The initial article treated NCB* as an aberration in the physician–patient alliance. In the few years since the publication of that article, there has been increased attention in the medical literature to this problem. The publications on this topic largely fall into two groups: articles on medication noncompliance, often dealing with related issues such as causes of noncompliance, and articles on disease-specific noncompliance, such as noncompliance in chronic pulmonary obstructive disease or asthma2 or noncompliance in patients with diabetes.3 What is apparent in most of these articles is that NCB is much more widespread than it was thought to be and that it has a serious, deleterious effect on health outcomes and medical costs.

Osterberg and Blaschke4 wrote that “even clinical trials report average adherence rates of only 43 to 78 percent among patients receiving medication for chronic conditions” and that of “all medication-related hospital admissions in the United States, 33 to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion per year.” Cramer et al, reporting5 on a meta-analysis of compliance in diabetes, hypertension, and dyslipidemia, noted that “only 59% of patients [take] medication for more than 80% of the [prescribed doses] in a year.” Even in the case of serious and symptomatic disorders, such as acute myocardial infarction, a study6 has shown that as many as one in eight patients discontinue all three medications of the commonly prescribed combination of ß-blocker plus aspirin plus statin within one month of hospital discharge. These patients have an 80% higher chance of dying within the first year after discharge compared with patients taking all three classes of medication.

It is apparent from these studies that NCB is epidemic and not just an aberration. NCB is likely one of the most common causes of treatment failure for chronic conditions, though this is not widely or consistently recognized.