Tag Archives: patients

Medication Mechanization: Microchip Sensors in Abilify to Increase Medication Compliance

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This entry first appeared at Mad In America on November 10, 2015.

I felt a chill go through my body when I read that the FDA has agreed to review for possible approval in early 2016 a new form of the drug Abilify that contains a microchip sensor capable of sending a message that indicates the exact time a tablet dissolves in the stomach. The message is recorded by a skin patch – along with data such as the person’s body angle and activity patterns – and, according to a press release from Proteus Digital Health, the developer of the device, “this information is recorded and relayed to patients on a mobile phone or other Bluetooth-enabled device, and only with their consent, to their physician and/or their caregivers.”

The Japanese drug giant Otsuka teamed up with Proteus Digital Health in 2012 to create this potentially profitable new “chip in a pill” just as its patent on Abilify – at $6.9 billion the #1 most profitable drug in the U.S. in 2013 – was set to expire in 2014, leaving one of Otsuka’s most valuable markets vulnerable to generics. It is especially ominous to me that our government is teetering toward passing the Murphy Bill, which would make forced in-home treatment the law of the land, at the same time it is lurching toward putting such an Orwellian device in the hands of a pharmaceutical company, courts, and families.

According to the Washington Examiner:

”The new smart drug could be particularly useful for ensuring the mentally ill continue taking their medications, not just by giving doctors a way to monitor their behavior, but courts as well…all but five states have court-ordered programs where a judge can mandate that offenders with severe mental illness stick with a treatment program as a condition of remaining in the community.”

As one Facebook commenter noted; putting a pill in your mouth and swallowing it, knowing it’s going to transmit a message to prove one is submissive and compliant, is beyond Orwellian – it feels fascistic. I agree. The social contract draws an invisible line that must be guarded against forces in a society that, driven by fears, fantasies of benevolence, or by simple greed, and are blind and deaf to the cries of its citizens as their bodily and personal integrity are ground into powder along with the preparations they are compelled to take in the specious name of “health” and “safety.”

Sometimes, radicalizing people politically takes a really callous, stupid, and dangerous threat to people’s liberty. This is one of those times.

The Washington Examiner article cites recent research that shows 74% of people who are started on antipsychotic medications stop taking them within 18 months. That’s the justification offered for a psych drug that monitors its own use.

“These individuals already have a history of problems due to their unwillingness or inability to voluntarily comply with treatment … this could be an important advance for them that would help them maintain treatment compliance.”

— D.J. Jaffe of the Mental Illness Policy Org.

Think about it: faced with the overwhelming 74% failure of a pharmaceutical intervention, why is the core issue deemed to be compliance rather than efficacy, and consumers’ safety & satisfaction? And why are we “gearing up” to ensure compliance in particular for a drug that even the FDA admits has an unknown mechanism of action?

What other medical specialty would blame its patients for so overwhelmingly choosing not to take the medications that have been prescribed to them? For a field that has taken on the charge of controlling and regulating social deviance, the ethical boundaries that the FDA should be protecting are blurred by the growing perception that people who are DSM-diagnosed are potential risks to society, despite overwhelming risk to the contrary; that a DSM diagnoses should be a signal that a person needs and deserves our protection.

Only a worldview that embraces the disease and deviance model of human emotional suffering would dare to suggest putting a sensor in a psychoactive substance to monitor and enforce its ingestion by an otherwise free citizen.

I believe that at some very basic level empathy seems to have failed in a society that sees the need to develop a sensor-equipped psychoactive substance. The blasé emphasis on prioritizing prescription compliance, without considering the profound subjective experience – to anyone, let alone a person in crisis – of having a digitalized foreign object inserted deep inside, an object that is in turn sending messages to an invisible outside presence. This oversight amounts to a vertiginous stumble forward in our society’s failure to muster empathy and compassion for its members, instead delivering them, in the form of a now-literally captive market, to the drug makers.

I’ve been seeing clients in therapy for over 35 years, and at no point can I imagine sitting a few feet away from a person in distress and suggest to them that they should consider having a device inside them that would let me know every day at a distance their most intimate experiences – let alone when they digest something, lie down, or when they have taken their meds. I couldn’t do it. It would feel ghoulish and perverse.

And I don’t want to be a part of a society that would do. Even – and perhaps especially – if it were being done “in my name.”

There is an aura of something shameful, a violation of a basic human right to privacy and bodily boundaries that is being ignored in the pursuit of this new digital monitoring of psychiatric medication. The shame is that, with a pill that records the moment of its absorption into our bodies, we are seeing the realization of a long-sought ideal of totalitarian governments; to cross the blood-brain barrier, gaining access to the very seat of our autonomy, and of our souls. With this, Otsuka could fairly revamp its marketing for Abilify by renaming it “Dis-Abilify,” without so much as risking – and potentially augmenting, in a society that seems to be exuberantly embracing an Orwellian ideal – its market share.

This is a time, if there ever was one, for citizens to act, and to act decisively; before the ability to make decisions, let alone act on them, is excised from our bodies completely by the next wave of pharma development.

Of course some will object to my characterization of those who developed this seeming well-meaning medical breakthrough as lacking a moral compass. But I have already heard the cries of outrage and fear from many of those for whom this Orwellian medicine is intended.

I’ll end here with an ever-more apt quote from C.S. Lewis –

“Of all tyrannies, a tyranny sincerely exercised for the good of its victims, may be the most oppressive.”

Why Involuntary Out-Patient Treatment Isn’t Necessary – A First Person Account

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This entry first appeared at Mad in America on August 2, 2013.

The last sentence in a recent New York Times article entitled “Program Compelling Outpatient Treatment for Mental Illness is Working, Study Says” tells of the police taking a man to get his monthly Haldol injection under the involuntary treatment law.

For years I worked on a community based team that helped homeless people in extreme states who had histories of being frequently hospitalized.

I met them wherever they lived – on the streets, under bridges, in abandoned buildings, and in parks. I formed close, trusting connections by being open-hearted and harmlessly helpful. I wasn’t trying to “treat” them or enforce medication compliance.

Many people made remarkable changes because I had truly befriended them, pursued them with compassion to where they lived in isolation, helped them get food, wash their clothes, find safe housing.

It breaks my heart to see that police-state tactics such as forced Haldol injections are understood to be the only thing that can reach some people. I know it isn’t true.

I remember the supervisor of our county hospital psychiatric emergency unit contacting me, because a long-time homeless man who I was helping, hadn’t been there in over six months.

He had been the most frequently-hospitalized person in our large county mental health system. He often had been brought to psychiatric emergency by the police – sometimes several times a month. He had spent long months in the state hospital.

The supervisor really couldn’t understand that my simply spending time with him on the streets almost every day was making the difference.

But it was.

That simple friendly contact – when we are not forcing anything on someone, but instead are harmlessly helpful and kind – is precisely what helps someone relax and choose to pursue the basic things they need, like food, clothing and shelter.

But more, that frequent time spent with me simply listening and warmly feeling concern for the homeless man, began to gradually reduce the intensity of the extreme emotional state he usually was in. He became more and more present in the moment, more lucid and at ease.

That gradual shift into a more focused and relaxed state, has happened with many other people in extreme states that I have spent time with in that heart-centered way over the past 35 years.

You might want to see one of my related MIA blog essays, “Responding to Madness With Loving Receptivity: A Practical Guide.”

I hope that our society doesn’t persist in the fear-induced reaction that forces people in our communities who are experiencing extreme states to experience violations of their human rights as well.

It’s not right, and It’s not necessary.