Loss or Gain

Enhancing Patients’ Treatment Adherence

The human brain is a truly wonderful organ, capable of amazing feats of muscular control, of perception, and of concrete thinking and imagination.   But when it comes to being rational, we have our limitations.  The limitations to our rationality can be used for or against good adherence to treatment.

One characteristic bias of human thinking is that we much prefer to avoid losses than to obtain similar gains, a phenomenon called loss aversion.  This bias can lead to an irrational inconsistency, as our preferences can change just by a small change in the presentation of two mathematically identical propositions. 

Imagine for a moment we are treating a patient for hypertension or hypercholesterolemia with an effective medicine.  Controlling the disease with this medication can be expected to change the patient’s long-term outcome.  Here are the stats:

There are two mathematically identical, yet quite distinct, ways to present this information to a patient.  First, we could tell the patient, “If you take this drug to improve your condition, you can expect to live two years longer.”  Alternatively, we could tell the patient, “If you don’t take this drug, you can expect to die 2 years early.”

These two propositions are, rationally, the same; they are mathematically identical ways to describe the statistics for this drug.  But people are not fully rational; the human mind perceives the two propositions very differently.  People would like to live two years longer, but they very, very much do not wish to die two years sooner.  Had my gerontologist told me that if I don’t take my simvastatin I would likely die sooner, I would probably be taking my simvastatin much better than I currently do.

Using people’s natural propensity for loss aversion is a straightforward (though as yet not well studied in controlled clinical trials) way to improve the motivation for good, consistent adherence to long-term medication regimens.

Dr. Steven Feldman is a professor of dermatology and public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC, where he studies patients’ adherence to treatment. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (, founder of and author of “Compartments” (