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A New Diabetes Epidemic: “Nonadherence”

Dec 23, 2017

How can health care practitioners play a more prominent role in helping patients to take prescribed medications?

Were “nonadherence to prescription medication” an illness, the human and fiscal impact would make it one of the costliest in the U.S. It is undoubtedly a major challenge to health care in every corner of the globe. And just as the U.S. is no exception to the geographical scale of nonadherence, type 2 diabetes is not exempt from the list of chronic conditions affected by it. It is a major issue that has been the focus of countless trials, studies, and reports in medical journals.


You would expect such a topic to draw the intense attention of the mainstream media. The numbers alone would seemingly entice any journalist: 125,000 lives lost, between $100 billion and $289 billion spent, 20 to 30 percent of prescriptions going unfilled. These were all quotes in a New York Times article back in April, sourced from a review in the Annals of Internal Medicine.

To say it is in the public interest would be an understatement. However, a review of American and British newspapers in 2013 concluded that “adherence is not well covered in the newspaper media despite a significant presence in the medical literature,” and that the media’s potential to educate and shape the public’s knowledge is not being realized.

Many of the articles that do report on the topic, such as another New York Times article published in April, highlight the need for doctors to better educate their patients. This is a valid point: doctors do of course have a responsibility to educate patients, and it is a job that can always be improved upon. But it is surely naïve to believe that doctors have the capability of achieving drastic results alone.

When it comes to media coverage, the topic of nonadherence achieves a certain level of traction for a brief period when new, eye-catching figures are released, but has little sustained presence. This is simply inadequate, as sustainability is the key to encouraging behavioral changes. Prof. Melanie Wakefield et al. conclude that “mass media campaigns can directly and indirectly produce positive changes or prevent negative changes in health-related behaviors across large populations.” While they note that such changes are likelier when it comes to one-off behavioral changes, such as vaccinations, habitual behavior can also be improved.

Take smoking for example. Over many years, the dangers of smoking have been increasingly presented in the media, be it in print, television, or online. You would be hard-pressed to find an adult in the USA who is not aware of the dangers of smoking. Those who continue to do so, do so in the knowledge that they are harming their bodies. Since 1965, the percentage of people smoking has dropped from 42.4 to 16.8 in 2014. In England, Tessa Langley et al. found that a freeze on tobacco control campaigns in the media was “associated with a dramatic decrease in quitline calls, smoke-free web hits and requests for cessation support packs.” This only recognizes those who use such services in the first place, but does certainly lend credibility to the theory that the media holds considerable influence regarding health-related behaviors.

There is no shortage of further evidence highlighting such an influence on public knowledge and behavioral habits. The aforementioned decline in smoking would surely have been far smaller had it been only doctors banging the drum about the dangers it entails. And yet, when it comes to patients not taking their prescribed medications, that is often cited as the answer.

In the UK, Trinity PR launched ‘Adherence: Let’s Take Care of It’ campaign, and there is a National Medication Adherence Week every October. Aside from that, there appears to be precious little else on either side of the Atlantic aimed at sustaining media coverage of the issue.

Nonadherence remains, to quote the New York Times, an “out-of-control” epidemic. While doctors can always push themselves to better advise and educate their patients, such efforts would surely prove more fruitful with sustained, targeted mass media campaigns.

Practice Pearls:

  • Nonadherence is responsible for 125,000 lives lost.
  • Nonadherence costs between $100 billion and $289 billion spent, which includes, 20 to 30 percent of prescriptions going unfilled.
  • Medical professionals need to do a better job of explaining the importance of patients following through on their treatment plans.

This article was a contribution from MyTherapy