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You are here: Home Bulletins 2018 Fall Nonfree digital drugs are a bad idea

Nonfree digital drugs are a bad idea

by Molly de Blanc Contributions Published on Nov 12, 2018 12:27 PM
Aripiprazole, also known as Abilify, is an antipsychotic drug used in the treatment of schizophrenia and bipolar disorder. It's also a successful conjunctive (or add-on) therapy for major depressive disorder, and has been known to help bipolar individuals during major depressive episodes. For some people, Abilify may be a lifesaving treatment.

Abilify is also the first pill approved by the United States Food and Drug Administration (FDA) to be available in both digital and non-digital forms. A digital pill is a pharmaceutical drug containing an ingestible sensor, which transmits medical data.

Digital pills were designed to solve a problem: people are bad at taking drugs. Whether it's lifesaving treatments for conditions like HIV and tuberculosis, or antipsychotics necessary for the treatment of schizophrenia or bipolar, or even oral contraceptives, treatments fail when pills are not taken at the necessary times. However, we need to look beyond the potential medical benefits and consider how digital pills relate to user freedom, including the ways they leave users vulnerable to invasions of privacy.

When someone takes Abilify MyCite (the digital form of Abilify), a sensor is activated by stomach acid. It then transmits a signal to a patch worn on a person's skin. This, in turn, communicates to a smartphone app. (This is a good opportunity to remind ourselves that smartphones are really just pocket computers that can also make phone calls.)

The obvious danger here is that people with highly stigmatized mental health conditions are being called to trust some of their most personal data to a smartphone app.

It seems almost redundant to emphasize the risks posed by proprietary smartphone apps. In the Spring 2018 issue of the Bulletin, I wrote about Uber, covering ways the company has taken advantage of the opacity of its software. Security leaks and vulnerabilities run rampant across every kind of computing device, and data is stored in ways that range from vulnerable to downright dangerous. Users need to be in control of what is being transmitted from their devices, rather than companies in control of what is being received. When some of our most precious data is being entrusted to proprietary software, we are unable to trust it and should not feel confident with its security.

Privacy, security, and surveillance are major free software issues. Software freedom is a necessary first step to accountability in computing, which enables user consent and user freedom. We cannot have accountability in computing until all of the software we use is free. Without the ability to examine code for vulnerabilities, and without the opportunity to see exactly what it is doing and how it is doing it, we cannot be sure how safe a given technology actually is, and therefore we cannot, in good conscience, consent to its use.

Knowing this, we can see how digital pills could go terribly wrong for users. Imagine a malicious party infiltrating a digital drug app to misreport the user's adherence to their daily regimen. Imagine a smartphone app being able to list and track every person who is prescribed a certain drug or class of drugs. Imagine how easy it would be to use the smartphone app to build lists of everyone with mental health concerns, and then to track not just what they're taking, but how much, and when. In societies where mental health issues are highly stigmatized, what is the value of this sort of medical information? People with mental health conditions benefit from their prescriptions.

Medication nonadherence is expensive and dangerous, and I appreciate that those who invented digital pills want to help people take care of their health. But we cannot simply and blindly accept digital medicine without first taking a serious look at the implications the technology has. This technology needs to be in the hands of the users of these pills, and the only way for that to be possible if when the software behind it is free.

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