So much of emergency medicine is reassuring the worried well or medicating the chronically impaired without significantly changing their disease. Meanwhile, most of us enjoy procedures and critical care because we intervene in a way that appears to have an immediate and significant improvement.

I would like to suggest a new procedure that every one of us can master, one that has immediate and ongoing benefits that can be offered to a majority of ED patients. The procedure is a pharmacectomy, an immediate, emergent removal of a medicine that does more financial and physical harm than good.

Here is a small sample of seven drugs that emergency physicians can stop to prevent debilitating expense and dangerous harm:

Chronic NSAIDs in all patients with hypertension, diabetes, congestive heart failure, renal disease, and patients under 70. Discourage over-the-counter NSAIDs in adults. Write a prescription so there will be a defined stop date, which actually may be cheaper for the patient with insurance. (N Engl J Med 1999;340[24]:1888; Arch Intern Med 2000;160[6]:777; Am J Med 2011;124[7]:614; JAMA 2015;313[8]:805.)

Aspirin for primary prevention in everyone but especially in ED patients who present with epistaxis, hemoptysis, GI bleed, and dyspepsia. (JAMA 2006;295[3]:306; New Engl J Med 2005;352[13]:1293; JAMA 2014;312[23]:2510; Lancet 2009;373[9678]:1849.)

Clopidogrel (Plavix) in patients on dual platelet inhibition for stroke or for stents more than one year out. This is particularly true for elderly patients with head trauma or any patients with bleeding or dyspepsia. (New Engl J Med 2012;367[9]:817; New Engl J Med 2014;371[23]:2155.)

Proton pump inhibitors. And don't prescribe it for uninvestigated dyspepsia. Instead, use nonpharmacological prevention and add an H2 blocker or antacid if you must. We should acknowledge that most GERD diagnoses are fabrications; the diagnosis is likely uninvestigated dyspepsia. (Acata Med Indones 2009;41[4]:222.) The relief of these emergent symptoms may take days with a PPI. (PloS 2015;10[6]:e0124653.)

Expenses aside, the potential harms with a PPI are monstrous, and include increased MI risk, increased mortality in cirrhosis patients (Aliment Pharmacol Ther 2015;41[5]:459), increased mortality in hospitalized elderly (JAMA Intern Med 2013;173[7]:518), increased mortality in GI bleed in western countries (Scand J Gastroenterol 1997;32[4]:328), increased hip fractures (Arch Intern Med 2010;170[9]:765), increased risk of community-acquired pneumonia (Ann Intern Med 2008;149[6]:391), and increased risk of Clostridium difficile. (JAMA Intern Med 2015;175[5]:784.)

Discourage cough and cold medications including Tessalon Perles, echinacea, vitamin C, and zinc. (Pediatrics 2004;114[1]:e85; Cochrane Database Syst Rev 2008;[1]:CD001831; New Engl J Med 2005;353[4]:341.) The philosophy of “what can it hurt to try it?” should be quickly countered with, “They are expensive, are proven not to work, and occasionally can be harmful.”

Gabapentin (Neurontin) for everything other than true neuropathic pain. Most of the uses of gabapentin are for chronic pain that is not neuropathy. Many of the studies done on this drug for chronic pain were falsified. (New Engl J Med 2009;361[2]:103; New Engl J Med 2009;361[20]:1963.) Gabapentin is only FDA-approved for neuropathy. It is the tramadol or muscle relaxer of chronic pain patients but with more cost and more side effects.

Multivitamins and all supplements including fish oil, omega 3, and calcium. (New Engl J Med 2010;363:2015; JAMA 2015;314[8]:791; BMJ 2005;330[7498]:1003.) The science proving no benefit and increased mortality in many cases is extensive and clear. (JAMA 2007;297[8]:842.) Unfortunately, for a majority of Americans, these products symbolize a quasi-religious, anti-science way of life. If they were just expensive organic placeboes, it might be easier to look the other way. But these natural remedies are deceptively dangerous.

Four of five bottles of supplements bought over-the-counter in Walmart, Target, and Walgreens had none of the advertised ingredients in the bottle! (“Times Article Prompts Investigation into Herbal Supplements,” New York Times Feb. 4, 2015; http://nyti.ms/1VzI2Ud.) Instead, researchers found rice powder, houseplant trimmings, and even toxic heavy metals. It is time for the natural supplement and vitamin users to be scared. There is no such thing as a supplement brand you can trust!

Choosing Wisely is part of a popular movement for medical professionals to order less (when more is not better). I would like to add the concept of Changing Wisely to stop medications already prescribed or taken. An emergent pharmacectomy may save more ED patients' lives than the rare central line or intubation. It has a higher success rate than other preventive strategies like “please stop smoking,” or “you need to get help with your alcohol and drug abuse” because we and other health professionals are the ones who often initiated or recommended the medication.

We started this. We can stop it — and save patients' finances and even their lives. The ED is exactly the right place to perform an emergent pharmacectomy.