April 13, 2009
Microchip-in-a-pill drug monitoring:
Furious Seasons covers a new microchip-in-a-pill that monitors the stomach and detects what drugs the patient is taking, reporting back to the doctor in real time.
The blurb from the company is even more astounding:
Proteus ingestible event markers (IEMs) are tiny, digestible sensors made from food ingredients, which are activated by stomach fluids after swallowing. Once activated, the IEM sends an ultra low-power, private, digital signal through the body to a microelectronic receiver that is either a small bandage style skin patch or a tiny device insert under the skin. The receiver date- and time-stamps, decodes, and records information such as the type of drug, the dose, and the place of manufacture, as well as measures and reports physiologic measures such as heart rate, activity, and respiratory rate.
Like Phil Dawdy, I feel a bit freaked out.
This is interesting for psychiatry for two reasons: one, monitoring for recreational drug or alcohol use and two, monitoring compliance with antipsychotics.
Both of these are interesting because these are both controversial legal areas, in that a court can impose an order or conditions that depend on a clean drug screen, and, thanks to the UK's new 'now with added coercion' 2007 Mental Health Act psychiatrists can impose community treatment orders.
This means that a patient can be returned to hospital, against their will, if they're found not to be complying with their prescribed medication regime. And as involuntary treatment is most commonly imposed on people with psychosis, this usually means taking antipsychotics.
You can see how this technology would be of great use on the monitoring end, but as it supposedly reports on any sort of drug, presumably personal drug use then becomes a data privacy issue.
In other words, you'd have to trust the information technology system to correctly discard the results that you don't want your doctor to see.
More concerning perhaps is 'rights slippage' which is a pervasive problem is psychiatry.
This is the same problem that occurs when a psychiatrist (and thanks to the UK's new Mental Health Act, now a psychologist) says to a patient who is in hospital of their own free will: "If you leave, I'll section you". Essentially, you're free to go, but if you try, I'll legally detain you.
You can see how this new technology could be used for similar strategies - if you let us monitor your drug use and medication compliance, we won't use impose any involuntary treatment, but if you don't, we will.
For people who voluntarily and knowingly decide to use the monitoring device, you can see how it would be a huge medical benefit, but in psychiatry, where involuntary treatment is possible, the ethical difficulties are amplified.
Also, I don't think I need to explain the ironies of potentially implanting microchip monitoring devices into people with psychosis who often have delusions about being implanted with microchip monitoring devices.
Link to Furious Seasons microchip drug monitors.
Link to manufacturers website.
