Is your medication violating your privacy?


According to The Wall Street Journal, Novartis is developing a system that reminds patients to take their medications.

The company is testing inserting tiny microchips into the pills as part of a system that tracks whether patients are taking their meds as prescribed. When patients veer off course, they get a text message reminder.

The technology has significantly improved adherence in a very small group of patients taking the company’s blood pressure medicine Diovan …

The benefits of this technology could be huge. Patient compliance is a very serious issue, and anything that promotes compliance is likely to improve health. But the technology has disturbing implications that we ought to explore before it is widely implemented.

Bioethicist Summer Johnson points out:

…The tiny little microchip inside the medication would monitor one’s blood level and when it slips too low it sends a message to the patient saying, “Hey dude, time to take your medication!” It’s efficient, simple, and could potentially save your life. No complaints here, right?

Wrong! This invades patient’s privacy and a patient’s right to be delinquent taking medication and screwing up their dosing. It makes it much more difficult for patients to ignore doses or to say, “If I don’t want to take medication, I don’t have to” with a microchip inside their body beaming out text messages to a device annoying them all the time. Particularly if that device can send its data to their physician or worse yet to their insurance company reporting them as a non-compliant patient.

Dr. Johnson dismisses these concerns:

But isn’t that the point? To motivate patients to be compliant? Personally, I think the more we can do to encourage chronic disease management that actually works and compliance with long-term dosing regimens that work, the better.

If this drug can actually do what it promises, I hope they make more of them.

I am surprised at that response. Didn’t we learn in ethics 101 that the ends do not justify the means? Although the goal is admirable, the privacy concerns are real and should not be dismissed out of hand.

The technology could represent a substantial benefit for patients who want help remembering to take their medications. Individuals suffering from complex medical conditions and elderly patients often have difficulty remembering to take medications that they fully intend to take. No doubt those patients would appreciate the reminder, and might also appreciate the fact that their doctor (and family) could be notified if they forget to take a particular medication.

Most of us, though, could buy a simple pillbox alarm if we felt we needed help remembering to take medication. It is not clear if there is any additional benefit to the micro-chip technology and there are substantial privacy concerns.

Taking medication is a personal decision. Although I as a doctor may lament the fact that some patients are non-compliant, should I employ tools to guarantee compliance? Should doctors be receiving minute-by-minute information on patient behavior? Should insurance companies have access to this information? Should they be allowed to terminate coverage if they learn that patients have not taken each and every recommended pill as directed.

Inserting micro-chips into medication is a form of surveillance. And as with any type of surveillance, the argument can be made that you have nothing to worry about if you are not doing anything wrong. Yet the police are not allowed to put cameras into people’s houses to make sure they are behaving behind closed doors. That’s because we value the right to privacy. That right to privacy should extend to medical decisions like whether or not to take blood pressure medication on time, or whether to take it all.