While much of the national debate is focused on how to help more people afford costly medicines, there is an increasingly urgent problem of non-adherence for patients already on drug therapies.

Earlier this year, the World Health Organization reported that only around 50 percent of people typically follow their doctors' orders when it comes to taking prescribed medicine. And the consequences of non-adherence are significant. Failure to take prescribed drugs contributes to everything from AIDS deaths to avoidable emergency room admissions, and it can undermine the management of chronic conditions.

This phenomenon helps to explain why the promising results of clinical trials are often unmatched when drugs are in the hands of patients. For instance, trials of antiretroviral therapies have proved effective in suppressing HIV in as many as 95 percent of participating patients. But in routine daily life, the reported rates of HIV suppression drop to the 40-50 percent range. Doctors believe the discrepancy is one important reason why there continue to be so many AIDS-related deaths.

The issue of non-adherence, even when the drugs may prolong or save patients' lives, belies simple explanation or demographics. Rich, highly educated people are just as likely not to take their drugs as poor or less-educated people. Complex regimens, forgetfulness and the increasing cost of drugs all contribute, but the major reason appears to be a fear of side effects. People dislike the way they feel when they take multiple drugs, so they simply stop taking them.

Later this year in Dallas, a second annual conference devoted exclusively to improving adherence to HIV therapies will be held. In addition, WHO is developing a training package for health care and community professionals focused on how to get patients to better adhere to antiretroviral therapy. And NIH currently has over 35 trials studying ways to improve patient adherence to medication for a range of conditions, including depression and other psychiatric disorders.

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