Fear of Side Effects

Fear of side effects is a major contributor to patients’ poor adherence. Some patients are particularly troubled by the risk of side effects. I can often recognize these patients right away and they may even be terrified of side effects of even our safest medications. In fact, they may actually prefer treating their disease with something that isn’t a drug at all. I’m able to manage these patients in part by assuring them that the treatment I’m prescribing is “natural,” that it is designed to complement their “body’s natural healing mechanisms,” and that I like to “take a holistic approach to healing.” I’m not sure words like “natural” or “holistic” have any real meaning, so these statements are, arguably, truthful, even when a risky, synthetic medication is prescribed.

Pharmaceutical marketers, however, generally don’t have the same leeway physicians have for describing their products to patients. Accurate information has to be provided on risks of both common and rare side effects that have been observed in trials, even if those risks were no more common with the drug than with a placebo. It is difficult for any patient to keep these risks in a reasonable perspective. Humans tend to overestimate risks of rare events. However, perception is key here and there are ways to help patients feel more at ease about the potential of side effects.

Graphical presentations can help. For example, I use pictures to give patients a clear visual idea of the quantitative magnitude of the rare risks associated with biologic treatments. I can show patients that the risk of death from the medication is far less than the risk of death from heart disease or even cancer, which we all face.

The behavioral psychology concept of framing can also be used to affect how patients perceive a risk. If I want to reassure a patient, I can tell them the risk is more likely than a lightning strike. If I want to dissuade them from a treatment, I could tell them that serious risk from the drugs is less likely than a coin flip.

Perhaps the best approach to managing the risks of side effects is to turn the challenge into an opportunity. A dermatologist in Texas shared a terrific example of this. When she prescribes the anti-androgen spironolactone to women with acne, she tells the patients, “Unfortunately, this drug is also a diuretic, and you may notice some weight loss while on it.” Now that’s the way to use a side effect to promote better adherence!

  • 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 (www.causaresearch.com), founder of www.DrScore.com, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”


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