Collaborate With Physicians (Part 2!)

Piano manufacturers invest resources to make products that can bring music and joy into people’s lives. But to get kids to play piano well, creating wonderful musical instruments is only the first step. The major hurdle is getting kids to practice. There’s not much the piano manufacturer can do to get kids to practice. To get kids to do this, we have to do more than just give the kid a piano and hand her some sheet music.

The Physician Must Be Involved

Similarly, physicians have to be more involved in getting patients to take their medications. Just handing the patient the prescription is not enough. Yet physicians aren’t well trained in adherence issues and what it takes to get patients to take medication as directed.

Becoming a physician requires four years of medical school, which includes a “comprehensive” course on pharmacology. The massive pharmacology book probably covers everything that affects blood drug levels—from GI absorption to first-pass hepatic metabolism, to volume of distribution, to renal excretion—all but the one most important thing that determines blood drug levels: Whether or not patients take the medication in the first place.

It is shocking, really, when you think about it. The single most important factor that determines variation in blood levels between different people—the variation in their adherence behavior—is ignored in medical school pharmacology classes. Students hear about research on pharmacogenomics and they also hear about how genes affect the efficacy of drugs. But almost no one is paying any attention to any of the behavioral issues that are the common causes of poor treatment outcomes. Maybe the pharmacology faculty will take notice when the pharmacogenomics studies identify genes for personality traits that affect adherence as determinants of treatment outcomes.

Pharmaceutical Companies Should Partner With Doctors

Pharmaceutical companies and doctors share the desire to see patients have a successful outcome from prescribed medications. Among pharmaceutical companies and their doctors, I think it is a safe bet that most patients have more trust in their doctors. After all, doctors are well positioned to make an impact on their patients’ adherence behavior—yet doctors may not even be aware that their patients have adherence problems. They may think, “Sure, other doctors’ patients are non-adherent, but my patients take their medications.” Even when doctors are aware of the non-adherence problem, they may not know how to address it.

Pharmaceutical companies know for a fact that there is an adherence problem. Pharma marketers can probably think of scores of ways that doctors could encourage patients to become more adherent to treatment. Even in the current regulatory environment, pharma companies and their reps can educate physicians about non-adherence issues by providing promotional or non-promotional adherence information, supporting CME events, developing or distributing enduring materials, or just bringing up interesting data on non-adherence at sales calls.

One final piece of advice: You know how big a problem adherence is. You know that doctors should be encouraging better adherence. Don’t ever assume the doctors know or appreciate the importance of either of these things.

  • Steven Feldman, M.D.

    Dr. Steven Feldman is Professor of Dermatology and Public Health Sciences at Wake Forest Baptist Medical Center. Steve studies patient adherence at North Carolina’s Wake Forest Baptist Medical Center. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (, founder of, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”


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