- We all know that American health care has issues.
We spend more on health per capita
than any other nation on Earth,
yet by lots of health indicators,
including life expectancy, the U.S. is far behind its peers.
Americans are largely reliant
on health insurance to afford care,
but at the end of last year,
around 12% of adults didn't have any.
But there's another problem,
one that isn't talked about as much.
Even when insurance comes through,
lots of people aren't taking the medicine
they're prescribed.
One study suggests that up to 50% of American patients
with chronic illness
didn't take longterm medication properly.
Medical nonadherence can cost the health care industry
100 billion dollars a year
and it can cost 100 thousand lives as well.
Of course, technology is ready to help,
(scraping)
but it may be at the cost of our privacy.
First, taking medication properly
can be deceptively complicated.
We asked our science reporter, Angela Chen about it.
- There's a lot of reasons
why people might not take their pills as prescribed.
Maybe there's a lot of side effects
that they find intolerable.
Maybe they don't trust the health care system.
Maybe they're getting better
and they think, I don't need it.
Maybe they're too expensive,
maybe their regimen is really complicated
and there's lots of different pills.
- Now, there are lots of ways to keep patients
on schedule with their meds.
There are are low-tech solutions like pill organizers
that track days of the week, though,
studies suggest they don't improve adherence all that much.
- The problem is people's issues might not have
to do with forgetfulness.
For instance, they're like these notifications
that I get on my phone that tell me to go run.
I see the notifications.
I know I'm supposed to run,
but if I don't want to run, that's not really gonna help.
- But technology gives us the opportunity to go farther.
In the past 10 years,
a few apps have hit the market that add a layer
of oversight to medication.
Apps like Emocha, SureAdhere,
and AiCure help remind patients to take medication
and they use a smartphone camera
to actually monitor them doing it.
The apps then send the results
to the patient's health care providers.
Some outlets have taken to calling them selfie medicine
and they show promise.
- The selfie medicine app is part
of what we call directly observed therapy
and the main benefit is that you can really trust
to a higher level that people are taking their pills.
If you really see it with your own eyes or through a phone
that they've taken it,
there's just a lot less doubt that people are on-track
with their medication.
- Ready?
(grunting) Ah, uh-huh.
That was a big one, okay. - Okay.
- How was this experience for you?
- I felt a little weird.
I'm also not a trained doctor,
so possibly doctors would feel less weird about it,
but it wasn't my favorite interaction with you.
- (giggling) Well, fine.
I'm just gonna finish this water and then hang up.
- Okay, see you later, Will. - Bye.
As handy as it is,
adherence technology raises some questions
about privacy and coercion.
One, storing your drug regimen on apps
and servers is a data security risk.
And two, there is the specter
of turning health care providers into enforcers
of drug adherence,
which is especially concerning
when what you're treating is mental health.
- I think first we need to consider
that we overmedicate a lot of people.
They might not be hurting anyone,
but because they don't look or necessarily act normal,
we want to give them medication.
But a lot of these drugs have side effects.
They make you feel groggy.
They make you feel like not yourself
and when it becomes enforcement,
you kind of take away the right of people
with mental illness to decide for themselves.
Oftentimes people who are most poor,
most vulnerable are most likely to be coerced
into taking medication against their will.
- We asked one of the app makers, SureAdhere,
about some of these concerns and their CEO, Kelly Collins,
told us that coercion is not their app's purpose.
- We would push back very hard if our application
or another like it was used to limit access
to health insurance or to care in anyway.
We're not trying to implement surveillance
among these patients.
It's more about engagement.
- SureAdhere was originally built for a very narrow purpose,
unrelated to mental health.
It was made to help patients of tuberculosis
who need six to nine months worth of medication
to get healthy.
Otherwise patients can become contagious again
and TB can become resistant to drugs.
It's so scary that the World Health Organization
recommends in-person visits with a nurse
to make sure patients take every dose.
SureAdhere is designed to ease that burden
for everyone involved.
- The idea is that this should be a mechanism
for engagement and a positive connection
between the provider and the patient.
This should not feel like an enforcement mechanism.
- But, does it work?
Does monitoring and reminding patients
to take their medicine really improve adherence?
SureAdhere has seen some promising results,
but broadly it's hard to know.
- I think that's the issue with a lot of these attempts.
There's so many different reasons
why someone wouldn't take their medication
and each effort maybe only targets one of them.
Overall, there's a really complicated picture.
- Just as one example,
a study last year took patients with recent heart attacks
and split them into two groups.
The first group took a normal course of heart medication.
The second group got the royal treatment.
They used the smart pill bottle
that kept track of their doses,
they got reminders from family members to take their pills,
and they got financial rewards for staying on track.
And the result?
- There really wasn't much difference in the two groups
between who took the medication, who didn't,
and even more importantly,
there wasn't that much difference
in who was hospitalized later and who wasn't.
- The point is there's lots of ways
to tackle drug adherence.
There's selfie apps, support from family and friends,
more affordable drugs, and we might need lots of ways.
We just need to understand that there might also be lots
of reasons people don't take their medicine
exactly as expected.
- I think that technology right now,
when it comes to taking medication,
focuses on the issue of forgetfulness.
I think they assume that if people just weren't so forgetful
then they'd be rushing to take their pills.
I think it's wrong to think of it as so simple,
forget or not forget when there's this whole ecosystem
of things that makes medication hard to take.
- This is actually one of our first videos about medicine
and health care and we wanna do more.
If there are topics that you want us to cover,
let us know in the comments and we'll check it out.
Thanks for watching.