This issue highlights aspects of a number of “biologic” treatments, including botulinum toxin, tumor necrosis factor (TNF) inhibitors, and ustekinumab. These treatments have changed the landscape of dermatologic treatment, but at the same time, they raise the bar on patients' concerns for safety. Drugs in general sound scary to many patients; “new” treatments, new classes of treatments, may scare patients even more, even when the new treatment is safer than previously available medications.
Much of patients' willingness to use medication is dependent on the trust they have in their physicians. Patients tend not to trust medication manufacturers. Drug companies just do not have a great reputation with the public. Patients will trust doctors who the patient feels are caring; projecting the image of caring (in addition to being caring) is critical to getting patients to use their treatments well and to getting optimal treatment outcomes.
How we present medications has also an impact. Rather than tell a patient, “This medication is a systemic poison,” it may be more fruitful to tell the patient, “This is an all-natural product designed to complement your body's natural healing mechanisms.” Both of these statements – full of rather ambiguous words – are arguably true about nearly every medicine we prescribe, but one engenders a far greater sense of comfort than the other.
Known risks can be very scary for patients, especially considering how risk-averse people are. When we tell patients there is a risk of lymphoma or some other very bad outcome, it is difficult for the patient to put the quantitative risk into perspective. Patients may think it is a 50:50 chance. One article in this issue describes giving patients risk information by graphically comparing the level of risk to other risks in people's lives. Knowing the risk of drug treatment is less than the risk of an automobile accident may be reassuring.
Fears of side effects are a powerful disincentive for patients to use their treatments. If we are to take responsibility for patients' treatment outcomes – which I think we should – it behooves us to address patients' fears with practical approaches that encourage better adherence to treatment.