The FDA announced approval this week for the first digital pill. It contains a sensor which communicates with a patch on the patient’s body, which then relays data to an app on when or whether the patient took the pill, heart rate, sleep patterns, fitness levels, etc, and the app can then share that data with whomever the patient chooses. Most articles focused on the technology and questions about privacy but didn’t delve into the specific drug in which this technology is being rolled out: Abilify (aripiprazole). As soon as we spotted that, the irony alarm in EHAB HQ went off at full blast. The New York Times was the first outlet we saw to pick up on this (“First Digital Pill Approved to Worries About Biomedical ‘Big Brother’“) and they have the perfect quote to explain why our irony alarm went off:

“Many of those patients don’t take meds because they don’t like side effects, or don’t think they have an illness, or because they become paranoid about the doctor or the doctor’s intentions,” said Dr. Paul Appelbaum, director of law, ethics and psychiatry at Columbia University’s psychiatry department.

“A system that will monitor their behavior and send signals out of their body and notify their doctor?” he added. “You would think that, whether in psychiatry or general medicine, drugs for almost any other condition would be a better place to start than a drug for schizophrenia.”

Technology has ruined paranoia.

Now, I struggled with paranoid delusions when I was dealing with mental illness and, as many people do, I recovered from that without any medication involved (you can learn about that here: Paranoia and Being Watched) so I don’t have any experience taking medication for the stuff in my head. However, I can see how this might be the most effective antipsychotic ever and you don’t even need to take it. Just imagine how this plays out:

Patient: Hey doc, I’m really struggling with feeling like I’m being watched. This feeling is always there in the back of my head and it affects how I act even when I’m alone at home. And I’ve stopped using lots of apps and websites because I’m convinced the data is being recorded. I’m not even doing anything bad, I swear. And sometimes it’s even like: what if there’s something inside of me? Or can people hear what I’m thinking? So sometimes I don’t go outside if I’m having lots of intrusive thoughts or I don’t go in a store because people will judge me for them. What should I do?

Psychiatrist: Ok, you’re in luck. There’s this brand new anitpsychotic that you can take that has some supercool technology that no other drug has. It’ll let us know when you take it and we can monitor a bunch of other stuff so we can maybe build a data model that helps us understand what triggers you or maybe how to prevent a psychotic break. Cool, eh?

Patient: So you want to put a tracking device in me?

Psychiatrist: Don’t worry, it’s just a teeny, tiny bit of magnesium, copper, and silicon. It’s totally safe. Well, I mean, there’s two black box warnings on it and the FDA has warned that aripiprazole may cause compulsive gambling and sex and binge eating issues and there are a bunch of other side-effects. But safe other than all of that.

Patient: But you’re saying I’m not delusional? The government approved a tracking device you want to put in me?

Psychiatrist: Uh, true.

Patient: So my fears are totally rational and reasonable.

Psychiatrist: Well…

Patient: I’m cured. I’m not delusional about anything! Thanks doc!

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