Adherence Arena: Overcoming the fear of adverse events
Patients need to know the risks of non-adherence as much as the risks of medication
By on Jan 25, 2012I have an idea. When a patient is newly diagnosed with a chronic condition, the physician should be obligated to hand that patient an “Important Safety Information” sheet. Not for the medication, but for the condition. It should be chock full of fear-inducing language and facts, in very small font size.
Let me explain. Often, the reason that patients fear pharmaceutical-related adverse events—even very rare ones—related to a newly prescribed medication is that they have glanced at the ISI and they don’t like what they see. Sometimes, the fear induced by that glance is enough to prevent the patient from taking that medication altogether.
The problem is this: the fear of the drug is greater than the fear of the disease. A patient’s fear of a muscle complication from a statin is greater than his fear of a stroke from his hyperlipidemia (perhaps he didn’t know about the stroke risk?). I think this is because the patient received the ISI for one but not the other.
Consider what the ISI for diabetes would read like: “Significantly increased risk of heart attack, stroke, blindness, impotence, neuropathy, amputation …” Scary.
What many people don’t adequately realize is that healthcare, like most of life, involves weighing risks vs. benefits. Pharmaceutical risks are emphasized and made plain as day, which I believe is important. What I think we need is an even greater emphasis on the risks of chronic disease, particularly poorly treated chronic disease in the setting of medication non-adherence. It is hard to weigh risk vs. benefit when the communication of risk is uneven between the two.
Consider this one example from a recent New York Times article, A Reminder on Maintaining Bone Health. “On average, the bisphosphonates reduce the risk of a fragility fracture by 30 to 50 percent. By comparison, the risk of the most talked-about serious side effect—an atypical fracture of the femur, or thigh bone—is miniscule … Dr. Khosla estimated that the drugs would have prevented more than 100 osteoporotic fractures in these women, a benefit at least 20 times greater than the risk.”
So there are risks all around: risks of treatment, risks of no treatment, risks of inadequate treatment. We simply need to level the playing field in our communication of those risks. Then, patients will see that the drugs they so fear are not actually all that scary—in comparison.
Katrina S. Firlik, MD, is co-founder and chief medical officer of HealthPrize Technologies, LLC. Prior to HealthPrize, she was a practicing neurosurgeon in Connecticut. She is also the author ofAnother Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside.
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