Replacing Injections With Needle-Covered Pills?

Around this time every year, I call my parents to let them know I’ve scheduled my flu shot, presenting the information with all the pride of a cat who’s just dragged a dead mouse inside: Look, mom and dad!

I am entirely too old to crave praise for this, I know, but the flu shot and I have come a long way from our earlier, rockier days. When I was younger, my parents get a kick out of recalling, the nurses at the pediatrician’s office would huddle in the back and draw straws over who had to take me on. I suspect they might be exaggerating, but then again, I also melted down at the sight of a needle for more years than I’d care to admit.

In my own defense, though, I’m not exactly unique as far as patients go: A 2001 Gallup poll found that as many as 20 percent of Americans have similar fears. The feeling is so common, in fact, that it’s lent itself to an entire catalogue of phobias. Trypanophobia is the fear of injections; vaccinophobia is the related but subtly different fear of vaccines. Belonephobics and aichmophobics are both afraid of sharp pointed objects, while algophobics fear pain. Over the past several years, the scientific community has come up with all manner of medication-delivery alternatives for all manner of needle-phobes, including patches, skin-penetrating laser pulses or pressurized jets, nasal sprays, and even a device that applies pressure and vibration to the skin before an injection to distract the brain’s pain center.

There’s a reason pills aren’t included on this list. Vaccines, along with DNA, RNA, and antibodies, belong to a class of drugs called biologics, which are made of molecules too large to be administered orally—their size means that they’d be broken down by the enzymes in the digestive system before they could be absorbed into the blood. But researchers at the Massachusetts Institute of Technology think they’ve found a workaround, albeit one that seems a little bit counterintuitive at first: To avoid the sting of an injection, swallow a pill that’s covered in needles.

In a study recently published in the Journal of Pharmaceutical Sciences, the researchers found that such a pill safely delivered insulin to pigs by injecting it into the lining of their stomachs without causing any harm. The reservoir for the insulin was hidden by the pill’s dissolvable coating; as it made its way through the gastrointestinal tract, the coating melted away, revealing five-millimeter needles that successfully injected the drug—a discovery that could have implications for a wide range of (human) treatments currently administered with a needle and syringe.

“If you look at medication noncompliance, a significant portion can be attributed to some of the difficulties that are associated with injectables,” says study co-author Giovanni Traverso, a gastroenterologist at Massachusetts General Hospital. An injection “means training a patient or having a nurse or a physician administer it, and it can be uncomfortable.”

With the ease of an oral alternative, he says, “Our sense is that there would be more patients who would be more adherent with their treatments, and therefore be treated appropriately for their conditions.”

Well, sure, if you can convince them to swallow a needle pill.

But “these are very small needles,” Traverso says. “Things like bones would be bigger, people who accidentally ingest fish bones.” (For additional reference, he also compared them to “the hair on a kiwi,” and a hangnail.) Because there are no pain receptors in the gastrointestinal tract, he says, patients wouldn’t be able to feel the needle stick.

And because of the pliable nature of the GI tract, he added, it wouldn’t shred, tear or otherwise damage a patients’ insides. “There’s a great deal of compliance at the level of the tissue,” Traverso explains. “It’s not a hard surface that you can push against. It’s very soft. In order to cut something, you need something else pushing in order for that sharp edge to pierce.”

So, okay, it’s safe to swallow, and it’s safe as it winds its way through the body. But what about, um, the other end?

They’re working on it, he tells me. For now, “you would pass it just as you would with any waste product.” But for next steps, Traverso and study co-author Carl Schoelhammer, a graduate student at MIT, are working on a fully biodegradable version of the pill, as well as one with needles made of sugar that dissolve after doing their job.

The idea for the pill, Traverso says, came from two pieces of common gastroenterologist wisdom. The first is the practice of treating stomach ulcers by injecting them with a shot of adrenaline: “As soon as you give that injection, you actually see an increase in the heart rate of the patient,” he explains. “So we had some hints that if you were to deliver drugs [in the stomach] using a needle, it would likely make it to the rest of the body.”

And the second, he says, is that many patients who swallow sharp objects—pins, screws, and the like—end up just fine without any medical intervention.

Not that anyone should try it at home. For now, unfortunately, I’ll be getting my flu shot the old-fashioned way, with mental apologies to all the unfortunate souls stuck giving it to kids like younger me.