There is sometimes heated discussion about adherence to medical regimens being of value, both to an individual patient and to broader patient categories. Inflammatory bowel disease is certainly one of these contentious areas. Patients often seem to go from doctor to doctor, seeking out one who agrees with the decisions they have already made.

Even in the face of good data, maybe thousands or hundreds of thousands of collective patient-years, people cling to an example of one friend of a friend who managed to beat their IBD without medicines or surgery. Maybe they used some questionable treatment strategy with success. Or maybe they just got lucky. Or maybe the desire to find their own path is so strong for some patients, that data doesn’t really matter.

Certainly, we have an inherent desire to be in control of our own destiny. It is part of the fabric of life, and more so as part of the American dream: “If you work hard, you will achieve success.” What could be more part of that philosophy than the mind-over-matter philosophy we carry about beating disease?

Granted, I understand the frustration of a patient who has done everything they should, and is still not well. Unfortunately, that has more to do with the nature of disease, not with you as a person. Disease is bad stuff; it isn’t fair. And the philosophy of, ” If you can dream it, you can achieve it” just doesn’t always apply. IBD is a complex immunologic and inflammatory process–it is not a broken bone that needs to heal, a wound that needs to close, or something that diet and exercise will reverse.

While personal choices may come with health costs that are difficult to quantify, what about financial costs? Those are numbers we can get a handle on a little easier.

New research showed an association between nonadherence to medications for inflammatory bowel disease and increased health care costs in patients. This was especially true in those whose nonadherence increased over time.

A study of children and young adults with inflammatory bowel disease shows those who increasingly failed to take their medication as directed had health costs more than three times higher than those who were adherent. The report in Inflammatory Bowel Diseases showed patients who improved their adherence over time had health costs similar to those who were consistently adherent.

“This study has important ramifications for health care reform and how practitioners approach adherence assessment and intervention in routine care,” Kevin A. Hommel, PhD, director of the Center for Health Technology Research at Cincinnati Children’s Hospital Medical Center, said in a press release. “With sustained efforts to reduce nonadherence in chronic conditions, we may see concomitant reduction in health care costs.”

If costs are less for patients who are compliant with medication decisions, we must be avoiding surgeries, ER visits, and admissions. All the things that patients want to avoid the most. The paradox of all this is not really that unpredictable, is it? When there is a lot at stake, people push their boundaries. What we as physicians need is not just for patients to listen to us and do as we say, but to work together to educate each other about what we need out of the relationship and why. We need to work together as a team and make decisions together. And when medication is not working, we need to both understand why and what we can do to close the gap in a collaborative fashion.

-Manoj K. Mehta, MD

See the article abstract here.