Personalized medicine could fix patient non-adherence problem

Patients who don't follow the advice of their providers cause a significant amount of waste in the industry, accounting for 13 percent of overall healthcare spending. Improving adherence is a major priority for healthcare providers, but improvement efforts do not focus enough on what works best for patients, argues a Forbes column.

The general policy consensus is that non-adherence comes down to patient ignorance or irrationality, writes University of Chicago economist Tomas Philipson. However, this view is not based on hard science and erroneously attributes the entire problem to under-adherence, when in fact over-adherence to ineffective treatment is just as harmful and costs the system even more, he writes.

While providers are experts on a treatment's effect on the population, Philipson writes, patients are the experts on how treatments affect them personally.

"Providers must recognize that patients' decisions are likely to be rational, even when they are made unilaterally--no one cares more about the patient's own welfare than the patient herself, including providers," he writes. 

To make this process more efficient and cut out the trial and error, Philipson recommends increasing use of personalized medicine--a major White House initiative--to test for treatment value before patients undertake therapy, such as a genetic test to determine whether patients are likely to respond well to the treatment. For example, President Barack Obama's Precision Medicine Initiative invested $215 million in fine-tuning personalized healthcare, beginning with oncology, as cancer is the costliest condition under the trial and error model.

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