Introduction
Patient compliance has been used since 1975 as a MeSH search term, defined as "voluntary cooperation of the patient in following a prescribed regimen" (U.S. Department of Health and Human Services and National Library of Medicine, 1998, p. 885). To get a rough sense of the growing popularity of this concept, the set of 16,114 English-language MedLine records categorized under the MeSH term patient compliance between 1976 and mid-1999 was searched to find titles using the word adherence. Expressed as a percentage of total articles in English categorized under the MeSH heading patient compliance increased from 1.6% of the total in the 1976-1980 period to 2.2% of the total in 1981-1985, 2.2% again between 1986 and 1990, 3.5% between 1991 and 1995 and 5.0% between 1996 and 1999.
The concern for compliance is a cultural phenomenon intimately connected with the self-image of physicians and their organized (and often successful) attempts to define the limits of their own discipline. Yet the present respect and authority accorded physicians in the United States is of recent origin and has been diminishing over the past two decades. Physicians have exercised their control over medical technology and pharmaceuticals only in the past century. Now for-profit hospitals, HMOs, and other types of medical groups are employing physicians as salaried workers; their growth is reducing physicians' monopolistic power. Physician control over the technology of medical care is also decreasing because pharmaceutical companies are again advertising directly to consumers, the Food and Drug Administration (FDA) is moving drugs from prescription to nonprescription categories, and HMOs are developing restricted formularies.
Some would argue that the preoccupation with compliance over the past two decades is partly a consequence of this declining authority of the medical profession. Since the 1980s, pharmaceutical companies have increasingly recognized patient power outside the examining room, most directly in the increasing trend of direct to consumer advertising...........
