The problem with pills

This issue comes to mind when considering a patient's request for phenteramine (a stimulant weight-loss pill). Wisconsin actually limits prescribing of this type of medication and has very specific requirements that must be met in order for it to be legally prescribed. Pills (or medications) are of wonderful benefit to many, many people with a variety of ailments. However, our country now counts on "pills" to solve every problem of deficient health (even in the absence of true disease).

Why is this? Well, in all fairness, there are a number of medications out there that do what no measure of diet, exercise, or "living well" can do - think of chemotherapy, blood pressure medications, antibiotics, etc. So, pills often do work. Second, drug companies market their product - to doctors and patients alike. While I have ethical concerns about direct to consumer advertising of medications, I also think these ads sometimes backfire. In my experience it makes patients even more aware of and concerned about potential side-effects. Next, we live in an era of instant gratification and pills can provide that, often more easily than lifestyle changes. Why make all those changes to your routine, diet and exercise habits, as well as deal with your stress if you can just take a pill to help you sleep? And finally, it is easy. It takes me about one-quarter the time to write and even explain the use of a medication than it does to talk about "therapeutic lifestyle changes" - eating right, exercising, dealing with stress and emotional drains, getting adequate sleep and rest, stopping smoking, not drinking alcohol to excess.

So, what is the problem with pills or medications? Well, for one they are rarely a "miracle cure". I have only been out of medical school for about 8 years, but even in my short tenure in the medical field, I have seen a number of medications touted as the next greatest thing or truly revolutionary only to be just one more potential treatment with a focused, but limited benefit. So, patients (and doctors) get frustrated that the medication didn't completely solve or cure the disease. Second, they are often costly. Generic medications fall out of favor quickly, and often unfairly. "Updated" medications - ones that are the next generation of a commonly used medication (like the next generation of anti-depressants, pain pills, anti-psychotics, etc) often offer advantages such as less frequent dosing or fewer side effects. However, they may not be more effective than the cheaper, older option. Using older medications may be perceived as being behind the times by physician colleagues, or be seen as not providing the best care by patients. As mentioned above, it is easier for me to prescribe a pill than discuss lifestyle changes. It is also easier for a patient to take a pill than make lifestyle changes. If lifestyle changes have an effect on a disease (and almost all diseases are affected to some extent by diet, exercise, sleep (or lack), smoking, alcohol, or stress) then lifestyle changes should take precedence over a prescription.

This "problem with pills" is not limited to prescriptions either. Herbal supplements and remedies also offer hopes of a miracle cure or 100% effective treatment and do so under a (sometimes false) umbrella of safety.

Diseases have been created once a pill exists to treat it.

As a stock holder of Pfizer, I clearly believe in the strength and benefit of pharmaceuticals. But, I believe more strongly in the benefit and importance of lifestyle changes first. This must be preached by doctors, but also sought by patients. Exercise is cheap!