I am not a creature of habit.  Forming even simple habits, like remembering to turn the alarm system on before I go to sleep, is agonizingly difficult.  So remembering to take medicine twice a day, every day, and not, say, leave for work without taking my pills . . . well, frankly, I am the leading cause of antibiotic resistance in this country. 


Unfortunately, I'm not alone.  One of the things that you learn, when you start working on health care, is what a startlingly high percentage of patients don't comply with even basic treatment regimes.  I'm not talking about schizophrenics who periodically go off their meds because they can't stand the tardive dyskinesia; I'm talking about people who discontinue their Singulair or calcium channel blockers because of fairly mild side effects, or just because they can't be bothered.

As someone who is supposed to take a lot of drugs, I'm pretty excited about this:

The container--actually a high-tech top for a standard pill bottle called a "GlowCap"--is equipped with a wireless transmitter that plugs into the wall. When it is time for a dose of medicine, the GlowCap emits a pulsing orange light; after an hour, the gadget starts beeping every five minutes, in arpeggios that become more complicated and insistent. After that, the device can set off an automated telephone or text message reminder to patients who fail to take their pills. It also can generate email or letters reporting to a family member or doctor how often the medication is taken.

Admittedly, this is creepy.  Sadly, it is also necessary . . . though we shouldn't expect too much.  Even intensive efforts to increase compliance have fairly minimal results:

An Express Scripts rival, Medco Health Solutions Inc., is tackling noncompliance with efforts including pharmacists, who use in-depth databases to detect when patients aren't refilling prescriptions regularly and call to offer information. Increasingly, insurers and employers are cutting or eliminating drug co-pays for patients with chronic conditions; the thinking is that patients will take medications more often if they don't have to pay as much for them.

The most effective programs combine education and reminders, says Daniel Touchette, assistant professor of pharmacy practice at the University of Illinois at Chicago. But even they improve the share of patients adhering to drug regimens by no more than about 10%.

Perhaps we should combine regular drugs with the illegal kind.  We might get more compliance if compliance were more fun.



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