Friday, June 22, 2007

Can an In-home Electronic Pillbox Solve Our Medication Error Problem?

Do seniors really need a $200 per month machine that looks like a bread maker -- and which is somewhat bigger than a bread box -- to dispense pills?

Will an in-home electronic pillbox solve this country's medication error problem?

Maybe the only two entities that think so are the company that invented the machine and the FDA.

"The device can be programmed to dispense individual doses of up to a month's worth of 10 different drugs, according to its manufacturer, INRange Systems Inc. The Web-connected medication box allows pharmacists, doctors and nurses to tweak both the dosing schedules and dosages of drugs loaded into the device in special blister cards. The company-described 'electronic nurse' alerts patients when it's time to take a drug with visual and audible alerts.

"The bread-box-sized device may reduce drug identification and dosing errors, the FDA said. Expected users include aging and forgetful patients, as well as those with HIV who must adhere to complex treatment regimens." (See: "Computerized Pillbox Is Cleared").

Here are some problems I foresee that will limit the adoption of this contraption:

  • The company and the FDA claim that the device will help prevent medication errors that "harm at least 1.5 million people in the United States annually." While INRange claims that "the greatest rise in prescription medication errors occurred in the ambulatory setting," the vast majority of medication errors still occur IN HOSPITALS, not in homes. Also, if physicians prescribe the wrong medication in the first place, this device will continue to dispense the wrong medication unless someone tells it differently.
  • The device dispenses pills in blister packs, which many seniors have trouble opening! Not only that, but pharmacists have to load the pills in these packs instead of simply putting them in bottles. I'm sure that's more work for the pharmacist.
  • The cost! Did I mention the cost? Not only the $200 per month per patient, but to Medicare if it had to pay for millions of these devices. Do the math.
  • Doctors and pharmacists are expected to remotely monitor and manage the devices to alter dosing and make sure the patient is compliant. Sure, that'll happen!
  • Imagine a HAL computer scenario if you will. Or just plain hackers. Or software bugs. Or power outages! Imagine the havoc these electronic bogey men would cause. Oh, the humanity!
  • Did I mention the cost?
I don't know why I bother writing about this, except that it illustrates an example of warped FDA priorities and BS marketing by INRange. If we really want to solve the medication error problem in this country, we need to computerize prescribing and dispensing at doctors' offices and in hospitals, not in the home!

And the drug industry -- including the FDA -- must do more to address the problem through patient/physician education and promotion of ePrescribing at least, instead of worrying so much about counterfeit drugs, which kill far fewer Americans than medication errors!

That's my opinion, and I'm sticking to it!


  1. Anonymous1:33 PM

    I like your skepticism about remote monitoring.
    Although this is a bit of a beastly piece of equipment, I think you are underestimating the nascent bull market in remote care (telehealth), much of which will include medication monitoring and management.
    I look forward to the 3rd or 4th generational iteration.

  2. Yes, I agree -- it's not excatly the iPOD of remote monitoring is it?

    A bull market in remote care presupposes the will of pharmacists and physicians to engage in it, which can only be incented by cash. Will MCOs blink?

  3. Anonymous9:20 PM

    If we, as consumers/patients allow Big Pharma and its adjuncts and enablers to continue “dumbing down” the population, I guess we will be getting no more (or less) than we deserve. Eventually Big Pharma can dispense a daily dose of “mind control” medication, and we will more quietly serve our corporate masters as “ultimate consumers.” Tell me, is there truly a need for an expensive product like this . . . or was the “need” manufactured after the product had been birthed? Just how gullible are American healthcare consumers? Hopefully this will meet with the same excitement and overwhelming patient support that accompanied the Exubera bong!

    Keep up the good work, John . . . and stick to your opinion, though it is no longer yours alone.


  4. Follow-up: see "Inappropriate Prescribing for Older Patients a Growing Problem"

    Inappropriate drug use among older patients includes being prescribed drugs they don't need, being under-prescribed medications they do need or being given inappropriate drugs.

    An electronic dispensing machine only makes this problem worse!


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