Some ideas are just so great I am left in awe.
Photo: Christopher HartingAs Emily Singer writes in Technology Review that drug-resistant tuberculosis is an important problem, especially in poor countries. After you get TB, you are supposed to take antibiotics for six months to prevent drug-resistant strains of TB from arising. The problem, however, is that the antibiotics have side effects, and there is little private benefit to the person taking the drugs. So there is little incentive to take the full treatment of medication.
So how do you solve this problem? To an economist, the obvious approach is to give the patient strong incentives to take the drugs even after they feel better. The difficulty lies in monitoring whether the patient is actually taking the drugs.
That is where the brilliance of science takes over. Jose Gomez-Marquez, program director for the Innovations in International Health program at M.I.T., along with his colleagues there, came up with an ingenious solution.
They “figured out a simple paper-based test that detects metabolites of the TB drug in urine.” So if you take the drug and pee on a special piece of paper, a secret message appears. If you don’t take the drug, you can pee on it all you want, but it will not reveal the secret message. Every time the drug taker texts the secret message to the people in charge, he earns a prize, like cell phone minutes or cash.
It’s the perfect marriage of science and economics.
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A great solution, although I foresee a future where those on TB medications start selling urine to those who choose to be non-compliant but want the rewards anyway.
Yes, what J Chang said. One pot of urine and all the people in the village dip in instead of taking those suspicious foreign drugs.
When do patients receive the pieces of paper? If they receive them when they get the drugs can’t they just pee on all the pieces of paper the first day and then just send the text messages later?
You’d think the key would be to set the incentives so they’re worth doing, but not worth breaking your back (and buying contraband urine) for.
I have one major concern with the incentives in this program: what stops a TB patient from taking the drug for two months, then giving her medication to her sibling/parent/child/neighbor? So long as somebody is taking the drug and urinating on the strips, they can continue to collect rewards, but this defeats the entire purpose of the program. This would be an even greater incentive in poor countries where TB is prevalent, but families cannot afford the treatment; the precise location that this program is constructed to target.
J Chang/1, that seems like a lot of effort to try to win a prize, when the alternative approach is to simply take a pill.
The problem isn’t that people abhor taking the antibiotics (unless they’re the unlucky ones to have strong side effects), it’s that they don’t feel like it.
I don’t understand. Isn’t the prospect of living with drug-resistant (and deadly) TB scary enough to enforce compliance?
Hmmm…a market in pee. Perhaps not a healthcare professional’s ideal outcome…
In fact would this not just encourage those who don’t mind the side effects to take the antibiotics for a fee? As and when they need the cash and so never completing a course of treatment, thus increasing the risk of anitbiotic resistance for both TB and other diseases?