Public Health: “Nothing would make more sense than a national strategy for medication adherence”

Cancer , diabetes, high blood pressure, heart and kidney failure: chronic diseases represent the leading cause of death in France. This situation is compounded by a staggering fact: nearly one in two patients does not take the medication prescribed.

Forgetfulness, discouragement, side effects, cost, and the complexity of treatments... The reasons for this disinvestment are multiple, personal, and complex. They preclude any moral judgment. But their consequences are clear. They are, first and foremost, human: worsening of pathologies, avoidable hospitalizations, relapses, and premature deaths.

In the case of cardiovascular disease, the risk of death can increase by 80% in non-compliant patients after a heart attack. These consequences are also economic: chronic diseases are the largest source of healthcare expenditure. Medication non-adherence is estimated to represent hundreds of billions of euros per year worldwide, and up to 10% of hospitalizations.

These consequences are all the more devastating because they constitute the blind spot of public health policies and society, a kind of Fates [in Antiquity, divinities of human destiny] indifferent to the lives of our fellow citizens. Not taking one's medication kills; the community, meanwhile, remains silent.

Take cancer, for example. With the development of oral treatments, such as hormone therapy for breast cancer or home chemotherapy, the issue of adherence has become central. These treatments are often extended over several years, and their effects are not always immediately noticeable. As a result, up to 50% of patients discontinue their hormone therapy before the end of the recommended five years. This non-adherence, of course, increases the risk of relapse and mortality.

How did we get to this point? And, above all, why is this silent scandal not provoking widespread mobilization or a national action plan? It's not just a matter of individual behavior, but of a collective and structural failure: healthcare professionals poorly trained to support therapeutic adherence, a healthcare system in a pitiful state, underutilized digital tools, and an organization centered on prescriptions rather than monitoring.

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