Paying Forgetful Patients To Take Their Meds

You'd think that if your life depends on you taking your medicines that it would be incentive enough. But not for some patients, whose conditions are often made worse because they forget to take their meds.

When they get really sick and "boomerang" in and out of the hospital, these forgetful patients actually cost a lot of money. So, government, insurance companies, and doctors created a counterintuitive program to coax patients to take their meds: by paying them!

In a Philadelphia program people prescribed warfarin, an anti-blood-clot medication, can win $10 or $100 each day they take the drug — a kind of lottery using a computerized pillbox to record if they took the medicine and whether they won that day.

Before the program, Chiquita Parker, a 25-year-old single mother with lupus, too ill to continue her job with special needs children, repeatedly made medication mistakes, although she knows she depends on warfarin to prevent clots than can cause strokes, paralysis, or death.

“I would forget to take it,” and feel “like I couldn’t breathe,” she said. Or she would “take two in a day,” and develop bruises from uncontrolled internal bleeding.

But in the six-month lottery program, she pocketed about $300. “You got something for taking it,” Ms. Parker said. Suddenly, she said, “I was taking it regularly, I was doing so good.”

Needless to say, the program is controversial as some view it as rewarding bad behaviors:

Skeptics question if payments can be coercive or harm doctor-patient relationships. “Why should people who don’t want to take medication be paid, when prudent people who take medication are not?” said Dr. George Szmukler, a psychiatry professor at King’s College London.

What do you think? Does the end justify the means? Is it okay to bribe patients to do something they should've been doing in the first place?


This disgusts me. GETTING BETTER is the incentive to take your medicine. If you're not taking medicine because you can't afford it, I support programs/coverage/whatever to help with that. But if you have the pills and you're just too dumb to take them, you deserve what you get, and any extra care required should be entirely at your own expense. How about we start fining these people instead or rewarding them?
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I'm conflicted, because Sara B is right. But from a public policy perspective, it's more cost-effective to pay these forgetful few to take their meds rather than treat them later on in the hospital when they got really sick.
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You have to first understand the mind set of people who do these drug trials in the first place. Sometimes there are groups of people who all know each other and do these drug trials for a living. I should also mention that there are many other 25 year olds as careless as Chiquita Parker, and the only difference is that she has Lupus. Just because they have a disease, doesn't instantly make people more responsible. These companies are doing it not for the individuals, but so they can get consistency in their trails and get their product approved faster.
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This isn't about should, or people's feelings, this is about making something effective. A lot of diseases are hard to understand, even if you have it, and when taking the pill doesn't have an immediate effect, a lot of people have a hard time remembering. The disease itself can contribute to memory lapses. So, if you tie it to a reward, a game, it can really work.

To argue against it is like when you mom got exasperated at you that you always remember your favorite TV show, or to play a game, but can't understand how you forgot to take out the garbage. Well, duh.

Taking a pill isn't fun. Winning a game is. Playing to human nature rather than against it is always going to work better.
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Mmm, I seem to disagree with the prevailing opinion. Busy people forget stuff, even if it's important, and if a tiny monetary reward can help to improve the results of a clinical trial, as well as prevent a life-threatening deterioration in a patient's condition, there doesn't seem to be much of a downside. To say that we can either pay forgetful, bad, evil slackers or give the money to good, honest hardworking people who can't afford their medication seems a false dichotomy, to me. Before automatic bill payment, I forgot to pay my bills on time fairly regularly, not because I don't care whether I have internet, and expect leeway over the poor kids in the inner city who can't afford it, but just because I'm absent-minded.
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Let Darwin run it's course and kick those losers out.

Like todays job market, there are hundreds of people dieing to replace the stupid people, and all of them have mastered the oh-so-hard task of following simple pill taking procedures without being bribed to do so.
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Gualdar, don't use age (or youth in this case) as an excuse for forgetting something that important and lifesaving. There is a "mindset" but it has nothing to do with age. I do think you are right about getting their products approved faster.

On that note, I disagree with rewarding them at the cost of others if they cannot *do* for themselves. I'm with Sara B on this one, though I don't think rewarding people is the answer either.

Crazy idea...maybe we should just do what we're supposed to?
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I understand the principle, but does it have to be so much money? Keeping forgetful people out of the hospital is a thoughtful, preventative measure to reduce overall costs, yadda yadda. I understand.

$300 in 6 months is a lot of money!
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I never said age has anything to do with it, I'm just saying that a 25 year old is a 25 year old. Disease or not, each one has it's own sense of responsibility. Havn't you heard the parrental argument that college students don't get the proper amount of sleep, and constantly skip meals? I am sorry that I didn't get my point across, we can both agree that age is meaningless, but automaticly people throw the assumption that life threatning ailment has to mean that to get on with their life they can't be as careless as anyone else in their age range.
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Why not set up intervention programs such as organising a cheap clock with an alarm system that they keep in a place of prominence, or confirming that a family member will remind them when they are supposed to take their meds?

If they can remember in the event of receiving a monetary reward, they can remember without it. If that's all it takes to help them "remember" then perhaps it's not a memory problem, but more of a motivational one.
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