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.
and 
. You can also watch it on 
Or they could save the papers, take the drug once a week, then do all of their business at once.
The better solution is to pay them to take the pills in front of a witness – just pay someone to walk around and hand out a daily dose… with a bounty if the monitor misses their daily appointment.
I think this is not practical. How much cash can you offer to the patient. And who would offer this reward? A patient’s close relative? This doesn’t seem practical at all. Good idea? I don’t think so.
Traditionally, we used to have people come in, watch them take their pill, and possibly give them a small reward when they come in. Directly-observed therapy works well, it’s just labor-intensive on the part of the observer. But do these poorer nations really have a shortage of people able to watch someone take a pill?
OK, April 1st, anyone?
@Sriram: The problem is that you need to keep taking the pills (and enduring the side effects) for several months after you’re actually cured. This is a problem not just with TB, but with any disease that’s being fought with antibiotics.
Personally, I’m pretty amazed by how naively Steven believes in the limitless power of artificial incentives, given how time and time again they prove to be useless or harmful (see current economy). As this example proves nicely, the problem is that most of the time you can “incentivize” only an indirect effect of the actual thing you want to encourage – and people end up maximizing that, often bypassing the primary goal.
and how to motivate the people in charge?
How about making the antibiotics mildly pleasant and addictive like caffeine? Then the person taking the pill gets the benefit buzz and also gets the headache if they don’t.
When I got to college, I tested positive for TB, but never had any symptoms. I may have “contracted” it years earlier. The doctor recommended I take this pill that would have side effects on my liver… and I couldn’t drink for 6 months.
I don’t know what you would have had to pay me to follow this regiment, but it would certainly have been upwards of ten thousand dollars… certainly cost prohibitive on a national scale.
I don’t know how it works, but I guess I still have a dormant TB in me… I haven’t gotten the test since (more than ten years later).
I guess real statistics on drugs like this would be nice before a patient would go through the trouble. But the doctors never have them.