The pill that texts the doctor – from inside your body
By FIONA GRAHAM
As a species, the human race is messy.
We can be inconsistent, disorganised, mendacious, unpredictable and frequently bad at making the right decisions about what’s really in our best interests.
Which means that being responsible for people in vulnerable situations – for example, chronic illness – can be fraught with difficulty. Because as cruel as disease can be, the consequences of human error can be just as bad.
According to the World Health Organisation around 50% of us fail to take medicines correctly, while over 50% of drugs are prescribed, dispensed or sold inappropriately.
Not only can this have horrifying consequences for patients, it also costs healthcare providers millions every year.
So technology to help avoid these situations could prove lucrative.
There’s no shortage of drug reference apps, like Micromedex, but a number of start-ups are exploring more interactive routes.
“Human beings aren’t robots, and if they’re asked to take medicines or do anything that requires very high levels of routine repetition they are going to find that really tough,” says Andrew Thomson, chief executive of California-based Proteus Digital Health.
“The biggest burdens in our health system are about chronic disease, and people typically who have some type of chronic disease need to take medicines every day. And they need to take them appropriately.
“And what we know is that most people don’t actually do that very well.”
So how do you make sure your elderly and forgetful mum is taking her medication regularly?
According to Proteus, by having that tablet text or even tweet you when it hits the stomach.
This isn’t science fiction – although the company appropriately enough shares its name with the Proteus, the microscopic vessel that boldly went where none of us have gone before – inside the human body – in the cult 1960s movie Fantastic Voyage.
“If you stick a bit of copper and a bit of magnesium in a potato and you wire it up you can power a lightbulb. It’s a simple bit of chemistry that says two dissimilar metals in an ionic solution create an electrical charge,” says Mr Thomson.
“What we have done is to take two absolutely required dietary minerals, one is copper and one is magnesium, and put them on a grain of sand that’s less than a millimetre square in a way that means that when we combine it with a drug, when you swallow it you become a potato.”
The ionic fluid is stomach acid. Enough voltage is created to power the sensor, which communicates with a small plaster-shaped patch worn by the patient, which also tracks vital signs, movement and sleep.
The patch in turn sends all of this data to an application which lives in the cloud. It can be accessed from a smartphone, tablet or PC, and set to send an alert to family, caregivers or healthcare professionals to say the pills have been swallowed.
This is particularly important where the timing is crucial or where missing a few doses means the drug won’t work anymore.
Patch, pills and tablet app
“Effectively when you swallow one of our digital drugs it will say, Hello I’m here, I’m Novartis, I’m Diovan, 1.2mg, I’m from plant number 76, I’m batch number 12 and I’m pill number 2.” says Mr Thomson.
The application can also track the drug’s effects – whether it’s been prescribed at the right dosage, or if it simply isn’t working.
The technology is being piloted in the UK at High Street chain Lloyds Pharmacy. Patients receive a labelled dosage tray, with an extra pill that contains the sensor. This will record the time each dose is taken, while the tracking patch builds up a picture of their health and movements.
“If you think about a hypertension patient who doesn’t take their medicines, the long term result of that will be things like a stroke or a heart attack which may cost the health system tens or hundreds of thousands of dollars,” says Mr Thomson.
“And the cost of the medicines is 30p a month. One of the most important things to understand here is that helping people appropriately use medicines has the potential to save hundreds of millions of pounds.”
Dr Patrick Hymel knows only too well the consequences of this type of mistake.
“My grandfather took a medication that he was taking for metastatic prostate cancer incorrectly for almost six weeks,” he says.
“Which was kind of devastating to us, that it was for that long. Now at that time he was completely sharp, he was a very smart man, he had all of his faculties, and my aunt, his daughter, was a critical care nurse, and my siblings are both physicians, all three of us are doctors.
“And so we came away from that experience, and I was thinking ‘If my grandfather didn’t have the support system to be able to take his medications correctly, in a life threatening situation, what are other families struggling with?’.”
He and his business partner Dr Stephen Brossette came up with the idea for a smartphone app to identify drugs correctly. But patient error isn’t the only thing they wanted to tackle.
“Medications are miracles, they allow us to live longer… But the flip side of that is they can also cause harm”
Before prescribing drugs, a full medical history is needed, including a run down of the pills and potions someone is already taking.
This can be difficult – people forget to mention things, especially when they’re sick or elderly.
Getting this wrong could mean missing a potentially serious interaction between drugs, or a pre-existing medical condition.
Healthcare professionals too can make mistakes.
“About 7% of electronic prescriptions generated in the United States have an error in them. If the doctor writes them down, they have about a 37% error rate,” says Dr Hymel.
“Dispensing errors occur about 2-3% of the time. And if I did have the wrong pills, who would ever know? Because the bottle would be labelled with the correct medication name.”
The problem is so big it’s been estimated it costs the US healthcare system over $200bn each year – or 8% of the country’s total annual healthcare expenditure.
The MedSnap ID app uses computer vision to correctly identify nearly 3,500 different drugs. In other words, a doctor or pharmacist takes a photo of all the different tablets a patient is taking, and the app then identifies them. It also flags up any potentially harmful interactions.
“Patients see so many specialists, often the lung doctor isn’t talking to the heart doctor and the heart doctor isn’t talking to the GI doctor, and medications get confused, interactions can occur. And if no one ever gives a good medication history, they never find out,” explains Dr Hymel.
This is complicated technology.
“Just like the Google autonomous car can tell that the red octagon is a stop sign, we have to be able to tell that the objects that are placed there are pills,” he says.
This is harder than it sounds. The app then matches the drugs against a massive repository of identifying data.
“We measure pills to within a tenth of a millimetre. We can interpret over 240,000 shades of colour, and then we read the imprints with some very sophisticated custom-built character recognition technology.”
Each pill requires a minimum of 60 images (capsules over 100) drawn from the collections of academic medical centres, hospitals and pharmacy distributors.
The app also learns as more images are taken in the field. The pictures are sent back to the Snap Lab – a team of pharmacy students and pharmacists – to be analysed.
Accuracy is vital, and the company claims the recognition rate is well over 99%.
A version of the app aimed at patients, MedSnap PT is due to be launched in early 2014, and there are plans to use the technology to detect supply chain errors and counterfeit medications.
“Medications are miracles, they allow us to live longer,” says Dr Hymel.
“They allow people with many chronic health problems to live independently. But the flip side of that is they can also cause harm.”