Security Notes: A Remedy for Wasted Drug Dollars

The health-care industry is predominantly a simple, repetitive daily act carried out by millions of Americans: popping a pill. Seven out of 10 Americans are on prescription drugs. About 4 billion prescriptions are written annually, an average of 13 prescriptions per person.

Taking our daily pills is our most common act of public health care. And this act is fraught with staggering waste and consequential health damage. The World Health Organization published a shocking prescription-administration error rate of 10% to 30%, with the elderly and the self-administering patients sustaining most of those errors.

Chronic illnesses relapse. Psychotic patients lose their mental balance, posing a danger to themselves and to others. A young lady in my family was hospitalized after mistakenly taking a double dose of a potent drug.

Errors and mishaps occur too frequently in hospitals, too. Nurses are overworked and misapply critical prescription pills. The cumulative health impact is under-reported.

Add to this the cost factor. The University of Chicago published information indicating that just in long-term care facilities some $2 billion worth of unexpired drugs are wasted annually. Overall, about $5 billion worth of paid-for drugs are discarded annually, according to estimates.

Here is a perfect application for the new dimension of payment in our society. Digital money is not just a way to frustrate lawbreakers, it is also, and mostly, a lever for new-ground breakers. Unlike legacy digital money, which is a number in a computer address, digital money is a string of bits that carries value and identity, and as such can be linked cryptographically to its terms of use—money tethering (see my book, “Tethered Money”).

Think of an elderly lady in her apartment. It’s 7 p.m., time to take her blood-pressure medication. She takes her smart phone (or dedicated payment device) to the proximity of a mounted lockbox, which pops out the pill she is expected to take. The pill is released when the lady’s phone sends to the lockbox the exact amount of money required for that pill. Pay-per-pill, pay-when-used.

If for any reason the lady neglects to buy her evening pill, this fact is communicated via the patient’s phone to the monitoring health-care professional, who checks on the situation. Perhaps the lady fell ill. A simple phone call will alert a forgetful patient.

The money for that evening pill was supplied by the lady’s health insurance, and it was tethered. That is, it was designated to be used exactly that evening, not the evening before. And it will expire if not used within a given window of time. The patient pays exactly for the pills he or she consumes. No more wasted, unopened, or half-used bottles. A patient will not be able to buy 90 days’ worth of opiates and sell them to addicts.

In a hospital environment, a patient-assigned iPad loaded with insurance dollars will “buy” the pills from the nurse, and will not pay for unprescribed drugs administered in error. It will also alert the nurse if an expected pill was not offered “for sale.”

Indeed, payment is not just for transfer of wealth any more. It is a detailed, fast, effective, high-resolution monitoring system. Much as Visa and Mastercard today know us intimately by our wallet movements, so our health insurance and caretaker will penetrate even deeper into our minute, momentary payments at large.

This daily, real-time knowledge is robbing us of much-desired privacy but buying us protection, attention, and real-time help with the daily routine of popping pills. Aging nation that we are, consuming pills is becoming an American cultural icon like political inflexibility and apple pie.

What we describe here is not limited to health care. When Edison presented his light bulb, it was described as a candle replacement. It took a long time for people to realize that electric light is more than a fancy candle. Expect no less time before it is clear that digital money is not a fanciful payment card. The technology is here. Unfortunately, hesitation is holding us back.

Whether I talk about it in my class or in the BitMint lab, someone always comes up with a new vision of life enhanced through high-resolution, fast, secure, tethered money paid not way in advance, not according to a later invoice, but at the exact instant of use. Is your imagination on fire? Drop me a note!

—Gideon Samid • Gideon@BitMint.com