Only Half of Patients Take Their Meds Properly
A new Cochrane systematic review of 182 studies shows that only about half of patients on chronic medications take them as prescribed.
Pharmacological treatments are a mainstay of modern medicine, and our knowledge of biochemistry and physiology has resulted in effective medications for many indications. But medications are only useful when they are taken properly.
Many patients will stop their medications, will frequently forget to take them, or will simply take them incorrectly (for example, taking them only as needed rather than on a regular schedule, or vice versa).
This is true even for serious medical conditions, such as HIV infection and seizures. Lack of compliance can lead to serious complications and is a significant health burden.
The review, unfortunately, also found that there is a paucity of evidence supporting specific strategies to fix the problem. Very few of the studies, only 17, we considered of high enough quality to even consider their results, and these were highly variable.
Common strategies include having a spouse or other family member help a patient take their medications properly, or patient education regarding the proper use of their medications.
Further research of higher quality is required to identify strategies to address this common health problem.
I bet there is a homeopathic remedy that could help people take their medications as prescribed. It is probably pretty expensive though.
Not really surprising. I take my seizure medications correctly now because I’m on a different medication, but the one I used to be on, Lamictal, I couldn’t remember if I took it or not and it would have been more dangerous to take a double dose than to skip it all together. This would happen very frequently, several times a week.
My memory isn’t as bad with my new medications, so I don’t miss doses at all anymore, but that’s probably part of it. Most people with epilepsy know how important it is to take their medication on time, but the side effects of the medication can cause memory loss, so that might be the problem more than people just not wanting to take their meds.
I bet there’s an app for that.
Did anyone try to figure out why patients don’t comply? Do they simply forget, or misunderstand the instructions, or try to avoid side effects? Different causes call for different strategies.
I’ve been a healthcare marketer for over 25 years so I have some insight here. There is a windfall of profit for a pharmaceutical company with a chronic medication that can successfully address this issue. It’s been a big problem, and opportunity, for decades.
While lack of understanding and forgetfulness are a significant issue, the largest issue with chronic drug persistency is neither of these. It’s a profound cultural ambivalence to taking drugs, especially when we don’t feel sick.
The hearsay is that Pfizer did a major push to understand this issue many years ago, and the ultimate insight they found was that patients regard medications as essentially toxic substances– “poison” was the word I was told. This is exacerbated with Rx meds, which are perceived as more powerful, and so more poisonous.
I get it. Many classes of drugs that are viewed as safe for chronic use have potential issues emerge over time and with broad use. Recently there have been signals that statins may be associated with elevated risk of type 2 diabetes. This is a window into the public’s ambivalence with science in general. Humans like certainty. When the “truth” changes over time, that is science, but is profoundly unsettling and degrades trust for many.
“There is a windfall of profit for a pharmaceutical company with a chronic medication that can successfully address this issue.”
I assume you mean the issue would be addressed by the company , not by the chronic medication.
The public wariness of Rx meds is exacerbated by their horrific side effects up to and including death, now plainly disclosed in TV ads.
Max
Yes, there is a benefit-to-risk balance with many medications. Regarding side effects, the FDA mandates that both the most common and the most serious side effects be communicated in Rx med consumer communications. (Non prescription drugs operate in a whole different framework that is much less stringent.) The most serious side effects are generally rare with a rate of 1% or less. But that is lost on viewers of the TV commercials of these products.
The “side effects” of many conditions that benefit from using chronic medications are much much more likely to occur and are generally many times worse. Take hypertension for instance. How’s minor ankle edema compared to a stroke?
I submit that humans are much more likely to focus on near term concerns and fears. It’s the lizard brain evolutionary construct that helped us survive when critters who would eat us were a real danger. Longer term threats to our health– not so much (see climate change).
Depends on which conditions we’re talking about. If the condition is more annoying than life-threatening, like, say, erectile dysfunction or acne, then it might not be worth risking your life to treat it.
Let’s take a look at prescription drugs pulled off the market since the 70’s.
http://prescriptiondrugs.procon.org/view.resource.php?resourceID=005528
#1. Accutane (Isotretinoin)
On the market for 27 years: 1982 to June 2009.
Use: Acne
Cause for recall: increased risk of birth defects, miscarriages, and premature births when used by pregnant women; inflammatory bowel disease; suicidal tendencies
Over 7,000 lawsuits were filed against the manufacturer over the side effects including a $10.5 million verdict and two $9 million verdicts.
#2. Baycol (Cerivastatin)
On the market for 3 years, 1998 to Aug. 2001
Use: Cholesterol reduction
Cause for recall: rhabdomyolysis (breakdown of muscle fibers that results in myoglobin being released into the bloodstream) which led to kidney failure; 52 deaths (31 in the US) worldwide; 385 nonfatal cases with most requiring hospitalization; 12 of the deaths were related to taking this drug in combination with gemfibrozil (Lopid)
#3. Bextra (Valdecoxib)
On the market for 3.3 years: Nov. 20, 2001 to Apr. 7, 2005
Use: NSAID (pain relief)
Cause for recall: serious cardiovascular adverse events (like death, MI, stroke); increased risk of serious skin reactions (like toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme); gastrointestinal bleeding
The FDA determined that Bextra showed no advantage over other NSAID pain relievers on the market.
#4. Cylert (Pemoline)
On the market for 30 years: 1975 to Oct. 2010
Use: Central nervous system stimulant to treat ADHD/ADD
Cause for recall: liver toxicity
The FDA added a box warning to Cylert in 1999, alerting doctors and patients to the potential of liver damage.
Max, the serious but rare side effects disclosure mandated for Rx drugs by the FDA for consumer advertising is akin to having to listen to an announcement when you get into your car that driving could result in maiming or death. (Not for every serious side effect, but definitely for some of them.)
Years ago I created a TV ad for a birth control pill. Out of 60 seconds, more than 35 seconds was used for the risk information. No, this birth control pill was not riskier than other birth control pills.
There is as much or more risk being pregnant and delivering a baby as taking birth control pills, statistically speaking.
Just saying.
Heh, you should’ve listed all the risks of pregnancy.
My rule of thumb about drugs and GMO’s and food additives and for that matter self-driving cars, is if they save more lives than they cost, then they’re probably worthwhile, but if they cost lives for convenience or for money, then it’s not so clear.