The contributors to this section consider historical foundations and evolution of the concept of treatment adherence and trends in research and practice. Trostle (chap. 2) begins with an interesting historical and anthropological account of compliance and adherence as definitions and research topics. He points out that the terms compliance and adherence reflect ideologies that support the authority of medical professionals, overemphasize the patient's response to the treatment regimen, and underemphasize the multiple competing tasks faced by individuals with chronic illness. Trostle registers concern that clinical care and research guided by concepts of adherence/compliance have generally neglected the broader context of illness management. Potentially important elements of this context includes patients' assumptions, motivations, and understandings of chronic illness and its treatment, and the changing context of prescribing and consuming medication, which is heavily influenced by managed care and pharmaceutical companies that advertise medications directly to consumers. Trostle considers reasons that the concepts of compliance/adherence continue to be so compelling to physicians and clinical researchers and articulates conceptual flaws of these concepts.
At the core of Trostle's analysis is that definitions of words such as adherence and compliance reflect ideologies--that is, systems of shared belief that legitimize behavioral norms and values. Such ideologies may serve to maintain the perception that health professionals are in control of health and health-related behavior. Along with his strong critique of the