On November 13, the FDA approved Abilify MyCite, a version of Abilify (aripiprazole) that is unique in being the first of its kind to allow digital tracking of whether patients have ingested their medication. It has a sensor embedded in the pill that transmits information to a wearable patch, which then transmits the information to a mobile application that the patient can use.
Other versions of Abilify have been used since 2002, when it was approved for the treatment of schizophrenia. Since then, at prescribers’ off-label judgment, it has also been used for bipolar disorder, and as an adjunctive medication for major depression and occasionally anxiety-related disorders.
Why is this potentially important?
Study after study reveals poor patient “compliance” with the regimens of anti-psychotic medications like aripiprazole and others. Poorer compliance seems to correlate with increased symptoms and hospitalization, though the poorer compliance may also be attributed to troublesome side effects. Using the long-acting (up to a month) injectable version of such medications seems to boosts compliance. However, those are used in the United States much less than in Europe.
So, what’s not to like about this “brave new world” of psychiatric medication? Though presumably the patient has control of the digital information, it seems evident that others could gain control of the information, whether through persuasion or surreptitious access. That could include family members or clinicians. And, practically speaking, it is not so important for the patient to know if they are taking the medication. They already know that, except in the most extreme psychotic states.
The practical usefulness if for the clinician and loved ones to know. However, that would reduce the autonomy of such patients—one of our ethical principles in medicine.
All so-called anti-psychotic medications of course have potential problematic side effects. On occasion, it can be hard to know if a reported side effect is really from the medication, not something else. Knowing that the patient is taking the medication may help to determine that. Of course, this system could fail at times, misleading all those involved.
The use of this medication may be a test of medical ethics from several perspectives. Will the cost—likely to be high—be worth the benefits? Who has power of decision for its use? Will it be adequately researched once it is on the market?
From my clinician perspective, it was invariably useful to know if a patient was taking whatever medication was being prescribed and, if not, why not. However, in the popular book Brave New World, the societal-forced compliance in taking calming medication seemed to be mainly for social control of the population. In the long run, we need safeguards for the appropriate psychiatric usage of such medications. What’s your opinion of this new medication? Send an email comment anytime.
In the meanwhile, enjoy your ingestion of a delicious Thanksgiving meal with loved ones. I’ll trust you if you tell me that you ate your dessert.