Invention Would Track Meds in Mentally Ill Patients, But Is It Ethical?

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Imagine if doctors could add something to their mentally ill patients' pills so that they could tell on their smartphones whether the patients were taking the pills as prescribed.

Inventor Don Spector has actually filed a patent that would do just that, and he did it after the Sandy Hook school shootings in Connecticut, which sparked a national debate about mental illness and privacy.

"This isn't house arrest, but it is an invasion of privacy to some extent," Spector, Chairman of the Board of Trustees at New York College of Health Professions, said of his invention. "But on the other hand, these are really people who shouldn't be released without medication."

New York University bioethicist Arthur Caplan said many technologies monitor drugs, but they can only be used in specific settings. For instance, many companies require their employees to submit to urine drug tests as a condition of employment.

"Without a court order, it's difficult to make anybody have to go along with drug testing unless it becomes a condition of employment," Caplan said, calling it a potential civil liberties issue. "For a mentally ill person or someone on drugs for mental illness, monitoring them might be nice, but you probably are still going to need to get some kind of judgment or legal order before you can use the technology."

He said it reminds him of forcing people found guilty of sex crimes to undergo chemical castration because of the consent issues involved.

Still, a mental health worker was stabbed to death in Oregon last May delivering medicine to a patient at home. Brent Redd, 30, whose mental illness was kept private because of patient confidentiality laws, stabbed 38-year-old Jennifer Warren with a kitchen knife after he lowered his doses of antipsychotic and antidepressant medications for an upcoming surgery. Five years earlier, Redd had been sentenced to 20 years in a psychiatric ward following the attempted murder of his mother, but was conditionally released into community care.

"Presumably, he had received treatment that made mental health professionals believe he was no longer at risk for violence," said Dr. Ken Robbins, a clinical professor of psychiatry at the University of Wisconsin-Madison at the time. Robbins was not involved in Redd's care.

Though monitoring of medications could have helped in a case like Redd's, Caplan said there's a slippery slope regarding which patients should be included in a monitoring program. It could be limited to patients convicted of violent crimes, or patients who could become violent, or patients who could become disruptive - which could turn to violence - and so on and so forth.

"It gets into trouble very quickly that way in terms of wide use," Caplan said.

Caplan added that even patients taking their medication can be provoked and act out violently, meaning the monitoring system wouldn't guarantee safety. He also wondered whether the invasion of privacy would discourage patients from taking their medications, fueling the battle to convince people who are mentally ill to take their prescriptions.

Spector said a patient could carry the pill with the tracker on it in their pocket and trick the program, but he suggested out a way to deal with that. Somehow, the trackers could be designed to tell if the pill has dissolved in the bloodstream.

Since patent applications are sealed for 18 months after they're filed, so that inventors can't steal each other's unpatented ideas, Spector said he couldn't explain how the "markers" in the pills would work to transmit information about whether they'd been ingested.

"I will say this: It's not very hard technology to do," he said. "It's a major difference in the way we monitor, but the technology is not going to be all that difficult to do."