Last week, the Food and Drug Administration (FDA) approved the use of a computer chip inside of aripiprazole (Abilify) pills. This computer chip is designed to indicate whether the person has taken his or her medication or not. The theory (and marketing push) is that this computer chip will improve treatment adherence (compliance). It will “ensure” people are taking their medications as prescribed. But will a computer chip inside of an antipsychotic really improve medication adherence?
The Computer Chip Inside of Aripiprazole (Abilify)
According to Prakash Masand, MD, the details on the computer chip inside aripiprazole can be described as:
. . . medication embedded with an ingestible sensor, [includes] a wearable sensor (being attached on left costal area on patient’s body), and software applications (mobile computing devices). After ingestion of the medication, the sensor embedded in medication is automatically activated in stomach and then a signal containing adherence-related information is transmitted to a secure cloud-based server via communication between the wearable sensor and the mobile application.
In other words, we are asking patients to wear a sensor on their body and ingest computer chips that talk to it and then to the cloud.
Who wants to sign up first?
Who Is Supposed to Use This Medication-Adherence Computer Chip?
As this sensor is being placed in aripiprazole (Abilify), an antipsychotic that is primarily indicated for schizophrenia (although it is commonly used for bipolar disorder treatment as well), what we’re really asking is people with schizophrenia to ingest computer chips.
Now, on the surface (at least, to a drug company), this might make sense. Medication adherence in schizophrenia (and, indeed, bipolar) is a major issue and keeps people from getting and staying well. I totally get this. And so some drug company thought a way to improve medication adherence would be to officially track whether medications had been taken via a sensor.
Okay, I see their logic.
But did no one in the marketing group have a minute of common sense? I mean, really, would these marketers want to wear a sensor all day every day so that their medication could talk to it via computer chip? Or did they think people with schizophrenia or other mental illnesses would do it simply because they’re “crazy.” Yeah, I figure it’s probably the latter.
Issues with Medication Adherence and an Ability Computer Chip
I figure people with schizophrenia or bipolar disorder are treated as “lesser-than” because they have a serious mental illness. After all, we can’t be trusted to take our medications, so surely we deserve to be wired up to a computer.
There are major, major issues with this “solution.”
- Schizophrenia typically contains pronounced paranoia. These are the people who are worried that the government is spying on them (often). There is no way to convince them more heavily that they are correct than by wiring up their bodies and medication.
- Computer chips in medication are of course, horrendously expensive. Aripiprazole (Abilify) is an expensive medication to begin with, and certainly embedding a computer chip in every one ups the price dramatically. Good for drug companies, bad for patients.
- People with schizophrenia (and often bipolar) are typically on social assistance that may not even cover aripiprazole, period, let alone some version of it with an embedded microchip.
- I don’t want to be tracked by a computer and I don’t think the average person wants to be either.
Using a Computer Chip in Medication for Serious Mental Illness Is Insulting
Actually, I find this medication adherence/compliance via aripiprazole (Abilify) computer chip thing to be very insulting. It feels like a paternal, unreasonably-powered force is not just watching over me but watching in me. I would never, ever agree to such a thing. And that’s coming from someone who never misses a medication dose.
I can’t say this would help no one. There must be situations in which this would be helpful to the patient. This would, after all, give doctors more information about what is happening for their patients and would give families peace of mind about their loved ones. I get that.
Helping People Adhere to Medication Treatment Isn’t About a Microchip
But in general, this is bullshit, seriously. This will not improve medication adherence to antipsychotics en masse.
And you know why? Because this doesn’t address the major reason people don’t take their medications: side effects. I don’t know how much research and development money it took to develop this new technology, but I can say that money would have been much better spent looking for an antipsychotic that doesn’t cause life-altering side effects. All this money could have been spent to actually help people rather than put them under a microscope.
[Treatment adherence, of course, is much more complicated than what I’ve briefly explained and an excellent discussion of medication adherence and this new development can be seen here.]
Microchips in Antipsychotics Won’t Improve Medication Adherence or Help Sick People
Honestly, the whole thing makes me mad. It’s not about helping sick people, it’s about helping doctors. It’s not about alleviating the pain of serious mental illness, it’s about further dehumanizing people with schizophrenia and bipolar disorder. (No, it’s not dehumanizing if you agree to it, but how many people are going to willingly sign up for this intimate sensor? I suspect a whole lot of sly manipulation will be needed in order to get people to agree.)
I’ll tell you what: as soon as you make cardiology patients and diabetics have microchips in their pills, I’ll contemplate it. Until then, I’ll consider it primarily discriminatory.
I have no problem with people who wish to use this technology for themselves with informed consent, I just worry this will be a tiny proportion of people and I just don’t think sick humans should be reduced to medication sensors.
Image by 심현주 (Own work) [CC BY-SA 3.0], via Wikimedia Commons.
I am not not sure what the need a mirochipped Abilify serves. There is the regular pill version in different strengths and the monthly injection version in 2 dose strengths. If someone not under a CTO has difficulty taking meds every day and wants help with that then the injection can help. I’m not sure why the pharma company would even develop this technology. If your voluntary you have 2 choices (daily pill or monthly injection). If your under CTO you get injection. What need is it meant to serve?
Good analysis. My first thought on reading about this was also about people with paranoia–I’ve talked to more than one schizophrenic complaining about chips implanted in them by the government so this doesn’t sound like a great solution!
I read this in another article and same first thing came to mind…good luck with people who are even partially paranoid. Great blog! It helpes me two or so uears ago show my pdoc. The article “How a Bipolar Min Thinks”. Im prob. wrong, but I think you know. Keep up the work!
Wow, not happy at all with having a chip track if I took my meds or not. The only thing I can control is my pills, and now even that is taken away? Uncool, just uncool.
Who is the target market for this anyway? Prisoners, homeless and those in mental health wards. Let’s go ahead and force them to take meds improperly proscribed that only create medication zombies.
Only benefit I could see would be someone with dementia or alzheimer’s is living alone and chooses to use this to ensure they remember to take their elected medications.
This is garbage. It is a way to place blame on the mentally ill person rather than recognizing that assistance for people with severe mental illness sucks. I’m speaking as a person who has bipolar disorder, and I have a sister who has schizoaffective disorder. She cannot remember to take her medication. When she was in assisted living, the staff came around every day to ensure she took her medication. When she was well, they tossed her back out on her own, in an apartment, with NO help. So she goofed and forgot to take her medication, and she ended up in such bad shape she was thrown in jail for disorderly conduct. IMO, that would NEVER have happened had they kept her in assisted living. It’s all about saving money at the expense of the mentally ill person’s privacy and dignity.
Your problem comes from starting with the assumption that any of this is in palce to help people. It was made as a way to force people to take drugs, and bypass the usual insurgent tricks used by people trying to get better without being doped up (cheeking, flushing, etc).
There is no care paid to the patient, or the person that will be subjected to this. Doctors get patients that are defensless and Otsuka rakes in cash.
It’s all about drugs and money, period.
I can see some times it could be helpful. Like when I’m extremely manic I miss meds, because I’ll take them out of the pill box and forget by time I pour a drink that I didn’t actually take them. My son does the same sometimes with his migraine meds. I see people it could help. But the idea of it being required for psych meds would bother me. And while I think the technology could be helpful with lots of meds (especially ones that have to be taken a strict intervals), I do think that they chose psych meds over other types of meds to try the technology on is because we would be easiest to force into trying it instead of choosing to
I think patients should be able to volunteer for this. If they don’t like it, as you suggest, then the manufacturer won’t make money and it will go away. I don’t think we should trash treatments because they are not your cup of tea. This could me the most telling thing you wrote: “I’ll tell you what: as soon as you make cardiology patients and diabetics have microchips in their pills, I’ll contemplate it.” My guess is you will see that and then I look forward to the mea culpa.
This will only make schizophrenics more distressed and paranoid. The burden of psychosis is enough and then having to ingest a pill will be emotional torture on top of that allready. These pill manufacturers and doctors have no idea the pain associated with psychosis, the distress and the turmoil. These people need to be kept as SAFE as possible and away from anything that can bring unnecessary distress and pain. i imagine we are going to see more trips to the shrink by these people having to have these Owellian pills in their body. Its great for the pharmaceutical companies but a big lose for mental patients. Its obvious they weren’t even consulted in the process and shows a gross ignorance of what psychosis is and how it makes a patient sick. You need schizophrenics in safe, predictable habits that don’t perturb them. The boiling over effect of psychosis can be stimulated by the slightest affect so we need care dealing with vulnerable patients not administering the next big pill that lands a pharmaceutical company a stash of money and honors. Its certainly going to be interesting to see how a pill meant to cure is only going to scare schizophrenics out of their minds and lead to further mismanagement of a catastrophic illness
I agree this is a bad idea. I am in Arizona and last night I heard something disturbing on the news. One city in the Phoenix area is trying to pass a law that people with mental illness have to permanently wear a color coded bracelet. The only one I can remember is that green is for bipolar. There was a pole. One third of the people were for the law while two thirds were against it. What a horrible idea!
My first thought when I saw this announcement was what you alluded to about confirming fears that chips have been implanted (It’s not a funny issue, but you can imagine the darkly comic potential). You’re right it’s totally insulting. But I can see this kind of technology being used (coercively) as part of CTO’s, forensic monitoring for parolees, etc. I’m having trouble thinking of non-coercive uses for this kind of technology (that can’t be done more easily and less intrusively through other means)
That said, the wearable/implantable sensors seem to have some interesting applications. Beyond the basic fitness tracker stuff, there’s a new diabetes meter where you poke yourself with a sensor that stays on for a couple weeks (and then can transmit to your smartphone) vs. finger prick multiple times a day. Pretty cool.
Hi Mark,
I agree with you in that there are many possibilities for sensors. The difference with diabetics is that they are the ones using the information as opposed to this pill which is just to “tattle” on you to your doctor.
Of course, I think medication adherence is very important, but I think people need to be treated in a different way to make it happen.
– Natasha Tracy
Yeah, I don’t want this in my psych meds either. In my scatterbrained 13 year olds migraine meds, where I could tell if he took them before getting on the bus instead of getting a call starting with “you know your the best mommy in the world” because he’s getting a migraine and needs me to bring them to school though… That could be useful…