If the new pill works as well in women as it does in pigs
December 6, 2019 10:14 AM Subscribe
Once a month contraceptive pill in development [NHS Behind the Headlines] "Researchers in the US are developing a pill that can stay in the stomach for a month, slowly releasing hormones to prevent pregnancy."
The team have developed a capsule designed to be swallowed. Once in the stomach, the capsule dissolves and a 6-sided star structure unravels and gradually releases the synthetic hormone levonorgestrel. [...] So far the pill has been tested in 3 pigs.
Three questions come up immediately. What does it feel like to have a star structure in your stomach? How do you know when it is time to swallow a new pill? Is this method feasible for delivering other medications?
posted by Midnight Skulker at 10:38 AM on December 6, 2019 [2 favorites]
posted by Midnight Skulker at 10:38 AM on December 6, 2019 [2 favorites]
In a pill? Wow this is a bad idea. Pharma can't even get 24 hour sustained release right. There's such a difference between individual bodies alone and that's before you take into account diet, enzyme expression, and other pharmacological factors. Just the difference in stomach pH can vary between 1.5 and 3.5. That's a thousand fold difference in acid strength to target. Also, you have things that can screw with pH drastically like antacids and proton pump inhibitors which are both over the counter and commonly used in the United States.
I wouldn't trust any oral "sustained release" formulation little alone for a MONTH. Especially when the consequence of a mistake is pregnancy.
posted by Your Childhood Pet Rock at 10:39 AM on December 6, 2019 [23 favorites]
I wouldn't trust any oral "sustained release" formulation little alone for a MONTH. Especially when the consequence of a mistake is pregnancy.
posted by Your Childhood Pet Rock at 10:39 AM on December 6, 2019 [23 favorites]
Fascinating idea. Are there any other such medications that work in this way because I've never heard of such a thing. And what happens if someone vomits but is uncertain whether or not they actually vomited up the pill? How does one monitor something like this?
posted by acidnova at 10:41 AM on December 6, 2019 [4 favorites]
posted by acidnova at 10:41 AM on December 6, 2019 [4 favorites]
Also, what if you do get pregnant due to poor efficacy in certain conditions? You can't just stop taking it. While the pill finishes its dissolution you would be at an increased risk of ectopic pregnancy.
posted by Your Childhood Pet Rock at 10:42 AM on December 6, 2019 [3 favorites]
posted by Your Childhood Pet Rock at 10:42 AM on December 6, 2019 [3 favorites]
a case study of three is....not impressive.
posted by misanthropicsarah at 10:56 AM on December 6, 2019 [2 favorites]
posted by misanthropicsarah at 10:56 AM on December 6, 2019 [2 favorites]
Previously, with Ivermectin. Collaboration with Gilead for anti-HIV drugs.
posted by Comrade_robot at 11:07 AM on December 6, 2019 [1 favorite]
posted by Comrade_robot at 11:07 AM on December 6, 2019 [1 favorite]
Medical origami!
posted by Secretariat at 11:08 AM on December 6, 2019 [1 favorite]
posted by Secretariat at 11:08 AM on December 6, 2019 [1 favorite]
Previously, with Ivermectin
"Some of the challenges we face in getting the capsule in place are the 'ship in the bottle problem' -- in this case, the neck of the bottle is the esophagus"!
posted by readinghippo at 11:20 AM on December 6, 2019
"Some of the challenges we face in getting the capsule in place are the 'ship in the bottle problem' -- in this case, the neck of the bottle is the esophagus"!
posted by readinghippo at 11:20 AM on December 6, 2019
Your childhood pet rock neatly enumerated all the reasons why a one month gastric sustained release contraceptive is a bad idea. And they're not wrong.
However, the delivery technique is promising for other purposes: I would really like to see this tech deployed for Vitamin D3 delivery. I live in Scotland, so far north that we get barely six hours of daylight at midwinter; vitamin D deficiency is a serious problem, and anyone with any sense is on a 25ug/day supplement. Being able to take a slow release 30,000iu dose once a month -- below the level for acute toxicity even if it somehow underwent total instantaneous absorbtion -- would be helpful, especially given typical levels of patient noncompliance (or aversion to needles).
And there are probably other examples out there if I think harder. (Needs to be a drug/dietary supplement with low effective dose and high therapeutic index.)
posted by cstross at 11:24 AM on December 6, 2019 [10 favorites]
However, the delivery technique is promising for other purposes: I would really like to see this tech deployed for Vitamin D3 delivery. I live in Scotland, so far north that we get barely six hours of daylight at midwinter; vitamin D deficiency is a serious problem, and anyone with any sense is on a 25ug/day supplement. Being able to take a slow release 30,000iu dose once a month -- below the level for acute toxicity even if it somehow underwent total instantaneous absorbtion -- would be helpful, especially given typical levels of patient noncompliance (or aversion to needles).
And there are probably other examples out there if I think harder. (Needs to be a drug/dietary supplement with low effective dose and high therapeutic index.)
posted by cstross at 11:24 AM on December 6, 2019 [10 favorites]
It would be a golden chalice for geriatric care (among others). Combine a high need for constant dose delivery of (multiple) drugs with patients who have potential attention issues with age. A single delivery device that could manage that could be a radical change for anyone who today has to take a lot of drugs on a set schedule.
posted by bonehead at 11:50 AM on December 6, 2019 [4 favorites]
posted by bonehead at 11:50 AM on December 6, 2019 [4 favorites]
Pharma can't even get 24 hour sustained release right.
What if, rather than chemical factors, the release was metered electronically? It has to be fairly large anyway. An internal drug pump rather than an unreliable ablative release mechanism.
posted by bonehead at 11:53 AM on December 6, 2019
What if, rather than chemical factors, the release was metered electronically? It has to be fairly large anyway. An internal drug pump rather than an unreliable ablative release mechanism.
posted by bonehead at 11:53 AM on December 6, 2019
What if, rather than chemical factors, the release was metered electronically? It has to be fairly large anyway. An internal drug pump rather than an unreliable ablative release mechanism.
At that point you could just have a Nexplanon implant and get the same effect with far less complexity and cost. Most brilliant BC ever invented IMHO. Got teenage girls? Take them to the doctor, couple of minutes and they can't get pregnant if they ever screw up and have unprotected sex. They should be available on every corner to every girl and lady that wants one. Second up would probably be Nuvaring.
posted by Your Childhood Pet Rock at 11:57 AM on December 6, 2019 [3 favorites]
At that point you could just have a Nexplanon implant and get the same effect with far less complexity and cost. Most brilliant BC ever invented IMHO. Got teenage girls? Take them to the doctor, couple of minutes and they can't get pregnant if they ever screw up and have unprotected sex. They should be available on every corner to every girl and lady that wants one. Second up would probably be Nuvaring.
posted by Your Childhood Pet Rock at 11:57 AM on December 6, 2019 [3 favorites]
hmm how about a horrible stomach shuriken for men instead
posted by poffin boffin at 12:34 PM on December 6, 2019 [27 favorites]
posted by poffin boffin at 12:34 PM on December 6, 2019 [27 favorites]
Aaaaaaaaah people - mandatory Bimeks for men at puberty, and all this hormone agony, as well as abortion, are a thing of the past.
Also, make them lockable and you can't get it unlocked until you pass a #$%@!& parenting test.
posted by CynicalKnight at 1:46 PM on December 6, 2019 [3 favorites]
Also, make them lockable and you can't get it unlocked until you pass a #$%@!& parenting test.
posted by CynicalKnight at 1:46 PM on December 6, 2019 [3 favorites]
Aaaaaaaaah people - mandatory Bimeks for men at puberty
I'd love that except sperm can live in nooks and crannies of the male sex organs for extended periods of time. This is why the urologist wants you to masturbate every day for 6 weeks after a vasectomy. They want to make sure the pipes are clear and you're actually shooting blanks. Each time you turn the Bimek on and off you're playing sperm Russian Roulette.
posted by Your Childhood Pet Rock at 1:59 PM on December 6, 2019
I'd love that except sperm can live in nooks and crannies of the male sex organs for extended periods of time. This is why the urologist wants you to masturbate every day for 6 weeks after a vasectomy. They want to make sure the pipes are clear and you're actually shooting blanks. Each time you turn the Bimek on and off you're playing sperm Russian Roulette.
posted by Your Childhood Pet Rock at 1:59 PM on December 6, 2019
Lovely. My Doctor didn't bother to tell me that. But it was a long time ago.
posted by aleph at 2:22 PM on December 6, 2019
posted by aleph at 2:22 PM on December 6, 2019
Also, make them lockable and you can't get it unlocked until you pass a #$%@!& parenting test.
And how quickly would that be abused by the establishment when people who wish to have children don't match certain demographic criteria...
posted by acidnova at 4:04 PM on December 6, 2019 [4 favorites]
And how quickly would that be abused by the establishment when people who wish to have children don't match certain demographic criteria...
posted by acidnova at 4:04 PM on December 6, 2019 [4 favorites]
Being able to take a slow release 30,000iu dose once a month -- below the level for acute toxicity even if it somehow underwent total instantaneous absorbtion -- would be helpful
You can already do this! Vitamin D is fat soluble and stored in the body for ages - this study found significantly higher levels of Vitamin D in adipose tissue a whole year after the discontinuation of supplementation, and higher to extent that is clinically relevant. This is the only reason people in Nordic countries have any significant Vitamin D at all left in them over the winter, when there are insufficient UVB light levels to generate any in the body. It's also why Vitamin D levels in northerly areas are lowest in February-March, when you've burned through a lot of your summer supplies but it's not yet bright enough for you to be making your own. Based on this and another study they cite, it seems like the half-life of Vitamin D in the body is ~82-83 days.
posted by Acheman at 4:29 PM on December 6, 2019 [6 favorites]
You can already do this! Vitamin D is fat soluble and stored in the body for ages - this study found significantly higher levels of Vitamin D in adipose tissue a whole year after the discontinuation of supplementation, and higher to extent that is clinically relevant. This is the only reason people in Nordic countries have any significant Vitamin D at all left in them over the winter, when there are insufficient UVB light levels to generate any in the body. It's also why Vitamin D levels in northerly areas are lowest in February-March, when you've burned through a lot of your summer supplies but it's not yet bright enough for you to be making your own. Based on this and another study they cite, it seems like the half-life of Vitamin D in the body is ~82-83 days.
posted by Acheman at 4:29 PM on December 6, 2019 [6 favorites]
I want to know what happens to the "polymer star" after the month is over: how many of these are you going to accumulate in your stomach before they start breaking down? Is this going to cause life-threatening blockages?
On the other hand, there are currently no long-acting contraceptives that can be self-administered, and hence usable under black-market conditions, so this might become attractive in some jurisdictions.
On the third hand, how would you follow the standard instruction to stop taking estrogen-based birth control immediately if you experience a severe side effect (stroke, blood clot, liver tumour, etc.)?
posted by heatherlogan at 10:24 AM on December 7, 2019 [1 favorite]
On the other hand, there are currently no long-acting contraceptives that can be self-administered, and hence usable under black-market conditions, so this might become attractive in some jurisdictions.
On the third hand, how would you follow the standard instruction to stop taking estrogen-based birth control immediately if you experience a severe side effect (stroke, blood clot, liver tumour, etc.)?
posted by heatherlogan at 10:24 AM on December 7, 2019 [1 favorite]
when people who wish to have children don't match certain demographic criteria...
Absolutely @acidnova, this policy would be a magnet for the eugenicists and what you suggest represents a profoundly evil abuse. But, something similar happens already with a multitude of public services like voting and health care, and the solution is not to discontinue or ban those services. The solution is to reinforce the regulations that prevent that abuse.
posted by CynicalKnight at 9:29 AM on December 9, 2019
Absolutely @acidnova, this policy would be a magnet for the eugenicists and what you suggest represents a profoundly evil abuse. But, something similar happens already with a multitude of public services like voting and health care, and the solution is not to discontinue or ban those services. The solution is to reinforce the regulations that prevent that abuse.
posted by CynicalKnight at 9:29 AM on December 9, 2019
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Either ‘women’ and ‘sows’, or ‘humans’ and ‘pigs’, but not as is, please.
posted by clew at 10:26 AM on December 6, 2019 [8 favorites]