The good patient is an obedient patient, one who adheres to the physician’s prescription in taking medications as directed. When patients are nonadherent-that’s the phrase used in the conventional medical literature-treatment is thwarted. According to the main article in last week’s Archives of Internal Medicine, “This misuse sometimes results in progression of disease and treatment failure.”
But these are not just patients gone bad. The point of the Archives article is that physicians don’t communicate critical information to patients about the medications they’ve prescribed. The editorial that accompanies the article acknowledges that “Medication nonadherence is not just a patient problem.” Another article in the Archives issue points out that patients might have good economic reasons for being disobedient-they can’t afford to buy all the drugs prescribed. There were no articles about people being nonadherent because the drugs make them feel worse.
I want to back up and repeat something. “This misuse sometimes results in progression of disease and treatment failure.” Only some sometimes? What happens other times? Do the patients do something else that works? What is it? And why aren’t these guys curious about it?
As a client of mine said, “They mean well, but drugs seem to be all they know.”
And what is it with this “Medication nonadherence is not just a patient problem?” Despite poor practices by physicians, we still don’t get a complete pass from the bishops of ecclesiastical medicine.
Similar venting of consternation at nonadherence comes from the bishops of ecclesiastical food science. Last week a market research company released results that confirmed a USDA study: the vast majority of people eat what they think is healthy despite the earnest efforts of commercial dieting enterprises and the nutrition experts who concoct the USDA’s food pyramid.
The point is not that Americans have an innate wisdom about what they eat or how they care for their health. The point is that people use their own judgment about what’s healthy. The bishops don’t get it. Their system is top-down. But the patients, instinctively or not, make up their own minds. Which sends the bishops scurrying for better ways to persuade patients to be good. Which in commerce is called marketing. And which in the military is called orders.
Maybe patients are wicked because, despite meaning well, drugs ARE all that conventional health care practitioners know and because the message is always top-down. “We know what’s best for you.”
Last week when I went through a list of alternative strategies that included nutrients, herbs, and homeopathics with a client, she asked “Do you want me to take all of these?” The correct answer that got us back on track was, “Use your own best judgment about what works.”
Which is what we’re all inclined to do anyway. Which is what we actually do despite or even in spite of the hierarchical pressures from ecclesiastical science-from whom you’ll rarely hear anything about genuine alternatives. They mean well. They just don’t know what you do.
The issues in this article are developed (with references) in issue #4 of the Progressive Health Observer in a review article titled “Fit to Print? A review of The Truth About the Drug Companies and Critical Condition.”
Related resources are available on the Health Politics page.
