Adherence to Medicine for Blood Pressure, Infection, and Obesity
A recent thread in the ongoing public discourse about new, advanced obesity medicines relates to how long people should take them and how long they actually do take them. The revelation that started this is data from a pharmacy benefit manager (PBM) indicating that two-thirds of patients typically stop taking them within a year. So with this thread, we find people diving into some conflicting impulses about adherence to medicines. This is something of a recurring problem with medicines for different conditions – not just obesity. So we’re going to take a quick dip into the subject of adherence in three different medical conditions – blood pressure, infection, and obesity.
Both contrasts and common themes in issues with adherence in these different conditions are informative.
Blood Pressure
“Adherence with pharmacotherapy for hypertension 1-year after initiation is typically reported at less than 50 percent,” write Michel Burnier and Brent Egan in a recent review. We note that this is very similar to the revelation about obesity medicines.
But the response is somewhat different in the case of blood pressure. It’s not cool to discourage people from taking their blood pressure medicine. Health will suffer. Everyone understands that this is an chronic therapy for a chronic condition with the goal of protecting against heart attacks, strokes, and death. PBMs have little to gain from discouraging access and adherence to these medicines. So all eyes are on making it better, not worse.
Infection
In most (but not all) cases the challenge of adherence with medicines for infection is different, because this is an acute problem that requires an acute drug regimen to clear the infection. We’ll leave the discussion of a chronic infection like HIV for another day.
So in this context, the challenge is to ensure adherence to the full course of medicine to clear the infection. An incomplete course of therapy invites a relapse and the development of resistant infections. Not good, but a different set of challenges compared to blood pressure. What’s similar is that everyone is on board with promoting access and adherence to these medicines.
Obesity
With obesity, we get some of the same issues, but a much more confused state of affairs. It is no surprise that a PBM could find data to say that adherence is a problem. In fact, the picture that emerges is very similar to hypertension, with less than half persisting with treatment after a year.
What is different is the response to this fact. The PBM says this means “there’s waste” in paying for these medicines. It becomes one more excuse to restrict access. This is precisely the opposite of the response to issues with adherence to blood pressure medicines.
Making it worse is the fact that many payers, providers, and patients conceive of these medicines not as long-term therapy for a chronic condition, but rather as a quick fix for weight loss. More like an antibiotic than a blood pressure medicine.
Understanding a Chronic Condition
The sad conclusion from this comparison of adherence to medicines for blood pressure, infection, and obesity is simple. We have a long way to go in building a better understanding of the chronic disease that obesity is. Some people (i.e. payers) are not even on board yet with the need for access to treatment. Many others are still laboring with the false idea that the solution is weight loss – an acute, short-term effort to clear the problem.
But by itself, weight loss is not an adequate treatment for obesity. We will do well to stop talking about these medicines as weight loss drugs and call them what they are – obesity medicines.
Click here and here for more on the adherence story on obesity medicines.
Self-Portrait During the Eye Disease, painting by Edvard Munch / WikiArt. More on Munch and his eye disease here.
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July 17, 2023
