These Pills Work Best When Taken Internally

A patient was referred to me for treatment of refractory hypertension. Her medication list was quite long, and I reviewed the medications with her, I asked "How many times a day do you take this one?" She took the bottle, and looked at it for a moment, and replied "I don't take this one at all. I just keep it on the nightstand." When I asked her why she wasn't taking it, she told me "Doctor, I just don't like to take medicine." I spent some time explaining to her the need to control her blood pressure to prevent a heart attack or stroke or kidney disease down the road, and that the pills were not likely to work by sitting on the nightstand. They needed to be taken internally.

The benefits of treating high blood pressure, high cholesterol, and diabetes are well documented. These treatments are cost effective, because of the reductions in cardiovascular disease they yield over time. The problem, though, is that patient acceptance and compliance are variable.

A new study released by the New England Healthcare Institute last week estimates that one-third to one-half of patients in the US do not take their medications, as prescribed. It estimates the increased cost of healthcare for these patients, based on increased needs for hospitalization, treatment of uncontrolled conditions, and early deaths at $290 billion annually. It also shows that patients with chronic diseases are less likely to take their medication correctly than are patients with an acute problem.

After all, a pain medicine can make you feel better quickly. An antibiotic can clear up an infection in a few days. While there may be some early reduction in blood pressure or cholesterol when treatment is started, blood pressore and cholesterol medications do not make you feel better on a daily basis.

It takes education and a receptive patient who is willing to endure the cost and inconvenience of taking medication daily to achieve the future benefit of preventing health problems later in life.

Prescribing medication is easy. Assuring that the patient will be a compliant partner in the treatment plan is not. Clearly, though, the medications work better when taken internally.