Following doctors' orders.

It takes more than a spoonful of sugar to get consumers to take all the medicine they are advised to take. Lack of compliance is a widely recognized problem, for which there are many reasons, including safety and side-effect concerns, bothersome packaging, and the failure of providers and directions to convincingly communicate the reasons for compliance. More than one third of the shoppers we recently surveyed on compliance and the reasons for non-compliance cited failure to provide reasons for compliance that were clear or credible as important reasons for not following through.

Increasing compliance probably benefits consumers and certainly benefits producers and retailers. Since compliance benefits consumers by improving outcomes, it's almost tragic when readily addressable barriers like poor communication, low message credibility, and hard-to-use packaging are added to harder-to-fix barriers like price and forgetting.

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Taking all the medicine they are advised to take when they are advised to take it has the best chance of making and keeping shoppers well. Producers and retailers benefit because shoppers who do follow their doctor's instructions purchase, use, and repurchase all the meds the doctor has recommended.

According to the widely used Merck Manual of Medical Information, only about half the people who leave a doctor's office with a prescription take the drug as directed. The Manual says that forgetfulness is the most common reason for non-compliance, that several other factors are at work, and that "compliance decreases when the drug regimen is complex, inconvenient, expensive, of long duration, or unpleasant to administer."

Questions we put to shoppers on The Consumer Network panel generally confirmed what the Merck Manual said, but showed that price has become the most important barrier of all. "Too much bother" and "too inconvenient" are up there with high prices and forgetting, and many respondents blame weak explanations and limited understanding of risks versus benefits and why full compliance might be important. So, clearer explanations and more consumer-friendly packaging might be just the medicine that the compliance doctors should be ordering, especially if the packaging can be designed to enhance memory, as well as reduce bother.

With more and more tablets and capsules being packaged in card form, even a memory aide as simple as numbering or lettering the push-outs would help lots of consumers keep track of whether or not they took their X, Y, or Z tablet today. And with many older consumers still struggling to cut and dig through a foil seal to get to their capsules and tables, it also behooves packagers to make sure that all their consumers understand that tablets and capsules can be pushed right through the foil.

Even though the packaging barriers are category wide, many consumers associate them with specific brands:

* "You can't open the Aleve bottle with one hand."

* "Pepcid AC capsules are too hard to get out."

* "Prilosec is very hard to remove from the 'bubbles.'"

Other complaints are expressed generically:

* "The meds never pop out. You always struggle."

* "Drugs that come sealed are often near impossible to get out unless one uses a scissors."

* "Tablets break when pushing through the card."

* "I struggle to peel foil or to push tablets through it."

Fighting a package when they aren't feeling well makes many people feel worse instead of better. It would be great if drug packagers could challenge themselves to come up with packages that were actually fun or pleasurable to use. If the drugs are supposed to make you feel good, isn't it a shame that the explanations and packages should make you feel bad?