Who cares if you take your medicine? A lot more people than you might think. Let’s start with drug companies. The more pills they sell, the bigger their profits. Pharmacies want you to take your pills for the same reason. They are constantly reminding you that your prescription is ready for pickup.
“Compliance” or “Adherence”?
There has been an amazing amount of research devoted to getting people like you to take your pills. Pharmacists and physicians have been trying to discover strategies to get people to take their medicines as prescribed. The old term was medication “compliance.”
That has fallen into disfavor because it sounds a little too patronizing. Remember what it felt like when a parent reminded you to “eat all your vegetables.” Or perhaps you were chastised by a teacher for not completing your homework on time.
These days, experts like to refer to medication “adherence.” This implies that the patient is using his or her medicine regularly as directed. It seems a bit more friendly than compliance, but the meaning is the same.
Why You Should “Take Your Pills”
There are certainly many situations where it is essential for patients to take their medications. People with HIV, for example, need to be rigorous about controlling the virus that could get out of control. As a result they must be very conscientious about following their medication regimen.
Cancer patients are often given a cocktail of toxic drugs. Completing the course of treatment can be challenging, but following the program may make a durable remission more likely.
People with tuberculosis must also take all their medicine for at least four months. Otherwise, this stubborn infection could persist and infect others.
There are many other situations that require you to take your pills conscientiously. These are just some examples.
Why Pharmacies Bug You To Take Your Pills:
Not surprisingly, pharmacies and the pharmaceutical industry are very interested in the concepts of compliance and adherence. The more pills people take, the more money these industries make.
If that sounds cynical, consider the estimate that the pharmaceutical industry loses over $200 billion annually because people don’t fill or renew their prescriptions. That may be conservative. Here is an estimate from the PRNewswire (Nov. 16, 2016) a few years ago:
“HealthPrize Technologies today announced the publication of an update to a research paper co-authored with Capgemini estimating annual pharmaceutical revenue losses of $637 billion due to medication nonadherence to medications for the treatment of chronic conditions. Globally, revenue loss has increased from $564 billion in 2012 to $637 billion in 2015, with US-based revenue losses increasing from $188 billion in 2012 to $250 billion in 2015.”
The Business of Adherence:
An entire business has evolved to encourage people to keep taking their medicines.
First, there is research to convince prescribers that the more pills people take the healthier they will be. Such studies can be expensive to conduct.
There are over 30,000 published reports in the medical literature about adherence and compliance. A key message is that people who skip medications risk developing complications that require hospitalization (Risk Management and Healthcare Policy, online, Feb. 20, 2014). Doctors, pharmacists, nurses and other allied health professionals are enlisted to encourage patients to take their medicine.
Second, there are organizations devoted to reminding people to take their medicine. Automated refill reminders have become standard in many pharmacy chains.
People get phone calls, text messages and emails reminding them to pick up their prescriptions. If those strategies don’t work, an actual person may call you up and encourage you to renew your prescription or take your pills as directed.
Third, cost can be an issue. Many medications are pricey. Pharmaceutical companies have come up with strategies to make this less onerous for the patient. They offer “copay cards,” “access cards,” “coupons” and “discount cards” to reduce the amount a patient has to pay out of pocket.
Such coupons may seem like a great deal for patients, but it is also a way to get patients on board the pharmaceutical train. Once the insurance company agrees to pay, the drug manufacturer can collect big bucks indefinitely. Here is how MarketWatch (Jan. 3, 2017) describes “The real reason drug makers offer discount cards (you’ll pay eventually).”
“But recent research has bolstered critics’ claims that these coupons only serve manufacturers’ interests, pushing patients away from cheaper alternatives and costing the broader health-care system billions of dollars in the process.
“’At the end of the day, the consumer is always paying for it, in some form or fashion,’ said Michael Rea, the founder and chief executive officer of Rx Savings Solutions, a software company that works with employers and health plans to help patients comparison shop. ‘They may think they’re getting a really good deal, but in reality it’s costing them more money.’”
“’The more that patients use drug coupons to obtain brand-name medications when lower-cost alternatives are available, the more expenses will rise for their insurers,’ making insurers likelier to raise their rates, said the NEJM piece [New England Journal of Medicine, October 2, 2013].’” The NEJM article was titled:
Fourth, side effects! Many of the articles about noncompliance or nonadherence do not like to mention the elephant in the room: adverse drug reactions. Many people ignore the advice to “take your pills” because of drug side effects. If a statin makes your muscles hurt so that you can no longer exercise, you might question the value of the drug. If gabapentin for pain or insomnia causes brain fog you might not want to keep taking it. Learn more at this link:
What About Lifestyle Changes?
Compared to the amount of money and attention devoted to adherence, prevention gets short shrift. The pharmaceutical industry, which underwrites a huge amount of health care research, has no vested interest in promoting lifestyle changes that could reduce the burden of disease and the number of pills people have to take.
Instead of tens of thousands of research reports, health coaching and lifestyle management have garnered only a few hundred published studies.
Doctors Get Frustrated!
Doctors often express frustration that they tell their patients to stop smoking, lose weight, exercise regularly and eat more vegetables and fruits. But at the next visit nothing has changed. Many patients have not made the recommended changes.
These behaviors could have a profound influence on overall health and reduce the need for many medications. Blood pressure, blood sugar and cholesterol all respond well to such interventions. But changing behavior is really hard. Scolding doesn’t help people change entrenched habits. Health coaching could make a difference, though (Work, May 24, 2019).
What is Health Coaching?
According to Wikipedia:
“Health coaching is the use of evidence-based skillful conversation, clinical interventions and strategies to actively and safely engage client/patients in health behavior change. Health coaches are certified or credentialed to safely guide clients and patients who may have chronic conditions or those at moderate to high risk for chronic conditions.”
Lifestyle interventions can be effective even for challenging conditions like obesity (PLOS One, April 18, 2018). In addition, people who make healthy lifestyle changes may be able to reduce or discontinue medications for hypertension, high cholesterol or diabetes under their doctors’ supervision.
Healthcare providers are rarely trained in health coaching, however. They don’t have the time or the staff that can help deliver these interventions and follow up with patients. Moreover, insurance companies are accustomed to reimbursing for procedures and prescriptions, but not for coaching.
Perhaps the pervasiveness of drug advertising is more harmful than we imagine. Rather than promoting a pill for every ill, we should be helping people prevent health problems in the first place with diet, exercise and other helpful lifestyle strategies.
What Do You Think?
Have you ever been reminded to take your pills? Do you get messages from your pharmacy to pick up your prescription(s)? Share your thoughts on the issues of compliance/adherence in the comment section.