Growing up, I was what the literature calls a 'non-adherent' or 'non-compliant' patient. Rather than take my medications as prescribed, I often shared the wealth with the trash can and toilet. One night, with my parents away and family friends babysitting, I issued a challenge. Like that of a wary princess assessing her suitors, mine was simple: I’d take a spoonful of medicine for every new Bible story they could muster. My babysitters took the challenge with confidence. They were, after all, seminarians—one formerly trained as a writer, the other a lawyer—and I was just 6 years old. “Have you heard the one?” they asked again and again. Unfortunately for them, I knew all of Elisha’s miracles and Moses’ plagues from my parents, Sunday School and countless Super Book videos. And those that I didn’t know—Dinah’s revenge, Hosea's family, Jeremiah's laments? They realized that those were stories they weren’t ready to tell a 6-year-old. That night, I went to bed victorious and un-medicated.
Non-adherence was not a particularly serious medical issue for me as an individual. I got better and did not get anyone else sick. But multiply non-adherence across all the other children, adults, and seniors who skip much more important medications for many other reasons-- not just because they don't like swallowing strange pills, but because of cost, forgetfulness, and lack of understanding-- and non-adherence becomes a public health problem.
Roughly half of all Americans who have had heart attacks do not take their medications as prescribed even though the evidence for the lifesaving potential of those drugs have long been proven. Medication non-adherence means that the many health benefits of drugs that medical science has advanced cannot be realized. It means that some patients who could've gotten better get sicker instead and their care gets more expensive for everyone, even you and me. Put another way, medication adherence is one of those rare win-win-win medical issues where doing better benefits patients, insurers, and doctors (not to mention policy and drug makers). An oft cited and sobering figure puts the annual cost of medication non-adherence in the US at $300 billion. The number is far from perfect and likely a gross overestimate (even the author acknowledges its limitations). But it provides an easy and rough idea of just how big this issue is on both personal and population levels.
This blog is in its early days and I’m still laying down groundwork. Stick with me through this and in the coming posts, you'll see a variety of neat health policy solutions to this very big problem.
Policy Implication: Non-adherence is a costly problem, in both health and expenditures, for just about everyone involved.