A factor that has confounded the issue of adherence or compliance for 40 years is the actual pharmaceutical and the disease being treated. Thirty years ago we had an education tape at Merck about this issue: Keeping the Hypertensive Patient in Compliance.
The biggest problem with hypertension and high cholesterol is simply these diseases are asymptomatic. The patient does not sense anything wrong. They are likely to think: “why should I continue to take a drug that makes me feel bad regardless of how much it costs, even if it is generic?”
The patient was probably feeling fine with their high cholesterol, osteoporosis or high blood pressure and now we prescribe them a drug that makes them feel worse and restricts their lifestyle.
For the drugs used to treat osteoporosis they cannot take the medication with food for at least 30–60 minutes; they can drink only water with the pill, and they cannot lie down and, by the way, the medication won’t really do anything for them for at least 9–10 months and we won’t really know what it is doing for them unless they fall and don’t break a hip.
Why should they continue to adhere to something with lots of side-effects and no visible positive outcome – getting heartburn every time they take their osteoporosis drug or postural hypotension from their high blood pressure medicine? Cleaner side-effect profiles may be the key to adherence – not price.