The Balancing Act of Suggesting Pills and Lifestyle Changes

I seem to have two types of conversations with patients about medications.

The first is when a patient has a strong desire to take medication to soothe everything from back pain to a fungal infection of the toenail. It is not unusual for a patient who really needs to engage in vigorous lifestyle change to inquire about the possibility of taking a pill instead.

The second type of conversation involves patients who do not like taking pills, are very sensitive to medications, or believe that ulterior motives (such as pharmaceutical sales) steer patients unnecessarily to medication. Not surprisingly, sometimes I feel that the patients who need medication the most are the most resistant, while those who have better, non-pharmacologic options, instead request pharmaceuticals.

I am personally a big fan of medications. We have awesome pharmacologic agents that prevent heart attacks and strokes, cure diseases that are potentially fatal, kill cancer cells, and change people’s lives who suffer with psychiatric disease. I am also a passionate advocate of the power of non-pharmacologic treatment. Food is medicine, as was so aptly stated by Hippocrates centuries ago. Exercise, in my opinion, may be the all around best treatment we have. Meditation and gratitude journals, cognitive behavioral therapy, and acupuncture all boast scientific evidence supporting their use. Therefore, I can often flex between my two groups of patients.

Sometimes, I can go either way. Anxiety, for example, has many treatment options on both sides of the aisle, so I can go through these options and tailor my recommendations based on my patient’s wishes.

Other times, I feel compelled to strongly advocate for a medication-most often this is a statin, anti-hypertensive, or diabetes medication. I encourage lifestyle changes while also extolling the benefits of inexpensive, generally well-tolerated medications. And, I get frustrated at the bum rap many medications-such as statins-get.

Today, I saw a patient who would really benefit from a statin. He has tried it and finds it causes muscle aches. He is not interested in trying it again. However, he also chronically uses an over-the-counter analgesic which is causing medication overuse headaches. These are the most challenging cases; when I am trying to advocate for one medication while arguing against another.

In our own family, we faced the lifestyle vs. medication issue when my daughter developed chronic daily headaches. Given what I’ve seen in my practice, I was highly motivated to brake the cycle of these headaches and willing to try anything reasonable to help her. Not surprisingly, the best treatment involved multiple modalities: both medications and non-pharmacologic treatment.

This is what I try to demonstrate to my patients. The most effective treatments are almost always a combination of chemistry and lifestyle which does not reflect a deficiency of either. The treatment cannot stand alone to provide the best therapy, but rather a great balance of multiple modalities working together to minimize harm and maximize benefit.