That low-tech solution can work. A study in the October 1 issue of Clinical Infectious Diseases showed that passing out pillboxes to HIV patients at high risk of skipping their meds—a $5 investment per person—improved adherence by 4 percent and cut their risk of progressing to full-blown AIDS by 11 percent. Drug companies are also working to make it easier to take meds, by combining two drugs into one pill, or reformulating drugs so they can be taken less frequently.
Some patients may not understand why they're on a medication—and why they need to stay on it, even if they feel well. A study released this summer looked at veterans who'd been prescribed statins—at low or no cost—to prevent heart problems. Within six months, more than half stopped taking the drugs or weren't taking them correctly. The nonadherers were more likely to say they didn't see themselves at high risk of a heart attack, believed a low-fat diet they'd adopted made the drug unnecessary, or figured that once their cholesterol levels came down, they were "cured." "There's a communication problem," says Devin Mann, an author of the study and an internist at Mount Sinai School of Medicine in New York. "We all need to start out on the same page so patients know why they're on a drug and how long they'll be on it."
Improving one's communication with doctors may be the cheapest and most far-reaching step the average person can take. But Christensen says doctors need to take responsibility, too. "It can even be something like asking the patient whether he'd prefer the once-daily or once-monthly form of a treatment," he says. "It's like when you're trying to get your 4-year-old to eat his vegetables. You don't say, 'Eat your vegetables,' you say, 'Would you rather have the peas or the carrots?' "
Patients' mistaken beliefs or misguided attitudes are increasingly problematic in the treatment of cancer, where it's becoming common for patients to take oral drugs for years. "People get tired of being reminded they have cancer," says Maurie Markman, vice president for clinical research at M.D. Anderson.
For Galvan, the decision not to take his drugs resulted from a combination of unpleasant physical effects—he hated giving himself a weekly injection as well as the rashes that followed—and a desire to escape the reality of a shocking diagnosis. "I felt this sense of urgency to be normal again," he says. "I went from only taking a Tylenol once in a while to having a big Ziploc gallon bag full of pills, another full of syringes, and another full of vials." It was the post-confessional heart-to-heart he had with his nurse and doctor that made a light bulb go on. "They told me, 'You're not the first person to do this, but if you don't take your medicine, you will die.'" Now healthy—and taking his medication as prescribed—he still returns to M.D. Anderson twice a year to make sure his cancer hasn't returned. But he's no longer being monitored more frequently to be sure he's complying. "They saw," he says, "that I'm a man of my word."
TALK WITH THE DOC
The best route to consistent and proper use of prescription drugs, experts say, involves making sure the doctor and you—or the loved one whose care you're overseeing—are on the same page. Some things you need to know whenever a doctor writes you a prescription or a pharmacist fills it:
- Why am I taking this medicine?
- How does it work in my body?
- What's the dosage schedule, and how do I take it?
- Will it safely mix with the other medicines I'm taking?
- What should I do if I accidentally skip a dose?
- What side effects might I experience? Which can I ignore, and which do I need to report?
- How will I know if the medicine is working?
- What should I do when I'm about to run out?