“Selfie medicine” could help people take their pills, but it could also be dangerous

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One of the most frustrating problems in medicine is that up to half of patients do not take their medications properly. Researchers are now studying whether requiring patients to upload videos of them taking pills can solve this problem. And although some results are promising, the initiative is the latest attempt at a technological solution fraught with concerns about privacy, access and interactions with doctors.
Today, The Associated Press reported on the so-called selfie medicine, phone apps that push people to take their pills. The patient opens the application and takes a video of the ingestion of the pills. The video then goes to someone at a clinic responsible for monitoring the patient. This is "already a daily routine" for tuberculosis patients in several cities, according to AP, and is saving Houston $ 100,000 per year. (There, it replaces a system where nurses go to a patient's home to see that they are taking their medications.) The intervention is being used for opiate addiction at a Tennessee clinic and other scientists are investigating whether it will work for the treatment of hepatitis C.
Selfie Medicine is trying to solve a major problem. Estimates suggest that people do not complete medication cycles 25 to 50 percent of the time. Other research suggests that not taking the medication properly, called nonadherence, can cause more than 100,000 deaths per year. There is a lot to do and a lot of money to do to correct these behaviors, but we must be aware of the importance of keeping the data safe, respecting civil liberties and the fact that similar solutions in the past have failed.
When it comes to privacy, of course, some people may not feel comfortable taking a daily video of the pills. But the biggest problem with all these electronic monitoring devices is the risk of damaging the privacy of the patient, such as if there is a violation of medical data.
At this time, selfie medicine is used to treat tuberculosis and hepatitis, but it could be applied to any medication, including medications for mental illness and disabilities. Last November, the US Food and Drug Administration. UU He approved an antipsychotic medication called Abilify MyCite. The "digital pill" MyCite has a sensor that tracks if the patient took it and sends that information to others. This, disability journalist David Perry wrote in Pacific Standard, can make it easier to force medication on people against their will, and threaten the civil liberties of people with mental health problems. "People with psychiatric disabilities, especially the poor and vulnerable, are too often forced to choose between mandatory compliance and basic freedom," Perry writes. "MyCite makes it easier to demand that people give up their privacy to adjust to some artificial idea of ​​the normal."
Another concern is what will happen if someone does not upload the video every day. Everything we know about behavior change suggests that you need external responsibility and consequences to make something happen. That's why a third of people who buy fitness devices stop using them after six months. Just trusting someone to know that they "should" take their selfie will not work anymore than knowing that "we should" exercise every day. But what happens if patients do not follow the instructions?
"It's time for real serum," Arthur Caplan, a bioethicist at Langone Medical Center at New York University, told the Chicago Tribune about Abilify last year. "Will the doctor start shouting at me? Will I receive a big accusatory speech? How will that interaction be handled?" It is also possible to imagine a scenario in which insurers will not pay for medications unless patients take it correctly. said Carolyn Neuhaus, a medical ethics specialist at the Hastings Center in New York.
Ease of use is a concern, too. Many people who need medication are older people, and some of them may not feel comfortable with the technology. For example, they may have vision problems, find the application difficult to navigate or have difficulty recording videos. The elderly population is a growing business opportunity, but all too often, people are creating solutions that the elderly will not use. For example, a company at CES this year, LiliSmart, created a watch for people with dementia. He vibrated and showed a picture of a pill to remind the patient to take his pill. But as the dementia gets worse, patients may forget to use the watch anyway.
There is an approach that has been repeatedly proven to work: make medicines cheaper. (Other research, however, has shown that making drugs free can also fail). But there is also a cemetery of failed attempts to correct the lack of adherence. An analysis of studies of "reminder packs", such as the containers of pills that have days of the week in them, showed that they work only a little.
Electronic methods are not much better. In a recent study published in the Journal of the American Medical Association, scientists randomly assigned more than 1,500 people (all of whom had heart attacks recently) to two groups. A group was the control. The other was given special electronic vials to control his medication. Their families were notified if they did not take the pills and were asked to provide social support. These people were even eligible to receive money if they took the pills, and worked with the staff that monitored them. The result? Adherence to the medication was the same between the two groups. The amount of time until they were hospitalized again was also the same.
None of this means that we should completely abandon self-medication medicine as one of the many possible solutions. But we must bear in mind that this is potentially dangerous, and there are many ways in which well-intentioned monitoring technologies can be abandoned or abused. If electronic monitoring becomes widespread, we will have to push for stricter regulations to protect privacy and the interactions between the patient and the doctor. And we must realize that there are many different reasons why people do not take their medications, and not all should be eliminated with technology.

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