Digital Pills, EKG Watchbands and Smart Toilets
““Everything these days is connected and smart, but I feel like the bathroom is a very untapped area. There’s not been much innovation there for hundreds of years.”
— Sameer Berry
IT’S FINALLY HAPPENED, and I can’t say that I’m surprised. The FDA has finally approved a digital pill – for the first time in American history.
The pill is effectively medication that’s embedded with a sensor that can tell doctors whether and when their patients take their medicine, and it aims to combat what the New York Times describes as “the expensive, longstanding problem that millions of patients do not take drugs as prescribed.”
Nonadherence to prescriptions costs as much as $100 billion per year and so it’s pretty clear that a solution like this could save both lives as well as money. It could improve healthcare outcomes, but it could also foster mistrust if the data isn’t used or stored correctly.
Still, it’s a great idea. Patients who take the new medication, which is a version of antipsychotic medication Ablify, are asked to sign consent forms to allow their doctors and up to four others, including family members, to receive data showing when the pills are taken. It’s entirely voluntary, but not everyone is excited. Dr. Peter Kramer, psychiatrist and the author of Listening to Prozac, said that while it’s ethical for fully competent patients to “lash him or herself to the mast”, the idea of digital drugs “sounds like a potentially coercive tool.”
This exact problem has already occurred to Eric Buffkin, senior vice president of etectRx. He says, “I get questions all the time: ‘Hey, is the government going to use this, and can you track me?’ Frankly, there is a creepiness factor of this whole idea of medicine tracking. The thing I tell them first and foremost is there’s nothing to reach out of this technology to pry your mouth open and make you take a pill. If you are fundamentally opposed to this idea of sharing the information, then say, ‘No thank you.’”
Whichever side you take in the perpetual debate between privacy advocates and people who think that data can save the world, it’s pretty clear that technology like this could vastly improve patient outcomes. The ethics surrounding it are less clear, but I’m an optimist. I think that as a society, it’s something that we’ll eventually come to terms with. We’ll have no choice.
This tech has always just been a matter of time, ever since the first Apple Watch was released back in 2014. The FDA recently approved an Apple Watch accessory that monitors the wearer’s heart rate and provides alerts and warnings if it detects a potential problem.
The new device is called the Kardiaband, a $200 watch band by AliveCor which gives wearers access to an FDA-approved electrocardiogram (EKG). All they need to do is to press a pad on the watchband and then the EKG will be shown on their Apple Watch display. The data is also recorded so that it can be accessed again at a later date.
But my approach is all about value-based healthcare, and the real value of the Kardiaband is that it looks for signs of atrial fibrillation (A-Fib), a heart condition that can lead to strokes and heart failure if it’s not detected and treated in time. Over 130,000 people in the US alone die from A-Fib related problems every year, and if the Kardiaband can save even 0.1% of those, that’s 130 lives saved every year.
As always, the problem is likely to come down to consumer adoption, rather than the availability of the technology. The Kardiaband costs $200, a small price to pay for something that could save your life. Still, that price tag will be a barrier entry for many, especially as under the current system, we focus on the cure instead of the prevention. But that will all change in the future.
The Smart Toilet
When I’ve talked about smart toilets at conferences, people have laughed at me. The good news is that I’m not alone, and Microsoft co-founder Bill Gates has spent several years trying to encourage the development of low-cost, highly efficient toilets that could improve sanitation around the world, and in impoverished areas in particular.
But Gates doesn’t take it as far as he should, which brings us on to LA gastroenterologist-in-training Sameer Berry, who explains, “Everything these days is connected and smart, but I feel like the bathroom is a very untapped area. There’s not been much innovation there for hundreds of years.”
Admittedly, the Japanese consumer market has witnessed some innovation thanks to high tech toilets that have everything from heated seats to built-in bidets. But from a medical point of view, we’re still missing a trick. As unpleasant as it might be to think about, our excrement contains vital clues about our healthcare.
This is evidenced to a certain extent by the “Flowsky” toilet, another Japanese invention which looks like a normal toilet but which looks for abnormalities in urine flow. The idea is to ultimately create an internet-connected toilet that uses AI to analyze and monitor human waste to spot warning signs for diseases and help us to monitor chronic conditions like diabetes.
Michael Lindenmayer, who’s the smart sanitation and digital health co-lead at the Toilet Board Coalition (yes, that’s a real thing), believes that smart toilets could give insights into overall public health conditions. In fact, the coalition, which is a registered nonprofit based in Geneva, is working with the Indian city of Pune and the European Space Agency to collect data from smart toilets in public bathrooms and to combine them with landscape and weather data from satellites. According to journalist Kate Baggaley, “The goal is to give health officials evidence of a disease before it becomes a full-blown disaster such as the West Africa Ebola epidemic in 2014.”
Another advantage to using smart toilets, as opposed to Fitbits and other wearable devices, is that people don’t remember to charge them or put them on. Perhaps that’s why there’s so much interest in them, including from Google, which was recently awarded a patent for a toilet that would gauge users’ blood pressure as they sat down.
Sam Gambhir, director of the Canary Center at Stanford for Cancer Early Detection, says that the experience of using one of these toilets won’t be intrusive, explaining, “People will simply go to the bathroom, flush and go on about their day. Meanwhile, the toilet will analyze the user’s waste, identify the person using fingerprint sensors embedded in the flush handle and then send the results to the cloud or an app on a smartphone. And should the toilet detect a worrisome trend – like traces of blood in the urine – it will send an alert prompting the user to schedule a doctor appointment.”
Want to learn more?
I talk more about new technologies and their impact on the healthcare industry in my book, The Future of Healthcare: Humans and Machines Partnering for Better Outcomes. Click here to buy yourself a copy.