Although medical professionals do not know exactly why any particular drug used to treat
mental illness is effective, once an effective drug has been found for a patient we do know that  it is important for the patient to regularly take it.  I was able to go off my medication for depression after my first major episode.  I was particularly happy as I had been taking it at such a high dosage that it made my hands shake and writing difficult.  But years later I suffered a second and third major depressive episode and I now regularly take my medication daily.

Thus I read with interest a recent article in The New York Times about new medical devices, most particularly a digital smart pill that has been developed to track whether someone has taken their dosage of Abilify, a drug used to treat schizophrenia, bipolar disorder and depression.  The sensor in the pill is activated by stomach acids and sends information to a patch on a patient’s stomach which further relays it to a smart phone app for patient and doctor to view.  The patch also sends information about when a patient is physically active, at rest, heart rate, etc.  The pill obviously meets a need, particularly as the World Health Organization estimates that half of people with chronic diseases in developed countries do not take their medication.  In addition, if the digital pill can help doctors determine the effectiveness and proper dosage of the drug that is also a big plus.

But there is something Orwellian about the concept.  More such pills for more chronic conditions are on their way.  When does it move from being a helpful, voluntary technology into being one that is coercive?  When can someone be made to take a digital pill to monitor his or her activities? This is not an idle question.  In researching and writing about my mother’s lobotomy for Examined Lives, I found that to be one of the troubling issues—patients in mental health institutions, V.A. hospitals and even private patients being given lobotomies without proper consideration for the necessity or consequences. Obviously taking a pill does not have the same dire consequences as having a lobotomy, but the issue of who controls the decision remains the same. The question needs to be addressed before the dazzle of the benefits blinds us to possible distressing consequences.