Digital Pills for the Brain

In the new Broadway musical “Be More Chill,” the lead character is a bullied teenager who doesn’t fit in with the cool kids in his high school. He is soon introduced to a new drug that’s becoming popular among his classmates. The drug contains a computer chip that balances the competing adolescent voices in his head – fears and desires — and instructs him what to do to be cool and get a girlfriend.

The play purports to be science fiction. But is it? Pharmaceutical companies have recently started selling electronic “smart” pills containing computer chips. The first digital cancer pill, approved by the FDA in January, contains a chip in capsules filled with capecitabine, a cancer chemotherapy that patients must take several times every day. When the pill hits the stomach, it sends a signal that a skin patch picks up, and relays to a computer, allowing physicians and families to track medication adherence. The company making the chip has already embedded it into 40 other medications.

These pills offer advantages to people who forget to take their meds. Physicians hope that patients take their meds 80 percent of the time, but for chronic disease, half of meds aren’t taken as directed, and about a third of patients don’t even fill their prescriptions. Adhering to drug regimens can be especially hard for patients who are elderly or have cognitive deficits

I also sometimes to forget to take medications, especially when I get up late on the weekends or am traveling.

Given these wide adherence problems, the FDA approved the first digital pill in 2017, containing aripiprazole, which is used for schizophrenia and bipolar disorder, and which many patients avoid taking due to side effects.

The U.S. Defense Advanced Research Projects Agency (DARPA) has also been designing computer-brain interfaces that help people with strokes and epilepsy, activating or deactivating certain brain regions. Individuals with amputated limbs can now use these technologies  to control prostheses.

These devices, originally developed in animals, have controlled the movements of birds, mice, and cockroaches, creating robo-animals to detect explosives or watch enemies. Frankensharks, with brain electrodes, can potentially be sent to observe enemy ships.

But these devices, like all computers, can be hacked or fail to work right. Human prostheses and frankensharks can be co-opted, and used nefariously.

In “Be More Chill,” the pill ends up causing problems, but can’t readily be turned off. Smart pills pose questions, too, about privacy. If I forget my cholesterol medication, I would be happy to get a reminder, but wouldn’t want my family or others to know.

Paranoid schizophrenic patients may also feel spied on. Courts already require that some patients adhere to medications for tuberculosis and psychiatric disorders in order to be released from prison or to get child custody, and courts could mandate that patients take digital pills. But for patients experiencing side effects, that mandate could be unfair or harmful.

In “Be More Chill,” the main character ultimately decides that the pill poses more harms than benefits. He sings about the clashing teenage impulses in his head, “They scream and shout. I tune them out, then make up my own mind.”

Many of us may, in the near future, have to make up our minds about these pills as well.