Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [5]
“Are you okay?” Susan asked.
“Not really,” the woman said. “My muscles ache terribly. And I don’t know how long the pain will last.”
She explained that she’d begun taking a statin a few months earlier. At first she felt fine, but over the past week she’d developed pain all over her body. Although her doctor had told her to stop taking the pill immediately, her muscles still hurt so much that she could hardly find a comfortable position, even in bed. And as Susan had seen, she couldn’t get up from a chair or walk without help.
As Susan walked home from church on that bright winter afternoon, she thought about her father, Michael Powell. He was an independent thinker who questioned everything and never took anything at face value. Michael Powell also had high cholesterol, discovered when he was about the same age as Susan was now, not long after cholesterol was recognized as a risk factor for heart disease. “People take too many pills,” he often told his children, and he never took any medication for his elevated cholesterol. He lived a long, full, and active life.
Susan returned to her doctor a month later.
“So, how are you doing on the medication?” the physician asked.
“I decided not to take it.”
The doctor’s face tightened in surprise and concern. “It’s very important to take this medication,” she said. “You really need it.”
Susan Powell is hardly alone in her decision. Studies show that up to half of the people who are prescribed a statin for high cholesterol either never take it or stop taking it within a few months. Even in research studies where participants are carefully monitored with frequent visits and phone calls to ensure that they’re taking their medication, people discontinue statins 25 to 35 percent of the time. This decision not to follow a specified treatment regimen, which some experts term “non-compliance” or “non-adherence,” extends well beyond statins. Numerous surveys show that between 20 and 50 percent of patients with hypertension, diabetes, osteoporosis, or asthma don’t follow the recommended regimen. A study of treatments for a variety of common illnesses conducted in 2006 for the National Community Pharmacists Association found that 31 percent of people never filled their prescription and another 29 percent stopped taking the medication before the supply ran out.
When we spoke to Susan five years later, we tried to delve deeply into why she chose not to fill the prescription. She certainly had seen the consequences of high cholesterol when caring for patients who had suffered a heart attack or stroke.
“I’m very much like my father,” she said. “Everything he did, he did with gusto, always active. That’s the kind of life I want to have. My father lived with a cholesterol level just like mine, and never took a pill.” She paused, then added, “I believe that for some people a level of 240 is really dangerous. But for other people, like my family, that kind of number is not really abnormal, not dangerous.”
Stories about people and the choices they make powerfully shape how all of us understand ourselves and the world we live in. This molding of our minds begins in childhood, when we listen to tales told by our parents and read storybooks at bedtime. As we grow up, we broaden our exposure to the experiences of colleagues, friends, and acquaintances. We also encounter a vast array of narratives from books, magazines, movies, TV, and the Internet. When we hear these tales, we try to locate ourselves in them. We imagine how we would experience life, what decisions we would make, in similar circumstances. Cognitive psychologists call the powerful influence of individual stories on our thinking an “availability bias.” Certain tales and testimonials,