Many people will not take medicines unless absolutely necessary, and would rather change lifestyle than swallow pills, according to a study published today.
It appears in a themed issue of the British Medical Journal that focuses on change in the consulting room climate. Where doctors once expected compliance - assuming the patient would accept prof essional authority and take the drugs prescribed, they are being asked to work towards concordance, whereby a patient discusses and agrees treatment options.
A second paper suggests patients are better informed and act on information from outside the consulting room; the numbers taking hormone replacement therapy (HRT) dropped by more than half after a study showing it did not cut rates of breast cancer, heart disease and stroke, but slightly increased them.
Most studies look at patients taking medicines, and so leave out those who decline treatment, say researchers from a central Liverpool primary care trust. They asked a group of lay people, GPs and practice nurses about their attitudes to lipid and blood-pressure lowering drugs that GPs are urged to prescribe more widely to reduce risk of heart attacks.
"Dislike of drug-taking was common, and many preferred lifestyle change to an imperfect treatment," write Ewan Wilkinson, a consultant in public health, and colleagues.
Widely differing views were found among potential patients on the minimum benefit they wanted from a drug to justify taking it regularly. A third of lay people wanted a perfect drug, one that either had no side-effects or would definitely prevent a heart attack. Many preferred a lifestyle change, such as a different diet or more exercise, to medication.
"There is a danger that increased pressure on GPs to prescribe some drugs may distort practice and marginalise patients' preferences," say the authors. "We believe guide lines should reflect the importance of true dialogue between clinicians and patients before embarking on lifelong preventative treatment."
The study published in 2002, which found HRT was unsuitable for prevention of chronic diseases, appears to have had a big impact, say researchers in New Zealand. Of 776 women on HRT before the study, 58% stopped taking it. Some restarted, 18% of the total, but 40% did not.
