ownership” of medication compliance, most importantly, will move into the hands of the patient, rather than their doctors or loved ones.
However, to address the compliance issue fully, we first need to understand its complexity and look at all the factors involved. For example, what treatment options are available for that disease, how does their environment (e.g. socioeconomic status) impact their health and what support is available to them from the healthcare system and their loved ones.
In the case of depression for example, though there are dozens of antidepressant medications on the market, finding the right antidepressant is often a trial and error process leading to low compliance. A staggering, 65% of patients fail to achieve remission following their first-time antidepressant treatment. A further 30% of individuals will simply quit treatment if their first antidepressant is unsuccessful!
Undoubtedly, empowering the doctor to both better prescribe the most effective treatment to their patient’s individual needs and monitor its uptake, will be a huge step forward in addressing the compliance issue.
This is exactly part of the work we are doing at Taliaz. Our artificial intelligence algorithm, Predictix Antidepressant, aims to look at the complex array of factors affecting compliance, such as a patient’s genetic, clinical and demographic profile. With this new insight, our algorithm can help doctors better predict which antidepressant is the most effective for each of their patients.
Combining this personalized medicine approach with a digital sensor tracking a patient’s treatment uptake, could bring huge benefits to mental health patients.
Yet, there are also valid concerns with its impact on our confidentiality.
A biological Big Brother or compliance-tracking device?
Though patients can decide whether to share data via a secure web portal to their doctors, the pill has the capability to collect much more information about the patient.
"It’s nice to keep track of taking your pills but what else are you keeping track of?" questions Arthur Caplan, a bioethicist at New York University in the article.
The issue of what data is being collected, where is it going and who has access to this information is a growing concern. In fact, the need for better governing of medical Big Data was a huge underlying theme from the recent conference I attended in Germany this week.
It is clear, we need new rules and guidelines as latest technologies out surpass traditional frameworks. Healthcare systems need to better protect patients as new solutions enable greater access to potentially private and confidential information. With that being said, we must not allow rules and regulations to affect the fast progress of software tools supporting doctors and advancing the quality of treatment.
On the side of the doctor, working with potentially more sensitive information will mean approaching and handling patients with even greater care. Especially challenging in the context of mental health patients.
We are clearly entering into a new treatment era where compliance rates should drastically increase with personalized medicine and better medication tracking. Where our doctors will have more information and tools available than ever before to more effectively treat patients.
The healthcare challenge now, as facing the business world, is to make sure this greater access to our personal information is used for the better, not the worse.
The good thing is the healthcare ecosystem is already hard at work trying to improve the quality of our health, by incorporating these great advancements safely into our daily lives.