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?

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.

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?

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?

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.

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/

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