"Did you take your medicine today?" Soon, patients won't have to rely on their memories for the answer. Scientists are developing tablets and capsules that track when they've been popped, turning the humble pill into a high-tech monitoring machine.
The goal: new devices to help people take their meds on time and improve the results coming out of clinical trials for new drugs.
Doctors can already prescribe pills that release drugs slowly or at a specific time. They even have camera pills that take snaps of their 20- to 40-foot journey through the gastrointestinal tract. The new pills tote microchips that make them even cleverer: They will report back to a recorder or smart phone exactly what kind and how much medicine has gone down the hatch and landed in the stomach. Someday they may also report on heart rate and other bodily data.
This next generation of pills is all about compliance, as it's termed in doctor-speak -- the tendency of patients to follow their doctors' instructions (or not). According to the World Health Organization, half of patients don't take their pills properly. We skip doses, take the wrong amount at the wrong time or simply ignore prescriptions altogether. In a 2006 survey of 1,000 people by two pharmacist associations, three-quarters of those queried admitted to occasional noncompliance.
Medication misuse can lead to hospitalizations and deaths. Those preventable events cost the healthcare system $100 billion to $300 billion annually, according to a 2009 report by the Pharmaceutical Research and Manufacturers of America.
The most common reason for medication mistakes is forgetfulness, particularly among the elderly -- just the age group, of course, that has to manage multiple medications. "The number of doctors that they have and the number of prescriptions that they get is mind-boggling," says Jill Winters, dean of the Columbia College of Nursing in Milwaukee, Wis., who says she often sees older people come to the ER toting a bag of prescription bottles. According to a 2004 report by the Centers for Disease Control and Prevention and the Merck Institute of Aging and Health, the average 75-year-old takes five different drugs.
Often, occasional lapses don't matter. Smart pills like these are "not for your aspirin or even simple antibiotics," says Maysam Ghovanloo, an electrical engineer at the Georgia Institute of Technology in Atlanta. The new technology is aimed at time-sensitive or costly medications.
For certain medications, not taking every pill can have serious consequences. For example, people who are mentally ill may require regular treatment to stay stable. Chemotherapy drugs and antibiotics for treating tuberculosis are time-sensitive as well.
Blood pressure medication works only when taken on a regular basis, and suddenly stopping it can cause blood pressure to skyrocket, says Daniel Touchette, a pharmacist and researcher at the University of Illinois in Chicago.
With drugs for transplant patients, a person who misses a dose risks rejection of the new organ. Novartis International AG, based in Basel, Switzerland, is developing pills for transplant recipients; the pills communicate with a patch on the skin when they reach the stomach.
And in the case of tuberculosis, which is common in many countries, treatment requires a six-month course of antibiotics that come with side effects such as nausea and heartburn. Many people don't understand why they have to keep taking the unpleasant drugs once they feel better -- but going off the medication can make patients contagious again and allow drug-resistant tuberculosis to develop. Currently, the World Health Organization recommends that healthcare personnel observe patients as they take every dose -- an inconvenience for patients and a burden on healthcare workers.
Yet another arena where compliance is crucial is in clinical drug trials. Drugmakers can only be sure their medicine works if they're sure subjects are actually taking it as directed. For now, experimenters rely on diaries where participants record their medication use. But people may fudge the data, not wanting to admit they dropped a pill down the drain or forgot to take it for a few days. To account for people who miss their meds, drug companies have to spend extra money -- trials cost hundreds of millions of dollars -- for larger trials just so enough people will actually take the drug.
Technology already offers some solutions, with cellphone reminders and pill bottles that record when they're opened. But none of these actually confirm that the medicine has been swallowed.
"You don't know who opened it," Ghovanloo says. "You don't know what is done with the pill."