Many patients are not taking their medications, and a recent study gives us insight into why. In another column, I discussed the fact that medicines are becoming more expensive, and that about 20% of people not taking their medicines are non-compliant because of the COST of medication. But there are also other more important reasons many people just don't take their pills. In the United States, approximately 25% of patients are non-compliant with taking oral medications for their illnesses. Those patients with the highest rates of non-adherence are patients with sleep disorders, diabetes, and pulmonary diseases (data from a study by Dr. M. DiMatteo, Medical Care, Volume 42, page 200, 2004). Patients who had gastrointestinal disease, arthritis, or AIDS were more compliant (non-adherence rates of 11% to 20%, compared to the higher non-adherence rates of 31 to 35% in patients with sleep disorders, diabetes, or pulmonary diseases). The most common reason for patients not adhering to their medication is usually SIDE EFFECTS of the medications that they are taking (according to a study by Dr. M. Kirk and Dr. C. Hudis as published in Clinical Breast Cancer, Volume 8, page 155, 2008). In their study of 534 breast cancer patients who were supposed to be taking oral hormonal therapy mostly to prevent the breast cancer from returning after surgery, the percentage of patients who were compliant with taking all of their medicines was 57.4%. Of those patients who were not taking their oral medications, 70% said that they were not taking their medications due to treatment related side effects. Patients generally knew how important the medication was to having a good outcome of their illness (89%), but only 13% said that their doctor or nurses asked them at every visit whether or not they were taking their medication. Doctors need to do a better job of keeping their patients on track! The most common symptoms that these patients were having included hot flashes, fatigue, and joint pains. It may be understandable that these patients had a tendency to not take their medications completely if the doctors and nurses were not helping get rid of these troublesome side effects. The lessons from this study are very important. First, you should take the medication which is prescribed for you by a physician. Secondly, if you are considering not taking the medication, discuss that with your physician completely. Third and most importantly, since most patients do not take their medication because of side effects or a fear of side effects, be certain that you discuss fully with your physician or nurses what side effects may occur, and what kinds of treatment can be given in case those symptoms do occur. If you are having symptoms, be certain to talk this over either with your physician or your pharmacist to determine if there are methods of alleviating those symptoms that can be as simple as over-the-counter medications, or more complex such as other prescriptions that can eliminate side effects. Fourth, if you are having trouble affording the medicines, ask the doctor and nurses if they have any solutions. Fifth, if you are just forgetting to take doses in the middle of the day, ask your physicians if they have substitute medications that can be taken only once a day. The other lesson from these results is that doctors shouldn't assume that just because they prescribed a medicine, the patient is taking it. Doctors and nurses need to be more aware of non-compliance and who frequent and serious a health problem is for their patients. If your doctors or nurses aren't asking you if you are taking all your medicines, remind them that they need to be checking up on you and also the other patients. Remember that taking your medication results in better health outcomes. Share your reluctance to take those medications or difficulties you have with the drugs with your family, friends, and especially your physicians, nurses and pharmacists before even thinking of not taking the medication.