It may depend quite a bit on the pill. As an adult I can easily dry swallow things like ibuprofen. But I’m not sure about something like oral steroids.
I was prescribed them as a kid due to a particularly bad poison ivy reaction. I couldn’t swallow pills at the time, so after running through all the tricks to teach someone, we ended up grinding them up and sticking them in ice cream. It was something like 15 years before I could eat cookies and cream again without tasting steroids. Grinding them definitely exacerbated the problem, but I’m not sure how I’d fare if prescribed the same pills again.
I usually rinse them. The spines relax enough when wet.
Alternatively there’s the golden kiwis which have skin that remind me of pears, just thicker. They don’t have spines. I’d still to prefer to rinse them, but more because you should rinse fruits and veggies if you’re going to eat the skin.