I take a green pill and an orange pill every day, …
While it may seem a bit of a stretch to consider this entry about color and medication pertinent to patient compliance, color plays a major role in our perceptions and, as experience and research have shown, a patient’s perceptions about illness, clinicians, the manufacturer of medication, family and cultural attitudes, and a seemingly endless list of other factors influence medication adherence. In that context, that the look and feel of a pill could have an impact on compliance does not seem so unlikely.
Rachel Perls has posted The right color pill helps the medicine go down, which addresses the effect of pill and capsule colors.
Ms Perls publishes Hue, a blog dedicated to color:
I created this blog to catalog and share my color-related findings. Design elements, architectural interiors, fine art… color has a major impact on our lives, and I’d like to draw attention to it’s importance. If you love color,
In addition to the highlighted entry, I read several random posts, all of which were interesting and some of which portrayed colors and combinations of colors that can only be described as gorgeous.
These are not academic discourses on color theory but are instead brief expositions of a topic with the goal of providing an impression of the impact color can have. Most striking are the examples, such as the blister-pack of pills shown atop this entry.
Of the non-medical posts, I especially recommend Watching the progress of an artist, an entry from February 17, 2007 which links to a video of Picasso painting on a transparent canvas while time lapse photography captures his strokes. Ms Perls elaborates in this excerpt:
… he starts with a simple shape, adds solid blocks of the primary colors, then starts adding and subtracting details, textures, and secondary colors. What can you take away from this? Don’t be afraid to try something new. If you are too committed to your first idea, you’ll never see what might have been possible. Textures, lights and darks, and form are your friends.
The right color pill helps the medicine go down is a worthwhile reminder of the nuances that affect healthcare compliance, and Hue strikes me as an enriching, stimulating blog to brighten ones Monday.
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Source: Teaching doctors to teach patients about lifestyle Kate Murphy International Herald Tribune April 17, 2007
The American College of Lifestyle Medicine
The American College of Lifestyle Medicine is a new national medical specialty society formed within the past two to three years to make lifestyle medicine a credentialed clinical specialty and a part of basic medical training.
Their philosophy is characterized by a quote from the organization’s president, John H. Kelly Jr., who holds that symptomatically treating disease without assessing patients’ lifestyles or offering them guidance on how to change is “irresponsible and bordering on neglect.”
Excerpts from the article:
The Centers for Disease Control and Prevention reports that 1.7 million Americans die and 25 million are disabled each year by chronic diseases caused or made worse by unhealthy lifestyles. And a 2005 study in The New England Journal of Medicine predicted that average life expectancy in the United States would decline in the next 20 years as a result of unhealthy lifestyles, reversing a trend dating to the 1850s. The American College of Lifestyle Medicine has 150 members in a wide array of specialties - nutritionists, ophthalmologists, gastroenterologists and oncologists, among others. Helping their cause is a new publication, The American Journal of Lifestyle Medicine, which appears every other month with peer-reviewed research on the way daily habits affect health.
Lifestyle medicine proponents include researchers and clinicians from the fields of medicine and public health. While they agree on the importance of questioning patients about their lifestyles and giving tailored advice on how to make improvements, there remains disagreement about who should provide such counseling and with what sort of training. Nor is there a widely accepted prescriptive approach for encouraging patient compliance.
Proponents of lifestyle medicine are quick to distinguish it from alternative medicine. “This is mainstream medicine supported by mainstream medical research,” said James M. Rippe, associate professor of cardiology at Tufts University School of Medicine and the editor of The American Journal of Lifestyle Medicine. “The lifestyle medicine movement is not an anti-procedure, anti-medication movement.” Rather, he said, it advocates that lifestyle interventions become part of the doctor’s arsenal in fighting disease: “For too long we’ve ignored our most powerful weapon when it should be our first line of defense.”
Commentary
While there is much potential from systematically integrating lifestyle medicine into clinical practice, I am most taken with the notion that patient compliance is an element of the same basic category as diet and exercise. That seems to me a more appropriate and useful conceptualization of adherence than as a pathology.
The American College of Lifestyle Medicine can be found online at http://www.lifestylemedicine.org/index.html
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‘Cognitive Dissonance’ Became a Milestone In 1950s Psychology By Cynthia Crossen Wall Street Journal December 4, 2006
As the title of this article suggests, it is an historical look at Leon Festinger’s development of the concept of cognitive dissonance. I’ve written about it today because (1) it’s interesting on its own merits and (2) it serves as a reminder that the phenomena underlying patient compliance are not unique to healthcare and that theoretical work in non-healthcare fields, including but not limited to cognitive dissonance, may be directly applicable to the problems of nonadherence to treatment.
This excerpt makes the same point:
Why, for example, do people who know cigarettes are bad for their health continue to smoke? This is classic cognitive dissonance: They know one thing and feel another. Mr. Festinger believed this incongruity is as uncomfortable to the human organism as hunger. One way or another, the anxiety must be assuaged. So the smoker builds a bridge — a rationalization — from feeling to fact: If he stopped smoking, he’d gain weight, which would also be unhealthy; some risks are worth taking to have a full life; the risks of smoking have been exaggerated. Indeed, in a 1954 survey asking people if they felt the link between lung cancer and cigarettes had been proven, 86% of heavy smokers thought it wasn’t proven, while only 55% of nonsmokers doubted the connection.
And, the examples are fascinating. For example,
But where Mr. Festinger found the richest raw material for his theory was in a cult that developed in Chicago in 1954. A woman Mr. Festinger called Marion Keech claimed she was receiving messages from another planet, Clarion. The messages predicted that on a given date, a cataclysmic flood would engulf most of the continent. Those who joined Mrs. Keech’s sect would be picked up by flying saucers and evacuated from the planet. … Before the dates of the expected flood, the cult was mostly averse to publicity and had no interest in attracting other believers. On the day before the flood, the group was told that at midnight a man would appear at Mrs. Keech’s house and take them to a flying saucer. But no knock came at her door, and the group struggled to find an explanation for why there would be no flying saucer or flood. At 4:45 a.m., the group said, a message arrived from God saying He had stayed the flood because of their strength. What interested Mr. Festinger was not so much this face-saving explanation as what the cult members did in the following weeks. Rather than shunning public attention as they had before, they began zealously proselytizing. “There were almost no lengths to which these people would not go now to get publicity and to attract potential believers,” Mr. Festinger wrote. “If more converts could be found, then the dissonance between their belief and the knowledge that the prediction hadn’t been correct could be reduced.”
Commentary
Among other insights it offers, cognitive dissonance goes a long way toward explaining why starkly presenting patients with facts, regardless of how valid the data and how elegant the research, is insufficient to improve compliance. In fact, as the example of the doomsday cult excerpted above points out, those individuals whose beliefs are proven inaccurate in the most definite and most public manner are most likely to react by intensifying their commitment to those erroneous beliefs. It further follows that perhaps aggressive, dramatically confrontational approaches to patient education are not only ineffective but counterproductive.
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