The importance of adherence, a term used to describe “the extent to which an individual’s behavior coincides with healthrelated instructions or recommendations given by a health-care provider in the context of a specific disease or disorder” [1], cannot be overstated in the context of both behavioral and biopharmaceutical interventions for chronic diseases such as hypertension and diabetes, which have reached epidemic proportions worldwide [2, 3]. It is therefore pleasing to see the paper by Sutton et al., printed in this issue, which reports the results of a randomized controlled trial focusing on electronic monitoring and measurement reactivity [4]. In multiple facets of science, the act of measurement itself is capable of altering the characteristic(s) of the parameter that we wish to measure. In the context of adherence assessment, it is therefore important to know whether the measurement tool itself elicits a change in adherence behavior, and if so of what magnitude. The rigorous evaluation and report by Sutton et al. suggests that electronic monitoring of adherence to a biopharmaceutical regimen for type 2 diabetes may itself lead to a small, statistically nonsignificant change in adherence. This is an important result, but, as the authors observe, one that should be weighed in the overall context of the critical importance of adherence assessment and the “gold standard” status afforded to electronic monitoring. Information is power, and this study has added useful information to contemporary and subsequent discussions of a powerful measurement methodology. The discipline of behavioral medicine has provided evidence that “behavioral interventions aimed at modifying lifestyle or psychosocial variables can help prevent morbidity and/or mortality in high-risk populations” [5]: this includes observations that lifestyle interventions targeting increased physical activity and weight loss can reduce the incidence of diabetes in prediabetic individuals [6, 7]. However, when the potential therapeutic benefits of behavioral interventions are not fully realized for an individual, biopharmaceutical interventions are the next step. As the European Medicines Agency has observed, “Glucose control in type 2 diabetes deteriorates progressively over time, and, after failure of diet and exercise alone, needs on average a new [biopharmaceutical] interventionwith glucose-lowering agents every 3–4 years in order to obtain/retain good control” [8]. For such pharmacotherapy to yield therapeutic benefit, individuals must be appropriately adherent. Medication adherence is also of critical importance for another chronic disease for which the first-line interventions are behavioral, i.e., hypertension. When discussing the results presented by Lim et al. [2], Dolan and O’Brien observed that “ischaemic heart disease, ischaemic, nonischaemic, and haemorrhagic stroke, hypertensive disease, atrial fibrillation and flutter, peripheral vascular disease, aortic aneurysm, and chronic renal disease (to which we must now add cognitive impairment and dementia) are all attributed to hypertension” [9]. These authors also noted the paradox of continued rampant hypertension despite our possessing many pharmacological agents that, if used appropriately, provide therapeutic benefit. Lack of patient adherence to appropriately prescribed regimens is one major problem in this field [10]. Sutton et al. [4] acknowledge that further investigations are needed in this field: I hope that behavioral scientists will J. R. Turner (*) Clinical Communications, Quintiles, Durham, NC, USA e-mail: rick.turner@quintiles.com