Faculty Bibliography

Thousands of articles on "noncompliance" have appeared since 1975. Yet the term has been criticized as paternalistic--as wrongly implying that patients should necessarily follow doctors' orders. This paper, which reviews how noncompliance has been constructed historically, argues that the problem with noncompliance is more than just one of terminology. Changing social and cultural factors during the 20th century have influenced the way in which uncooperative patients have been described. For example, resentment of poor immigrants in the early 1900s led doctors to describe tuberculosis patients who did not follow advice as "ignorant" and "vicious." Following World War II, patients who balked at taking new curative antibiotics for tuberculosis were called "recalcitrant." The term "noncompliance," popularized by Sackett and Haynes in the 1970s, reflected their early role in the field of research now termed "evidence-based medicine." While Sackett and Haynes had hoped that the new term would eschew earlier value judgments, noncompliance, through its association with the positivistic ethos of evidence-based medicine, has been conceptualized as a "tragic" problem potentially solvable by clinical research. Hence, noncompliant patients are still seen as deviant. With the growth of managed care in the United States, there is increasing pressure to get patients to follow medical recommendations. History suggests that labels such as "noncompliant" are invariably judgmental. Rather than seeing the provider's role as trying to get noncompliant patients to comply, we should emphasize the importance of negotiation and accommodation within the provider-patient relationship.

David M. Oshinsky reviews the book "Mutual Contempt: Lyndon Johnson, Robert Kennedy, and the Feud That Defined a Decade" by Jeff Shesol

In February 1996, George Shultz went to visit his old boss, Ronald Reagan, at the former president's home in the Bel Air neighborhood of Los Angeles. He drank tea with Reagan and his wife, Nancy, and talked a little politics. In all, he stayed perhaps an hour. Reagan 'absolutely' did not 'show any signs of dementia or Alzheimer's,' said Dr. John Hutton, who cared for him from 1984 until the end of his presidency and remains a close family friend. Extensive mental status tests did not indicate evidence of Alzheimer's until 1993, more than four years after Reagan left office, Hutton said. Dr. Lawrence C. Mohr, one of the White House doctors in Reagan's second term, was seeing him for the first time in six months, and afterward, the doctor and the former president talked. As usual, Reagan asked about Mohr's family. But Reagan 'was distant,' he said, and seemed 'preoccupied, which was unusual, because Ronald Reagan is a person who was engaged when he would talk to you.'

In February 1996, George Shultz, the former US Secretary of State, went to visit his old boss, Ronald Reagan, in Los Angeles. He drank tea with Reagan and his wife, Nancy, and talked a little politics. In all, he stayed perhaps an hour. That night Shultz received a call from Mrs Reagan, who told him: `Something poignant happened today that you would like to know about.' At one point, Reagan had left the room briefly with a nurse. When they came back, Mrs Reagan went on: `He said to the nurse, `Who is that man sitting with Nancy on the couch? I know him. He is a very famous man.' It is almost three years since Reagan disclosed that he had Alzheimer's disease. And if, at 86, the old actor still looks the image of vigorous good health, the truth is that, behind the firm handshake and barely grey hair, he is steadily, surely ebbing away

'It was like ignoring half of it on purpose,' Dr. [Catherine Wilfert] said. Because her name was on the masthead, 'it implied that I agreed with it, when I didn't

Two members of the New England Journal of Medicine's editorial board, both internationally recognized experts on AIDS, are resigning in protest over the content and handling of articles criticizing the ethics of a number of federally funded AIDS studies in developing countries in Africa and elsewhere. The journal's attack on the experiments has led to widespread discussion, including harsh criticism of the journal itself, and focuses attention on the role of the 25-member editorial board, including the two who are resigning, Dr. David Ho, a virologist at the Aaron Diamond AIDS Research Center in Manhattan, N.Y., and Dr. Catherine M. Wilfert, a pediatrician at Duke University in Durham, N.C

Two members of the New England Journal of Medicine's editorial board, both internationally recognized experts on AIDS, are resigning in protest over the content and handling of articles criticizing the ethics of a number of federally funded AIDS studies in developing countries in Africa and elsewhere. In the trials, which involve more than 12,000 pregnant women infected with the AIDS virus in Africa, Thailand and the Dominican Republic, some women receive a drug, AZT, that has worked in studies in the United States, while others receive dummy pills. The journal's attack on the experiments has led to widespread discussion, including harsh criticism of the journal itself, and focuses attention on the role of the 25-member editorial board, including the two who are resigning, Dr. David Ho, a virologist at the Aaron Diamond AIDS Research Center in Manhattan, and Dr. Catherine M. Wilfert, a pediatrician at Duke University in Durham, N.C