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A Smart Pillbox To Improve Medication Compliance

kdawson posted more than 6 years ago | from the you-talkin-to-me dept.

Medicine 145

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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145 comments

And How Does The Pillbox Know... (5, Insightful)

Nom du Keyboard (633989) | more than 6 years ago | (#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:And How Does The Pillbox Know... (2, Insightful)

gotzero (1177159) | more than 6 years ago | (#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...

Re:And How Does The Pillbox Know... (2, Insightful)

Original Replica (908688) | more than 6 years ago | (#22363346)

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]

Re:And How Does The Pillbox Know... (1)

brianosaurus (48471) | more than 6 years ago | (#22364528)

My problems is more one of forgetfulness than thinking I know better than the doctor. I keep taking the pills (well, in theory anyway...) after I start feeling better, until the end of the 10 or 14 day (or whatever) course. I start feeling better in the first few days because the antibiotics start to knock out the virus and my body can begin functioning normally.

The virus is still multiplying and trying to do its thing, but the antibiotics are keeping it down below the threshold that my body can tolerate. If I take away the antibiotics right when I start to feel good, the virus just has to spread a little bit to knock me out again. So instead I keep taking the pills as prescribed and overload the virus until its gone.

That's the theory anyway. In practice I don't take anything on a regular basis, so when I get sick enough to go to the doctor, and I get a presciption it is not part of my routine; its something new. When I wake up in the morning feeling groggy, I don't always remember to take the pill. If I'm not home in the evening to take another with dinner, I usually don't remember to take it when I get home. At the end of the course I'll have at least half a dozen extras, and then I don't know if I should try to finish them off over the next few days or do I timeout on the 10 days and stop? Ugh.

I'm much better about giving my pets their prescribed medications than I am myself. But still not perfect.

Re:And How Does The Pillbox Know... (1)

JavaManJim (946878) | more than 6 years ago | (#22364634)

Hmm medical update. A virus is a virus and typically does not have an easy "pill type" cure. Antibiotics are targeted toward bacterial infections.

Jim

Re:And How Does The Pillbox Know... Wrong pills. (1)

Herschel Cohen (568) | more than 6 years ago | (#22364878)

... 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 virusesis 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 ...
You are a bit confused, it would be better to skip the regime entirely, since antibiotics attack bacteria and are ineffective against viruses. What I think you meant, was that a bacterial infection is unusually comprised of differing populations. Those killed off by a partial dose leaves only the most resistant to grow unimpeded by the presence of the usually more rapid growing, but less resistant strains. Partial dosage cultivates those resistant bacteria (not viruses). Meaning these cells have a differing metabolism from their more frail kin.

Bacteria are living single cell organisms whereas a virus is a particle containing a strand of viral DNA (they are larger) or RNA (much smaller and sometimes more deadly). Furthermore, the viral coat is a set of tight fitting protein molecules that protect the D/RNA payload. In addition, there is a mechanical structure to inject its code into the host cell. A virus exists at the edge of what is usually defined as a living system. It can only reproduce by taking over the machinery of an infected host that is then converted to spew out new copies of viral particles. Those may lie dormant for extended periods or in worse cases suffer irreversible damage that makes the new particles unable to infect new hosts. Others that remain infectious can carry new markers on the outer protein coat making them less liable to the host's immune response. There are still very few good anti-viral pharmaceuticals, and those tend not to have a broad range of effectiveness. Vaccination tends to be the more effective means to combat viral infections, however, in a rapidly mutating virus, albeit a frail one, e.g. HIV, with an insidious infection mode finding an effective vaccine can be a frustrating endeavor. Moreover, that vaccine will likely never meet the level of effectiveness sought in other common diseases.

Very different creatures. Indeed one is and the other perhaps should not even be characterized as such.

Re:And How Does The Pillbox Know... (1)

causality (777677) | more than 6 years ago | (#22363652)

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.

Any halfway decent doctor will also tell the patient that they need to completely follow the instructions given them along with whatever prescription they are taking. If someone disregards their doctor's medical advice and suffers as a result, I'm really not sure what they were expecting or what there is to complain about. This situation is not broken, nor does it have a victim. What's the point in even going to a doctor if you (very unwisely) think you know more about medicine than they do?

I foresee a silly objection, so I'll say that this entire question obviously wouldn't apply in the case of people who cannot be expected to follow instructions (say, an Alzheimer's patient) and other arrangements would have to be made.

That said, I think a huge proportion of prescribed drugs are unnecessary, and that practice should be looked into more...

If we're going to make an effort to change anything, this would be a much more worthy target. Truly unnecessary medications would have implications that can directly and indirectly affect nearly everyone. Since you are supposed to go to your doctor for a diagnosis and let them advise the best way to treat your condition, getting rid of the commercials and other advertisements that market prescription drugs directly to the public would be a good first step.

Re:And How Does The Pillbox Know... (0)

Anonymous Coward | more than 6 years ago | (#22363828)

This is true.
I suffer from depression, and have been prescribed fluoxitine (Prozac) a number of times. I stopped taking the meds once I "felt better", but a couple months later I was back in the GPs office listening to him say that "while you felt fine when you stopped the medication, it requires a further few months to have a lasting effect."

Re:And How Does The Pillbox Know... (1)

stranger_to_himself (1132241) | more than 6 years ago | (#22364630)

I foresee a silly objection, so I'll say that this entire question obviously wouldn't apply in the case of people who cannot be expected to follow instructions (say, an Alzheimer's patient) and other arrangements would have to be made.

Although I broadly agree with you, there are an awful lot of people who find it difficult to comply properly with their meds, not just Alzheimer's patients. Particularly older people, who are taking maybe ten or so different meds, all from identical looking bottles with badly printed labels, with pills that can also look very much alike. So you've got the weekly pill that if taken daily will kill you next to the five times per day pill, and you have to be some kind of pharmacist to tell them apart. Combine that with a mild memory problem (which is very common), bad eyesight, or questionable literacy, and you have a recipe for disaster that is at present causing a lot of harm.

Re:And How Does The Pillbox Know... (5, Funny)

dotancohen (1015143) | more than 6 years ago | (#22362912)

And how does the pillbox know that you actually took the pill
It should wear a condom if it's not sure.

Unicorns (1)

milsoRgen (1016505) | more than 6 years ago | (#22362916)

Or what if you take the pill out intending to take it, but due to arthritis (or the shakes) you drop it, and then due to dementia you forgot what you were doing to begin with... Box wouldn't know what became of the pill.

A Smart box (2, Insightful)

mangu (126918) | more than 6 years ago | (#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.

Re:And How Does The Pillbox Know... (5, Insightful)

truesaer (135079) | more than 6 years ago | (#22362954)

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.

Re:And How Does The Pillbox Know... (1)

gmack (197796) | more than 6 years ago | (#22363122)

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.

Re:And How Does The Pillbox Know... (1)

Adambomb (118938) | more than 6 years ago | (#22363288)

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".

Re:And How Does The Pillbox Know... (1)

mi (197448) | more than 6 years ago | (#22363412)

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 "nonadherents"...

THX-1138 is here! (1)

goombah99 (560566) | more than 6 years ago | (#22364638)

Old folks will recall that the plot of THX-1138 revolved around Criminal Drug Evasion.

There have been proposals for criminal control outside prisons through the use of mood altering drugs. Fun shit like Thorazine that reduces your atention span to less than the guy in Memento, so basically you can't get in to mischief because you'll get completely bored an move on before any harm happens.

The sick part of these proposals were to use RFID labeled pills, so that a relative simple compliance monitoring device could determine if the pill was inside you versus just inside your pocket or in the trash can.

In other words THX-1138. Busted for drug evasion.

Re:And How Does The Pillbox Know... (1)

John3 (85454) | more than 6 years ago | (#22363008)

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

Re:And How Does The Pillbox Know... (1)

4D6963 (933028) | more than 6 years ago | (#22363044)

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:And How Does The Pillbox Know... (1, Insightful)

Dunbal (464142) | more than 6 years ago | (#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".

Re:And How Does The Pillbox Know... (1)

Kaki Nix Sain (124686) | more than 6 years ago | (#22363310)

And how does it know I'm double-dosing, as opposed to needing another one because I dropped the first behind the cabinet (again)?

uhh (1)

deathtopaulw (1032050) | more than 6 years ago | (#22362876)

Unless a court has ordered it, you can't be forced to take your medicine. Pretty much all they can do is bad vibe you. This is a terrifying little idea because I could easily see the insurance companies lobbying for laws requiring that you take medication.......

Re:uhh (1)

mangu (126918) | more than 6 years ago | (#22363468)

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?

Re:uhh (1)

ScrewMaster (602015) | more than 6 years ago | (#22363524)

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?

Re:uhh (1)

esper (11644) | more than 6 years ago | (#22363612)

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:uhh (2, Interesting)

bzipitidoo (647217) | more than 6 years ago | (#22363940)

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't buying what they aren't taking.

Re:uhh (1)

mangu (126918) | more than 6 years ago | (#22364036)

Because we don't know what is best. MDs are hardly infallible

OK, I see your point, and the two others who answered my post. But then, why pay insurance? If you think grapefruit will make you well, good for you, but why do you have to pay an insurance company to eat grapefruit?


If you are paying an insurance company to get medical treatment, they *will* give you the treatment you paid for. However, if you prefer some "alternative" form of treatment, then why the f**k do you need an insurance company?


Well, you may be among those who make their living from medical malpractice suits. THEN I can understand you may not be willing to take the medicine the doctors prescribed you.

Re:uhh (1)

MttJocy (873799) | more than 6 years ago | (#22366020)

It seams you completely failed to understand the point re grapefruit, grapefruit juice has an effect on a multitude of liver enzymes (inducers of some, inhibitors of others some strongly), opiate drugs in particular are heavily effected by it, although many other classes are too, for instance with any opiate bar codeine grapefruit will greatly increase the potency and duration of the drug, with codeine it will reduce the effect of the drug to practically 0. Other foods also can have similar effects, and can cause anything from sudden side effects making the drug intolerable for the patient, or even worse (grapefruit and a strong opiate can lead to dangerous overdose plasma levels of opiate). Thus doctors cannot know everything, they do not take a full dietary history with every prescription even if they did the science of pharmacology does not know all the chemicals or foods that can affect the pharmoknetics of all drugs not to mention the problems of individual biological variance as well. It is perfectly understandable why some people may choose to stop taking a medication prescribed to them where they suffer side effects which are worse than the condition it is intended to treat ("The cure is worse than the disease" to quote a phrase).

Re:uhh (1)

syousef (465911) | more than 6 years ago | (#22364166)

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?

1. Some doctors are complete idiots. I've had one doctor who'd only met me for the first time suggest stomach stapling in the first 10 minutes of the visit for high blood pressure (I wasn't on blood pressure meds and he didn't suggest them until i brought up the possibility. Apparently if you're overweight he thinks a stomach stapling is better than blood pressure meds as a first line defence against high blood pressure). Yes I'm overweight, but no not enough to make this appropriate. The same doctor was unable to clear my ear of earwax and I had to go back to my regular doctor a couple of days later because my ear had actually been more thoroughly clogged. Not my only horror story with doctors just my most recent. My wife has been told to take increasing dosages of medication for seizures that was actually causing them (3 doctors upped the dosage despite contraindicaitons being, you guessed it seizures). Don't get me started on doctors that can't even tell if a shoulder is dislocated because it's posterior not anterior.

Don't get me wrong. A good doctor may save your life literally. (Unfortunately bad doctor will kill you literally)

In other words don't assume that any doctor will know or care what is best for the patient. Taking away a patient's right to self-determination and placing it in the hands of a badly flawed medical establishment is a violation of human rights.

2. There is a lot of very bad medicine out there with very bad side effects. A contra-indication is a condition that, if it occurs, means you should stop taking the medicine as soon as possible (some medications have very bad side effects if you quit cold turkey). How do you tell if a patient is pinged for compliance because they've stopped taking the medication when its the right thing to do or not?

Re:uhh (1)

orangesquid (79734) | more than 6 years ago | (#22365920)

A good doctor will admit when he/she needs to consult another doctor, or refer you to someone who understands your particular situation better. I've met a few excellent doctors. Some of the best doctors I've ever met have said things you'd "never want to hear a doctor say," like
(1) Wow, that's interesting. I want to show this to some of my buddies, hold on...
(2) I'll be damned if I knew why that was happening!
(3) I don't really know. What do *you* think is going on?

People expect doctors to be gods. The placebo effect (which accounts for part of the medical establishment's income, and can probably never be completely eliminated) depends largely (in our society, at the current time) on doctors having somewhat inflated egos. In other words, the problem is just as much the patients as it is the doctors.

The doctor-patient relationship works best when there *is* one---when there is an exchange of information, resulting in a solution (or at least progress). I've (unfortunately) met a few doctors who would would just look me over and hand me a prescription, without asking me what was wrong!

Knowledge is most effectively used when its limitations are carefully observed; beyond that, extrapolate carefully, experiment inventively, and document everything extensively.

Re:uhh (0)

Anonymous Coward | more than 6 years ago | (#22364722)

That is not what Law is for.

Good (1, Redundant)

mastershake_phd (1050150) | more than 6 years ago | (#22362894)

Maybe this will stop certain people I know from taking others unused antibiotics when they get a cold. Much easier than unsuccessfully trying to explain the difference between viruses and bacteria.

Re:Good (1)

fbjon (692006) | more than 6 years ago | (#22364012)

Easier: return unused antibiotics to the pharmacy. And also, unused antibiotics should be an exception. Either you take all the medicine as prescribed, or you have a problem with the medicine, and the doctor says you can stop. Patients don't get to decide when they've recovered, especially with antibiotics.

Re:Good (2, Informative)

ScrewMaster (602015) | more than 6 years ago | (#22364486)

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

Costs ? (2, Insightful)

Romwell (873455) | more than 6 years ago | (#22362904)

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

Re:Costs ? (0)

Anonymous Coward | more than 6 years ago | (#22362982)

In the case of the healthcare system no (this is money it spends out of a theoretically fixed budget), but in the case of the pharmaceutical industry yes (this is extra money we give them).

Re:Costs ? (1)

4D6963 (933028) | more than 6 years ago | (#22363014)

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 ? (4, Insightful)

gEvil (beta) (945888) | more than 6 years ago | (#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".

Re:Costs ? (2, Insightful)

Captain Vittles (1096015) | more than 6 years ago | (#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.

100 billion? Really? Just take your meds. (1)

v(*_*)vvvv (233078) | more than 6 years ago | (#22362948)

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.

In response to:

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

Re:100 billion? Really? Just take your meds. (2, Insightful)

stranger_to_himself (1132241) | more than 6 years ago | (#22363052)

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.

Re:100 billion? Really? Just take your meds. (1)

gmack (197796) | more than 6 years ago | (#22363260)

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 meds? Heart attack. If that doesn't kill you they will spend inordinate amounts of time treating the problem and it's permanent affects on your body

Daily Asthma meds require a certain amount to be in the bloodstream to work so if you forget them you end up with an attack that just doesn't go away no matter how much ventolin you take

Insulin prevents long term damage to the body that an abnormal blood sugar level causes

I can go on but I think I've made my point. Many problems are much less life threatening (and cheaper to deal with) if properly medicated.

I'd love something that works (3, Insightful)

LearnToSpell (694184) | more than 6 years ago | (#22362950)

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.

I'd love something that nags. (0)

Anonymous Coward | more than 6 years ago | (#22365312)

Twice a day? Lucky you, I have to do it all through the day and heaven help me if she doesn't want to take it. $21/day isn't bad since Medicare picks up the tab.

Soon.. (1)

rdradar (1110795) | more than 6 years ago | (#22362970)

Soon we have machines bitching about our eating, drinking, oversleeping, computing.. And those machines are controlled by corporations and run "without costs" with advertising. Advertising that MAKES you go out and buy. Oh I cant wait!

Re:Soon.. (1)

Shados (741919) | more than 6 years ago | (#22363068)

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.

Probably Third-World Only (2, Insightful)

lobiusmoop (305328) | more than 6 years ago | (#22362974)

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.

Doubtful (1)

dreamchaser (49529) | more than 6 years ago | (#22363116)

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.

Re:Probably Third-World Only (1)

fastest fascist (1086001) | more than 6 years ago | (#22363480)

What do you need a smart dispenser for when you lack the meds you need to fill it with?

Re:Probably Third-World Only (2, Interesting)

ScrewMaster (602015) | more than 6 years ago | (#22363606)

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.

I feel bad saying it (2, Insightful)

Joe Tie. (567096) | more than 6 years ago | (#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:I feel bad saying it (3, Insightful)

pete-classic (75983) | more than 6 years ago | (#22363206)

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

Re:I feel bad saying it (1)

bill_mcgonigle (4333) | more than 6 years ago | (#22366148)

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?

so the only way to really measure compliance here is to do a urine check every few days while on the 'scrip - and assign people ratings based on their historical compliance and base treatment in the future on stats ... you willing to go there?

Re:I feel bad saying it (1)

quanticle (843097) | more than 6 years ago | (#22364394)

I wouldn't for any adult not suffering from a mental disorder.

That's one of the populations that researchers are trying to help with this device. There are a large number of elderly out there who are suffering from mild to moderate dementia and neurological problems. Current practice is to check up on them on a frequent basis and remind them verbally to take their medications. An automated reminder system would help this system considerably.

Re:I feel bad saying it (1)

wwahammy (765566) | more than 6 years ago | (#22364838)

Oh don't worry, 47 million people in the US already know they don't deserve modern healthcare.

Preventing double-dosing (1)

erick99 (743982) | more than 6 years ago | (#22362978)

To alert the patient that it's time to take the medicine, the box flashes its lights and sounds a buzzer. When the compartment is opened, the uBox records the exact time and prevents double-dosing by refusing to open again until the next treatment is due.

I like that it can prevent double-dosing. Not only do some forgetful folks miss a dose, they sometimes take that dose multiple times because they believe, each time, that this is there first dose.

And this is better how? (2, Insightful)

nurb432 (527695) | more than 6 years ago | (#22363020)

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:And this is better how? (2, Interesting)

SashaMan (263632) | more than 6 years ago | (#22363180)

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 a mistake. In fact it was sort of proof to me that the health care system really isn't interested in making people healthy in that neither her doctor nor pharmacist set up a plan to ensure med compliance. I couldn't see why her pharmacist couldn't just dole out the proper dosages in separate boxes ahead of time.
2. More importantly, the device described in the article could be capable of notifying someone if my grandmother didn't take her meds. That would be a big benefit to my family and is something a simple pill box could never do.

Re:And this is better how? (1)

nurb432 (527695) | more than 6 years ago | (#22363432)

she sounds like she has reached the stage of liability anyway.

Re:And this is better how? (1)

Geste (527302) | more than 6 years ago | (#22363996)

My Dad, age 87, who can no longer read his pill bottles, would still kick your punk ass.

Somebody please mod this jerk down.

Re:And this is better how? (1)

nurb432 (527695) | more than 6 years ago | (#22364170)

Did i comment on age alone? No. I commented on the 'shape' she was in, which could be at any age.

*IF* your dad is still capable of "kicking my punk ass" ( which i honestly doubt, since you would be incapable as well. You know, its its nice to be loyal to family, it can also be misplaced ) then he wouldnt be considered a liability would he?

Re:And this is better how? (1)

MagicDude (727944) | more than 6 years ago | (#22364374)

It is possible to get meds in individual packaging. Some pharmacies will sell medicitaions in blister packaging, so the meds for the morning, afternoon, and evening are in little bubbles that you just burst. If you look around you should find it, more likely in local pharmicies rather than the national chains.

Re:And this is better how? (0)

Anonymous Coward | more than 6 years ago | (#22363254)

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.

My Mom has Alzheimer's. The first symptom for her was inability to remember what day of the week it is. So a passive pillbox by itself doesn't help.

I had thought of trying to build something like this myself, but I'm not that talented. I think it's a good idea.

Re:And this is better how? (1)

physicsphairy (720718) | more than 6 years ago | (#22363266)

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 (5, Informative)

CrystalFalcon (233559) | more than 6 years ago | (#22363084)

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?

Re:Already exists (1)

ColdWetDog (752185) | more than 6 years ago | (#22363202)

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....

Doesn't Solve The Other Problem (1)

humphrm (18130) | more than 6 years ago | (#22363200)

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.

Memory is not the problem. (4, Insightful)

Adambomb (118938) | more than 6 years ago | (#22363226)

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.

Re:Memory is not the problem. (1)

Adambomb (118938) | more than 6 years ago | (#22363236)

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

My apologies to the grammarstapo.

Yes, memory is the problem (0)

Anonymous Coward | more than 6 years ago | (#22363732)

Nothing helps if people refuse to take their pills but for many it's a very real problem to remember to take them. I suffer from epilepsy and must take pills twice a day and despite having done that for over 10 years, I still sometimes forget to take them on time. I have a box that I fill weekly and it has slots morning/evening for every day of the week so I can then check it if I get unsure whether I've remembered to take my pills as I should. I also have my cell phone set to alert me whenever it's time but despite those measures I sometimes have difficulties. It happens quite easily if I'm in a hurry in the morning - e.g. if the pill alarm goes off when I'm in the shower and thus can't take them precisely when it sounds. And in the evenings it has happened simply because I've turned off the alarm when the phone has rang and then been interrupted by something when I was on my way to take the pills from the box. Now, I don't think that this is anything revolutionary but simply having the alarm and the pills in the same location, would be an improvement.

Another issue is that it's a bit troublesome to carry along such a box and thus I have a matchbox-sized one with only one day of pills that I carry with me everywhere and keep the big one at home - an ideal solution would let me check remotely whether I've taken the pills from it or not (some bluetooth thingy in the box that would let me login remotely to my home server and check it that way, or something....). It is an awful feeling when you're unsure whether you've taken the pills and contemplate whether you should go home and check or stay and assume that you have taken them. It may sound like a trivial problem but just imagine if you had to always carry around a ~5x3x1 box with pills just to be able to confirm that you've taken them. And unfortunately it is also true that people react strangely if they seem someone taking or having pills with them. It shouldn't be any of anybody else's business but in practice, I must always visit the bathroom or something similar if I'm not at home at 8 am and 8 pm.

Great, too bad it's illegal (5, Insightful)

AK Marc (707885) | more than 6 years ago | (#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?

Re:Great, too bad it's illegal (1)

Icarus1919 (802533) | more than 6 years ago | (#22363408)

The smart pillbox would most likely be dispensed by the pharmacy, thus rendering it the official bottle. This would be a non-issue.

Re:Great, too bad it's illegal (2, Informative)

Randall311 (866824) | more than 6 years ago | (#22363418)

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.

Re:Great, too bad it's illegal (2, Insightful)

Scrameustache (459504) | more than 6 years ago | (#22363720)

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:Great, too bad it's illegal (1)

IHC Navistar (967161) | more than 6 years ago | (#22363848)

If I was threatened with arrest just for carrying my pills in a daily or weekley pillbox, I would have accused the officer of having a small pecker, told him to blow his charge out his ass, ask him if he really thought his overzealous charge would actually stand up in court, and to arrest me. The resulting lawsuit against him and the department would more than pay for a lifetime of medication, and the officer may even lose his job (the issue would definitely come up in his next performance review).

Every police officer/Sherriff's Deputy I know has much more common sense than make such a stupid accusation. They would definitely be able to understand that it is more prudent (and reasonable) to take the chance that it is just someone wanting to take their meds at the right time, than to bust someone for having pills out of their original container. Also, they should be able to take into acount the situation that the person was found with the pills. Was it a 15 year old with a box full of OxyContin, or an older fellow with a weekly box full of miscellaneous pills in his luggage? Or was it a 30-year old man in good shape, no injuries, with a bottle of Morphine? Which is more suspicious?

Any Judge would understand that having a daily/weekly pillbox to make sure you took the right meds at the right time was more important (but illegal) than carrying them in a bunch of bottles (not illegal) Although what you did was *technically* illegal, the charge would/should be dismissed on the grounds that it violated your rights and was a threat to your health/well-being. What's more serious: Going to the hospital for forgetting to take medications, or not having them in the original bottles?

I know we like to ridicule judges for making outrageously stupid rulings (Here in the U.S.A. it happens all to much), but all but the most incompetent Judges and District Attorneys would dismiss/decline the case/charge. And even if you did lose, it would be overturned almost immediately.

What the officer should have done is check his I.D., checked him for warrants and related priors, and if no warrants or no related priors came up, let him go without further question.

Yet another alarm clock? (1)

polemon (743631) | more than 6 years ago | (#22363296)

Great idea, really. But I forget to take my PDA with me VERY often, and that device is significantly handier, that that robotic pill box; at least, from what I can tell by viewing the images (http://web.mit.edu/newsoffice/2008/itw-india-enlarged.jpg). I don't know how exactly the device works, but it hast to have some sort of battery in it, what happens, when that battery drains? I forget to recharge my PDA about as often as I forget to take it with me... This box may be of great use in the well developed world, where people are used to electronic medical devices, like electronic blood sugar testers, for instance. What if people treat the device like I treat my alarm clock sometimes: Throw it at a wall when I can't find the snooze button. And I guess the box behaves much like an alarm clock...

A technological solution to a behavioral problem? (2, Insightful)

Scrameustache (459504) | more than 6 years ago | (#22363746)

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!

Re:A technological solution to a behavioral proble (0)

Anonymous Coward | more than 6 years ago | (#22365700)

The purpose of such a thing is not to make it impossible to miss pills. The purpose is to make it less likely that those who use the system will miss doses or take extra doses. You might as well argue that alarm clocks aren't worth buying because its possible that people either won't set them or will turn them off and go back to sleep. Nevermind that they work most of the time for most people. Lets focus on everyone else.

Can't afford the pills (0)

Anonymous Coward | more than 6 years ago | (#22363772)

Now if we only had national health care so I could afford the pills...

Fantastic device will be misused (1)

syousef (465911) | more than 6 years ago | (#22363826)

I fear that the way health care operates, this will be used to punish patients who have forgotten to take their pills by refusing them cover for further medication.

"I'm sorry Mr Jones but we can't supply you with more blood pressure medication. It says right here you missed a dose 3 months ago. Now what's the point of giving it to you if you won't take it? Next!"

What about the cost of adherence? (1)

smchris (464899) | more than 6 years ago | (#22363906)

'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.

I assume the latter is not the least concern.

Some quack must have been watching TV and recently put my mother on Vytorin. Pick your favorite Google result on how worthless that drug is.

mod parent up (1)

pimpimpim (811140) | more than 6 years ago | (#22365232)

You have a very valid point. Even more valid than you could imagine.

During my pharmacy study I received the weekly dutch magazine for pharmacists. A professor from my university had a column where he reevaluated case studies from random patients. He studied the pattern of drugs prescribed, knew the illnesses for which these are normally described, found that a lot of drugs were described against side-effects of previous drugs, and in most cases concluded that the 10+ drugs weekly should be replaced by nor more than 2-3 different drugs. If there would be a program that would do this systematically for you, the amount of money saved on both hospital visit because of wrong drug prescriptions and of course the costs of those drugs would be enormous! It would lead to less income for the pharma industries, but the wiser application of their drugs can also lead to less costs in legal and economical damages after their drug has proven dangerous when applied incorrectly. This is a long term win-win situation, but unfortunately no one is interested in doing the short-term investment to actually start such checks.

By the way, this actually made me understand why there is such an intuitive dislike against the roland piquepaille posts. He just places the standard PR messages from companies/universities as news, without taking a single effort of a critical evaluation of the message. It is certainly not journalism. You might call it blogging, I call it ad-farming. Or maybe he honestly believes that every single PR message he receives/reads is completely true,b as innovative as it claims, and faultless.

Already been done (1)

whois_drek (829212) | more than 6 years ago | (#22363966)

Already been done: http://compumed.com/ [compumed.com] Comes with strobe lights for deaf people, audio alerts for blind people, I think it can even phone an emergency contact if the medicine isn't taken--very well thought out. And it's been around for several years.

militarised medicalism (2, Interesting)

squibshaw (1186123) | more than 6 years ago | (#22364020)

when did the medical community begin using military terminology like "medicinal non-compliance?"

Re:militarised medicalism (1)

BC_Man (1236426) | more than 6 years ago | (#22364702)

About the time they started convincing people that people die of Aids, Cancer, Heart Disease, etc, etc. Most people die of bad nutrition and from the use of these medications themselves. I wonder how many people read the warning sheet that actually comes with the medications ? Why are many people abandoning the medical system and doctors, and diagnosing themselves ? This is not dangerous ... it might just save your life.

Other uses... (1)

noidentity (188756) | more than 6 years ago | (#22364194)

I've always thought it would be cool to have a candy box that would limit consumption. How big of a "pill" can this thing handle? And is it hard to break open if one is desperate for some chocolate?

I'd use this. (2, Insightful)

DdJ (10790) | more than 6 years ago | (#22364200)

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.

Sometimes, it's not about you (1)

R3doy (1223454) | more than 6 years ago | (#22364370)

This box could be a great new product, but could be even bigger overseas. Think a place like, oh, Africa. Few people have clocks, and not many can tell time in the remote regions. An automatic dispensing system could potentially revolutionize health care. This, of course, depends on people actually caring about Africa, not just listening to Bono spout off about erasing debt.

Sorry - No dice (1)

nanoakron (234907) | more than 6 years ago | (#22364622)

Intelligent pillboxes are not a new phenomenon, and this will not be the final say on the matter - I should know, I started a company to try to produce one for the UK market.

The patent landscape is littered with numerous attempts to solve the problem of patient compliance with self-administered, even back to the 1960s. They all rely on a similar solution to this one - an intelligent alarm, an internal counter, and some form of interface for either the physician or the patient.

The problems my product was trying to address were these - noone wants to get their packs of medications and then dispense them into some special second device which counts them back out to the patient; and no pharmacist or drug company wants to issue a new pill box for each prescription.

Once these issues are solved, this idea may fly - but I don't think the MIT team are offering anything the marketplace hasn't seen before.

Lies, Damned Lies, and Doctors (1)

BC_Man (1236426) | more than 6 years ago | (#22364822)

There are natural cures for Aids, Cancer, Heart Disease that save life's. This is no secret, but those natural cures won't make Big Pharma huge profits. I'm afraid this is profit above human life .. wake up folks. http://naturalnews.com/ [naturalnews.com]

It's communication skills, stupid (1)

kenrick (888343) | more than 6 years ago | (#22364944)

In my experience with patient concordance to prescriptions (NB: 'concordance' is the new PC term for 'compliance'), patients don't take their medicine because of poor communication on the part of the doctor.

With increasing patient loads, and consequentially reduced consultation times, doctors often don't take enough time to explain why the patient needs to take the medicine, how to take it, and how often. Also, by appearing to be rushed/stressed, doctors don't give patients the opportunity to ask questions about their medication regime.

not in california (1)

mbeckman (645148) | more than 6 years ago | (#22365154)

Unbelievably, the idi0t California legislators made it illegal to carry rx medications in anything other than the original containers they were dispensed in. They probably were off their meds at the time.

I for one... (1)

hyades1 (1149581) | more than 6 years ago | (#22365202)

welcome our new, drug dispensing overlords. Although I'm not quite sure what it says about us when the pillboxes are smarter than we are.

Say what you will... (3, Insightful)

tguyton (1001081) | more than 6 years ago | (#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.
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