A post at McKinsey focuses on patient adherence to treatment issues. (McKinsey Post) According to the post, 50% to 60% of patients fail to follow recommended treatment regimens. They trot out the hoary statistic, almost a decade old now, that lack of medication adherence alone costs thee system $290 billion a year. When that study was published we and others pointed out the many, many defects in it. Similarly, McKinsey cites other research, equally flawed, that non-adherence leads to 125,000 unnecessary deaths each year. Now I don’t believe this exaggerated nonsense, but I do think patients failure to follow recommended treatments is a serious problem. McKinsey’s solution is to create a 360 degree perspective of patient’s lives, using all kinds of personal data to try to predict non-adherence and intervene. Just what we all need, more invasion of privacy and use of our personal data. The airline industry is used as an example, uh, might want to rethink that comparison. McKinsey says that using a step approach like this could increase adherence by 5% to 10%. Gee, so non-adherence would drop to 40% to 50%; that is really a big improvement. The post does identify some factors that may be related to non-adherence, like cost, but I am very dubious that anyone is going to develop either data sources or an algorithm that in near-real time, which is what would be needed, identifies likely failure to adhere. I suspect that strongest predictors are previous failure to follow a treatment regimen or to engage in healthy health behaviors. Those are pretty easily seen, but getting the people who do this to change is a lot harder than finding them.
Of course, bad treatment recommendations could be an even worse problem than failure to adhere. There is lots of evidence to suggest that doctors often misdiagnose and prescribe inappropriate treatments. I suspect that costs the system even more. And in regard to drugs, many times patients’ failures to adhere are due to adverse events and side effects. It may actually save the system money if they stop using the drug. Certainly drug companies have no interest in shrinking the pool of people receiving their products, so their version of adherence is prescribe the product for as many people as possible. Getting treatment regimens right and ensuring that patients comply is a complex problem. And our unwillingness to use strong penalties for people who don’t do even basic things like stop smoking or lose weight, means that adherence is very hard to create, since tough consequences is the best way to change behavior.