How to make the Patient Compliance Concept more useful NOW Step #4. Don't say "Adherence" when you mean "Brand Loyalty"

The how to fix Patient Compliance now series* *

By Allan Showalter on Oct 19, 2009

The how to fix Patient Compliance now series


This is the fourth in a series of posts offering  steps to improve the study of and communication about patient compliance.


These recommendations are simple and inexpensive; their implementation, in fact, is solely a function  of motivation on the part of those working in the field.


Finally, the benefits of these recommendations are magnificently  self-apparent.


Previous Steps follow:



  1. Always provide context-pertinent definitions of Patient Compliance terminology

  2. Differentiate between unintentional and intentional noncompliance 

  3. Support compliance claims

Don't say "Adherence" when you mean "Brand Loyalty"


"Compliance" (in this post, "Compliance" and "Adherence" are used interchangeably),  if it is to have useful significance as a term, cannot be used as code for "selling more medication X." (I hasten to add that I have no problem with the notion of selling more medication X. It's one of my favorite pharmaceutical agents, useful for any number of ailments and almost devoid of side-effects. I object only to its marketing being confused with medication compliance.)


A helpful rule of thumb follows:
If an alleged Medication Compliance Program applies to only one drug  or one small group of drugs, all produced by the same manufacturer, what you've got yourself there is not a Medication Compliance Program  but a Brand Loyalty Program.


A Medication Compliance Program is concerned with all the medications in a patient's regimen; eliminating or replacing a given medications from a patient's regimen  does not disqualify a patient from participation in a Medication Compliance Program.*


Again, I am enough of a believer in free market theory that I don't seek to ban Brand Loyalty Programs for pharmaceuticals as long as the programs do not promote the inappropriate prescription or continuation of the medications on which they focus - and the intent of the Program (i.e., to sell more doses of Medication X) is made transparent to doctors and patients.


That one can certainly devise a lexicographical rationale for using "compliance,"  "adherence," and similar terms in association with Brand Loyalty Programs does not mitigate the ongoing confusion about the concept of compliance.

It's simply a matter of clarity and trust.


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*The exception, of course, is a single-agent Medication Compliance Program that concerns treatment deemed so essential that its proper execution warrants special adherence protocols (e.g., DOT in the case of tuberculosis treatment).  One supposes that a Medication Compliance Program could also legitimately focus on a single given medication with inherent qualities, such as a particularly complex dosing schedule or overwhelmingly noxious side-effects, that rendered adherence especially difficult. I have, however, yet to find a Medication Compliance Program for a single drug that described its intent in that manner or its drug of focus in those terms