The Language of Medication-Taking

• Dose-response relationship, drug
• Patient compliance
• Physician role
• Physician-patient relations

Over the past 50 years, periods of intensive clinical and research interest in medication-taking have coincided with breakthroughs in drug development, such as antibiotics for infectious diseases in the 1950s (1-3), medications for hypertension in the 1960s and 1970s (4, 5), and highly active antiretroviral therapy for HIV infection in the 1990s (6-10). Hundreds of studies have found that only 50% to 60% of patients consume their medications for chronic diseases as prescribed (5), yet intensive, multimodal interventions often only marginally improve medication-taking or therapeutic outcomes (11, 12). Because medication-taking remains a clinically important problem despite 50 years of study, reassessment of an issue as basic as the language we use to describe it may be necessary to identify new strategies for clinical intervention and research.

The terms we now use to describe medication-taking—“compliance” and “adherence”—are problematic for several reasons. First, these words exaggerate the physician's control over the process of taking medications (13, 14). Second, they imply that the patient must take the medication as prescribed to obtain benefit. Third, the terms “noncompliance” and “nonadherence” create a clinically unjustifiable distinction between persons who take all of their pills as prescribed and those who deviate from the prescription in any way. Finally, none of these terms accurately represents patients' motivations for choosing to take their medications a certain way.