{"id":2605,"date":"2013-08-29T09:55:42","date_gmt":"2013-08-29T08:55:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2605"},"modified":"2013-08-29T18:17:31","modified_gmt":"2013-08-29T17:17:31","slug":"under-treatment-treated","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2013\/08\/29\/under-treatment-treated\/","title":{"rendered":"Under-Treatment, Treated."},"content":{"rendered":"

Right: file this paper from the JAMA<\/em><\/span><\/a><\/span><\/span>\u00a0under “Properly Odd”. \u00a0It’s a proposal that nonadherence to a treatment regime be classed as a treatable medical condition in its own right.<\/p>\n

No, really. \u00a0Look at the title: “Medication Nonadherence:\u00a0A Diagnosable and Treatable Medical Condition”.<\/p>\n

Starting from the fairly straightforward premise that non-adherence to treatment regimes is “a common and costly problem”, Marcum et al<\/em>\u00a0move at the end of their opening paragraph to have\u00a0medication nonadherence recognised “as a diagnosable and treatable medical condition”. \u00a0The authors allow that, as a precursor to treatment, there must be an accurate diagnosis. \u00a0However,<\/p>\n

for undetected and under-treated conditions such as medication nonadherence, one way to identify the population of interest is to conduct screening. The 1968 World Health Organization principles on screening tests have clear application to medication non-adherence. For example, the condition is an important problem, there are suitable tests available, and there are acceptable treatments for those with this problem.<\/p><\/blockquote>\n

Well, OK; but it hasn’t yet been shown that nonadherence\u00a0is<\/em> a condition, and so it’s too early to say that it’s a condition for which tests and treatments are available. \u00a0It shouldn’t be hard to see what’s gone wrong here:\u00a0the fact that treatable medical conditions are serious problems that are (or could in principle be) reversible doesn’t entitle us to say that any serious problem that is (or could be) reversible is a treatable medical condition. \u00a0The authors appear to have got things – to use the vernacular – arse about tit.<\/p>\n

So is there any evidence offered in the paper for non-adherence being a medical condition in its own right? \u00a0The paper is short, but even so, it’s not something I want to reproduce here; all the same, there’s nothing that leaps out. \u00a0The main planks of the argument are simply that it’s a problem, that it’s a problem that has something to do with health, and that it’s therefore a health problem properly understood.<\/p>\n

The authors continue:<\/p>\n

Using previously established methods and instruments, screening to diagnose medication nonadherence among adults across care settings should be routine. A number of screening tools or instruments are currently available to determine the underlying behavior(s) of interest. \u00a0This approach illustrates how clinicians and researchers can begin conceptualizing the diagnosis and treatment of medication nonadherence. \u00a0[…]\u00a0Also, given the proposal to routinely screen for medication non-adherence in adults, the next step is to match the identified barriers to a proven treatment for the condition.<\/p><\/blockquote>\n

Well – if I can interrupt for a moment – they can begin diagnosis and treatment of the condition\u00a0so long as the condition is actually a thing<\/em>. \u00a0Which it isn’t.<\/p>\n

I have a horrible feeling that I know what’s going on here; there’s a couple of telltale signs:<\/p>\n

Inclusion of medication adherence data in the electronic health record will\u00a0allow for sharing among health care professionals and insurers, establishing trends over time as well as benchmarking for quality improvement purposes. Moreover, it is paramount that patient-reported medication adherence information (eg, medication beliefs and values) is incorporated into such documentation.<\/p><\/blockquote>\n

And this makes me think that it’s got something to do with the role of private insurance in the US medical system. \u00a0If you can get non-aherence accepted as a condition, then it’s something that insurers’d have to cover, which would mean…<\/p>\n

\"Eh?\"<\/a><\/p>\n

… Actually, no. \u00a0I’ve no idea. \u00a0I mean, it wouldn’t actually make it a condition. \u00a0You can’t just define a condition into existence because it’d suit some purpose.<\/p>\n

In the current health care climate, there is a strong demand for improving the quality of care delivered, including medication adherence.<\/p><\/blockquote>\n

Hmm. \u00a0That’s not really helping.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Right: file this paper from the JAMA\u00a0under “Properly Odd”. \u00a0It’s a proposal that nonadherence to a treatment regime be classed as a treatable medical condition in its own right. No, really. \u00a0Look at the title: “Medication Nonadherence:\u00a0A Diagnosable and Treatable Medical Condition”. Starting from the fairly straightforward premise that non-adherence to treatment regimes is “a […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[963,1542,576,407],"tags":[],"class_list":["post-2605","post","type-post","status-publish","format-standard","hentry","category-curios","category-in-the-journals","category-the-art-of-medicine","category-wtf"],"yoast_head":"\nUnder-Treatment, Treated. - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2013\/08\/29\/under-treatment-treated\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Under-Treatment, Treated. - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Right: file this paper from the JAMA\u00a0under “Properly Odd”. \u00a0It’s a proposal that nonadherence to a treatment regime be classed as a treatable medical condition in its own right. 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