The other day I read Should Patients Be Paid for Medical Compliance?, an article written by Dr. Victoria Rogers McEvoy. The article is a response to Pam Belluck’s For Forgetful, Cash Helps Medicine Go Down, written for the New York Times. Both articles explore the concept of paying patients to take medications prescribed to them by their doctors. Belluck states one-third to one half of patients are not drug compliant, whether by not taking medication as directed or failing to fill a prescription at all.
After reading both articles, there are three main concerns I have with the concept of paying patients to take their medication. Overuse of medications to solve potential lifestyle issues, the ethics of paying someone to take medication, and the issues of personal freedom and responsibility.
We live in a society obsessed with health. “If you don’t have your health, you don’t have anything” seems to have become society’s mantra. As medical science advances and we are able to treat or cure more and more diseases, ill health and death almost become an insult to our intelligence. But no matter how hard we try, there is no magic pill that prevents eventual death.
So when it comes to placing people on precautionary medication because they are at risk for high blood pressure, type 2 diabetes or high cholesterol, I am reluctant. I find the situation to be a bit like the infiltration of cell phones into everyday life. We existed before their creation, but now we can’t seem to live without them. The same is true with prophylactic drugs. Once we encouraged changes in diet and exercise choices, now we turn to pills to manage our risk. Has our society become too drug dependent? Will we find in the future we have become immune to our prophylactic medication as we have with certain types of antibiotics due to overuse?
Also, in my experience, the use of drugs can propagate the use of more drugs. Side effects from one drug may be managed by another drug, but that drug often comes with its own side effects. It’s a vicious circle. In my case, the circle is necessary. If I don’t take immunosuppression drugs then I put my new heart at risk, but those drugs cause stomach issues. No worries though because there are other drugs to take care of that problem.
Which leads to the ethics of insurance and drug companies paying people to take their medication. My pharmacist friend Dave, the one who directed me to the articles, reminds me it is more of a financial issue than an emotional one. In that case, I can appreciate the theory that greater drug compliance will lead to less emergency room visits, saving the health care system a great deal of money. But I am bothered by the fact that this is more of a financial issue than an emotional one. Are we trying to keep people healthy for their sake, or for the sake of the bottom line?
And just how ethical is for drug companies to pay people to take their drugs? Their benefit from drug compliance far outweighs their loss from instituting a reward system. Especially if being drug compliant leads to side effects that require other drugs.
Belluck’s article is based on a study done in the States, as a potential solution to an over-burdened health care system. In Canada, my friend Dave argues that drug recalcitrance is caused by our complacency with our free health care. After all, Canadians don’t have to be drug compliant because our health care system will rescue us when a health crisis hits.
Speaking on behalf of myself and my friends who have medical issues and are drug compliant without monetary reward, I find his argument offensive and untrue. This is where the issue of personal freedom and responsibility comes in. Taking medication is a choice, and whether you make the decision to take what your doctor has recommended or not to, it should remain your choice. Belluck states in her article that once the monetary reward ends, the drug compliance can end as well. I agree with McEvoy who writes, “If a patient chooses not to follow instructions, perhaps that patient should bear the consequences of her actions,” because part of my motivation for taking medication is the prevention of such consequences. You cannot force someone to take medication unless you are injecting it into them and some people simply learn by experience.
McEvoy also makes a good point when she writes that “this dollar reward for compliance runs the risk of infantilizing patients and creating a paternalistic ambiance around health care”. Paternalism in medicine began to be challenged in 1970s and paying patients to take their medications is a step back to paternal attitudes.
When it comes to solutions, I don’t think this is a problem that can be solved by throwing money at it. This issue is not about money, this about the best way to support people in living healthy lifestyles, whether that lifestyle includes medication or not. It is my hope that paternalism and the passive patient will work their way out of the health care system and be replaced by the activist patient. It is my belief that patients who seek to be knowledgeable about their condition, risks and treatment and are supported by a positive medical team will have higher levels of drug compliance.
It’s Saturday night, and I have just completed my Saturday night ritual: packing up my pills for the week ahead. It takes me about twenty minutes and involves ten medications and seven vitamin and mineral supplements for a total of thirty-three tablets per day. If I were getting paid to take drugs, I’d be rich by now. But I take them at the required times not because I’m getting paid, but because I’m taking care of my health, and doing what I can to ensure my future.