It May Be Time to Question the Pills You Take

I realized the other day that I’m taking fewer and fewer pills.

For years, I’ve swallowed a handful of capsules and tablets every night. Most of them are over-the-counter drugs or supplements, intended to keep me from developing heart trouble, cancer or some other disease. They were recommended by my doctors, and the research behind their recommendations seemed solid to me. But over the years, scientific studies have discredited quite a few.

The latest is aspirin.

For decades, experts advised almost all of us in our later years to take one low-dose aspirin every day to head off heart attacks and strokes, but now a large study of older people who had no history of heart trouble has called that advice into question. Researchers found that those who took an aspirin a day were no healthier at the end of four or more years than those who were given a placebo, and they were no less likely to have had a heart attack or stroke.

What’s more, the people who took the aspirin were more apt to develop a problem with bleeding in the digestive tract or the brain and were slightly more likely to have died for some reason but especially from cancer.

Let me emphasize that an aspirin a day does seem to help shield people who have already had a heart attack or stroke, as well as those with significant risk factors, such as high cholesterol or high blood pressure. But it looks as though aspirin’s risks outweigh the benefits for people with healthy hearts.

There are other pills I’ve given up because researchers raised questions. I stopped hormone replacement therapy (long touted as a way for women in midlife to prevent heart disease) after a major study found that not only did it fail to defend against heart disease but it actually increased the risk of having a stroke or developing blood clots or breast cancer.

I weaned myself from a drug called a proton pump inhibitor. I’d taken it for years to hold acid reflux at bay, but then studies linked it to a whole roster of problems, including heart attacks and dementia. Once I stopped taking it, I discovered that acid reflux now rarely bothers me.

I gave up fish oil after researchers reported that it didn’t, after all, seem to have the ability to prevent heart problems. Why waste money on something that doesn’t work? (Please note, though, that there’s still a lot of evidence that eating oily fish like salmon helps prevent heart disease.)

After all these disillusionments, it’s tempting to conclude that while we’re healthy, we may be better off without that daily handful of pills. But preventing diseases is important—science’s success at doing that is part of the reason we live so much longer than our ancestors did.

And it’s true that many scientific “facts” are only as factual as the latest study. A few years from now, new research may reveal that some of medications I’ve given up are, after all, excellent preventives.

Right now, though, I’m going to ask my doctor about dropping aspirin from my nightly regimen. I’ve been taking it as a preventive and not because of a heart problem I’ve already developed. I want his opinion mostly because while I was researching this blog, I discovered that if you suddenly stop taking that daily aspirin, there can be a rebound effect, which could include the heart attack or stroke you’ve been trying to prevent.

Similar rebounds can happen with many medications: discontinue them abruptly after long-term use, and the problem they were supposed to treat can return, or if you were taking them for prevention, the very thing you were trying to avoid may happen. That’s why doctors often suggest reducing dosage gradually. I’ve been lucky in the past: I’ve had no ill effects when I stopped taking medications, but I did often wean myself slowly.

Right now, there doesn’t seem to be any pill that’s a sure-fire way to prevent heart trouble. Many studies have shown, however, that the lifestyle choices you make can actually prevent or delay the development of heart disease. I’m talking about things like not smoking. Getting enough exercise and enough sleep. Sticking to a healthy diet and maintaining a healthy weight. Maintaining low blood pressure. Learning how to manage stress. Keeping cholesterol and triglycerides under control and controlling diabetes if you have it.

None of that is as easy as popping a pill. We’d all love it if science would just come up with a medication we could take once a day that was all we needed to stay healthy.

Until that happens, though, keep in mind that those lifestyle measures really do get results.