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Millions fail to use medicine correctly

New report calls problem a crisis

WASHINGTON -- Consider it the other drug problem: Millions of people do not take their medicine correctly -- or quit taking it altogether -- and the consequences can be deadly.

On average, half of patients with chronic illnesses such as heart disease or asthma skip doses or do not use their medication correctly, says a report to be issued later this week that calls the problem a national crisis costing billions of dollars.

The government is preparing new steps to try to persuade patients and their doctors to do better.

But with contributors that range from hurried doctor visits to confusing pill bottles, there is no easy solution.

"We go into this with some humility," says Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an "in your face" campaign to improve medication adherence. "It's really pretty appalling how badly we do."

This goes far beyond the issue of affording prescriptions. People often buy their drugs but misunderstand what they are supposed to take, or how. Or they forget doses. Or start feeling better and toss the rest of their medicine, or skip doses for fear of side effects.

It is not just a problem of poverty or poor education. Even the rich and highly educated skip their medicine. Perhaps the most high-profile example is President Clinton, who stopped taking his cholesterol-lowering statin drug at some point and later needed open-heart surgery to avoid a major heart attack. Statins offer significant heart protection, but about half of patients on statins quit using them within a year.

The globe-trotting tuberculosis patient who was briefly quarantined in May after ignoring doctors' orders not to travel by airplane is out of the hospital now but, like all patients with hard-to-treat TB, must take his remaining antibiotics while health workers watch. So many TB patients skip their pills when they feel better -- but before all the bacteria are wiped out -- that health departments now enforce what is called "directly observed therapy."

For most diseases, however, patients must choose to take their medicines. The new report combs a decade of research to conclude people generally do a lousy job.

Clancy hopes to make "take your medicine" a new priority. Her Agency for Healthcare Research and Quality is starting discussions with the new report's authors, the Food and Drug Administration, and health groups about what steps to take.

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