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Diagnosis: We all fib

Patients are only human, and humans are born to lie -- at least they start doing it by age 3. By age 4 they’re already good enough to fool people.

By the time they’re adults, they’re lying one or two times every day, one well-known study showed. In another, 60% of undergraduate students, when trying to make a good impression, lied at least once, and on average two or three times, during a 10-minute conversation.

And to doctors?

“It’s an important area we don’t really know much about,” says Dr. Robert Klitzman, professor of clinical psychiatry at Columbia University.

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Still, a number of studies have tried to chronicle how much patients lie about doing what the doctor ordered.

In one study, published in the journal Chest in 2000, 40 patients said they had quit smoking. But saliva tests indicated that, in fact, 10 of them -- 25% -- had smoked recently.

Another study, co-authored by Klitzman and published in 2002 in the Journal of Homosexuality, found that gay men and lesbians are nearly three times more likely to have unprotected sex than they are to tell their healthcare providers about it.

It’s well-known that patients don’t always do a perfect job of following -- or “adhering to” -- the treatment plans their doctors lay out for them. A paper published in 2004 in the journal Medical Care analyzed more than 500 studies on that matter and found that, on average, about 75% of patients met the adherence standards researchers had set.

But these figures may overestimate adherence because some patients are probably fudging. “Patients who say they always take their meds may not be,” says Dr. Steven Hahn, professor of clinical medicine at Albert Einstein College and an internist at Jacobi Medical Center in New York City.

“Patients who say they don’t always take them are likely to be missing significant amounts.”

One indication of how much people fib is how things change when they know they’re being watched.

In a 2001 study in the Journal of Hypertension, scientists followed 41 patients who had been unsuccessful in lowering their blood pressure with three prescribed drugs. Patients continued taking the same three drugs during the study, but they now knew they were being monitored electronically: The drugs came in special packages that recorded the date and time whenever they were opened.

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After two months of being monitored, about one-third of the patients had lowered their blood pressure to the normal range. Chances were good, the researchers concluded, that those patients had not been taking the drugs properly before.

A number of other studies have found that patients in clinical trials sometimes “dump” their medication -- i.e., simply dispose of it -- so it will look as if they’ve been using it as prescribed even though they haven’t.

Also, in the above-mentioned 2000 study published in Chest, 236 patients used inhalers to take medication intended to help them breathe. The inhalers were fitted with electronic monitors that could record the date and time whenever patients used them. Not all of the patients knew about the monitoring feature.

During one year of the study, 30 of the 101 patients who did not know they were being monitored -- about 30% -- dumped at least once. (Dumping was defined as activating the inhaler more than 100 times within a three-hour period.)

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Of the 135 patients who did know they were being monitored, only one dumped.

Most of the dumping incidents occurred just before a clinic visit, and researchers concluded that patients dumped in order to give the impression that they had used their inhalers more often than they had.

--

health@latimes.com

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