I wish I could assign Lisa Rosenbaum’s characteristically wonderful essay in the latest New England Journal of Medicine to every twentysomething programmer in Silicon Valley planning to disrupt healthcare based on his uninformed interpretation of the problem to be solved.
Consider – as Rosenbaum does – the problem of medication adherence. As many as half the Americans prescribed medications don’t take them as recommended, even after a heart attack – despite very strong evidence of benefit in this context (namely, the prevention of a second heart attack).
At first blush, this seems like a perfect opportunity for a smart app, or a clever pill case that monitors usage and reminds forgetful patients to take their next dose. In fairness, for many patients, such technological innovation might prove impactful. Yet what Rosenbaum (a cardiologist) captures in her piece are the many reasons why patients, in the real world, deliberately choose not to take their medicines – even after a heart attack.
Some patients begin with an intrinsically negative view of medicines, and consequently tend to exaggerate potential side effects, and underestimate the likely benefits. Other patients choose not to take medicines because they don’t like to be reminded that they are sick – each pill taken to stay healthy paradoxically reinforces the concept that they are ill. Of course, many patients avoid medications because of the view that drugs are chemicals and therefore “unnatural” — in contrast to vitamins, or herbal remedies, which presumably are made only of organic goodness.
Still other patients subscribe to the view that “if it ain’t broke- don’t fix it,” and prefer to avoid medications when (as in the case of preventive care) the benefit is often imperceptible. (There seems to be less discussion of non-adherence in the context of oxycontin, for example.)