1 Boring Old Man

Ever heard the expression pharmaceutical bottom fishing? It’s a specialty of KOLs. LOL.

That has a dystopian feel to it.

The funny part is that using Smart® means the subjects will take all the pills and report the full compendium of adverse effects…

Oh, great! Turns out that the Xhale corporation’s SMART products will be laced with one or more of several organic alcohols that will then be converted to ketones, which are to be detected by the ‘breathalyzer.’ Here is the patent description.

Just as we are working to get rid of unnecessary organic chemicals as food additives, these guys want to put them in our pills. Pharmaceutical bottom fishing, indeed.

Just say no to drugs.

Alto, that last comment from you doesn’t move the ball down the field.

Being a clinical trial subject is still mostly voluntary.

I just can’t wait for these machines to come to the doctor’s office tied to insurance coverage /sarc

and then there’s this – a whining pill carton [from eyeforpharma 2014]

Thanks, Dr. Nardo!

I could use that whining pill carton to increase my FICO® Medication Adherence Score

Even though my comments have been snarky about “medication adherence” products, as a techno-junkie, I think some of them are kind of cool and I would use them.

It isn’t what patients can do with these products that troubles me. It is what’s going to be done to us through them by managed care, administrators and government.

Pharmaceutical/med device/EHR opportunists being only part of the problem here.

I think the idea is pretty good. Medication compliance is a frequent problem in getting patients to stability, and patient reports are often inaccurate. It would be wonderful to have an unobtrusive means of documenting medication compliance and linking it with treatment efficacy. It seems that the main problem is one humanity always faces — our technical capacity outrunning our moral capacity. My biggest worry (along with Arby) is what managed care will do with this.

On a related note, I am on pap therapy and submit data cards to physicians for downloads of the data. Unfortunately, even if I feel like crap, if the data looks good, that is all the doctors seem to care about. Concerned the same thing will happen in this situation and the patient will stop being listened to. Of course, not to disparage all doctors but that is already a big problem in medicine even when technology isn’t an issue.

Even more concerning to me is what happens when the patient has a disagreement with his/her psychiatrist about the usefulness of the med and starts taking himself/herself off of it. Doctor sees this from the compliance data and threatens the patient with involuntary commitment if this person doesn’t get back on the med.

Finally, just so the psychiatrists on this blog can see I am not picking on them, what if a patient goes to a “conventional” doctor who recommends a med that is a disaster and the he/she refuses to do anything about. Insurance company decides that because patient isn’t complying with treatment, doctor visit will not be paid for.

I apologize for my failed attempt at ironic humor, referencing Nancy Reagan in the mid-1980s.

Personally, I would not want to be monitored in this way should it become widespread in prescribing. I would refuse the drug instead.

As wiley said, this idea is dystopian.

I’m all for reducing “noise” in clinical trials. I think it’s a good idea, given that we’ve complained here about older studies being better because they were done on inpatient units with better control. I wouldn’t worry about managed care, they won’t want to pay for it.

Dr. O’Brien, I think you are looking at this from the wrong angle.

If they can show non-compliance with treatment, they can refuse to pay for any of it. Now that the pre-existing condition exclusion is gone, they’re probably salivating over this idea.

Check out the CPAP industry for an example of what is on the horizon.

Do you know what the compliance rates is for CPAP? Considering the cost of a PSG, and how few people actually use CPAP for OSA frankly I don’t blame them. PSG is now a racket. Besides there are better and cheaper alternatives now.

My previous comment was deleted in which I did mention the use of the cpap as an example so I am reluctant to comment but will take a risk. Dr. O’Brien, as an FYI, I could do go into a million reasons why cpap compliance is low as someone using the machine. But to keep this discussion in a positive mode and to not get too far off track, any physician who visits this list who has a patient who is struggling with pap therapy, might want to refer their patient to http://www.cpaptalk.com which has excellent members who help people troubleshoot various issues that keep them from being compliant with the therapy. For example, many patients are given wide open prescription ranges that cause them to feel suffocation due to the minimum pressure being too low which will cause the machine to take too long to reach optimal pressure.

So of course, the person is going to feel like ditching the machine without knowing what is going on. Of course, they should ideally consult the doctor but many times, sadly, they don’t get any help. That is why cpaptalk.com is so valuable as a site in encouraging patients to stick to therapy with their assistance. And it is free.

Back to regularly scheduled programming.

AA
It wasn’t deleted. My filter marked it for approval first all by itself while I was watching Atlanta lose in the last 4 seconds [gloom]…

Sorry for the horrible grammar in my last post. Anyway…putting aside the issue of CPAP..

I don’t have a problem with insurance companies making sure the treatment they (and by extension all the subscribers) are paying for is actually being used. That seems more than reasonable if other people are paying for it, especially taxpayers. There have been Medi-fraud cases involving ambulatory devices that were never used by the patient and were total billing scams. If a patient on Medicare runs up five figure bills for a treatment he is not complying with, that is an abuse and the tragedy of the commons at work.

However, I don’t think insurance is going to like the additional costs involved with this kind of enforcement. They will make the calculation that compliance costs probably do not exceed the financial benefits of this.

I mentioned the CPAP industry because the DME companies already use RF units. And, like AA stated, everything around OSA treatment has to be validated with you showing them your machine data. It’s a template of things to come.

Have you seen the numbers they are throwing around about the costs of non-compliance with medications?

The logic of “they’re not using X, so I don’t blame Y for not paying for it or for the consequences” is exactly how this will be promoted.

I can follow this line of reasoning to a certain point, but, I know that it only makes sense in a perfect world with perfectly identified illnesses and perfect treatments that work the same for everyone.

However, as far as the managed care point I was making, I was speaking to the Faustian bargain we’ve made by paying (taxes/premiums) for someone else to pay our medical bills. Monitoring compliance non-voluntarily will be pursued, and mostly likely by the gov’t first, to save on costs; damn the patient.

Dr. O’Brien, we cross-posted. I didn’t see your response above before making my own.

The cost of the compliance was not born by managed care directly. the DME’s absorbed it. Looked for pharmacies to do the same for medications. Of course, the companies don’t ultimately pay for it, we do.

Thanks Mickey. My apologies for making invalid assumptions.