Heck Of A Guy

Patient Complies Or Pill Pet Dies

In searching for items of interest for AlignMap, my blog dealing with patient compliance, I found the Pill Pets, a device succinctly described in this excerpt from BusinessWeek:

A BBC article, Pill reminders from robot pets, goes on to explain that

Much like the Tamagotchi (pictured below), the electronic pets that had to be fed and cared for lest they expire, the Pill Pets, to thrive, have to be informed that their reminders to take medication are being acted on.

According to Dr Coughlin of the MIT AgeLab, “We’re trying to get in [to people's minds] on another channel – rather than on an intellectual level, on an emotional level. We’re trying to find a way to get people to take care of themselves.”

Pill Pets – A Good Start

The brainiacs at MIT and their artsy-fartsy counterparts at the Rhode Island School of Design may be onto something. Adherence to treatment is, after all, an important goal. And, the idea of reaching folks on an emotional rather than intellectual level to achieve compliance rings true. Besides, we’ve all been eager to see some kind of useful manifestation of the High Tech/High Touch paradigm since reading about it in John Naisbitt’s Megatrends – in 1982.

Yet, as is so often the case, it falls to the Heck of a Guy Think & Bait Tank to point out that, while the basic premise of the Pill Pet is sound, it simply hasn’t been extended sufficiently. Disappointingly, I found little evidence of Pill Pal evolution; news stories and blog posts dating to 2002 are almost identical to those of the past few months. My hope is that the publication of these observations today will kick-start a new round of progress on this project.

First, it’s not clear to me why this effort is focused exclusively on the elderly, who certainly aren’t the only age group with poor adherence to medication schedules.

Perhaps “elderly” is, in this case an euphemism for “demented” or “easy (and fun) to fool”¹ because I suspect many individuals who are old but in possession of their faculties may not embrace either the concept of the Pill Pets or the cute little critters themselves. I’m pretty sure, in fact, that, were my mother to be emotionally blackmailed to follow her prescribed treatments by a circuit board masquerading as a lovable furry semi-mammal, she might well drop kick that creature into her driveway, drive her car over it a few times, and then grab her walker and a large stick to track down the miscreants responsible for this annoyance.

But, reaching out to threaten the sentient as well as the intellectually incapacitated of all age groups into desirable behavior is certainly possible, especially with the technical skills MIT and its cohorts bring to the table, but a new model is necessary.

What we’re going for is a Pill Pet with an attitude.

Consider, for example, the same pattern – i.e., Comply or your pet dies - executed² in the no-nonsense fashion of the famous National Lampoon cover:

Now, that is a “visceral reminder.”

The New, Improved Pill Pet Gang

Now, I’m just blue-skying here, but what if we recruited a crew from Disney Animatronics and some of those actors that played mob members on The Sopranos³ until that series ended. Maybe we even hire a screenwriter or two.

Now, while we could talk about any age group and any behavior, let’s use the same situation, convincing an older woman to adhere to her medication regimen, to make comparisons simpler. The new Pill Pet Gang scenario might look something like this:

Granny steps into the kitchen to prepare food for Precious, her Pekingese, only to find a note attached to the doggy bowl.

Also awaiting Granny is an addition to her pet menagerie, the revised Pill Pet, Squealer The Stool Pigeon, an automated pill dispenser (prototype shown below), constructed by the boys in the lab, that also sends a video feed documenting medication compliance back to Pill Pet Gang headquarters.

When Granny still doesn’t follow Squealer’s instructions, the next day a beefy chap redolent with garlic and sausage drops by to remind her of all the accidents that could befall an old lady and to hand her a small box. Inside the box is – you guessed it – a lifelike simulation of a Pekingese ear that the animatronics guys have wired to twitch convincingly.

Now adequately motivated, Granny demonstrates acceptable levels of compliance, the intact Precious is returned, Squealer sticks around as part of the family to assure continued adherence, and everyone lives happily ever after.

Admittedly, much fine tuning is necessary. We would need to run a few trials to determine the relative effectiveness of faking the kidnapping, say, of a grandchild Vs faking the kidnapping of a pet Vs making threats to destroy Granny’s property Vs threatening Granny herself.⁴ And, of course, groups with different characteristics and demographics may require different threats. Cost-effectiveness must be calculated. The Pill Pet Gang doesn’t work cheap, but health insurers and pharmaceutical manufacturers might well be convinced to subsidize such efforts. And, … But you get the idea.

I think the MIT guys can take it from here.

1. There would be, one supposes, some economic advantages in targeting the gullible. The folks pushing Pill Pets have, for example, apparently managed to sell at least four of these things to that poor soul in the graphic atop this post. Of course, it’s possible the photo does not show a patient receiving medication instructions but instead documents a senior member of the MIT Lab staff putting in her workday identifying the genders of Pill Pets.↩
2. Smirk↩
3. Arguably, one could hire actual criminals and probably save some money but actors would, I believe, look more authentic – and working with murderers is not without certain risks↩
4. It may be that organized crime has already accumulated this data; if so, there is no reason to duplicate efforts.↩