Take as directed - my a*se!

Former U.S. surgeon general C. Everett Koop often is quoted as saying, "Drugs don't work in patients who don't take them."

Yet, study after study shows that in the USA and other developed countries, only about half of people with chronic health conditions continue to take medication as directed. Doctors say the problem cuts across all socioeconomic groups, and the problem often goes unrecognized.

"Adherence is a huge problem, costing billions of dollars," says Alexandra Papaioannou, a geriatrician at McMaster University in Hamilton, Ontario. "Obviously, if you don't take the drug, you won't have the full benefit."

About 20% to 30% of patients taking daily or weekly osteoporosis treatments quit six to 12 months after they begin, Papaioannou writes in the January issue of Drugs & Aging.

The main reason is either side effects or fear of them, she and her co-authors write. Memory problems, depression and a daily regimen of many pills for other conditions also contributed to patients' lack of adherence.

One study found a lack of adherence to tamoxifen, which has been shown to reduce the risk of a breast cancer recurrence in women whose tumors are sensitive to estrogen.

Irish researchers reported 22% of the breast cancer patients they had studied stopped taking tamoxifen by the end of a year, even though they had been told to take the drug for five years. By the end of 3½ years, more than a third of the women had stopped taking their tamoxifen.

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Insider's view: Big Pharma should listen up. This is an opportunity. Find out why compliance is an issue and help solve the problem rather than try and expand markets!