Heartfelt with Dr Melissa Walton-ShirleyView all posts »
MI FREEE, POWER, and better health: You can't even GIVE this stuff away!Nov 16, 2011 11:57 EST
Americans love bargains. We'll get up at 2 am to shop the discounts on Black Friday and tackle the kindly little lady next door when she grabs the last Game Boy for her grandson. Almost all of us would take home all the free loot we could lug, but it doesn't mean we'll use it or even take it out of the package. Our love affair with "free stuff" is bad enough, but our lack of respect for what we acquire is worse. In the MI FREEE trial, copays were waved by third-party payer Aetna, making the most widely prescribed post-MI drugs completely free, yet compliance rates in those fortunate folks who have already cheated death once were less than a deplorable 50%. Half the study cohorts must have had bottles of pills stacked up like used bread wrappers on a "Hoarders" rerun, except unopened and unused. Beats the heck out of me how someone could turn down a chance to lower their death rates by 40% for free, but it really happened.
The same phenomenon was noted in the POWER trial. Obese patients were given, for free, the opportunity of a lifetime; a cure for their diabetes and hypertension, the ability to avoid a stroke, and the opportunity to nearly vanquish the risk of a heart attack. Coaches stood ready, practically begging for an opportunity to help them. Access to websites, emails, phone support, and face-to-face visits resulted in a dismal 52% of patients who were able to achieve the goal of a 5% weight loss.
So what exactly goes on in the mind of an individual who won't take years of hassle-free decades of life for free? How can you "make" someone love not having to buy bushel loads of medication or pant for air when they walk to the mailbox? How can you make them see that looking younger and feeling great are still compatible with the aging process?
The answers to these questions are as complex as the disease process itself, and we must insist upon finding the answers, but first we have to ask the right questions. Is it a fear of side effects? Is it the actual experience of having had a side effect? Is it because you know someone who had a side effect? How willing are humans to take medications if they aren't having immediate symptoms? Have they been socialized that taking medication is a sign of weakness? Do they have trouble swallowing? Do they have memory issues? Do they not buy into the belief system that exercise, diet, and control of a disease process by pharmacologic means will actually help?
Since there were improvements in compliance in the MI FREEE trial and measurable weight reduction in 52% of the cohorts in the POWER trial, the findings indicate that success can be achieved by combining the best of both trials. Third-party payers should provide free coaching and inexpensive options for medications. Access to remote support is cheap and readily available for most patients. These studies prove that any effort above what we are currently doing in traditional medicine will translate into some measure of success.
Perhaps when we design these trials, a psychological survey should be presented and an in-depth analysis performed of exactly what makes these noncompliant cardiovascular patients tick. We should invite our friends the psychiatrists to jump on board with each study. When we start to design trials that acknowledge the psychological aspects of compliance by utilizing measurable tools for study and modification, then we will truly get somewhere. Then and only then can we "give away" longevity, well-being, and good health to the masses.