Yunus Challenge Award Focuses On Patient Compliance
Source: MIT honors humanitarian tech invention
Candace Lombardi, CNET News.com May 3, 2007
Tb Treatment Adherence Central To 2007 MIT Ideas Competition
From the MIT Ideas1 Award web page
Adherence to medication regimens-the extent to which patients take the drugs they are prescribed-is estimated at only 50% worldwide. This surprisingly common problem is the cause of both individual treatment failure and public health problems across a wide range of diseases and countries.
For this year’s Yunus Challenge, we will focus on tuberculosis (TB). TB kills 1.7 million people a year, yet the vast majority of cases are curable. Adherence to TB drugs is low and is a major driver of the epidemic. The most successful program geared to increase TB drug adherence, Directly Observed Therapy, Short-Course (DOTS) is relatively expensive and, in 2002, was available only to approximately 37% of people with TB.
The $7,500 award, given to two winning teams, is named for the 2006 Nobel Prize winner Muhammad Yunus, who pioneered the idea of microcredit–issuing small-business loans to the poor.
The Winners
CellCentives
CellCentives proposed a disposable pill packet that reveals a numeric code each time a pill is removed within a prescribed time frame. The code, which can be punched into the keypad of the TB patient’s cell phone, rewards the patient’s compliance with free cell phone minutes.
uBox
The uBox is a round, plastic pill dispenser that lights up to prompt patients to take their next pill. Twisting the uBox dispenses a dosage and records the time. The information can then be retrieved with a USB-like device when DOT workers make their scheduled visits. The uBox, which records when patient data is retrieved, can also be used to monitor DOT workers and offer them incentives for success. Beyond TB sufferers, the uBox system also could be applied to patients suffering from other diseases that require extensive treatment, including HIV/AIDS. According to Bill Theis, part of the team that developed the uBox, “It adds accountability to DOTs and so increases the effectiveness of DOTs. It can also be privatized for commercial use.”
Commentary
OK, I’m not sure why MIT Ideas Competition considers these two projects to be award-worthy, hot-shot innovative concepts. They are clever enough, and I’m a proponent of incentives, but both devices share the same flaw: the behavior they support or monitor is removing an oral medication from a container at the right time. There is no assurance that the medication is ingested by the designated patient. The cell phone minutes incentive, for example, could be earned by a family member removing the medication at the prescribed times. This defect is especially glaring given the wording of the Challenge itself, which positions the innovations as an alternative to DOT, a methodology which focuses on the patient actually taking the medication.2
Still, it is heartening to see patient compliance spotlighted in this competition and these two devices are certainly worth a clinical trial or two to determine if they are effective.
Footnotes
- ”Ideas” is an acronym: Innovation Development Enterprise Action Service [back]
- A determined patient could, of course, cheek the medication. Nonetheless, DOT has been demonstrated to be an effective compliance enhancement. [back]
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