Thursday, February 21, 2019

Human Nature - the biggest and most untackled barrier for Medication Adherence

The other day, I wrote about my cholesterol issue and the research surrounding it. I got some interesting feedback, so I thought, I'd write another post along that vein based on a personal experience. It was, in fact, my Iliac Crest Replacement Surgery that led me to develop an interest in Healthcare later on! (A blog post for another day).


Recently, I developed a bacterial infection, and I was put on some strong antibiotics. It has been nearly two decades since I was on antibiotics, and yet, I vaguely remembered it playing havoc with my digestive system. And along came my new medication. In approximately 24 hours, after I started a two-week regimen (last time too, I was on a two-week regimen), my digestive system was shot in the middle of my President's Day Weekend Photography Shoot (I am a Nature Photographer, and I frequently travel to California Destinations). Incidentally, I had to refuse the one-shot Penicillin that was originally recommended, because again, I vaguely remember being "allergic" or something to Penicillin and being taken off the drug when I was a child. The Doctor didn't want to take a chance that I might have an issue with the drug, so here we are.

Reacting to the Side Effect

I was feeling quite a bit of discomfort after taking the medication. The first day of facing the side effects, I took it like a sport. By day two, it became quite annoying, then irritating and finally exasperating!

So, guess what I did?

I skipped my medication!

Here I am, highly literate, working in Healthcare, and the thing I did was skip my medication. I did not forget to take my medicine. I chose not to! There was no way the side effects would make me forget the medication. I just could not stand the damn thing.

I did get back on the bandwagon, but I still reserve the right to skip and go to the next dose. So, while I turn a 14 day regimen into a 28 day or longer regimen, let us look at the implications for a second.

The Implications

See, what many Medical Device folks and others, including yours truly, have been thinking, is that Medication Adherence is a logistics issue.

Logistics: I have suffered from migraines all my life. I self-medicate using OTC drugs. Given that full doses of the standard issue pain relievers consisting of 250mg Acetaminophen, 250mg Aspirin and 65mg Caffeine relieve my headaches, but sometimes upset my stomach, over the years, I developed little tricks:

1. I try to eat something before taking the pills

2. I mash the pills into smaller pieces and try to never eat more than a quarter at a time.

3. And sure, I try to make my headaches be as far and few in-between as possible.

Limits of Solutions to Logistics Issues: Everyone is tinkering with all manners of pill boxes. My medication adherence and behavior modification solutions. I now see some commercial solutions, that I consider likely predatory, that purport to pack and give you pills meant for consumption based on the day of the week.
brother Sai Yamanoor and I also developed some

Yes, there are viable solutions. However, they cannot do anything when the underlying behavioral issues don't get resolved.

Human Nature and Its Implications: The things that stopped me were the side effects. A number of people are stopped by this too. When the treatment makes other parts of your body suffer, you are not too happy about it. If you go on to develop a fear or aversion to the medication, getting back on track can be quite difficult.

The Nature of Cats? 

When it comes to studying behavior, cats are perhaps the best alternate to humans, in certain areas. As someone who has been around cats for nigh on a decade now, I have learned much. Early on, I made it a point to adopt senior cats, and with that came the somewhat frequent need to medicate them.

Cats, like dogs, have highly tuned perceptions, and they just hate pills! I now wonder if it is owing to the displeasure the side effects cause them. I had cats run away, hide, and one that quaintly ate the pill pocket around the pill without getting anywhere close to touching the pill! I suspect, cats are informing us of the problem with medication adherence, in their own way.

A Difficult Problem: Some day, we will have genetics help determine what medications work for us. Perhaps, with 3D Printing, measured release mechanisms and other tools, we can titrate dosage much
better, and thus mitigate side-effects. And on and on she goes.

Until then, a bunch of pill boxes with LEDs and cute kitten sounds is only going to get us so far.

Solutions: It appears to me, that getting to some of that 3D Printed drug solutions, bringing back that sense of "compounding" that was once the mainstay of pharma, looking at device/drug combos would all be good ways to go.

It would also behoove to get psychiatrists and psychologists involved, as well as measure patient responses to the side-effects and find ways to help them continue therapy. This is not that far fetched. This is done with pediatric patients, cancer patients and others to quite an extent already.

One thing is for certain. Until technology presents us with the ability to thread the needle, we need creative ways to accomplish medication adherence.

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Image References:

1. Assortment of Pills:

2. Question Mark:

3. Gears:

4. Man and Cat:

5. Chess:

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