[Observance in the matter of health]

Despite the common-sense nature of ordinary rules of "good health" and general acceptance of scientific knowledge, non-compliance to medical prescriptions is frequent. In a survey conducted in 1994, the French Committee on Education and Health observed a 59.5% rate of self-prescription. In addition, 57.9% of all physician's prescriptions are modified by the patient. Most patients do not really question the competence of the prescriber nor the pertinence of the prescribed treatment: their non-compliance is simply an expression of their desire to "adapt" the prescription to their own personal needs. This classical problem of non-compliance to medical prescriptions takes on a much more dramatic tone in case of HIV infection. For the individual patient, the risk concerns not only his own health status, but also his conception of personal liberty and self-identify. For the general public and health authorities, the risk concerns disease spread, health care costs, viral mutations, resistance to treatment and production of scientific knowledge. In their article in this issue of La Presse Médicale, N. Munzenberger et al. address this problem in an analysis of patient compliance during an HIV treatment trial. They observed that clinical research in HIV is highly influenced by social interrelationships due to the different or contradictory personal objectives of the participants (prescribers and patients). Thus it is essential for those who design prospective protocols to take into account social relationships and manage clinical trials within the real social environment. Finally, the results reported underline the importance of reconsidering the myth of a "double-blind" protection against bias and the true meaning of "informed consent".