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First Digital Pill Approved to Worries About Biomedical ‘Big Brother’ (nytimes.com)
24 points by runesoerensen 30 days ago | hide | past | web | favorite | 24 comments



> First Digital Pill Approved to Worries About Biomedical ‘Big Brother’

Is it just me or does this headline not parse?


Definitely not just you, it’s an awkward phrase with an awkward cadence


It does seem strange to have a schizophrenia medicine as the starting point. Is there a biomedical reason which makes the drug to be digitized well?

> Dr. McQuade said, “We don’t have any data currently to say it will improve adherence,” but will likely study that after sales begin.

Improving adherence is the whole point of a digital drug but they don't have any data?


Prescriptions for schizophrenia medication have a very low compliance rate. Partly because schizophrenic patients are by nature prone to resisting their treatment (due to paranoia, delusions), and partly because antipsychotics are unpleasant to take pretty much all around (I don't know anyone who actively wants LESS dopamine).


They aren’t making novel drugs anymore just novel delivery systems. They can charge 1000x the price per pill.


This is just too much. No way. These people are crazier than the patients.

I mean, ingestible RFID is a conspiracy theory trope.


and in the real world, medication compliance is a serious problem that leads to real life death and suffering. internet trolls and tinfoil hatters can fuck right off.


The juxtaposition of "medication" and "compliance" is horrifying. Let me see. What comes to mind? Alan Turing. Soviet psychiatric diagnoses. Medication that's not voluntary is a human rights violation.


"Compliance" does not mean what you think it means here. In the context of medicine, it doesn't imply coercion any more than the phrase "doctor's orders." It just means "the patient is following the course of treatment prescribed by their doctor."


It means what it means: doing what you're told to do. And there were examples of coercion in the article.

For me, physicians are just service providers. Expert consultants. Contractors. It's my decision to take their advice, or not.


> It means what it means: doing what you're told to do.

It is literally medical jargon for "is the patient following the doctor's advice or not." https://www.wikiwand.com/en/Adherence_(medicine) You said that's "horrifying". Are you honestly saying a doctor shouldn't care if a patient finishes a course of antibiotics, or keeps up with physical therapy that will allow them to walk without pain after an accident, or--in this case--sticks to the pills that stave off paranoid delusions and psychosis?

> For me, physicians are just service providers. Expert consultants. Contractors. It's my decision to take their advice, or not.

No one has said otherwise.


> Are you honestly saying a doctor shouldn't care if a patient ... in this case--sticks to the pills that stave off paranoid delusions and psychosis?

I'm not saying that the doctor shouldn't care. I'm arguing that it's the patient's decision whether or not to take the drugs. Some antipsychotics have serious side effects. Many patients are misdiagnosed. Ideally, patients would tell their doctors that the drugs aren't working for them. But biomedical monitoring is a dystopian SF trope, and it's disconcerting to see it implemented.


What else comes to mind: People who forget their medication and suffer for it.


So there are factors causing suffering and people forget their medication that alleviates that suffering, but the first sane thought in your head should never be 'let's start chipping people and confirm the nightmare scenario of the patients we're supposed to be treating'


---

When it comes to many antipsychotic medications patients suffer from the side effects of taking their medications.

---

So I'm a little curious why an article on monitoring compliance digitally only talks to patients who are very very unlikely to be noncompliant.

Then there's this misstatement:

"Many patients with these conditions do not take medication regularly, often with severe consequences."

These people take this medication daily. They may miss a day or two and not notice. Longer periods, they would notice the slow return of phobias or irrational thoughts and realize they had been missing their medication and start taking it again.

For those admitted to the hospital or having a history of severe mental illnesses:

People wonder why anyone would stop taking the medications and relapse. I have no proof but think the treatment can be worse than the disease.

Schizophrenia: a serious mental illness that interferes with a person's ability to think clearly, manage emotions, make decisions and relate to others.

Now look at the list of side effects of Abilify: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009101/?repor...

These patients are on a cocktail of medications each having a list of potential side effects.

For all areas of health care 20-30% of prescriptions are never filled and half of all medications are not taken as prescribed. https://www.theatlantic.com/health/archive/2012/09/the-289-b...

Factors involved in the high rate of noncompliance in psychiatric patients:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799245/


> So I'm a little curious why an article on monitoring compliance digitally only talks to patients who are very very unlikely to be noncompliant.

Noncompliance is a huge problem with schizophrenia. I'm not sure why you'd think otherwise. Something around 50% of medicated schizophrenics go off their meds. Google <schizophrenia noncompliance>.


Well, maybe ~50% of medicated schizophrenics consider the side effects to be worse than the disorder.

Keeping crazies drugged so they don't bother their caregivers is pretty far down the slope, in my opinion.


Is that really the best reason you can think of to treat schizophrenia? I'd think "so they don't harm themselves or others" might rate a bit higher, just for one example.


Well, harming themselves is pretty much OK.

Harming others isn't OK, of course. But drugging people isn't an acceptable solution. It's prone to overuse and abuse.


> Well, harming themselves is pretty much OK.

Oh. You're trolling.

Sorry for wasting my time.


I am not trolling!

I stand firmly for the non-aggression principle. There's no violence against others in self-harm and suicide. And unrequested intervention is aggression.


There are other ways to deal with that.

But if it's totally voluntary, there's no issue.

What's problematic is coercion. Court-ordered medication. Insurance-mandated medication.


> After several minutes, the signal is detected by a Band-Aid-like patch that must be worn on the left rib cage and replaced after seven days

And who watches the watcher?


I can see this being used in psychiatric hospitals when patients pretend to swallow.




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