|WHAT WE’RE READING
Stuff we read this week that made us think.
Big brother, now in pill format
It’s incredibly frustrating for doctors when patients forget to take their medications. Start-up Proteus Digital Health offers one solution, placing a digital sensor inside the medication that sends a signal when the pill is digested in the patient’s stomach. A new piece in the Washington Post takes a skeptical view of whether the company’s $1,650 digital pill is the most cost-effective method to drive medication adherence. Proteus partnered with Otsuka Pharmaceutical to create Abilify MyCite, a version of a generic antipsychotic drug that includes Proteus’ digital sensor. The drug received FDA market clearance but has largely remained off the market due to insurer and physician reservations. Last month, Virginia’s Medicaid program became the first to cover the therapy. Doctors question whether the added benefits are worth the cost (roughly 30 times the cost of Abilify without the sensor), and whether the pill, which sends its signal to a patch worn on the patient’s torso, which then transmits it to a smartphone, is an invasion of patient privacy and autonomy. (Not to mention the potential skepticism of some schizophrenic patients, who may be prone to delusions and hallucinations). Moreover, we wonder whether the high-cost Proteus technology addresses the real root causes of medication noncompliance. Most often patients fail to take their medications because they can’t afford them or simply forget, problems not solved by a costly solution that simply measures whether a pill is swallowed. $1,650 a month could provide a patient with home health support or housing assistance—investments likely to make an even greater improvement in the health status of at-risk Medicaid patients.
Start-ups under scrutiny for referral practices
Two start-ups promising consumers easier access to medications and new diagnostic tests came under scrutiny this week for questionable billing and referral practices. Testing start-up uBiome, one of the earliest entrants into the field of microbiome testing, offers patients the ability to sequence the DNA of the bacteria and other organisms that inhabit their digestive tracts, tapping into the exploding (pardon the term) amount of research linking the gut microbiome to diseases ranging from obesity to depression. Patients can access the sequencing by filling out a questionnaire on the company’s website. A doctor on contract then approves the test, and the patient’s insurance is billed. As reported in the Wall Street Journal, the FBI is investigating uBiome’s billing practices and relationships with prescribing doctors. Also this week, Nurx, an online women’s health company that has dubbed itself the “Uber for birth control”, came under scrutiny for its efforts to loosen prescribing standards and pressure put on doctors to increase approval rates. Experts worry that the prescribing methods of both companies may leave patients at risk, missing or ignoring symptoms that could indicate a serious underlying condition, and failing to connect patients to follow-up. Both Nurx and uBiome have received millions of dollars of outside investment. As direct-to-consumer healthcare technologies circumvent traditional provider relationships and safeguards, more oversight may be needed to ensure that start-up culture and investor-driven growth expectations don’t put patients at risk.
Sink your teeth into this unsettling article
Do you dread going to the dentist? We do too. If you find yourself in the waiting room nervously anticipating your turn in “the chair”, here’s a piece of advice—do not pick up the latest issue of The Atlantic from the magazine rack. Inside, a long and disturbing article explores “The Truth About Dentistry”, telling the story of one California practitioner whose record of unnecessary and expensive overtreatment reveals everything that’s wrong with the practice of dentistry today. As the article highlights, dentistry has largely diverged from mainstream medicine over the past century, missing almost entirely the shift toward greater academic rigor, lengthy apprenticeship, peer oversight, and evidence-based practice. Instead, most dentists work in solo or small practice, untethered from oversight or peer scrutiny, and able to wield significant sway over their (often) frightened patients. Only in the last few years has a move toward clinical best practice taken hold in the profession, and with it a growing recognition that dental health and overall physical health are deeply related. What’s shocking is just how pervasive overtreatment, driven by the profit motive, has become—rather than universally recommending sealants for children’s teeth (a low-margin but highly-effective prophylactic measure), we over-rely on filling cavities. The twice-yearly checkup and cleaning? That’s a mid-20th century invention of toothpaste companies, not an evidence-based practice. (The same is true of regular flossing.) Extracting wisdom teeth, conducting root canals, performing expensive gum procedures—all big revenue drivers for dental practices based on limited clinical evidence. Dental-phobes, beware: there’s a lot of worrying information in this article, but it’s a thought-provoking piece on the urgent need to re-integrate dentistry and modern medicine.