One topic that you’ll probably see quite a bit about in the future on this blog is drug compliance. Perhaps you call it adherence, but whatever you call it, the situation is bleak. I’m referring, of course, to patients that don’t take their medications as prescribed by their doctors. I’ve seen a number of figures, but one of the more popular papers written on this topic by Lars Osterberg pegged just some of the cost of non-compliance at over $100 billion a year. There’s also no question that for many diseases, a lack of compliance leads to worsening of disease and also an increase in the risk of death. One study looking at non-adherence to medication after a heart attack found an almost 4-fold increase in death one year after the event. That’s bad.
Consider that last stat. Presumably, the doctor has told the person the importance of the medication and their risk if they don’t take it. I’ll also assume that people generally want to live. So then how come so many people stop taking their medication? Truth is, no one knows because the answers are so individualized. What impacts one person may mean nothing to the next. However, almost every program ever created to address non-compliance has focused on a one-size fits all approach. The way I sum it all up is like this: “We try to impact everyone, yet only really impact a few, and even fewer to a great extent, and we do it inconsistently.”
I’m saying “we” because in my past job, I led some of the compliance initiatives for Arimidex, a breast cancer treatment, at AstraZeneca. Yes, there are problems in adherence in breast cancer where almost 1 in 5 women stop their treatment after a year (instead of the typical 5 years they should) and increase their risk of recurrence by more than 20%. No one has figured out how to fix compliance and pharma companies and physicians have tried for years. Anyone who tells you they’ve got it figured out probably is exagerating a bit.
So, when the most recent issue of Pharmaceutical Executive arrived, I was interested in their story about “Tech Toys” designed to improve compliance. Some of the ideas were interesting and some a long way from ever being accepted by patients. As I read through the gadgets one at a time, I realized that they were all pretty much the same thing. They were either elaborate reminder systems or snitches. They blink, buzz, text, call, or email when you miss a few doses or they call and tell someone you missed your dose. What bothered me the most was that each company featured thought their idea was light years ahead of everything else and was going to be the solution to the problem we’ve all been seeking.
One in particular stood out to me and was really the impetus for this posting (and inspired the title). A company called Vitality has created a device that fits on top of your pill bottle and has a sensor that tracks if you’ve taken your medication (actually it only tracks if you opened the bottle, which is not necessarily the same thing) and a little LED light that blinks when you don’t. Check it out below.
The part that bothered me was this. The company’s CEO, David Rose, put together a quote for the article, as follows: “People just aren’t taking their medication as prescribed—especially for asymptomatic and chronic diseases; the research shows adherence rates as low as 50 percent. The research that we have seen is that the problem isn’t just a reminder problem. There are a lot of devices on the market that are essentially glorified alarm clocks.” I added the bold to add some emphasis. The device then is described in the article: “It’s basically a smart medication vial cap that fits the standard bottle. Inside is an LED and a sound chip, as well as a two-way wireless radio that connects to a set of Web-based services that include reminder calls, weekly e-mails, monthly reports to a doctor, and refill service at the pharmacy [emphasis mine again].”
So, if Mr. Rose says it isn’t a “reminder problem” and that most devices are “glorified alarm clocks,” how is his device which includes services such as “reminder calls” and “weekly emails” not a reminder device that’s a “glorified alarm clock?” The answer is that it is. This device is a glorified alarm clock. Just because it doesn’t ring and sends an email instead doesn’t change this fact. Using digital, such as email, doesn’t inherently make your product better or change it’s basic function.
If reminders worked, then simple beeping alarms would have solved the compliance problem long ago. The way I look at this is for a serious disease like breast cancer, isn’t opening your eyes each morning enough of a reminder that you have a disease that could kill you at any point? I’d think that might remind you about your medication. If reminders worked, wouldn’t the fact that you could die be reminder enough?
The reality is that compliance isn’t a reminder issue. It’s a complex phychological issue. People don’t take their medications for a number of reasons many of which include the patient’s decision that the drug isn’t helping them or isn’t necessary. Very few patients are informed enough to truly make this decision (they’re called doctors though) and yet it happens every day. People aren’t convince themselves that the risks outweigh the benefits or that they are feeling fine, so they must be “cured.” Point is, it’s something different for everyone. Very few people actually stop because they simply can’t remember.
So, we have to change this mantra: “We try to impact everyone, yet only really impact a few, and even fewer to a great extent, and we do it inconsistently.” Instead, it needs to be this: “We find only those who need help, so the impact is magnified, because we learn what they need to help them consistently over time.” Digital technologies allow us to quickly segment individuals and find who needs the most help (and who wants it). This allows you to dedicate more resources to these people instead of spending a little on everyone and having no impact on anyone. There is no reason that each person in a compliance program doesn’t essentially get their own, completely customized program. If we really want to make an impact on compliance, this is what needs to happen.
I’ll be talking a lot more on this subject in the future, but for now I figured I’d at least set up the problem. Curious if you’ve had any success with compliance programs or any failures you’d like to share. What’s worked and what hasn’t? And you even tracking these programs to know that answer?
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