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Bill Sardi
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Posted December 18, 2019: by Bill Sardi
Drug companies are exploring new ways to increase sales by getting patients to take their drugs on time.
Numerous surveys show many patients fail to take their prescribed medicines for a variety of reasons. One survey shows 90% of patients said they take their medications as directed, but in reality, only 25% did. Surprisingly, use of reminder devices, such as digital timer bottle caps, do not improve drug adherence. Even notices sent to smartphones may only be marginally effective at improving drug adherence to daily drug regimens.
A confounding factor is forgetfulness. A report published in Managed Healthcare Executive magazine says forgetfulness is one of the most frequent reasons for failure to properly take drugs. Paradoxically, unwary doctors may prescribe drugs that impair memory and then prescribe more drugs to remedy the problem that also impair memory.
An example would be metformin, the most commonly prescribed drug for adult-onset diabetes, which depletes vitamin B12. A deficiency of vitamin B12 is known to induce short-term memory loss. Then a drug like memantine (Namenda) is prescribed for memory loss which is a drug known to impair memory as a side effect. (Even worse, one particular memory-enhancing drug (Exelon- rivastigmine) may result in an increased risk for death.
Some blood pressure pills, incontinence medications, cholesterol-lowering agents, anti-anxiety medications, antihistamines and sleeping pills, may impair memory. Drugs known as benzodiazepines and anticholinergics are major memory killers. Some of these drugs even induce amnesia.
The list of just one class of drugs that impairs memory is long.
High-tech answers are being sought to overcome the problem of poor adherence to drug regimens.
The most recent of these intelligent automated technologies to improve drug compliance is a tiny ingestible sensor comprised of dietary minerals that activates when a pill is swallowed. A signal is sent to a smartphone app that not only helps the patient remember they took the prescribed medication but sends a signal back to the doctor’s office or other caregivers.
But technology like this is raising fears it will be used to cancel insurance policies or stop reimbursement for prescribed drugs.
Patients are more likely to be adherent to med schedules if they fear they will experience a mortal heart attack or stroke or other mortal consequence if they don’t take their pills as prescribed. Cardiologists tell their patients if they stop taking cholesterol-lowering drug they may die. But statin drugs don’t prevent mortal heart attacks, they prevent non-mortal heart attacks!
Not only do patients have misplaced fears, most patients only have a remote chance they will ever benefit from Rx drugs because of the way these drugs are approved by the Food & Drug Administration.
Drugs are approved by relative risk rather than absolute risk. When the risk for a disease or adverse health event is low, such for heart attacks (3 in 100 over a 5-year period), and statin cholesterol-lowering drugs lower that risk (to 2 in 100), the relative risk has declined by a third (33%), but in hard numbers, only 1 extra patient in 100 will avert a non-mortal heart attack in 5 years.
According to one published online report, it takes 39 high-risk patients taking a statin cholesterol-lowering drug for 5 years to avert 1 non-fatal heart attack. It takes 125 patients taking blood pressure-lowering drugs over a 5-year period to avert one stroke.
When the number needed to treat (NNT) to avoid a single adverse health event is higher than 5, the promise of a health benefit is considered to be small. A whopping 1,667 healthy people need to take a full-size aspirin tablet every day for a year to prevent one stroke or heart attack.
The NNT for a few other commonly used medications is as follows:
As an aside, you may be surprised to learn that statin drugs don’t protect against mortal heart attacks, which are usually caused by an electrical storm in the heart, often induced by a shortage of potassium or magnesium known as electrolyte minerals. Cardiologists often instill fear of death in their patients if they stop taking their statin drugs in order to get patients to return to their offices for re-prescriptions and re-evaluations. But truth be told, physicians ought to be writing scripts for electrolyte minerals, and passing up cholesterol blood tests.
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