Sun, Jul 17, 2005 - Page 9 News List

Why we don't take our medicine

Prescribed drugs are intended to make us better. For some they are the difference between life and death. So why are so many of us refusing to take them?

By Vivienne Parry  /  THE GUARDIAN , LONDON

Look in pretty much any bathroom cupboard and you will find a hoard of half-used or even untouched medicines. Many of us forget to take our pills, or don't finish a course of antibiotics. But we probably weren't that ill. The real surprise is that people taking life-saving medicines do the same. For example, 25 percent of transplant patients don't take their anti-rejection medicines as directed, with some stopping completely.

It is estimated that overall, anything between 30 to 50 percent of prescription medicines are not taken as directed. Usually, patients take them in much reduced doses or intermittently, but 20 percent of medicines never even make it out of the packet. Given that the drugs bill for the UK's state-funded National Health Service (NHS) runs at around ?7 billion a year, the financial cost of non-compliance is an extraordinary waste of money.

But finance is the least of it. Joanna Shaw is director of the Medicines Partnership, an initiative supported by the UK Department of Health which aims to help patients get the most out of their medicines. It has calculated the losses caused by people not taking cholesterol-lowering drugs called statins, as directed.

"For 2003, we estimate that there were 10,000 heart attacks, 5,000 deaths and about 10,000 operations that would have been avoided if those who had been prescribed statins had been taking them," Shaw says.

So why don't people take their medicines? When I began recording Can't Take, Won't Take for BBC Radio, I had an image of someone who doesn't take medicines as older or forgetful. I soon discovered that there is no correlation with age, or, come to that, level of education or gender either. Instead, whether we take our medicines varies from prescription to prescription.

Two elements are at work. Unintentional non-compliance is where we want to take a medicine but are prevented from doing so by barriers beyond our control. It might be that side effects are so immediate or severe that the drug has to be stopped, or something as simple as not being able to get the cap off a bottle or use an inhaler effectively.

Too complex a regime, too messy, too bitter, too hard to break, too big to swallow -- here it is the medicines themselves that defeat people's best intentions. Much work is done by drug companies to improve formulations. For example, a single dose vaginal pessary for thrush has now replaced the gruesome fortnight's worth of messy knicker-staining pessaries that used to be prescribed.

But it's the reasons behind the other element, the intentional non-compliance, that are so fascinating.

"One of the main reasons why people don't take medicines is that they don't want to. They make a decision either not to take it all or to take it in a way that differs from the prescription, which is usually to take less," says Rob Horne, professor of psychology in health care at Brighton University, UK, who is currently completing a major study for the NHS on why people don't take prescribed medicines

"Research has shown that these `to-take or not-to-take' decisions are influenced by two types of belief. First the degree to which we perceive a personal need for the treatment and second how we balance this with concerns about adverse effects," he says.

Many people are suspicious of drugs in general and drug companies in particular. This latter feeling has increased in the past decade, fuelled by media reports of pharmaceutical scandals, such as the link between certain anti-depressants and suicide.

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