Smart Pills Can Tell Your Doctor That You’ve Taken Them

We have many kinds of pills available these days to treat all kinds of different disorders. Of course, the problem with pills is that they don’t work if you don’t take them. Even Worse, for some medicines, missing a dose can cause all kinds of undesirable withdrawl effects and set back a patient’s treatment.

Smart pills aim to fix this problem with a simple monitoring solution that can tell when a patient has taken their medication. They’re now publicly available and authorized for use, so let’s look at how they work.

They’re Putting Microchips In The Pills Now (Really!)

The development of the smart pill is very much a product of miniaturization. Modern electronics has advanced to the point where tiny sensors can be created in a size small enough to embed in a single pill.

Proteus Digital Health developed the Abilify MyCite system with Otsaka America Pharmaceutical. Proteus later went bankrupt, though also developed smart pill solutions to treat other diseases like tuberculosis. Credit: via Internet Archive.

Perhaps the most well-known example is the medication known as Abilify MyCite, approved by the FDA in 2017. It’s a treatment that consists of an aripiprazole tablet with an included sensor that helps determine when a patient has taken the pill. The mechanism of action is ingenious. A tiny CMOS circuit is placed in the pill, along with a primitive battery cell. The battery cell is made up of magnesium and copper chloride. It is activated and releases its energy when the pill is in the presence of stomach acid, powering the CMOS circuit which sends a low-power modulated signal at a frequency of between 10 and 30 KHz, at a rate of approximately two packets per second. The signal is then picked up by a patch worn on the body, which sends a ping to a paired smartphone or tablet over standard Bluetooth. The components that make up the sensor are either harmlessly processed by the body or passed out as waste, with the sensor itself roughly the size of a grain of sand.

The system allows a smartphone to log when the patient takes a pill, updating the patient’s own records and sharing them with medical personnel. It also allows reminders to be sent if the patient forgets a dose, for example. By taking an automatic log, the system can help patients that may have issues remembering to take their medication. It can also alert doctors early in the case that a patient is missing their regular doses.

In the case of the Abilify MyCite pill, the medication involved is an ayptical antipsychotic drug by the technical name of aripiprazole. It’s primarily used as a treatment for conditions like schizophrenia, bipolar disorder, and obsessive-compulsive disorder. It’s a medication that can have negative withdrawl effects. The conditions it is intended to treat are also those that often come with issues around forgetting to take medications regularly. Thus, on paper, a system to track patients taking such a medication would appear to be a great tool to avoid negative outcomes.

Despite this, the Abilify MyCite monitoring system has raised significant concerns around patient privacy and safety. To ease this, thus far, patients using the system must sign consent forms allowing doctors or family members to monitor the system. The smartphone app will also allow the patient to block the sharing of this data at will.

Alternative solutions for those who can’t regularly take pills include long-lasting “depot” injections. These can be uncomfortable, but last for up to a month with a single dose. Credit: WhispyHistory, CC-BY-SA-4.0

However, there are concerns that such technology will enable more invasive activity from the healthcare system. Insurers could theoretically require such systems for patients requesting certain medications, and penalize those that don’t comply with their treatment scheme. Similarly, patients on release from psychiatric care could be threatened with involuntary admission for not adhering to their prescribed dose schedule. This comes with the risk that a malfunctioning pill or sensor patch could unfairly punish even “compliant” patients. Even worse, conditions like schizophrenia often come with symptoms of paranoia, particularly around surveillance and technology. Literally putting microchips into the pills to treat the condition won’t help in that regard.

There are also questions around whether or not the system will actually help patients to take their medications more regularly. Typically, medical professionals talk in terms of “patient compliance” with treatment. However, the sensors aren’t a sure-fire solution to this. Some have noted that patients could induce vomiting after taking the medicine in an attempt to fool the system. Alternatively, it’s plausible that dropping a pill into something approximating stomach acid may also trigger the chip inside to send a positive signal. Notably, the FDA notes from 2017 admit that the system hasn’t been proven to “improve patient compliance with their treatment regimen.”

Overall, smart pills are an amazing piece of medical engineering. Being able to sense when a pill has been ingested in a non-invasive manner is an impressive technological feat. As with so many new developments, though, there are heavy ethical concerns to contend with. Expect smart pills and their usage to become a shifting battleground between doctors, patients, and insurance companies in the years to come.

50 thoughts on “Smart Pills Can Tell Your Doctor That You’ve Taken Them

  1. Nope.
    Nope, nope, nope, nope, nope.

    As someone with chronic pain, I can see how this could easily be turned against a patient who needs medications that other people regard as controversial (opiates, for example). Will we have to walk through pill sensors at the airport, and will anyone testing positive get kicked off their flight for being “a danger to those around them”? How about police checking for the presence of medications without regard to whether or not they actually impair the driver?

    The last thing ANYONE needs is garbage tech like this. At what point do we stop trying to monitor people and start letting them mind their own business?

      1. Opiates were the first real long term treatments available. And they are the preferred “end of life” pain medication; term means “care more about the patient’s wellbeing than long term effects, because long term isn’t that long.” but it does not mean “death is imminent”,

        So what are your great long term therapies? Nerve blocks, NSAIDs, Tylenol?

        1. Thank you, [Quin]. I wish those sorts of things actually worked for me.
          I love how any mention of opiates brings out people who think that they are inherently evil and have no place in modern medicine. To those people I would ask them, If you suffered in constant debilitating pain, would you give up an effective, inexpensive, and functional treatment just because an uniformed part of the population thinks it’s immoral somehow?

          1. “Oh absolutely, I mean it would be so uncivilized to make my life less horrible with such stuff…” (read in the most upper class snobbish voice you can imagine – I actually agree with you)

            That said I wouldn’t want to touch opiates myself if less addictive and dangerous options are available and actually works – progress on which is largely good. Though when I have/had (been a while, long may it continue to be absent) my really bad months I found almost nothing even touched the pain… At which point whatever works, even if you know its going to kill you many years early you will do your very best to leap at like a pouncing cat…

            Such prolonged bad pain is a fate so nasty those that haven’t ever had a real taste of it can’t really imagine, and beyond just the pain there is the fatigue being in such pain creates… Its been long enough without a dip that low for me I know I don’t really remember how bad it was, just well enough to know I never ever want to go back to it.

    1. Thank you for your common sense take. As someone who has been offered a depot injection for a course of antipsychotics I didn’t appreciate being treated like a criminal, so i went with the tablets.
      Later on I found the side effects to be excruciating (akathisia, burning nerve pain) so I tapered off against medical advice. I did inform the doctor of what i did when i was ready.
      I can understand the difficulty of treating bipolar disorder though.
      When i was in a ward a nurse checked underneath my tongue to see had i swallowed the tablet. That is the old school method of verifying dosage.
      A patient should be able to trust their doctor and discuss illegal matters such as drug habits, in order to tailor their care. this information should not be passed to the police, or the system of trust breaks down, leading to lives being lost through suicide from lack of support, or police brutality.

    2. Actually I expect the insurance companies to be the first ones outside of doctors to take advantage of this. I mean, look at auto insurance, where they’ll give you a discount for voluntarily monitoring your driving habits…

        1. I agree. At the WEF meeting in Davos, a rep from big pharma said that they had this pill technology. The next statement was, “Imagine the compliance.” Wow, now that’s a telling statement.

        1. They can hardly keep from wetting themselves at the prospect. The absolute dystopia most people are sleepwalking into, and taking the alert ones with them. Why, we have one right in this very thread! Named ‘Gravis’.

  2. If your pharmacy uses Express Scripps to handle their billing back to your insurance, and a tremendous number do, then the prescriber gets a message when you don’t buy a refill on time. I suspect that holds for many or all back office providers. The “smart pill” does cut the latency dramatically. Antipsychotics show up not infrequently in “court supervised therapy”. Tuberculosis is mentioned, and that one frequently involves “directly observed therapy”, i.e. a nurse has to watch you take your pills every morning.

  3. There are some days that I would really need this. I am sometimes quite forgetful and it would be nice to have something that is pestering me until I have taken my medication.
    Luckily my medication is not essential to my survival so it would be to expensive to include in my pills.
    My point is that people with bad memory/dementia could really use this to remember to take their medication.

    1. Although we could all think of one niche helpful situation for an overall bad idea, it doesn’t make it a good idea.

      If your memory is bad, what happens between taking the medication and it confirming that you took it? Do you take it again because it hasn’t confirmed yet…and when you forget again..? What happens if it just stops telling you that you took the medication because you took some antacids?

  4. Please don’t start with the panicked imaginations. First, the pills don’t broadcast anything until their internal batteries are energized by stomach acid. They’re not going to ping an airport sensor while they’re in your suitcase, or respond to war driving.

    They’re very low power inefficient transmitters. Not that they can’t be made better, but these aren’t yet. They have to be received by a patch worn on the body, which then retransmits the info to a cell phone or bluetooth device. If you want to be concerned about security start with the Bluetooth signal, the phone software, and the service it contacts, because those points are where the system is likely to be compromised.

    Finally, not every use is unwanted. I’d love a reminder that could tell me that I’ve forgotten to take my evening pills. Not that I would track such things for my doctor or insurance company, just that I don’t want to miss a dose so *I* don’t suffer as a result of missing it.

    I’m fortunate that I don’t suffer from the disorders that this particular pill treats. If I was, I’m not sure if I’d recognize the pills’ help or not. But treating mental illness with antipsychotic medicines is a really tricky business, and if this helps patient outcomes, it’s a good thing.

    1. Digital surveillance is a thing which happens by many small iterations. So yes, panicked imaginations are warranted. For instance, if you traveled back to 1992 and told people about the incursions into our lives that we take for granted today, they would fall into a paroxysm of horror. The creep is slow, and people are abused according to their tolerance for putting up with it.

      We don’t need pills with digital transmitters in them of any kind. You don’t just address the immediate nature of an advancement—you ask what the next iteration is. How it will develop from there once this is normalized and expected. If you were a taxi driver or hotelier a couple decades ago, would you look at a cell phone and say “oh, well it’s just a phone with no wires.. no big deal?” Yeah, probably. And then look at what that tool did to their industry. These things mutate and extend into unbidden uses with far-reaching consequences.

        1. Slippery slope arguments are not universally fallacious. Any rebuttal citing ‘slippery slope’ must either demonstrate the fallacy in the original argument, or admit to the fallacy in its own argument. The ball’s in your court…

  5. No UN troops needed. “For the safety of others” you will simply be prevented from getting a job, getting health care, getting an education or going out in public to buy food. Damn I miss 1983 err 2019.

      1. Keep being right about the future? Conspiracy theorists have a better chance of being struck by lightning than actually being correct about any of the BS they believe. If you disagree then you should go look into what those wackos believe.

        1. I dunno – a lot of us who were warning about privacy abuses in Facebook’s and Google’s early days were branded Conspiracy Theorists. Amazingly, the abuse is no longer considered a theory, and is widely recognized as a fact.

          Similar examples abound. Perhaps you should reconsider your “broad strokes” approach and try a narrower brush with subtler technique.

          1. Not only are these abuses “confirmed fact,” most of the public seem not to care and keep using google and facebook. The authorities also seem reluctant to punish the offenders. It sucks.

        2. Plenty of ‘Conspiracy theorists’, or at least folks branded as that are proved correct eventually, just as plenty of leading lights of science are eventually proved wrong – just because there are some loud mouths who are really disconnected from reality doesn’t mean everyone saying unpopular things is.

  6. “The conditions it is intended to treat are also those that often come with issues around forgetting to take medications regularly”

    It’s worse. In schizophrenia there is often a pronounced lack of disease awareness, resulting in patients refusing to take their medication. Also, the paranoid delusions that often accompany schizophrenia may make them think that efforts to make them take medication are plots to poison or control them.

  7. There is waaay too much panicking over this technology. The signal is so obscenely weak that it needs to be picked up by a patch that you have to wear, presumably on the dermis closest to your stomach. The whole, “reporting to your doctor” angle is shitty one. How about it just reminds you on your smartphone if you miss it by preset times?

    Seriously, this technology barely works and is rudimentary to circumvent. Panic is completely unwarranted.

    1. I don’t know about that, but I suspect there will be hackers ‘filtering’ wastewater streams to find and repurpose those microcontrollers. And then there will be a HaD thread about the best locations and techniques for reclaiming and sterilizing them!

    2. At the really tiny size its just a grain of surprising pure mineral sand. Will be completely irrelevant as the waste water is always full of fine particulates, some of them rather more hostile to be removing than what amounts to sand.

  8. A technology that in reality, although not officially, is intended for abuse. Not “having a risk of”, but actually being intended for furthering dystopia. You can’t change my mind on that.

Leave a Reply

Please be kind and respectful to help make the comments section excellent. (Comment Policy)

This site uses Akismet to reduce spam. Learn how your comment data is processed.