The People's Perspective on Medicine

Show 1136: Do You Really Need That Pill?

Americans are taking more medicines than ever, but that isn't always an advantage. Find out when you should ask if you really need that pill.
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Do You Really Need That Pill?

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Americans take a lot of medications. We appear to have adopted the advertising-based attitude that there is a pill for every ill. But while some medicines may be helpful or even essential in some circumstances, a lot of people end up taking too many of them. Sometimes doctors end up prescribing one drug to counteract the side effect of another. This prescribing cascade can really add up, especially for older adults who may be more susceptible to side effects. What can be done? Have you asked if you really need that pill?

Changing Guidelines:

A recent change in the guidelines for treating high blood pressure could result in millions more individuals taking at least one medicine (and possibly several) to control hypertension. Before jumping on board this train, doctors and patients alike need to know about the pros and cons of such treatment. What is the evidence supporting it? What are the possible harms? Can a problem such as elevated blood pressure be addressed with lifestyle measures? How can doctors help patients try that approach? Above all, find out if you really need that pill.

Drug Interactions:

Computer programs can warn prescribers and pharmacists about potential interactions. Too often, though, the warnings get overridden due to alert fatigue. Do patients need to research possible interactions among their various drugs themselves? How would they proceed?

Getting Off Your Medication:

One problem that should be addressed when you start taking a new medicine is how to stop it. Some prescription pills (even some OTC drugs) can be very hard to discontinue. How can doctors learn more about helping patients quit taking certain medicines?

Making Sense of Side Effects:

Most of the prescription drug ads you see on TV have a long list of side effects. Try listening with your eyes closed so you hear what could happen instead of watching people have a lovely time. Then ask your doctor and your pharmacist about these possible reactions. If they reassure you that they are rare, as they may be, ask exactly what that means: 3 in 100 or 3 in 10,000? That way you will be better informed to decide whether or not you really need that pill.

This Week’s Guest:

Jennifer Jacobs, MD, MPH, is a family physician specializing in integrative medicine. Dr. Jacobs is a clinical assistant professor in epidemiology at the University of Washington School of Public Health and Community Medicine.

Dr. Jacobs is the author of Do You Really Need That Pill? How to Avoid Side Effects, Interactions, and Other Dangers of Over-medication. 

Her website is http://jenniferjacobsmd.com/

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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My son has been on antiepileptic drugs for 7 yrs even tho there is no clinical evidence of epilepsy. Every time I try to make sense of the pills he is prescribed the dr just acts like I’m nuts. I think he is the one that’s very nuts because it’s wrong!

The patient is not always the one who demands the doctor prescribe a medication the patient saw in a TV commercial. More often than not, the patient comes into the office describing some ailment and a few seconds later the doctor prescribes a pill. As for doctors spending time talking with patient about nutrition and exercise, most doctors are clueless with regards to these topics. Medical schools, even today, spend minimal time covering the role of nutrition and exercise in maintaining good health and preventing illness.

This should be heard by everyone, it’s enough to make a grown person cry, to think where our medical profession has gone. Drug companies are out of control!!!

Thank you a thousand times over for the work you do. I have learned a great deal from you both and your readers. My first husband died of leukemia twelve years ago. I honestly believe he weakened his health from excessive antibiotics and other needless pills and prescriptions. He was a hypochondriac and always at one kind of doctor’s or another. I have no diagnoses and take no meds. Hope to keep it that way! Of course, even trim, non-smoking, non-drinking, exercising people can get sick. But the odds are way, way in their favor not to do so.

Thank you for including the title of the book and website. I plan to use/consult both. This doctor expresses many of my own beliefs. I have turned down multiple medications, including turning down steroids 7 times within 5 years, prescribed for 5 different problems. I dealt with every one of the problems without medications and did well. I also skipped antibiotics prescribed when what I had was viral and cough syrup with codeine prescribed for my cough so I could sleep when I was sleeping just fine! Most doctors whom I have run into are far too ready to prescribe without considering alternatives that might work. (I am also succeeding with Listerine and vinegar for nail fungus; didn’t consult a doctor and risk being prescribed Jublia!) Thanks for your column; it is great! (I am a reader, not a listener, so the column and books and websites mentioned therein are my sources; I skip the podcasts.)

About 15 years ago my doctor prescribed a statin drug because of my numbers. Like a good girl, I took the pill. Then I found that my muscles ached so that I was reluctant to exercise and I was losing words and feeling brain fog. I told my doctor that I would no longer take the pills. At every checkup she admonished me to take them. I simply refused. I am now 88, take no pills, rely on good diet and exercise, and my doctor is now holding classes on how to be healthy without medicine.

Another case: my friend in Florida has been on osteoporosis medication for decades. She has broken bones many times, including both her femur and pelvis in one month, has had hip replacements and can now barely walk with a walker. I believe all that medication made her bones so brittle that they break on their own.

Case 3: Another friend faced a quadruple bypass more than 30 years ago. After asking his doctor if he could avoid the surgery, he went on the Dean Ornish diet. He avoided the surgery, will (hopefully) celebrate his 102nd birthday in two months, and is still driving. He is still a vegetarian.

Toss the pills, eat good food, move your body.

Thank you, Mary for your thoughtful post. My primary care provider told me she would no longer be my doctor if I didn’t start seeing a cardiologist. She is the first doctor I’ve had in years who was willing to touch me and didn’t stare at the computer the whole time I was there, so I agreed to do so. The cardiologist has me on a calcium channel blocker, a beta blocker, 2 baby aspirin a day and a “water pill”. I have high blood pressure and AFib attacks about once a year. Now in my 80s I have a major distrust of most things pharmaceutical.

My husband suffers now from being on statins 17 plus years. He has peripheral neuropathy in both leg, starting in hands and arms. He now gets infusions to try to keep it from getting worse. Statins are at fault but no doctor admits it. There are a few JAMA articles that admit it causes neuropathy.

I caught the end of the show and was very interested to hear about possible links between statins and dementia. This may be the situation with my father who was put on Lipitor after his TIA three years ago. We thought the dementia was due to the TIA but now I am having second thoughts.

On a different topic, is there any chance your website people could add some sharing links to make it easier to share your posts on Facebook and Twitter?

Thank you SO much for this program! My husband is a pill lover and will take anything one of his many doctors give him. He now has developed Parkinson’s and after listening to this program I’m convinced that all his pills have pushed this along. He did listen to half of the program so I’m hoping the doctor has convinced him. I have listened to this program for years but this is the best!

As a primary care physician I do not find it very helpful to promote the idea that most physicians are not thoughtful as we struggle to work with patients to determine how to stay well. Especially in the world of vascular disease life style is primary but how many years should be spent discussing this/coaching the patient/watching the progression of atherosclerosis before using a statin medication?

A question I have is How Can You Be Sure a rise in cholesterol/LDL cholesterol is a strong indicator of atherosclerosis without further tests (if you are able to think about it and actually order more tests). My doctor urged me to go on statins many times and I refused (my cholesterol was borderline). I appreciate her concern. Finally, she sent me for a cardiac score and scan of my carotid arteries. Results: NO PLAQUE whatsoever in my blood vessels (cardiologist was very surprised). Recently, I discovered some liver conditions can cause elevated cholesterol with no corresponding cardiac risk. This was of interest to me, since I am a live liver donor. How do you define the “vascular disease life style”? And, if your patient does not live that way, do you still recommend statins if their blood work is “out of whack”? I do not fault doctors — I get that generally, time with patients is severely limited due to our current state of medical affairs. But, especially in light of recent study results concerning taking statins, I believe two things: you can’t always make an individual diagnoses using only one test (blood work); and statins are not a panacea drug that will help or be appropriate for every individual…..

2 weeks into titration of Loreapam. I got down half a dose last year and it was a horrible time and had to stop. I can not find a doctor that wants to help me get off safely. I determined to be free of this drug so started going down again. My de prescribed this for 10 years for sleeping issues didn’t realize until last year I should of only take. This drug for two weeks. I have left my primary care dr of 25 years after finally realizing she is a major pill pusher. I am praying I can get through it this time.

How long? As long as it took me to find out on line that there is no evidence and almost no testing that statins make any difference on the lifespan of elderly women. Just legcramps.

When I bring up muscle aches and ask my physician if my statin could be causing them she just blows me off. I wonder how prevalent muscle pains from statins are? What about stopping statins for a while and see if the muscle aches go away?

I came upon a link on your site about dry eyes (visionalive.net) This is clearly a sales site. My question is, do you recommend the products advertized on your website?

Gene, the advertising supports the costs of running a web site. We cannot and do not review every ad to make sure we endorse the products. We do try to avoid any pharmaceutical advertising, however.

Where can a consumer find alternatives to prescribed drugs such as lifestyle and nutritional alternatives with comparable effectiveness?

Go to U-Tube and watch/listen to lectures by Dr. T. Colin Campbell, Dr. Caldwell Esselstyn, and Dr. Neal Barnard: When you implement the principles of diet and lifestyle that these doctors recommend, you will be able to stop all of the poison medications, enjoy life and not be a prisoner of the greedy pharmaceutical industry.

Dr. Jacobs’ book offers recommendations.

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