In the article by Cohen1 about adverse drug effects and compliance, the author appears to advocate a "start low, go slow" approach. While this approach has merit, and may minimize adverse effects, it has an important psychological flaw, which may diminish compliance. It is hard enough for patients to begin long-term treatment for a chronic disease. If they start a medication regimen, then undergo dose titrations or medication changes, they may perceive such adjustments as failures, become frustrated, and discontinue use. I agree with the author when he advocates flexible, individualized prescribing.
Reinharth D. Start Low, Go Slow, Is Not Always Best. Arch Intern Med. 2001;161(21):2623. doi: