More Texts, Fewer Pills Please

Nearly one hundred years since the discovery of penicillin set off a pharmaceutical arms race, many members of the medical profession have completely accepted the notion that there is a pill to solve every ailment. Want to protect yourself from heart attack and stroke? Take an aspirin every day. Trying to control your blood sugars? Get on the metformin, STAT. Have sore knees after a long run? Grab a few extra-strength NSAIDs off the shelf.

As a society, it has become commonplace to respond to every medical issue, especially the management of chronic diseases, by implementing long-term pharmacotherapy regimens. While there are many, many fantastic drugs available today, the process of developing, testing, and gaining approval for new drugs is extremely expensive. What’s more, in some cases placing patients on long-term pharmacotherapy plans often masks the true source of their problems, such as poor diet, lack of exercise, or recurrent use of both legal and illicit drugs. The use of even the most common drugs does not come without risk of side effects, misuse, and economic costs.

Penicillin, then aspirin, then propranolol, and now our ACE inhibitors and long acting insulins have each shaken up the medical field in their own way. Now, medicine is reaching an new milestone that is both exciting and stressful: the capability to use modern information technology to transform patient care. For a century, we have turned to pills as the most effective route to maintain our health, but early mobile health research results show in some cases, the use of a simple patient monitoring system, may be just as effective or more effective that prescribing more medication. For example, in a study of Epharmix’s diabetes intervention, EpxDiabetes, the treatment group experienced over a twenty point drop in blood glucose levels over a ten week period, a result more significant than nearly every traditional diabetes medication currently available.

SMS-pills

Epharmix is devoted to creating mobile health interventions that improve patient-provider communication, real time symptom monitoring, and early intervention in the care of patients requiring additional support, all without adding work to providers. The company name itself is an acknowledgement of medicine’s new direction: the creation of powerful electronic-pharmaceuticals. Epharmix interventions are prescribed by a physician or care manager like any other drug, but are made up entirely of text messages or phone calls that track a patient’s symptomology and facilitate better care coordination and disease management. Although the ideas behind Epharmix are very simple, the potential transformative improvements in patient care that Epharmix interventions produce are formidable, as are the implications for quality metrics.

Why is it that simple text messages can have similar effects as compared to a traditional pharmaceutical? Epharmix messages do more than collect patient-reported outcomes and help care teams more closely monitor difficult populations; they also engage patients in their medical care, make them feel more connected to their provider, and challenge them to think more frequently about their lifestyle decisions. There is much research left to be done to confirm the efficacy of mobile health interventions on improving hard clinical outcomes. However, early results point strongly towards a shift away from traditional prescriptions and more towards the use of e-pharmaceuticals to transform care. In the future, you may try reaching for your phone and not the medicine cabinet.

Guest Author, Eric Sink

Independent Clinical Researcher, Epx Research Center, Washington University in St. Louis School of Medicine

Saint Louis University School of Medicine, Class of 2019