Adherence to Treatment Among Economically Disadvantaged Patients With Panic Disorder Mukherjee S, Sullivan G, Perry D, Verdugo B, Means-Christensen A, Schraufnagel T, Sherbourne CD, Stein MB, Craske MG, Roy-Byrne PP. Psychiatr Serv. 2006 Dec;57(12):1745-50.
This article is featured in today’s post not only because of the information it offers but also the comparison it provides to the newspaper story discussed in yesterday’s post, ADD Medication Adherence: Cultural Changes & Individual Attitudinal Shifts.
Study Parameters
This excerpt from the abstract of “Adherence to Treatment Among Economically Disadvantaged Patients With Panic Disorder” describes the basis of the study:
And, the study’s finding that is most pertinent to patient compliance is “barriers to adherence were predominantly logistical.”
Commentary
I agree with the authors that the logistical hurdles these patients faced in attending CBT and the consequent recommendations for clinicians are significant and helpful. For example,
I am less convinced, however, that the complete set of causes of noncompliance in these cases is predominantly logistical. Rather, I suspect that the research methodology used, semistructured interviews subsequently coded for patterns, lends itself to patients listing such rationales rather than reasons that might be uncomfortable or embarrassing to voice (e.g., forgetfulness, dislike of the clinician, substance abuse) or might be unavailable to the patient’s consciousness (e.g., psychological conflicts).
Comparison & Contrast Of Scientific Vs Lay Press Articles
It is instructive to compare the presentation of this study, “Adherence to Treatment Among Economically Disadvantaged Patients With Panic Disorder” with the Las Angeles Times story, “Many of the ‘ADD generation’ say no to meds,” from yesterday’s post.
Both today’s study and the newspaper story are based largely on interviews, and, the null hypothesis of scientific studies, notwithstanding, both display a bias on the part of the authors.
The vital difference, however, is that while the newspaper story provides no details of methodology (e.g., how subjects were selected, how many were interviewed) let alone potential problems in the techniques used, the authors of “Adherence to Treatment Among Economically Disadvantaged Patients With Panic Disorder” take pains to point out the limitations, both apparent and potential, on the conclusions one can draw from their work. The following excerpt is typical:
Further, the study’s authors straightforwardly acknowledge that the statements of the interviewees reflect those subjects’ perceptions, which may be difficult to interpret. Consequently, they suggest, “Additional research is needed to better understand patients’ definitions of well-being and the levels of symptoms and functioning that denote ‘equilibrium,’ especially because this equilibrium appears to be related to decisions about adherence.” In contradistinction, the newspaper story appeared to accept the interviewees’ declarations as unadulterated reflections of reality (i.e., if a subject reported discontinuation of a medication resulted in feeling happier, that statement as unquestionably accepted as fact).
Finally, the researchers distinguished between patients’ feelings and clinical results. A patient’s anxiety about taking medication, for example, was acknowledged and respected but did not lead to the conclusion that such patients would not benefit from medication. The point of the newspaper story appears to have been that patients didn’t want to take the medication so they shouldn’t, with no thought given to the possibility that the medication could have been helpful. Of course, neither I or the newspaper reporter has any way of knowing if the medication’s benefits (if any) outweighed its problems (if any); and, that’s precisely the point. I hold that the author has a responsibility to point out such pertinent negatives.
That scientific papers are implicitly and, in the majority of medical journals at least, explicitly expected to include this kind of self-critique to alert the reader and demonstrate the authors’ own awareness of the possible misinterpretations of their work is especially significant in an era in which even hard news stories on TV are skewed by the simple process of editing out video footage that doesn’t support the program’s own agenda.
Perhaps the lay media owe their audiences at least a disclaimer that, while conclusions drawn from stories such as “Many of the ‘ADD generation’ say no to meds,” may or may not turn out to be accurate, those reports cannot be taken as complete, unbiased, or scientifically valid and actions taken based on them may prove more dangerous than one would assume from the article itself.