What the quiet stop costs

Let me put the costs in one place, since they're spread through the book.

There's the outcome cost, which is the one the studies measure. About a quarter's difference in outcomes between high and low adherence across conditions, a fifth fewer cardiovascular events among people who take their blood pressure tablets well, a doubling of asthma admissions for each quarter of the year spent without the preventer. With the healthy adherer caution from chapter 13 applied, these are still the difference between a treatment that's happening and one that isn't.

There's the cost to the next appointment, which chapter 19 takes on its own, and which I think is the least noticed.

There's the cost of the medicine itself, dispensed and not taken, which is money the health service spent on you and which you'd never have burned in cash. I'm not going to put a figure on it, because the figures I've seen are estimates and the point doesn't need one.

There's the withdrawal cost, for the medicines that have one, and the rebound cost for the ones where on-and-off is worse than either.

And there's the cost you'd notice first if you looked, which is the low hum of a thing undone. The packet in the drawer isn't neutral. It's a small daily reminder that you're not doing something you agreed to do, and a reason to put off the check-up, and a subject you've learned to steer around at the surgery. Book 20 in this series, Get it looked at, is about the appointment people avoid. This one is about the tablet, and the two habits feed each other, because the packet is the reason for the avoidance and the avoidance is what keeps the packet in the drawer.

Set against all of that is what the habit gives you. A morning with one fewer thing in it, and the feeling that you're not the sort of person who needs tablets. Those are real. They're just small, and they're the same size every day, while the costs compound.