Publisher’s Note: May not exactly be what TB patients in Africa need to meet the challenges of adherence and effectiveness.
Imagine a “smart pill” containing a biodegradable electronic chip that monitors how your body responds to the medicine, broadcasts the information to your iPhone, which then emails the information to your physician. It may sound like science fiction, but drug companies have been studying just such an approach, according to an article in the current edition of ACS’s Chemical & Engineering News, the weekly newsmagazine of the American Chemical Society, the world’s largest scientific society.
In the cover story, C&EN Senior Editor Rick Mullin cites the smart pill venture between Proteus Biomedical, a start-up company in California, and established Swiss drugmaker Novartis as an illustration of the new and nontraditional research partnerships that are being forged. One major goal is to forge a closer, life-long relationship between pharmaceutical companies and patients, gleaning more information about a medication’s effects than now is available from clinical trials.
The story cites numerous examples. Sanofi, a pharma company, and AgaMatrix, a developer of glucose meters, recently announced a product that connects a glucose meter to an iPhone, which can retrieve, archive and transmit data. In another nontraditional coupling, Sanofi is teaming with venture capitalists. They also are collaborating with academic scientists in new ways, partnering on projects early on. PTC Therapeutics and Roche are joining forces with SMA Foundation to include the patient perspective in developing drugs for spinal muscular atrophy. Even insurance companies are getting involved — Humana recently teamed with Pfizer, the world’s biggest drug company, and Medco Health Solutions, a pharmacy benefits management firm, to reduce inefficiencies in getting drugs to patients. Experts point out that these joint ventures could provide detailed information on how individual patients respond to therapy and could help usher in an era of personalized medicine.
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It remains a challenge that many TB patients stop taking their medication before they are completely healed. Treatment of the disease requires a strict six-month regimen of antibiotics. If patients abandon the treatment early, the TB bacteria survive and can become resistant to first-line antibiotics. Patients abandon treatment due to side-effects or because they feel better, rendering them infectious for longer, and making them more likely to relapse and die or develop resistant strains.
One of the main reasons why patients fail to take their medicine is forgetfulness.
Questions have been raised as to whether mobile phone technologies can effectively replace face-to-face contact, but others note that mobile phone technologies enable health workers to monitor a greater number of patients, as well as freeing them to focus on patients who require most attention.
The Directly Observed Treatment Short-course DOTS strategy focuses on following up patients to ensure that they take their medication. Because TB takes at least six months of treatment to be cured, DOTS advocates that TB patients are directly observed and supported to take their TB medication every day until they are cured.
DOTS places a heavy burden on fragile health systems in many poor countries. In some cases you have more than 1000 patients requiring daily follow up, within a country. This is also a logistic challenge. It has been shown that comprehensive interventions such as education, patient reminders, more frequent visits, more telephone calls from health care providers have been shown to improve patient compliance.
Mobile phone technologies could prevent tuberculosis (TB) patients from abandoning treatment — a problem that can affect up to 20 per cent of patients in developing countries.