Message from a Pill Bottle

It’s like flipping a coin with your health. Despite the fact that medications can save or extend lives, the average patient fails half the time to take those pills as prescribed. The reasons behind this failure are varied–ranging from simple forgetfulness to confusion to ambivalence–but the problem costs an estimated $290 billion in emergency-room visits and other avoidable medical expenses in the United States alone, according to the New England Healthcare Institute. Large organizations have been trying to tackle this problem for years. Drug-store chains send paper reminders in the mail–to little avail. HMOs have tried calling patients daily–but they found this labor-intensive solution way too expensive.

David Rose, founder of the startup Vitality, had an altogether different idea: to build reminder technology right into the pill bottle itself.

The result is a device called GlowCaps, a wireless-enabled cap that fits onto a standard pill bottle. The cap detects when someone opens it, and it uses the network to communicate with a small nightlight outfitted with a cellular modem that relays the data to the patient’s pharmacy. Both the nightlight and the cap emit an escalating series of lights and sounds when the user neglects to take a dose, beginning with a subtle glow accompanied by a soft ringtone. If that doesn’t work, the prompt progresses to a flashing light, then a pulsing tone, and ultimately a text message to the user’s cell phone. The cap can also e-mail reports to friends and family members and has a refill button that will send out an order for more.

Vitality, based in Cambridge, Massachusetts, isn’t Rose’s first attempt to build monitor-and-alert technology into everyday objects. He previously founded Ambient Devices, which developed gadgets like a smart umbrella, whose handle glows when the forecast calls for rain, and the “ambient orb,” an illuminated glass ball that flashes light in patterns based on trends in pollen levels, traffic, or the stock market.

“What we found is that when you have a device that is showing you information, that you look at throughout the day, it can really change your behavior,” says Rose. “Weather becomes top of mind, so you’re more likely to go on a bike ride or bring an umbrella.”

So when he learned how large and intractable a problem prescription noncompliance was, he set about trying to conceive an appliance that could help. “I was excited about behavioral persuasiveness in pervasive displays,” he says. Beyond the reminders, the device stores two months’ worth of data on whether patients are taking their meds, ultimately creating reports sent to their doctor.

Initial studies have been promising. In a study conducted by the Center for Connected Health, in Boston, researchers showed that GlowCaps boosted adherence rates for patients taking blood pressure medicine from 65 percent to 98 percent. “That’s quite a striking difference,” says Joseph Kvedar, the center’s director.

According to estimates from the World Health Organization, only about 50 percent of people who are prescribed drugs actually take them according to directions. In addition to the hundreds of billions it costs the economy in extra trips to the doctor or emergency room, the pharmaceutical industry loses about $70 billion annually when patients skip days here and there or stop taking their meds altogether. “It is so amazing that we as health-care providers have the delusion that people will do what we ask them,” says Kvedar, whose institute has measured adherence rates even lower than 50 percent.

At first, Vitality’s business model was to sell the device directly to consumers, through retailers such as Amazon.com, on the Pollyanna-like assumption that patients themselves have the strongest motivation to take care of their own health. But Rose has since learned that pharmaceutical companies and pharmacy service providers such as Express Scripts are willing to shoulder the entire cost. So Vitality is now selling GlowCaps to them, on the theory that they will earn back their investment many times over when patients simply take their medications as prescribed. “We want it to be free to individuals,” says Rose. Under these programs, about 2,000 people are currently using the technology. Vitality aims to have 25,000 users by the end of the year.

Some doctors are skeptical that GlowCaps will do significantly more than other kinds of reminder technologies, such as text messages. “There is convincing evidence that reminders help improve adherence, and innovative ways to deliver reminders are helpful,” says William Shrank, a physician and researcher at Brigham and Women’s Hospital in Boston. “But adherence is a complex behavior, and there are many reasons patients don’t take their meds. It is unrealistic to think that this would eliminate the problem.”

Beyond simply forgetting, patients may fail to take their medications because the drugs or copays cost too much, because they aren’t well informed about why the drugs necessary to treat their illness, or because they simply aren’t engaged in caring for their own health, says Tom Hubbard, who oversees research on medication adherence at the New England Healthcare Institute in Cambridge.

Vitality’s Rose says the technology addresses some of these other problems with its built-in tracking and accountability features; patients get weekly reports detailing how well they’ve followed their prescription, and reports can also be sent to family caregivers or physicians. “If someone is watching and monitoring you, like a report card, people pay attention,” says Kvedar. “If a doctor can say ‘You’re not taking your medication 50 percent of the time,’ I think we’ll see a whole other level [of change].”

Despite research suggesting that these technologies can help, even simple reminder strategies have yet to be implemented on a large scale. “The biggest challenge around adherence is an economic model to sustain it,” says Kvedar. “We need a bigger shift in industry around this problem and who owns it.”