“I’m not really a pill person.”

“I was never one for all those pills.”

“I don’t really like taking those pills.”

“I’m not really into taking pills.”

As a doctor, I hear some version of this phrase every day. It’s almost accusatory, like “Hey, Doc — don’t even think about pushing all those pills on me!”

Luckily, since I am a gastroenterologist, I don’t dispense nearly as many medications as doctors in some other fields do; ninety-percent of the medications I write for are antacids, laxatives, antibiotics, diuretics and a few meds for colitis. However, I recently had the experience of starting a patient on a blood pressure medication to help lower his absolutely out-of-control blood pressure. I normally refer patients with such issues back to their internists to treat their non-GI issues, but this patient was in between internists, having just moved to the area. So I reached back in my mind and tried to remember some internal medicine from residency training, and gave him a prescription for a diuretic-antihypertensive combo pill. “Start this medicine today,” I said, “and you need a new internist now that you live on Long Island, so make an appointment ASAP with Dr. Schwartz. Here is his number.”

A few weeks later, I see the patient for follow-up regarding his gastro issues, and his blood pressure is still 220/110. Maybe my memory from residency was a little fuzzy when it came to treating hypertension? After all, I was very sleep-deprived back then. So I told the patient that the meds that we started recently were not cutting it, we would have to up the dose now. And he really needs to see that internist before he ends up in the hospital with a heart attack or stroke! It was then when he told me he wasn’t really taking the blood pressure medication that I went out of my way to prescribe him. I asked him why not, was there a side-effect, could he not afford them, what happened? And that’s when he uttered the dreaded phrase: “Eh, I’m not really one for all those pills,” while making a dismissive rapid back-and-forth rotary movement with his open right hand that suggested that all pills, in general, were nonsense.

When someone has a real disease and tells me they’re not a pill person, I can’t help but wonder what exactly does that mean? Someone with dangerously high blood pressure, who is not a pill person will soon become a stroke person. Someone with uncontrolled diabetes who is not a pill person will soon become a blind person, or a dialysis person, or both. When you have ulcerative colitis and are not a pill person, you are a bloody diarrhea person. These are usually the alternatives.

Now don’t get me wrong, I am all for “natural” methods of controlling diseases. However, when the natural remedies and diets fail, it’s time for real meds. The very natural alternative to taking pills is uncontrolled disease. Suffering and death are very natural parts of the human experience — let’s avoid those things for a while if we can.

Frederick Gandolfo is a gastroenterologist who blogs at Retroflexions.

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