Smart Toilet Medical Uses: How soon until you have one in your home?
It's the morning, and it's time to get to business. Sitting on the toilet, scrolling through your email and social media, and then you get an alert:
"Electrolyte imbalance & high glucose detected in your urine."
This is all due to the recent smart sensor that you installed in your toilet. It's been monitoring your urine and fecal excretions, and now you're seeing the results.
So. The question becomes twofold:
How close are we too smart toilets in the home, and
Do we need smart toilets?
What's the deal with Smart Toilets?
The idea isn't necessarily new and has been a topic in Sci-Fi for quite some time. After all, we use a lot of data from our bodily fluids to track our health. In the case of our urine and feces, there's some interesting data that can be tied back to our current health:
Possible pregnancy
Electrolytes
Glucose
I/O of fluids
Blood loss
Stool formation (e.g., Bristol Stool Chart)
Renal function
Medication presence
Infection (UTI, virus [Covid])
However, most of the time (aside from home test devices), the samples must be self-collected and then turned over to a testing lab. People can find this bothersome, especially having to collect their stool and then freeze it.
But what if we could get rid of the lab? What if the toilet was the lab? Wouldn't that be convenient? With that, we've seen the rise of creating a 'smart toilet' that would have the ability to have a sensor that could interpret both urine and feces.
The issue, however, has been how to implement this. Should it be a toilet seat attachment? A device that is placed at the well or trap? Or should it just be a completely smart device? They all have different viability, with likely cost and installation issues.
What's the research around smart toilets?
It's been quite interesting to see that there was a recent rise in the publication and product launches in the smart toilet market in the past several years:
Overall some preliminary data and ideation around the concept are available. Using urine and feces may be plausible, though still some work for certain things to track and measure, which makes sense due to the dilution in the water of a toilet. The other aspect of using the toilet seat to collect digital biomarkers such as temperature, heart rate, and blood pressure is also intriguing and could also be tied with other collectible data points.
Why the sudden interest?
CES 2023 is always an interesting time for new health devices, and Withings just announced a new product that will gravitate some attention. They are calling it the 'U-Scan.'
The U-Scan is coming to Europe shortly and will likely need some data for FDA clearance in the States. It works by using a rechargeable device with a microfluidic sensor with built-in cartridges that can detect certain substances in the toilet water when detecting use. This includes:
Specific gravity
pH
Vitamin C
Ketones
So far, only a little about what else it can detect has been announced, so I'm curious to hear more coming out of CES.
It is interesting that it can determine the difference in users based on their urination. I suppose this is due to the technology using radar to sense urination direction and position (though I'll be curious how it differentiates multiple users that may choose to stand or sit while urinating).
Currently, it costs $499 Euros. That's a hefty price tag, and it's targeted toward the wellness community. The app will help track changes and make dietary suggestions.
Is the U-Scan a conceptual model for future devices? I suspect yes, given they are taking their smart scales in that direction, and Withings have been targeting the RPM business. So I'll be excited to see what else they may envision in the future and learn from user habits and utilization of the current high-end product.
Implications to Pharmacy
I've been thinking about the implications of smart toilets' medical use and what it could mean for pharmacy. Some aspects range from health condition monitoring and possible screening, such as:
IBS/IBD by monitoring stools formation and frequency alongside other gastrointestinal conditions
Diabetes with glucose monitoring
Certain hormones could be tracked and measured though concentration amounts may be an issue
Hydration and electrolyte imbalance due to certain medical conditions
Infectious diseases such as urogenital-related issues and possible viruses
Possible renal function
Aside from general disease monitoring, there could be some aspects related to medications. Medication-related issues may also be tracked in terms of clinical impact or medication safety, including:
Medication adherence by tracking the presence of some metabolites in the urine. I've seen some research on putting some biomarkers into medications that are non-medical use but would be released in the urine or feces to track certain medications that were ingested, but that may be a more expensive affair.
Bleeding due to anticoagulants.
The impact of glucose levels, though, might be difficult compared to, say, glycosuria due to diabetes or medications like SGLT2 leading to more glucose in the urine.
Extensive electrolyte and fluid loss due to diuretics.
Renal dosing, possibly by estimating renal function remotely.
These general aspects could be expanded upon, depending on costs and sensor development. I wonder if the pharmacy or RPM-focused companies or newcomers like Best Buy are suddenly going to latch on to selling smart toilets, but I could see the appeal, as stated in the beginning, for some users.
There likely will be a push from the health and wellness end and then medical clearance in certain areas as time progresses. I think for us as pharmacists, recognizing that these types of tests and measurements could be something feasible by the end of the decade. Will our patients look towards these tools as a way to ensure their medications and treatments are working? Can we remotely titrate medication doses for safety?
I'd love to hear more conversations about this in the pharmacy community, and I welcome your thoughts!