Additional Assumptions Patients Should Not Make

This is a continuation of blogs from May 10, 2012 and October 17, 2012.

Don't assume the doctor knows what you are thinking.

I wish I would have been listening more carefully when Dr. Peter A. Ubel of Duke University was on the Tavis Smiliy program on PBS discussing his book “Critical Decisions.” I just happened to hear him make the above statement on the late night early morning (locally 0100 AM) show of Oct 18, 2012. He commented that patients need to speak up because doctors are not ESP aware. After reading the reviews about his book here, I looked at the other books he has written. They are interesting and on controversial topics of health care rationing and assisted suicide. Many physicians and nurses are pushing for assisted suicide and healthcare rationing (euthanasia), so be alert to the position of your doctor if you are opposed to assisted suicide.

His answers to Tavis's questions about communications were most interesting and he stressed the need for communications between the patient and doctor, even if the time constraints prevented extended communications. This is why people like David Mendosa and me write blogs about preparing for the doctor appointment. Yet many people just don't understand the need to optimize the time with their doctor. My health depends on optimizing the short time I have with the doctor.

Do not assume that your doctor is completely independent of interest conflicts.

This is something many patients do not consider about their doctors and is a fact of life that needs to be at the heart of every patients concern about their doctor(s). Many doctors are honorable, but they are human and can be influenced by money or other enticements. Even with this being on a neurologywebsite, it is applicable for all medical professions and doctors.

Three states do have mandatory marketing disclosure laws, which require the reporting of physician payments. The states are Minnesota, Massachusetts, and Vermont. Anyone can also access Dollars for Docs (bit.ly/cZzi9A), a free ProPublica database that allows individuals to search by physician in order to find disclosed payments made by 12 pharmaceutical companies to healthcare practitioners. Some patients are already using this resource. Much of the data available may be incomplete.

As patients, help is on the way. Unless there is delays (and do expect them), beginning in 2013, the implementation of the Physician Payment Sunshine Provision of the Affordable Care Act will provide a database of financial relationships that will be available to patients. The final regulations from the Centers for Medicare and Medicaid Services (CMS) are not complete, and many physicians are concerned about the accuracy and manner in which the tool will display information. It is expected the physicians will call on CMS to delay implementation.

Never assume that the doctor will follow protocol or your wishes near the end of life.

Yes, in a survey conducted by Medscape and published in their 2012 Ethics Report asked several questions related to end of life. It is immoral the percentage of doctors that would do things in violation of do not resuscitate (DNR) orders and orders to resuscitate. Many look to sidestep orders by going to an ethics committee and follow those recommendations over wished of the patient or their families.

Never assume that the doctor is giving you all the information.

In the same ethics report above, the percentage of doctors that would withhold information is only ten percent, but another 18% hide behind the “it depends” defense. In cases where the doctor feels a procedure is necessary, ten percent think it is right to withhold adverse information and another ten percent use the “it depends” defense.

Take time to view the slide show to find out what the doctors think of the 20 ethical questions. You may be surprised!

Finally, never assume that the hospital is working in your best interest.

Hospitals and healthcare facilities are required to review code status with authorized decision makers, (i.e.), administrators, to see if they can ration your care and thereby bypass legal barriers to resuscitation orders. This is a two edged sword for the well-being of the patient. Those who wish to have every reasonable attempt made to keep them alive are often euthanized in the name of quality of life to avoid wasting money and resources. Others that have do not resuscitate (DNR) orders are resuscitated because according to the hospital and doctors, they are too young.

Therefore, it is always wise to have family members involved in any hospitalization where end of life questions may become a factor. It is even wise to have a family member that is capable, or two that agree with your wishes, empowered with a medical power of attorney or full power of attorney to see that your wishes and desires are followed. If a family member is not available, if you have a friend that you trust, then give them a medical power of attorney.

Always be aware that some hospitals and healthcare facilities will attempt to bypass legal orders and may try to ration care. Many hospitalists and nurses are known to pull together to cover up adverse advents. Yes, I am very wary of many hospitals and even more wary of most healthcare facilities for the mistakes that are hidden from patient's relatives and investigatory agencies.

The Many Forms of Advocacy

Merriam-Webster's dictionary defines advocacy as the act or process of advocating or supporting a cause or proposal. This is just a general definition. There are other forms of advocacy and one that fits quite well - advocacy represents the series of actions taken and issues highlighted to change the “what is” into a “what should be”, considering that this “what should be” is a more decent.

For purposes of this discussion, the above is considered part of health advocacy. Health advocacy supports and promotes patient's health care rights as well as enhance community health and policy initiatives that focus on the availability, safety and quality of care. These are just a few of the forms of advocacy and each is important.

I can understand those that are just newly diagnosed with diabetes not being active advocates for diabetes. They are still trying to find the path of maintenance that works for them. However, others that have had diabetes for several years that say or do nothing need to realize that they must speak out for things they have found lacking in their own experiences. They must know that advocacy takes many forms and by remaining silent only lets people who might benefit by what they may say continue without information or direction that may be helpful. This is one reason why I blog, to put information out that may assist people and educate them that a diagnosis of diabetes is not a death sentence.

I feel better knowing that I am busy and working for the education side of diabetes. Those of us with type 2 diabetes have many causes that we can advocate for and most of them need our voices to be heard loud and clear. Some of these causes are:

1. The need for more test strips to help us manage our diabetes more efficiently, to determine what foods do not spike out blood glucose levels.

2. The need for better nutrition information tailored to our needs and not the needs of government.

3. To be recognized as individuals and not lumped into a one-size-fits-all category.

4. Training to be peer mentors or peer-to-peer workers to help others with type 2 diabetes.

5. Better information about oral medications - the limits of each, side effects, and changes dictated by the Federal Food and Drug Administration.

6. More information about insulin and the education of people with type 2 diabetes about the advantages of insulin when oral medications are not working for us.

7. More community involvement to educate not only the community, but assist other people with diabetes set realistic goals for themselves to not only manage diabetes to prevent the onset of complications, but to prevent those with prediabetes from developing diabetes.

This is a very incomplete list and leaves many items for people to expand and become advocates for their change. Some will say that education is not advocacy because it does not raise funds for research and the cure. I say that we have a great need for education to become aware of areas that need research.

I have been blogging about self-management of blood glucose (SMBG) because we need to know what to do for more efficiency in testing. The Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the US Department of Agriculture (USDA), and the Department of Health and Human Services (HHS) all have funded research aimed at reducing the number of test strips we can use for testing our blood glucose levels. In selecting participants for the trials, they exclude people that are knowledgeable in SMBG and include people that do little or no testing of their blood glucose. How do they know there are people that do little or no testing? They know that there are doctors that do not encourage their patients to test so they look for these patients. These doctors do not encourage testing for many reasons. They don't want their patients to become depressed when they see high blood glucose readings and some follow the USDA logic of whole grains (high carbohydrates) and low fat and don't want their patients to understand what is happening to them. Most of the trials do nothing to educate the participants about what the testing will do and therefore the A1c levels change very little. The researchers can then say that testing makes no improvement in the health of the trial participants, and the CMS uses this information to reduce the number of tests strips covered and eligible for reimbursement.

This is why we need to advocate for proper research and education in blood glucose testing. We need to demand that the research be done scientifically and use education to show what proper blood glucose testing can do for reducing A1c's and improving the health of the trial participants. One such study has been done, but it is not getting the recognition it deserves. Roche Diagnostics performed the study using the Structured Testing Protocol (STeP). More studies are needed to show what proper blood glucose testing to do for lowering the A1c.

The other government agencies, the USDA and HHS do not want people to know that the problem with their nutrition guidelines are what is behind much of the diabetes epidemic and obesity epidemic and they support the CMS position on reducing the number of test strips. Until people with diabetes are taught the purpose and value of SMBG, this is widely publicized, and more trials are advocated for, we will have little to refute the CMS position and prove what USDA and HHS guidelines are causing much of the problem.

Yes, we will still have many people with type 2 diabetes that seem to not care and believe these government agencies can do no wrong. If only they knew!

Before stopping your reading on advocacy, please go to Health Central and read a recent blog by David Mendosa on his thoughts on diabetes advocacy.

No Guidance for New Diabetes Patients

For many patients with type 2 diabetes that have had their diagnosis for several years, this news is not new. A new study published online in the journal Primary Health Care Research & Development says that patients that are newly diagnosed with type 2 diabetes feel left in the dark and wonder where to find information to give them guidance. Even though this is a study done in the United Kingdom (UK), it is still applicable for new patients in the USA and other countries.

With the increase in diagnosis of type 2 diabetes, most countries do not have the necessary personnel trained to teach the new people what is necessary to manage diabetes. The patients is the USA may think that certified diabetes educators (CDEs) are available, but many areas of the country are without them and in other areas doctors will not make use of them. This is often because the doctors think they are the only source of information and others have had conflicts with the CDEs.

The authors state, “With type 2 diabetes being most common in older patients it was commonly reported that it was difficult "to break habits of a lifetime". This barrier to changing lifestyle is partnered with negative views of the 'new' diet, with it viewed as mundane and unappealing.” I have heard this said by many patients and the complaint is about bland food.

Recently I asked a woman complaining bitterly about the foods her doctor had recommended to her – why she had stopped using spices and condiments to add flavor back. She looked at me as if to say “your a man and don't know how to cook.”

Her friend who had been agreeing with her said their doctor had taken both of them off highly processed foods and prepared meals from the freezer section. The doctor had ordered them to eliminate as much fat as possible and eat more carbohydrates. He had also said to eat more fish and skinless chicken. I asked how long they had been doing this and they both had been doing this for about six months. I commented that getting away from highly processed foods, was probably the best advice they had received. I then asked if they were testing to see how different foods affected their blood glucose. Both looked at me and stated their doctors had not given them anything to test with or any information about testing.

The next question I was hesitant to ask, but I asked how much weight they had gained since diagnosis. They did not hesitate in saying – one had gained 15 pounds and the other had gained about 20 pounds. Both said they could not keep the weight off even by walking and swimming. I knew they were because they were not that much overweight for their size and bone structure. At that point, the one lady asked how I knew about testing. I said I had type 2 diabetes and was using insulin and tested regularly. She then asked what my last A1c had been and when I said, she stated that hers had still been over 7.0% and the other lady said hers was about 7.0% also.

Since we were in a store that had a pharmacy, I suggested we go to that area and I would show them the meters. After seeing them, both asked how to use them. The pharmacist had seen us and came over to answer questions. She asked which doctor(s) they were seeing after she learned they had diabetes. After they answered, the pharmacist stated that the doctor they were seeing would not give out meters and did not recommend testing. I asked if they were determined to stay with their doctor and both said it sounded like they should consider other doctors. The pharmacist asked if they saw doctors in other areas and both said the same city as mine are located in and I suggested my endocrinologist. The pharmacist volunteered to call the office and see if they could get appointments and she got their names and information and I said I would go home and get my meter and come right back.

When I returned the pharmacist had received appointments for them and was covering what Medicare and their supplemental insurance would cover. The one lady was asking what their out of pocket costs might be if they needed more strips. The pharmacist covered the costs for the meters they had in stock and both agreed it could be worth the extra cost. At that point the pharmacist handed me a marker and said to show them where to use the lancet, which I did. I then used it and explained how to adjust the lancet device to set it to have the least amount of pain and still get a sufficient amount of blood. I then took out a test strip and inserted it in the slot on the meter, explaining why I was doing it in the order I was. I then used the lancet and let them see the blood while I took the meter and carefully pushed the tip of the test strip into the blood. My reading was 98 mg/dl. The pharmacist asked how long since I had eaten and I said about four hours.

Then I changed the device in it to have a clean lancet and asked if anyone wanted to test. The pharmacist said wait and went to get a few alcohol pads and wiped the lancet device down and since the bathrooms were clear across the building, wiped one of her fingers. She had me put a test strip in the meter and while she adjusted the depth on the lancet device and pricked her finger. She took my meter and carefully pushed the tip of the test strip into the blood. The reading for her was 76 mg/dl and she said that she does not have diabetes and therefore it should be lower. Both women then said they would test. The pharmacist again wiped the device after I had replaced the lancet with a new one. Then she adjusted the depth and I inserted a new strip in the meter. The first try was insufficient blood and the pharmacist demonstrated the proper way to get enough blood. The reading was 168 mg/dl for the first person and 198 mg/dl for the second. We talked about when they had eaten and what medications they were taking. The pharmacist agreed that both readings were too high and that depending on their ability and what they desired, to strive for much lower readings. We discussed the different levels that people should consider for the medications they were taking.

The pharmacist said she was busy and if they had more questions they could ask them another day. The one woman said that since it was such a good day, we could adjourn to her place, which had a screened in patio, and they had more questions for me. The other asked if she could stop and get her husband and it was agreed. The four of us would get together in about 20 minutes. Neither had purchased a meter at my suggestion since the office for their appointment would probably give them a meter and I wanted to discuss the different meters with them.

After we were all together, I started by talking about food. The hostess said we get it, we will get off the carbohydrates and back to bacon and eggs or sausage and scrap the bread until we have our meters. She continued that my talk about spices and condiments had given her ideas for other foods and they would be trimmed until they had their meters. Both women agreed and said I had given them ideas, and that they would stay away from processed foods. I asked if anyone had taught them how to count carbohydrates and they admitted they had not had anyone talk about that. I asked what cookbooks she had and if any of them were recent. She said her husband had just bought one they were going to give their daughter. She got up and brought it back. She also brought a diabetic cookbook. I took the Better Homes and Gardens cookbook (must be the tabbed ring binder), flipped open to the meats section, found a page with recipes on both pages, and laid it out for them. One recipe had servings for four and the nutritional information for one serving. We looked at the information and the light came on in both their eyes. The carbohydrates were listed as 22 grams and fat at 40 grams. The hostess said that is as recipe she and her husband would eat and folded the corner. I told her to look at the diabetic cookbook. She said that most of the recipes were not something they would eat and no nutrition information was given. I gave them several more cookbook titles that I knew had nutrition information.

Both women said they were going to go shopping after their appointments the following Tuesday. When she returned the cookbooks, she brought her laptop back and asked for my email address. The other woman reached into her handbag and brought out a pen and small pad. She copied my email address and asked for potential web sites for reliable information. I pulled up several sites and those she was interested in she bookmarked. She said she would email the list to her friend later. I finally gave her my website and both looked at me. Then the hostess said that is the reason you were not afraid to speak out. I showed her my blog on cookbooks and she said no wonder you were not bashful in showing us the information. She looked through several of the blogs and said this was something she would have to read later. I had her bookmark several other blog sites and Health Central. I showed them where to join and this would allow them to select bloggers the they might desire to follow.

Since we had talked about their medications. they were each on one of the sulfonylureas, I asked if they had been told about hypoglycemia. They admitted they did not know what I was talking about. So I directed them to two of my blogs here and here. On the second blog, they followed the link to Joslin and both asked if I knew why they had not been told. I asked if they had been instructed not to take the medication if they were not going to eat a meal and they answered yes. I said then the chances were they may not have had any problems with the number of carbohydrates they were told to eat. I suggested that they maintain that number until they met with the doctor on Tuesday and definitely discuss different medications at that time.

Both thanked me and said they would have to thank the pharmacist also for recommending a change in doctors and making them aware of what they had not been told. We parted company for the day, but they have stayed in contact and expressed how much they appreciated their new doctor. They have changed oral medications, are happy with their meters, and are testing to see how the different foods affect their blood glucose. Yes, they are paying for extra strips out of pocket, but are happy that they are able. Both have been told to learn about insulin in case they do not get their A1c's to at least 6.5%. They are confident they will, but they are asking me questions and are happy that I and others have written about insulin and the related issues. I asked them if they felt they were threatened and both answered no, they felt like the doctor wanted them to learn about insulin so they would be ready if insulin was needed in the future. I said I was happy to hear that and that they were not discounting insulin.

Diabetes Diets and Your Meter

In reviewing some of my blogs, I have found several that have gained readership beyond what I anticipated. This says there is a need for people to understand what they need to know at the early stages and to review some topics after they have gained additional knowledge. It is important to say that I am not an expert, but hopefully my readers are finding some information that they have been able to apply with the help of their meters and that they are adapting some information to their own management of diabetes.

Also, this statement may prove helpful to some as they read other diabetes blogs or websites – “what works for me, may not work for you.” Other people use this - “your mileage may vary” to help them understand that the results worked, but not as well as they hoped. Those of us that blog about diabetes understand that, and know that some ideas are helpful, some ideas make sense, but don't get the great results for them, and a few ideas just don't help. I have found this happens to me and I have a few – now many pages of helpful sites (the URLs and a brief summary) that I use to review from time to time. I apply what I find works for me and keep the information for future reference. Sometimes when one thing quits working, I return to my list and see if something else is now working.

I may overuse this, but testing is important and goes a long way to helping you discover what you body will allow and still get the test results you want. The meters are not expensive (often your doctor will hand them out free), but it is the test strips that are expensive. Insurance will only cover a limited number. I have found it worthwhile to talk with the medical insurance people about allowing extra testing shortly after diagnosis. Some will allow extra for a couple of months and then go back to their allowance, but most will require a letter from your doctor. Forget Medicare, they will only allow one or two test strips unless you are on insulin and then you are allowed four test strips per day. This is unreasonable at best and criminal what they will do to people needing to learn how different foods affect blood glucose readings. For those unable to obtain or afford extra test strips, okay, check with the manufacturer for financial assistance. Most do have this and if you follow their instructions, you may qualify.

In writing about diabetes diets, I made some statements about the collusion between four government agencies and four diabetes organizations. Now another blogger on the nutrition side is speaking out about two government agencies and taking their “experts” to task for our obesity epidemic. She also has an excellent discussion about her organization and their part in promoting the obesity epidemic. This is also why they do not want us testing to see how different foods affect our diabetes management. This last sentence is what drove my thoughts in writing about getting our test strips back from Medicare. It even caused me to listen to one of the candidates for congressional representative from my district and ask some rather direct questions about why USDA was working so hard to give out bad nutritional advice – to which I was totally ignored and then several others asked similar questions which were also ignored. Since the candidate is the wife of our current Secretary of Agriculture, it did my spirits good to see her defeated.

There are many good reasons to ignore some of the quasi professionals in the Academy of Nutrition and Dietetics and the American Association of Diabetes Educators when they do not attempt to help many of us with type 2 diabetes which I blogged about here. Even my cousin that is a certified diabetes educator has now disowned me for some of my positions. Another cousin that has been helping me with nutrition when I am a volunteer peer mentor says she likes working with me and was very surprised at the reception she has received and has continued to have with some of one doctor’s patients. Once she stated she would not be pushing high carbohydrates and low fat, but wanted to work with them at the level they were at, whether low carb or what ever type of regimen they were wanting to discuss, she has been well received. She has now consulted with another group of patients with the same doctor that are interested in nutrition.

My second peer mentoring session with a husband and wife practice in Kansas for October was good. The primary discussion was on different meters and the proper blood glucose levels or guidelines they should follow. I wish I would have had the second question from Diabetes Mine and the second comment to the discussion, but we did cover most of the points. Many were not enthused about the ADA guidelines and wondered about the points in Jenny Ruhl's website here and here. I stated that they were excellent targets for many people. I asked if anyone was hypoglycemically unaware or recently had a low that they were not aware of until they tested. No one had such an experience that they were aware of and I warned them about this and knowing the signs of sweating, nervousness, being lightheaded, and the other symptoms. That did bring one admission from a patient saying now that he knew what to look for; he may have had one in the last month. He admitted that when he tested the reading was 73 mg/dl and an hour later the reading was 88 mg/dl.

I asked him how long it had been since eating and he said about 7 hours because he had not felt good and skipped the noon meal. I asked what medication he was taking and he stated it was one of the sulfonylureas and yes he had taken it at noon. I advised him to talk to the doctor before leaving that afternoon and ask about skipping the medication when he felt like not eating. When the doctor came to get the next patient he did ask and she stated he should not have taken the medication unless he was above 150 mg/dl. He said he had not tested and she advised him to always test if he knew he would not be eating. She stated this would guide him on taking the medication. She asked if there were other questions on medication and not eating – there were so she said they would cover this later before the session ended. I then explained what can happen if someone was high and took their medication without eating and got the hypoglycemia symptoms, but their test showed they were in the upper 80s or in the 90s. I said the symptoms of hypoglycemia can happen when they have a rapid drop in blood glucose levels. One person spoke up and said like a false positive. I agreed, but warned them that testing was important just the same.

Next I asked if any of them had pizza from time to time. Of the 12 patients in the room eight admitted to having a piece or two with the family. So I then asked how many were on a regimen of higher that 40 percent fat for a meal. Six answered yes, and I talked about not testing at one or two hours post meal, but at three or four hours and said this was known as the “pizza effect” because of the fat content that would slow the absorption of carbohydrates. I said I realized many of them could not use that many test strips, but for those that could, they should test at half hour intervals starting at 2 and one-half hours after eating and test until the 4 and one-half hour mark. One woman said she had read this someplace and had tested at the 2 hour, 3 hour, and 4 hour points and her high had been somewhere between the 3 and 4 hour points, so she knew I was right. I stated that it would vary from person to person, but that even a few people might have the high after four hours. One person asked if this would apply to her being on insulin. I said yes, and asked which insulin. She said Novolog and I said definitely, and advised her that she could be like me and only have a 3 and one-half hour effective period. She stated that as far as she could determine she was getting a 4 to 4 and one-half hour effective period. I suggested that she think about not injecting her insulin until after she had eaten, but to test before meals as always and count her carbs she would be eating to determine the dose, but not to inject until the end of the meal. She said she would ask the doctor.

I then had a few other questions before the end. I wished everyone happy holidays and both doctors asked me to remain online until all questions had been answered. The first question was the woman on insulin and the doctor said let her think on it, and she faced the video cam and asked if I had suggested this and why. I responded that this had been raised when discussing the “pizza effect” and the doctor said now she understood the question and that she agreed with my suggestion and it would maximize the effectiveness of the insulin. Then she stated that this would also be a good idea for those on sulfonylureas. Then she asked if anyone thought they had slow emptying stomachs although she did not think anyone did. No responses, so she continued that injecting after eating could also help these people in case anyone had friends with this problem.

The rest of the questions were answered and the husband asked how people felt this was working. Of the 14 people present, only one said it was not helpful and that was because he was still not on medications. The other person that was not on medications said it still was a help for him because he knew what needed to be done if he had pizza with the grandchildren. He said he would have to exercise longer, but how to test was still valuable to him. The husband asked how many would attend in January and 13 of the 14 said yes. Then a person asked a question about something I had written in my blog about the reason insurance companies limited test strips. The wife asked, “the one saying about the collusion between four government agencies and the four diabetes professional groups and them not wanting us to learn what high carb and low fat diets did to our health.” The person said yes, and the doctor said she agreed and her husband said he agreed as well. He went on to say that how were we going to maintain our health on the limited number of strips.

He then announced something that surprised even me. They had written all of the test strip manufacturers and all of the insurance companies they knew were being used by people there and were waiting to receive replies from two of the manufacturers. He said the responses to date would require copies of the front page of each person's federal form 1040 for the prior two years and they would need two copies of each, one set for the test strip manufacturer and one set for the insurance company. Once they had all the copies, they would send them all in and then they would be provided with a list and what would be allowed for each person. At that time, an email would be sent to each person with the details and a return form to say if they wanted to participate or not, and what their cost would be and the amount the insurance company would allow.  He concluded by saying that it may not benefit everyone, but unless they participated, they would not know.

Your Doctor Will Be Checking On You

Big brother has now entered the medical world and your doctor will now be able to determine if you are compliant or not. The US Food and Drug Administration (FDA) has approved the first digestible microchips to be placed in your pills. “The Proteus digital health feedback system combines an ingestible sensor placed on a pill, with a wearable sensor on an adhesive patch, and a mobile application that displays data on a mobile device, such as a smartphone.” Then the data can be transmitted directly to the doctor.

I can see some important advantages for this use, and even a few disadvantages. First question is the life of the wearable sensor as 7 days does not seem like it is long enough. If acceptance is good, then I can see technology raising the life to possibly a few weeks. How well it will hold up under showers, baths, and exercise perspiration is another point of consideration.

The Ingestion Event Marker (IEM) represents a new category of medical device. It is made entirely ingredients found in food and is activated on ingestion. The sensor put in the pill is approximately the size of a grain of sand. The system is integrated between the ingestible pill, a disposable patch worn on the body, and a mobile device carried in the pocket or purse. The sensor is capable of detecting the exact time the medication is taken and will identify the unique signature of the medication. The disposable patch will capture and relay the body's physiological response and behaviors. In addition to recording information from the sensor, the patch will record heart rate, temperature, activity and rest patterns. The mobile device will be able to display data in context and support care.

The IEM (sensor) does not contain a battery, but is instead activated by the fluids in the stomach. The body transmits the digital signal generated by the sensor. The IEM is the only ingestible sensor that is powered by the body. The sensor passes through the body similar to fiber. “The chips are aimed more toward people taking medications for chronic conditions than those on a short round of antibiotics. They don't provide any information, though, on how well pills are absorbed or whether they help. Continuous monitoring holds promise to alert physicians immediately if there is a problem, though plenty of people, no doubt, will find it just too Big Brother.”

You can use your imagination, but I can see patients using this to prove to their doctor that they are compliant. By the same token, I can also see many patients saying this is none of the doctor's business and refuse to take these pills, or at least not wearing the disposable patch. As pointed out in the article, this could be a great advantage for patients with chronic conditions.