Wall Street Journal (10.21.03) - Thursday, October 23, 2003
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
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
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.