2002 Roy Porter memorial prize essay therapeutic infidelities: 'Noncompliance' enters the medical literature, 1955-1975

Although a concern with patients who do not follow their prescribed therapies can be found in Hippocratic writings, the description of a patient as specifically 'non-compliant' did not rise to prominence in the Anglo-American medical literature until the late twentieth century. This article surveys the nascent noncompliance literature in the post-Second World War era to ask how and why the noncompliant patient became a resonant category and research priority at that time. In varying accounts, attention to 'non-compliance' developed as a logical result of the mid-century epidemiological transition, the growth of better screening techniques, and an effective pharmacopoeia for chronic disease, as an ideology of social control, or as a means for younger, sociologically-trained physicians to critique older forms of medical authority. In fashioning 'noncompliance' as a subject in the 1960s and 1970s, many researchers believed they had discovered an objective and value-neutral method of inquiry that would address questions central to enhancing the efficiency of clinical practice. Although the category has only grown in importance in recent decades as a central component of HIV/AIDS and tuberculosis control efforts, a residue of stigma and culpability still adheres to the term in common usage.