On white-coat effects and the electronic monitoring of compliance

Compliance was "discovered" and christened about 20 years ago.¹Because thoughtful physicians have always known that patients may not take medication in the recommended schedule, the "discovery" of noncompliance was not new. What made it important was its formal identification as an important constituent of quantified analyses of therapy. Inadequate compliance could lead to gross distortions in therapeutic evaluation if an efficacious medication was falsely regarded as useless in a patient who had failed to take it. See also p 1509. The name produced by the christening process did not receive universal acclaim. The wordcompliancemay imply obeisance or servility that is an unwelcome concept in an era of heightened concern for increased patient autonomy and reduced physician paternalism. No other single word, however, has been available as a preferred substitute forcompliance. Adherence seems too sticky; fidelityhas too many other connotations; andmaintenancesuggests a repair