chapter  2
7 Pages

The medical construction of compliance

The failure of patients to take medicines as prescribed by their physician appears to be longstanding. Hippocrates is reported to have cautioned physicians against accepting the accuracy of patients' reported compliance (Trostle 1 988 : 1 300) . There is evidence that professional concern with non-compliance predates the mid-twentieth century development of a truly effective pharmacopoeia . From the mid-nineteenth century, medical concern over control of patient behaviour and medicine taking was bound up with the consolidation of professional authority and the development of commercial interests and predated the discovery of effective treatments (Freidson 1 970; Schwartz, Soumeris & Aj orn 1 989; Trostle 1 998 ) . In the early decades of the twentieth century, the profession successfully appropriated control over access to infant feeding formula and nutritional supplements and the information given to mothers about how to use it. This illustrates the growing concern of doctors to influence the health-related behaviours of the lay population, and acquire control over access to information. It was also an early instance of the development of compliance as a marketing device by the pharmaceutical companies (Trostle 1 998 ) . Lerner ( 1 99 7 ) describes the censorious medical response to TB patients after the First World War who failed to cooperate with what treatment was available, and discharged themselves prematurely from hospital in large numbers . However, the availability from the 1 940s of the sulphonamides and antibiotics, and thereafter an increasingly large range of very effective treatments, substantially boosted medical authority and focused attention on the irrational and vexatious nature of non-compliance among patients . It was apparent early on that even with these new, very effective (and expensive ) treatments patients often failed to complete their prescribed course of treatment. This behaviour was consistent across all social strata. Patients now came to be regarded as 'disobedient' rather than ethnically or socially degraded, as had formerly been the case with non-compliant TB sufferers (Lerner 1 997 ) .