For years, physicians and pharmacists have been studying how to get people to take their medicines as prescribed. The old term was medication “compliance.”
That has fallen into disfavor, because it sounds patronizing, like a teacher chastising a student for not doing his homework. Now, experts like to refer to medication “adherence.” This implies that the patient is using his medicine regularly as directed.
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. 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. 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.
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.
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.
Compared with 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.
Instead of tens of thousands of research reports, health coaching and lifestyle management have garnered only a few hundred published studies.
Doctors often express frustration that they tell their patients to stop smoking, lose weight, exercise regularly and eat more vegetables and fruits. 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 just scolding doesn’t help people change entrenched habits. Health coaching could make a difference (Work, May 24, 2019).
Lifestyle interventions can be effective even for challenging conditions such as obesity (PLOS One, April 18, 2018). In addition, people who make healthy lifestyle changes may be able to reduce or discontinue medications for high blood pressure, high cholesterol or diabetes under their doctor’s supervision.
But health-care providers are rarely trained in health coaching. 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.