The quarter-of-a-trillion-dollar question

By G.F. | SEATTLE

IN JULY Babbage, a 40-odd male, got a drug-coated stent in his left anterior descending artery. He unexpectedly found himself in need of the procedure, probably owing to radiation therapy to his chest 15 years ago. It had been administered as a prophylactic against the recurrence of Hodgkin's lymphoma (itself treated with chemotherapy) but a growing body of research suggests that can lead to early-onset coronary ailments. At a recent cardiac rehabilitation session he sat patiently and took notes as a nurse described the purpose and benefits of five major categories of medicine prescribed to patients with heart disease after an intervention.

Your correspondent needed one of each: an angiotension-converting enzyme (ACE) inhibitor that widens blood vessels and thus lowers blood pressure; a beta blocker to regulate the heart's action and let it work at a lighter pace; aspirin, to thin blood and reduce the potential re-occurrence of clots; a platelet inhibitor to prevent the stent from being coated with sticky cells; and an increased dose of an anti-statin drug he already takes, used to reduce cholesterol level and thus mitigate formation of arterial plaque. He also takes three other medications routinely for more minor conditions. (Babbage has also modified his diet and now eats plenty of kale too.)

The pharmacopoeia does not require a regime as strict as that used to manage HIV. But skipping doses or increasing them can have serious consequences, so sticking to the schedule matters. Babbage is not alone. The average American aged 65-69 takes 14 different prescription drugs each year, according to a pharmacists' trade group. The New England Healthcare Institute says non-adherence swallows $290 billion a year in additional health costs.

Part of the problem is the price of drugs. Babbage, who lacks any benefits in his pharmacy plan, at first estimated he needed to spend as much as $4,000 in the next year (for generics, no less) through a preferred mail-order provider, but reduced that to $1,000 with a bit of price shopping in chain pharmacies. Some patients may simply not be able to afford treatment. But little can be done about drug prices without overhauling America's health-care system. Helping patients remember how many of each pill to pop when should be more tractable.

Sure enough, apps and software programs such as MediMemory or My Pill Box help keep track of a drug schedule and send reminders to smartphones. GlowCaps lids, connected to the AT&T's mobile network via a mobile transmitter, glow and beep if a medication is missed—at a hefty price and recurring monthly charge. A button even sends a request to a pharmacy to refill the container.

Babbage's hospital, meanwhile, licenses software called MyChart from Epic Systems. It consolidates test results, prescriptions, upcoming appointments and other data from all doctors and departments in the system, and increasingly others within the greater Seattle area. (Though it is far from perfect: Babbage's MyChart discharge instructions failed to include aspirin among the medications, for instance.)

Many older patients, who are most in need of help, lack the devices and the computer skills to operate them. The best they can hope for is for pharmacies to call (or e-mail) them to say that a 30-day or 90-day prescription should be running out (as some are beginning to do automatically). By then, however, it is often too late; many doses have been missed. Still, the developments, however modest, are welcome.

Future generations of the elderly will be more comfortable wielding smartphones and other gizmos to aid their memory, and there is much promise in the so-called internet of things, in which home appliances and other everyday objects are embued with network smarts. Shame the technology didn't come sooner.