They Won't Take It

The medics at the huge San Diego Naval Training Center were baffled. They had beaten off one epidemic of meningitis among 12,000 seamen recruits, and they were confident that they were doing just what was needed to guard against another attack. They issued mountains of sulfadiazine tablets, and ordered everybody on the base to take two a day. The dosage was supposed to clean out transient meningococci, the microbes that cause this form of inflammation of the brain covering. But for five weeks, sporadic new cases of meningitis kept cropping up. The Navy flew in Dr. Harry A. Feldman, the nation's top authority on the meningococcus, and the specialist from Syracuse, N.Y., ran blood tests on a sample of 20 recruits. He found that only eight of the boots had faithfully taken their tablets. The Navy was up against a perennial problem: too many people would rather take chances than take medicine.

"Those Pills." During World War II, "Atabrine discipline" was difficult to enforce because the antimalaria drug made many a serviceman's skin turn yellow. Today's malaria preventives have no such drawback. But medical officers in all the armed forces still have to fight against ignorance and superstition. It takes only one oddball muttering "Those pills will make you sterile, buddy," and rumor buzzes around the base. Great quantities of medicine get flushed down the toilets. Penicillin was whispered to impair potency. Recruits who were supposed to take it daily as a preventive against rheumatic fever often spat out the tablets after they had passed the issue line.

Resistance to taking medicine is also widespread among civilians of all ages. And it has a variety of causes. At Ohio's Longview State Hospital, Dr. Douglas Goldman has an impressive collection of jars in which former patients stored pills that they were supposed to swallow.

Act of Rebellion. Pill hoarders are not necessarily mental patients or even borderline cases. "The real point," says Psychiatrist Goldman, "is not the hoarding but the refusal to take the pills. Some patients stop taking medicine as soon as they feel better. Others refuse it as an act of rebellion against the authority of doctors, nurses or family. Still others are afraid of being tagged as sickly or weaklings. And on the borderline are the people who are afraid of being poisoned."

Where men are massed together in the armed forces, military discipline makes it easier to get medicine into them. Instead of passing out penicillin tablets, service medics now usually give a long-acting form of the drug by injection. With medicines that must be taken by mouth, like sulfadiazine, the men swallow their pills while still in line, under the relentless eye of a medical officer. Similar precautions in hospitals will outwit any but the most determined evader. But in civilian practice, doctors can do little more than add information and persuasion to their prescriptions.

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