© 2004 by Society for the Social History of Medicine
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2002 Roy Porter Memorial Prize Essay Therapeutic Infidelities: ‘Noncompliance’ Enters the Medical Literature, 1955–1975
1 Doctoral Candidate, MD/Ph.D. Programme, History of Science Department, Harvard University, Science Centre 317, Cambridge, MA 02138, USA. E-mail: greene{at}fas.harvard.edu
Although a concern with patients who do not follow their prescribed therapies can be found in Hippocratic writings, the description of a patient as specifically ‘non-compliant’ did not rise to prominence in the Anglo-American medical literature until the late twentieth century. This article surveys the nascent noncompliance literature in the post-Second World War era to ask how and why the noncompliant patient became a resonant category and research priority at that time. In varying accounts, attention to ‘noncompliance’ developed as a logical result of the mid-century epidemiological transition, the growth of better screening techniques, and an effective pharmacopoeia for chronic disease, as an ideology of social control, or as a means for younger, sociologically-trained physicians to critique older forms of medical authority. In fashioning ‘noncompliance’ as a subject in the 1960s and 1970s, many researchers believed they had discovered an objective and value-neutral method of inquiry that would address questions central to enhancing the efficiency of clinical practice. Although the category has only grown in importance in recent decades as a central component of HIV/AIDS and tuberculosis control efforts, a residue of stigma and culpability still adheres to the term in common usage.
Keywords: noncompliance, non-adherence, doctor–patient relationship, therapeutics, treatment failure, pharmaceuticals, chronic disease, epidemiology, twentieth century