"Poor medication adherence," the latest euphemism to replace the much-disliked "poor compliance," is a hot topic these days. According to the New England Health Institute, a third to a half of American patients don't take their medi­cations as prescribed. And people with chronic conditions, including diabetes, are reportedly the worst when it comes to medication adherence and "persistence" (the length of time they continue to take a prescribed drug).

Because three-quarters of the U.S. healthcare budget goes to treat chronic disease, poor medication adherence is getting a lot of scrutiny from budget watchers. Drug-related morbidity, which includes the consequences of poor adherence, costs about $290 billion annually, 13 percent of total healthcare expenditures. Diabetes patients with poor adherence, for example, are twice as expensive to care for as those with good adherence: $16,498 versus $8,886 every year. And it's not just about money: A study of diabetes and heart disease patients revealed that those who did not adhere to their medications died at nearly twice the rate of those who took their medications as prescribed.

These statistics are fueling big interest in technology that can get people to take their medicine. One company, called Proteus, has come up with a kind of internal spyware: a little digestible chip that's embedded in prescription pills. After you swallow the pill and it reaches your stomach, the chip is activated by stomach fluids. From there, inside your stomach, it sends a signal to a microelectronic receiver on your shoulder, either in a small skin patch or inserted under the skin. The receiver records the date, time, type of drug, dose, and even the place of manufacture. It also measures and reports your heart rate and respiratory rate. Then the receiver wirelessly relays that information to doctors. By checking the logs from the receiver, doctors can tell whether you are actually taking the medication as often as you are supposed to. They can also monitor your vital signs, such as heart rate, before, during, and after taking the medication, allowing them to understand how you are responding to the medication.

Joe Jimenez, head of pharmaceuticals at Novartis (which is partnering with Proteus), told the Financial Times that after the smart pills, called "Raisins," were used to deliver a blood pressure medication to 20 patients, their "compliance" rose from 30 per cent to 80 per cent after six months. "This industry is starting to explode," he said. In fact, he noted that he may designate a "compliance tsar" to oversee the various Novartis partnerships and programs to "strengthen appropriate use of medicines."

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