There are diagnoses for some people who can’t or won’t take pills. There’s dysphagia, or difficulty swallowing. There’s emetophobia, the fear of gagging or vomiting. There’s pharmacophobia, the fear of taking any medicine at all.
And then there are people who have none of these conditions, but really, really hate to do it anyway. Hate it so much, in fact, that when a recent survey asked people if they’d prefer to risk immediate death or swallow a daily pill for the rest of their lives, more than a third chose the former.
In a study published earlier this week in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association, researchers from the University of North Carolina and the University of California, San Francisco, surveyed 1,000 people on what they would be willing to give up to avoid taking a daily pill—one without any cost or side effects—to protect heart health.
Here’s what people were willing to trade:
- More than 20 percent said they would pay $1,000 or more; around 3 percent said they’d pay up to $25,000.
- Around 38 percent of respondents said they’d be willing to gamble some risk of immediate death; around 29 percent of the people surveyed said they’d accept a small (lower than 1 percent) risk, while 9 percent of them said they’d accept a one-in-10 chance of immediate death.
- When the question changed from risk of death to certain death, around 30 percent said they would trade at least a week off their lives, and 8 percent were willing to give up a full two years.
The researchers aren’t sure why the survey respondents were so averse to the idea of taking a pill each day, but they have some educated guesses. Beyond the simple hassle of remembering a daily chore, “We think that part of the opposition is the stigma of ‘being sick’ or needing to be treated,” Robert Hutchins, a physician at UCSF and the study’s lead author, said in an email.
Because the study asked about specifically about a pill as prevention rather than treatment, there’s also the possibility that people simply didn’t see much benefit to taking it, or much risk to skipping it. “The problem with many of the pills that people take for their whole life is that they don’t necessarily make them feel better—they are medications like aspirin and statins that prevent an adverse outcome,” Hutchins said. “If that outcome is prevented, the person doesn’t know how bad the alternative to taking the pill actually is. If someone is taking a pill for back pain, they should get relief from that pill and don’t mind taking it, because the alternative, pain, is worse.”
The American Heart Association recommends a daily aspirin as heart-attack prevention in people at higher risk, though the Food and Drug Administration is less sure: In May, the agency revised its guidelines on the subject, declaring that while aspirin should be taken as a preventive measure by people with a history of heart attacks or strokes, the risks outweigh the benefits for everyone else.
Either way, the Circulation study adds a little more nuance to what’s already been identified as a major problem: Not only do people dislike taking pills, but they’re also pretty bad at it. A study published in the Annals of Internal Medicine in 2012 found that patients’ failure to follow their prescriptions—either by not taking medication correctly or by not taking it at all—causes around 125,000 deaths and 10 percent of all hospital visits each year, and costs the U.S. somewhere between $100 billion and $289 billion annually.
Hutchins added that among the respondents in his study, the three-quarters who who said they already took daily pills were even more vehemently opposed to the hypothetical one the survey described. “Maybe those people know what it's like to take pills and know how much of a hassle it is,” he said. In a follow-up study, he and his colleagues are examining which physical qualities of a pill—taste, size, texture—make the most difference in a person’s attitude towards taking it.
But much of people’s resistance, the researchers believe, stems less from the properties of the pill that’s being swallowed and more from the act itself. Even when side effects are discounted, “The act of having to take a daily pill can have a large effect on an individual's quality of life,” Hutchins said in a statement. “That effect multiplied across millions of people can have very large effects on the cost-effectiveness of that drug for a population.”
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