A meta-analysis of the association between adherence to drug therapy and mortality BMJ Volume 333 pp 15-18

Commentary: The healthy adherer & the placebo effect BMJ Volume 333 pp 18-19
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A meta-analysis of 21 studies with a total of over 46,000 participants demonstrated that those who take their medicine as prescribed, even if the medication is a placebo, have a lower risk of death than those with poor adherence. It is significant that this finding is congruent with numerous other studies of placebo over the past 50 years.

The authors speculate that patients who exhibit high levels of adherence also maintain a constellation of healthy behaviors and that this group of salubrious habits accounts for the improved mortality. Others¹ extend the notion that “healing lies not in the treatment but rather in patients’ emotional and cognitive processes of ‘feeling cared for’ and ‘caring for oneself.’”

Commentary

While the correlation between adherence and health is intriguing, it begs the chicken-egg question: assuming adherence can be taught , would that learned adherence similarly enhance the health of patients who were originally noncompliant, independently of whether the medication was active or placebo?

Footnotes:

1. Barrett B, Muller D, Rakel D, Rabago D, Marchand L, Scheder J. Perspect Biol Med 2006;49:178-98.
   Miller WR, Rollnick A. Motivational interviewing. New York: Guilford [back]

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