title: The costs of compliance.
abstract: While the many costs of noncompliance have frequently been reviewed, this article addresses some of the costs of compliance, to the detriment of patients, doctors, and the doctor-patient relationship, and to the benefit of the pharmaceutical companies. Some psychiatric history is reviewed to analyze why psychiatric practice has become so focused on making specific diagnoses and treating those with specific medicines, even as fewer than 50% of patients follow medical advice. Some evidence for specific drug treatments is presented, and the powerful effects of nonspecific therapies, usually dismissed as confounders, are explored. Lastly, an argument for collaboration rather than compliance is made, imploring physicians to tailor individual treatment to each patient, and encouraging patients to be active in their own care.
authors.affiliation: Columbia University, College of Physicians and Surgeons, USA. el7@columbia.edu
authors.forename: Eve
authors.initials: E
authors.lastname: Leeman
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D003299:Cooperative Behavior; D017281:Cost of Illness; D003866:Depressive Disorder / Q000188:drug therapy; D016527:Drug Costs / Q000706:statistics & numerical data; D004345:Drug Industry / Q000379:methods; D011307:Drug Prescriptions / Q000592:standards; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049690:History, Ancient; D006801:Humans; D007880:Legislation, Drug / Q000592:standards; D040541:Marketing / Q000379:methods; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D010349:Patient Compliance / Q000706:statistics & numerical data; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011570:Psychiatry / Q000266:history / Q000379:methods; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D014481:United States; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence
chemical_list: D000929:Antidepressive Agents, Tricyclic; D011619:Psychotropic Drugs