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No Pills, No Problem

I’ve often felt like a proud outlier in the geezer-pharmaceutical matrix, arguing consistently over the years against the use of prescription drugs. Turns out that I’m just another lame conformist, part of a large — and mostly invisible — trend.

Surveys estimate that about three in five Americans are under doctors’ orders to take a prescription drug at any given time, and among the senior set, that number rises to about nine in 10. But as Jane Brody reports last week in the New York Times, as many as half of those patients either never pick up their pills at the pharmacy or never take them when they do.

As you might imagine, doctors are having some difficulty figuring this out. Lisa Rosenbaum, MD, a cardiologist at Brigham and Women’s Hospital in Boston, surveyed 20 of her patients who had suffered heart attacks to understand their attitudes about taking pills. She was surprised by how widely their opinions diverged from hers.

Despite explaining the various salutary benefits of this or that pharmaceutical, Rosenbaum found many of her patients were hesitant to commit to a pill-taking regimen.

Among the more noteworthy arguments:

  • “If they have a lawsuit out there that says a medication causes certain side effects, then I’m not taking that medication.”
  • “Medications remind people that they’re sick. Who wants to be sick?”
  • “The name ‘drug’ says it all. It’s a substance that shouldn’t be in the body on a regular basis.”
  • “They start to take the medication. They start to feel better, so they think they can get off of it. So they take themselves off of it because they don’t want to go to the doctor.”

Beyond cost considerations, others worried about losing control of their health or expressed a willingness to focus on lifestyle changes, such as improving their diet and getting more exercise, which they saw as a substitute for the drugs Rosenbaum wanted them to take. The results, she admits, were eye-opening.

“Although we tend to view nonadherence as patients’ failure to know what’s good for them, learning about people’s feelings about medications has made me recognize that my ideas of good and bad were defined solely in my terms,” she writes in The New England Journal of Medicine. “What I’ve learned is that if I felt what they feel, I’d understand why they don’t.”

The challenge for Rosenbaum and her ilk, of course, is that they don’t really have any other tools to offer their patients.

And to hear University of Michigan kinesiology professor Victor Katch, PhD, tell it, those pill-averse patients may be smarter than their doctors think. Katch points to research showing that the efficacy of these prescription drugs tends to be wildly overstated.

“For an average individual, reduction in heart-attack risk is normally less than 5 percent over five years for most cholesterol-lowering drugs,” he writes. “Results are about the same for blood-pressure drugs and blood-thinning drugs, as well as other drug treatments.”

Lifestyle changes, he argues, are much more effective. “It’s not really a choice between taking a pill versus making lifestyle changes to reduce and eliminate the underlying causes of chronic disease,” he notes. “Treating the root cause of disease, by eating healthy and moving more, can accomplish more than drugs.”

None of this really surprises me. Despite the number of people who look to their doctors for a silver bullet to cure their ills, there’s a bit of the revolutionary in many of us that believes our future is governed more by how we live than by what pills we take. I may not be ahead of that curve, but I’m happy to be rolling in the same direction.

Thoughts to share?

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