New research suggests that the NHS spends close to £200 million a year on cholesterol-lowering statins for people who then fail to take them properly. This must be galling for a Chancellor faced with the herculean task of reducing the national debt.

And this study, presented at the British Pharmaceutical Conference in Manchester last week, represents the tip of a much larger iceberg. Other research suggests that though people on statins may be better at taking their medication than some others, overall it is thought that four out of ten don’t take their medicines regularly enough to derive any benefit. If you extrapolate that to the total annual NHS drugs bill of around £10 billion, it equates to £4 billion wastage a year — enough for 120,000 extra nurses.

But it is not just the cost of the medicines. The patient gets little or no therapeutic value so suffers unnecessarily, ends up being admitted to hospital or even dies prematurely. Scarce NHS resources, ranging from doctor’s appointments to blood tests and scans, are wasted and there is an indirect cost to society in lost production due to absence from work. And finally, with infectious diseases such as tuberculosis, there can be a very real risk to friends, relatives and neighbours.

Broadly speaking, there are two ways that people do not take their medicine properly – unintentional and intentional. Unintentional can include forgetfulness (particularly in the elderly), over-complicated drug regimes and not understanding the doctor’s instructions but being too embarrassed to admit it. Common intentional reasons include concerns about side-effects and drug safety, misunderstanding the long-term implications of their illness and the importance of treatment, or simply not agreeing with the doctor’s opinion.

And it is a problem right across the therapeutic spectrum. Although poor compliance with medical advice on how to take medication is generally more of a problem with preventative treatments for conditions such as raised cholesterol levels and high blood pressure, it is still a major problem even in those with established disease. Nine deaths out of ten due to organ transplant rejection are caused by poor compliance with immunosuppressant regimes.

Whatever the cause, it’s a problem that needs to be addressed urgently from both sides of the consulting room desk. The medical profession needs to be aware of the public’s reticence. It needs to spend more time explaining why patients need treatment, and how it should be taken. And patients need to be more candid if they have reservations or don’t understand why they need a drug.

Asthma is a case in point. The Medicines Partnership — part of an initiative to improve the use of medicines by the NHS — estimates that half the 5 million people on treatment for asthma across the UK are not using their inhalers properly, and the younger the patient, the bigger the problem. While seven older patients out of ten take their medication as prescribed, less than half those under 16 do — and the more severe the child’s asthma, the poorer their compliance. The classic mistake is to underuse prevent- ative medication (such as inhaled steroids typically taken twice daily) and to overuse reliever inhalers (eg, salbutamol which provides rapid but short-term relief). This use of reliever medication leads to poor control with predictable consequences — troublesome symptoms, time off work, treatment in hospital and deaths.

Proper use of inhalers would not only make people with asthma feel better — symptoms interfere with the daily activities of around half of sufferers — it could also dramatically reduce deaths. Around 1,300 people die from asthma in England and Wales every year and the Medicines Partnership estimates that more than 600 could be prevented if everyone used their inhalers correctly.

But it’s not all the patients’ fault and doctors must shoulder some of the blame. The report identified misunderstandings about the condition and its treatment as one of the most important reasons why patients don’t take their inhalers as prescribed, and it is the doctor’s job to ensure that patients understand.

Patients must do their bit too. Some years ago a recently widowed woman came in to my surgery with two bags stuffed full of unused preventative asthma inhalers that had been prescribed to her husband. He had never understood what they were for but didn’t want to upset me, so stashed them in the attic.

So please own up if you are not taking your medicines properly. Misleading your doctor won’t help you, and just wastes valuable NHS resources.