Wearable technology may be just starting to make its mark on the world of health. But already there is a new wave of technology waiting to take mHealth even deeper. And by deeper, we do really mean deeper: smart pills (also called ingestibles) and embeddables are set to take technology under the skin and into the body.
Smart pills – not to be confused, with so-called smart drugs like modafinil, which allegedly boost the cognitive ability – are, according to the FCC, “broadband-enabled digital tools that we actually ‘eat’”.
In 2014 the smart pill market was worth $1.56bn, according to a report by Markets and Markets. This is expected to grow to $3.83bn in 2020 and $8.98bn by 2024. Big business, in other words.
Smart pills essentially have three uses: patient monitoring, drug delivery and the rather more esoteric capsule endoscopy.
The first of these is relatively straightforward, as the FCC explains, with the pill monitoring where other medical systems fear to tread: inside the body. “There are ‘smart’ pills that use wireless technology to help monitor internal reactions to medications,” the FCC explains. “Or imagine a smart pill that tracks blood levels of medications in a patient’s body throughout the day to help physicians find optimum dosage levels, avoid overmedicating, and truly individualise treatment.”
One example of this that is already on its way to the market is the Ingestible Sensor from Proteus Digital Health, which was cleared by the US Food and Drug Administration (FDA) for measuring medication adherence in July 2015.
Proteus claims that 50% of people do not take their medication as prescribed, potentially reducing the efficacy of – and leading to costly escalation in – treatments. Their Ingestible Sensor is intended to address this, recording time of ingestion, steps, rest and heart rate, which it communicates to a mobile app via Bluetooth.
Proteus co-founder and chief medical officer Dr. George Savage says that ingestible devices like his own “have the potential to speed clinical trials and improve the real-world effectiveness of medicines in community settings”.
A smart drug delivery pill takes this principle one step further, not just monitoring the patient’s body from inside but releasing drugs while it is there.
“A smart drug delivery pill is controlled by electronics and has great flexibility and precise control in delivery location, release rate and dose,” the International Pharmaceutical Industry magazine explains. It can also, the magazine continues, measure the gastrointestinal tract and report back in real time.
That may sound like the medicine of the future – but it’s already on the market, courtesy of the IntelliCap ingestible electronic capsule from Medimetrics.
The IntelliCap capsule is swallowed and travels naturally through the gut. As it travels it measures pH levels and reports back on its finds, allowing the capsule’s location to be identified. This, combined with programmable drug dispensing, allows it to deliver the drug payload at the right place and in the right amount.
This is good news for patients, clearly. But for medical researchers too, with the IntelliCap recently helping scientists to obtain and analyse samples of the small intestine’s microbiome (microorganisms that share our body space) in a non-invasive way for the first time ever, a breakthrough that the company claims “is likely to lead to a greater understanding of the significant role the gut microbiome plays in health and disease; and with it, opportunities for new therapeutics”.
Capsule endoscopy, the final use for smart pills identified by Markets and Markets, has similar thinking behind it, cramming tiny cameras into capsules to record images of the digestive tract, allowing doctors to examine areas of the small intestine in new ways.
It is, apparently, a very safe method to determine an unknown cause of a gastrointestinal bleed and for anyone worried about the mechanics of swallowing a little camera, fear not: it is usually pooped out within 24 – 48 hours and, while one patient did keep the capsule inside his guts for five years, there
were no reported symptoms.
Embeddable technology is similar to that of ingestibles, the key difference being that rather than being swallowed, the technology is inserted under the skin or deeper into the body.
Again, that might sound quite far out. But there is one type of embeddable tech has been in constant use for more than 50 years: the heart pacemaker.
These can be quite clunky beasts, not to mention invasive. But with technology only getting smaller – the same computer processing power apparently becomes 100 times smaller each decade – this opens up the possibility of simply injecting embeddable devices into our bodies.
“If you do the math and fast forward a little bit, in about two and half decades the power of your smartphone will fit into something the size of a red blood cell. It completely changes the game if humans can have red blood cell-size computing,” David Evans, chief futurist at Cisco, told the recent Wearable Technology Conference in London (via Engineering and Technology Magazine).
Already we have seen one office in Stockholm implant RFID chips in the hands of office workers, which can be then used to open doors, swipe in etc. But the medical uses are likely to be far more significant than never losing your key card.
In January 2014 Google announced its smart contact lens, which aims to help people with diabetes by measuring glucose levels in their tears, giving them a pain-free alternative to the traditional finger pricking way of measuring glucose in the blood.
There is still, as Google acknowledges, a great deal of work before this product could potentially enter the market. But, with one in 19 people globally apparently dealing with diabetes, this could one day lead to a very useful product indeed.
“We’ve always said that we’d seek out projects that seem a bit speculative or strange, and at a time when the International Diabetes Federation (PDF) is declaring that the world is ‘losing the battle’ against diabetes, we thought this project was worth a shot,” project co-founders Brian Otis and Babak Parviz write on the Google Blog.
And then? Well, the sky’s the limit: Evans, in fact, sees a world where humans can actually replace their body parts with something more impressive.
“Where I think we’re going in the next decade is the embeddable phase, where all this technology we wear will be embedded in our bodies,” he said. “But ultimately where I think we’re going in the next couple of decades is to actually move into the replacement phase; where we take perfectly good parts of our body and replace them with something a little bit better.”
That could mean everything from infrared eyeballs for soldiers to mechanical limbs for athletes to improve reactions.
And what a future that might be.