According to the World Health Organization, adherence refers to “the extent to which patient behavior corresponds to the recommendations of a Health Professional.” When patients fail to take their medicine as prescribed, the financial impact on the pharmaceutical industry is substantial. Even more distressing is the damage that is done to a patient’s health and well being.

IMS statistics indicate that for every 100 prescriptions, only 50-70% actually make it to the pharmacy to begin with. From there, adherence may be lost at any point, from picking up the first prescription to picking up refills. Only an estimated 15-20% of patients take their medicines correctly, and for as long as they should.

Drug safety concerns are among the many reasons why patients neglect to fill prescriptions or continue taking their medications as prescribed. I know this from personal experience. Recently, my physician recommended that I take Crestor for my high cholesterol. I have heard some troubling things about Crestor’s side effects from people I consider professionals and who should know about these things. Consequently, when I was first prescribed Crestor I did not fill the prescription.

How might I have acted if Crestor marketers focused squarely on the safety concerns of Crestor rather than touting the benefits to better compete with Vytorin (or rather to take advantage of Vytorin’s recent bad publicity)?

An example I like to point to is the ongoing 150-second Celebrex TV ad — and the 2-page print ad (see figure below) — that proclaims “Understand the risks. See the Benefits.” This ad is an example of what has been called a “risk-first” DTC advertising.

Although the Celebrex ad has been criticized for mentioning “death” several times, an article in Pharmaceutical Executive Magazine suggested that this “risk-first DTC” appears to be a new tactic—”to persuade the public about a drug’s usefulness … acknowledging the negative allows the product to gain credibility, mitigates resistance and counterarguing, and permits information that would normally ‘hit a brick wall’ to be viewed in a credible context.”

The idea that being up front about communicating risk to consumers can actually increase credibility in a troubled brand is fascinating. Even more fascinating is the suggestion that better communication of drug risks can achieve greater adherence.

I first heard this idea expressed by Hugo Stephenson, President, iGUARD.org (listen to a Pharma Marketing Talk audio interview with Stephenson) during a panel discussion I hosted last month at the 2nd Annual Pharmaceutical Sales & Marketing Executive Congress, held in Rockville, MD.

“One of the things we are exploring is whether or not better communication about risk can improve compliance,” said Stephenson. “Communicating risk should not be just about avoiding liability, but it could actually give patients a better experience with the product and result in better compliance. For example, if you know certain patients are more at risk to get nausea when taking a drug, you can communicate that risk along with tips on how to avoid the problem. This can reduce side effect dropouts. This can be supplemented by the sharing of patient information, which can help other patients put their risk in perspective.” (See “DTC Risk Communication” in the April 2008 issue of Pharma Marketing News.)

Pfizer began airing it’s “risk-first” Celebrex ads over a year ago and continues to do so today. That must mean that the ads are effective, considering the price of running them on TV. And they may be effective because putting risk first AND in perspective not only helps patients “understand the risks” but also see the benefits of adherence.

As for me, without any upfront discussion about the risks of Crestor from AstraZeneca to comfort me, I am sticking with Pravachol — a tried and true brand I have been taking for years! [Actually, I hope to switch to the generic pravastatin and save some money as well!]