The expression that something is “a hard pill to swallow” isn’t just a metaphor. Swallowing pills can be difficult and downright unpleasant. It causes one in three people to gag, vomit, or choke. That may keep people from sticking to their medication routines, which can make them sicker. “We often see people who can swallow food and liquid just fine but have difficulty with pills. Some people have an aversion to swallowing pills, and others have physical issues that affect their ability to swallow,” says Denise Ambrosi, director of the Speech-Language Pathology Department at Harvard-affiliated Spaulding Rehabilitation Hospital.