05.05
Imagine that you have contracted tuberculosis. The current standard of care includes Directly Observed Therapy (DOT), which requires you to head into a clinic each day for six to nine months to stand in line so that a nurse or technician can watch you take your antibiotics. A permanent record is made of your compliance or lack thereof. Refuse to show? If you’re lucky, health authorities might invest the resources to visit you each day to watch you take your pills. Still not complying? Expect to go to jail for the duration of your treatment.
There is no evil intent here. Public health authorities are working to protect the public by reducing the incidence of drug-resistant Mycobacterium tuberculosis circulating in the general population. Partial treatment encourages the emergence of drug-resistant strains by quickly knocking off the most sensitive organisms in a patient while providing a breather during which the more resistant bugs can reproduce unhindered.
What about a less-invasive approach? Let’s call it EOT, or Electronically Observed Therapy.
The UK’s Telegraph newspaper reports:
The scheme, originally developed by students at the US Massachusetts Institute of Technology, offers free top-ups to sufferers who send text messages to health care centres with a unique code proving they have taken their drugs.
TB sufferers are often prescribed a cocktail of 15-20 pills, which they must take every day for six months to overcome tuberculosis, but many fail to complete the course, allowing the disease to build resistance to conventional drugs.
The global threat of drug-resistant TB was highlighted at a 27-nation conference in Beijing, which heard dire warnings from the World Health Organisation (WHO) of the consequences for developing nations if more action was not taken to tackle the disease.
It is estimated that more than 500,000 of the 9 million new cases of TB diagnosed each year are drug-resistant, with 50,000 cases categorised as the virtually untreatable “extensively” drug resistant strain. Nearly 2 million people die annually from TB.
There’s a lot that’s good here. Instead of a Big Brother approach, patients are given incentives — free mobile phone time — in exchange for following the regimen most likely to result in a complete cure. The individual benefits, as does society, since EOT is likely to prove more effective, less invasive, and a whole lot cheaper than DOT. The drawback is that this method requires an extra step by patients: testing urine to reveal a secret code on the test strip that, once texted via mobile phone, results in a topping off of the patient’s pre-paid mobile minutes.
My own company, Proteus Biomedical, is pursuing another EOT approach with its Raisin system. I think that this is an important idea that, given time, could help reverse the TB and HIV/AIDS epidemics sweeping the globe.
I returned from Africa on Saturday. Take a look at the photo at left to gauge how tough the trip was.