Few doubt that Americans care about improving their health. You might even say some of us are obsessed with it: Our smoking rate is down, sales of nutritional supplements are up, restaurants with low-calorie fare are thriving and throngs of walkers and runners crowd local 5K races every weekend. But there's one area where too many of us still stumble over good intentions — following our prescriptions.
The American Heart Association reports that 12 percent of American adults fail to fill some prescriptions; 12 percent don't take a medication after bringing it home; 22 percent take a smaller dosage than prescribed; and nearly 30 percent stop taking their medicine before it runs out — and analysts believe that surveys underestimate nonadherence because some patients lie about whether they're taking their drugs.
The end result: a deadly toll. A 2011 study jointly produced by the American Society on Aging and the American Society of Consultant Pharmacists concluded that missed medications contribute to as many as 125,000 deaths annually and cost the nation's health system $100 billion per year.
"It's a huge and costly problem that has many in the medical community concerned," says Dr. Danielle Ofri, an associate professor of medicine at New York University School of Medicine and author of Medicine in Translation: Journeys With My Patients. "I mean, if you're not taking your medicines, you're not getting any better — and there's a good chance you're getting worse."
Here are the four of the most common excuses people use to justify failing to take medications properly — and expert advice on how to get back on track:
"I feel fine. Why do I even need this?" Adults with high blood pressure or high cholesterol, or who are in the early stages of Type 2 diabetes often feel well because those conditions alone don't carry any outward symptoms. Likewise, patients who've successfully managed a chronic condition for months or even years may believe they've got things under control and decide to stop taking their prescriptions.
"It's easy to see why someone who feels great on a day-to-day basis may not want to take their pills," says Sean Jeffrey, president of the consulting pharmacists group and an associate clinical professor at the University of Connecticut Health Center's School of Pharmacy. "But there's a reason they call these diseases silent killers."
If this applies to you, then it's time to have a conversation with your doctor, who may not have done a good job of explaining your meds to you. Ask exactly what every medication is for, the potential consequences if you don't take it and, for long-term prescriptions, under what circumstances you can stop using it. The answers can empower you, Jeffrey says, and improve your health. "Once people understand that the medications are intended to prevent things like a stroke," he says, "they're more likely to stay on top of taking them."
"I forgot." Ofri once conducted this brief experiment with her med students: She handed each of them two "prescription" packs of Tic Tacs. "They were instructed to take these 'medicines' exactly as prescribed for one week — and not one student was able to do it," she says. "So imagine how tough it is for someone who's on multiple medications for a chronic condition and trying to go about their daily lives. Usually it's not that they're neglectful or don't care. The reality of life is not so simple."
Here, again, communication with your doctor is the key. Let your physician know you're having a hard time following one or more prescriptions. In many cases, you can solve the problem by buying a simple pill box, setting a daily alarm, asking your spouse or family member to help you keep track or using a smartphone app.
If you're taking multiple medicines and find yourself frequently missing one or more, Ofri suggests asking your doctor to prioritize the pills. Staying on top of a depression prescription, for example, may be more vital than keeping up with a statin for high cholesterol; in this case, the absence of the former may influence neglecting the latter. Your doctor might also look for alternative medications that only need to be taken once a day or come in patch form. "Most doctors will be willing to negotiate a plan that's workable," Ofri says, "but first you have to be honest with us and let us know this is a problem for you."
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"I feel worse when I take the pills." There's no doubt many common medications have unpleasant side effects, from incontinence or constipation to dry mouth, muscle aches and reduced libido. But these side effects do not affect everyone equally. If a medication is causing you discomfort, "in many instances there is a really quick fix for that," says Jeffrey Delafuente, a professor at Virginia Commonwealth University and a pharmacist who works primarily with older adults.
Delafuente recalls one patient who was being treated for high blood pressure but didn't like how his prescribed medication upset his stomach. "Rather than tell his doctor, he just stopped taking the pills," he says. "Meantime, his doctor was baffled because the patient's blood pressure never got better. The doctor tried several different drugs with no success, so I was called in to see if there was some other drug that was being overlooked. I met with the patient and he told me he'd never bothered to fill any of the subsequent prescriptions because he assumed they'd all have the same effect as the first. What he wasn't willing to tell his doctor could have proved deadly for him. But once we knew what the problem was we were able to address the stomach concerns and control his blood pressure."
Patients should never suffer in silence, Ofri says. "There is creativity in medicine," she says, if you give physicians a chance to address your concerns. "Some medicines can be changed or stopped. We have lots of options at our disposal to help our patients feel better."
Similarly, if you don't believe a medication is improving your condition, say so. "Faking it doesn't do any good," Ofri says. "It's better to have medicines you're able to take and see value in than medicines you're not willing to take."
"I can't afford the prescription." In an AARP survey of adults 50 and older, 40 percent of respondents who hadn't filled one or more prescriptions said cost was the main reason. Concerns over drug prices lead some patients to cut pills in half, take them every other day or finish one round and avoid getting a refill.
While limiting the impact on your wallet, the health costs of such practices can be high, Ofri says. "It doesn't work for patients to decide for themselves what medicines they'll take, when or for how long," she says. Diabetics who reduce their insulin dose, for example, could have seizures or go into a coma. People with a stent need anti-coagulants daily. And those on blood thinners must take their drugs precisely for them to work.
If you're struggling to meet your medication bills, Jeffrey says, your pharmacist may be able to suggest a generic or lower-cost alternative, perhaps one your doctor isn't aware of. If that's not an option, your pharmacist or physician may be able to direct you to local, state or national agencies, or programs like needymeds.org, that provide assistance.
"Whether it's cost, convenience or side effects, whatever the barrier," Ofri says, "bring it to our attention quickly so we can work together to find a solution."