Mission Accomplished: Noncompliance Bites Dust

Little did I suspect when I began my routine daily scan of scientific, news, and commercial reports pertinent to patient compliance that I would be reading about the imminent demise of healthcare noncompliance, my central professional interest for the past several years.¹

The opening sentence of Science sinks its teeth into 2500 year-old drug problem, a story in the 15 January 2008 online edition of Science Centric, provides the basic information, albeit a tad obliquely. ²

The introduction’s subjunctive voice (”may achieve”) and generic quality (”help patients follow treatment”), which finesse the issue of claims being made for this device and preclude accusations of overstatement, dissipate by the final lines of the article, giving way to a more positive and, eventually, a fully triumphant timbre.³

Well, that’s that. Clinicians no longer have to worry about nonadherent clients. The patient compliance research projects can start winding down, the pharmaceutical companies can end their medication reminder programs, and all those electronic gadgets that track compliance and set off bells, whistles, lights, sirens, email messages, or fireworks to signal that it’s time for a medication dose can be consigned to eBay.

Perhaps I can reorient AlignMap.com as as a nostalgia site with a spiel along the lines of this:

You kids may not know this, but once upon a time, some patients didn’t automatically take their medication as instructed - back in the old days, we called that “noncompliance.” That’s a funny word, isn’t it? But all that was before everyone had a prosthetic tooth that releases a controlled dose of medication at regular intervals.

And, after the wizards responsible for the prosthetic tooth that will end 2500 years of patient noncompliance have that issue under control, maybe they can take a crack at perpetual motion or world hunger or existential angst or …

But before that, let’s take a look at that tooth, or as I like to think of him -

Marshall Molar, Medication Modulator

The article first establishes its credentials by quoting both Hippocrates and Koop on compliance,⁴ noting that standard but misleading statistic that “studies indicate that up to 50% do not take their medicine,” and listing a number of negative consequences of noncompliance.

Information about the medication-packing tooth itself follows the introduction:

That device looks something like this model.

Heck, I’m impressed already - and I’m curious about the technique they use to remove two molars from the patient’s jaw and install that prosthesis with its ersatz tooth cover without resorting to an invasive procedure.

The article also discusses the increased bioavailability of the drug caused by passing it through the buccal tissue.

IntelliDrug’s Operative Mechanism

Excerpted from Science sinks its teeth into 2500 year-old drug problem:

A more complete rendition of the process is provided by Gizmag:

According to the piece, IntelliDrug, which could be applied to any drug, could be on the market in three years. On the other hand, a poster I downloaded just now from the IntelliDrug Project Site confidently asserts that “The prototype will be ready and tested by the end of 2006. It is expected that in 2007 the device will be available on the market.”

Just A Few Questions

For the sake of this post, let’s assume the tooth works perfectly. After all, it’s just “a reservoir and release mechanism; a programmable circuit, micro-sensors, an infrared sensor, micro-actuators and batteries. All housed in a tiny package.” What could go wrong?

Even so, questions arise. A representative but not exhaustive list follows:

• How much will the IntelliDrug appliance, its installation, and its ongoing operation cost?
• Who will pay that bill?
• Really? Which insurance company?
• If the candidate for the IntelliDrug doesn’t happen to have a handy two molar sized space in his or her jaw, is the plan to remove two healthy teeth - noninvasively - to make room for the device?
• What percentage of patients, according to the studies those folks on IntelliDrug must have done, will agree to have their medication compliance enhanced through installation of the bionic molar medicator, let alone endure the removal of two teeth if that is necessary?
• If we all think real hard, is it possible that we might come up with an alternative or two that might cost less, be less traumatic, and give the patient control of his or her own body?

Another Solution

IntelliDrug seems a legitimate, scientific project that could have an impact in some cases in which medication noncompliance is too dangerous or too costly to risk and the patient is cooperative.

Transforming an expensive potential tactic to improve adherence among a relatively small group of individuals into “an end to the 2500 year-old patient compliance conundrum” makes the project seem a joke and leads to mistrust of any future claims of effectiveness, however reasonable they might otherwise be.

My recommended solution to this problem follows:

Update

Some time after completing this post, I discovered that the Science Centric article, dated 15 January 2008, I first read this morning is actually a virtually unchanged copy of a report released 18 Oct 2007 by ICT Reports, which describes itself thusly, “The ICT Results service was developed in 2003 for the European Commission’s Directorate-General Information Society and Media. It changed names in 2007 and is now operated by a consortium with experience in research, editing, communication and marketing services, led by ESN and partners Assystem. ICT Results features online news and analysis on the emerging results from information and communications technology research. It reports on prototype products and services ready for commercialisation, as well as work in progress and interim results with significant potential for exploitation.”

So much for the “breaking news” angle. It seems the solution to medication adherence was announced three months ago, but I didn’t notice the change.

I must have been distracted.

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Footnotes

1. I first read about IntelliDrug in February 2007, when similar reports surfaced. At that point, I had neither the time nor energy to address it. When a report of this technology reappeared this morning, however, I felt compelled to respond. [back]
2. For the proper “late breaking news” effect, viewers may wish to click on the arrowhead below to trigger the clacking teletype sound for background and read the rest of this aloud with that Walter Winchell staccato phrasing. [back]
3. To achieve the best effect in this instance, viewrs may wish to hum either “We Are The Champions” or “The Theme From Rocky” while reading this portion of the report. [back]
4. These quotes have become almost obligatory for articles on patient compliance:
   Hippocrates: “Keep a watch also on the faults of the patients, which often make them lie about the taking of things prescribed.”
   Dr C Everett Koop: “Drugs don’t work in patients who don’t take them.” [back]

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