Sample Essay analysis

April 24, 2012

Choosing Pills over Bills: Use of Dietary Supplements to Avoid Health Care Costs

Introduction

Over the past few decades, nutritional supplements have come into prominence as a widely accepted method to improve one’s health. Currently, a wide variety of supplements exist in an equally wide variety of forms and they are available to general public at relatively affordable prices. Collectively, supplements offer the chance to augment one’s diet and move towards complete nutrition, which is a critical feature of overall health. Although supplement usage appears to be a simple concept, it is, in fact, complex with multiple underlying dynamics including conflicting scientific research findings, differing insights from professionals, diverse consumer opinions, and underlying economic considerations. A particular factor existing in this spectrum is the possibility of supplement usage to replace the use of health care.

There has been a substantial amount of research conducted in regards to nutritional supplements. Overwhelmingly, published research regarding dietary supplements fall under distinct and recurring categories. These domains include: benefits of supplement use, dangers of supplement use, supplement use in the hospital or clinical settings, trends in supplement use, and consumer motivations for supplement use. As a whole, supplement research is extensive but not complete. Specifically, no research thus far has focused on the usage motivation question: do supplement consumers choose supplements to avoid the high costs of health care?

Research was conducted to answer the question above. Additional aspects of the research study were constructed to re-evaluate some statistics and confirmed motivations from previous research in order to secure this study in the context of existing literature. Supplementary results on related variables were also collected to determine if they were correlated to results of the primary research question. Research was conducted via a ten question survey on health supplement usage motivations and an interview with a certified sports nutritionist, Neena Mathur. The survey, the primary research method, was distributed to thirty pharmacy customers of Dick’s Pharmacy in Altoona, PA and to thirty biology students attending Penn State University, University Park campus. Pharmacy customers were selected as random clients of the pharmacy. Biology student were chosen from one section each of Biology 129 and Biology 473. The interview was conducted via electronic correspondence due to geographic distance from the interviewee. All findings were analyzed to answer the research question and its related factors.

Literature Review

In order to conduct my specific research to determine if supplement consumers choose supplement in order to avoid the high costs of health care, it was first necessary to explore the relevant existing information on supplements. This specific information consisted of scholarly literature focused on the positives and negatives of supplement use, professionals’ thoughts on supplement use, consumer motivations for supplement use, and existing research on the economic advantages of supplement use. Information on these specific topics was compiled in order to build a scaffold into which the results of the present study could be placed.

To begin, the positive and negative effects of supplement use have been heavily explored by researchers seeking to determine if supplements should be taken, to what extent, and the results of supplement use. In a 2003 article by Davidson and Geohas entitled “Efficacy of Over-the-counter Nutritional Supplements,” commonly available nutritional supplements were analyzed to determine their contributions to health improvement. The researchers explored how intake of readily available dietary supplements positively changed the health of consumers. The statistical results of this study supported that supplement could be used to significantly improve the health conditions of consumers. This supports the premise of the main research question.

Along the same lines, as with most substances in existence, use of nutritional supplements can also result in negative effects for consumers. The 2010 study “Safety of Vitamins and Minerals: Controversies in Perspective,” by Soni, Thurmond, Miller, Spriggs, Bendich, and Omaye examined specific vitamins that are commonly sold as supplements to see if they could cause negative outcomes when consumed improperly. This study followed the analyses of the effects of overconsumption of vitamins A, C, and E as well as the sage wisdom that “dose makes the poison” (pp. 350). The authors cited that the use of dietary supplements must be controlled to avoid drug-like side effects such as nausea, headache, diarrhea, and even skin lesions and instead enjoy health augmentation. This article formed the basis for the counter-case of the research question in which supplement consumption forces the use of health care.

Continuing with the idea of supplement control, professionals in the field of nutritional supplements insist that the supplement usage should be done under the supervision of experts. The researchers Skinner and Smith reported on an English Nutritional Society meeting in the 2008 article “Dietitian management of oral nutritional supplement prescribing is cost effective and improves quality of care.” In this report, they explored the benefits of having dietitians evaluate and alter supplement usage. They found, overwhelmingly, that supplement consumers should seek the guidance of dieticians in order to reap optimum benefits in health and cost from supplement use. This research did not look into the condition of supplement use tuned to partially or complete eliminate the need for health care; this was explored in the present study.

Another vastly explored domain in supplement research is that of consumer motivations. A 2001 article by Blendon, DesRoches, Benson, Brodie, and Altman from the Archives of Internal Medicine “Americans’ Views on the Use and Regulation of Dietary Supplements,” took a look at some of the most common motivations for supplement use. Surveys conducted by the Henry J. Kaiser Family Foundation and the John F. Kennedy School of Government were used as reference data to formulate the reliable results of this study. The researchers concluded that approximately 48% of the surveyed population (circa 1999) consumed nutritional supplements. 85% of this population did so to improve their health and prevent illness. The research did not directly look into the economics of supplement use but did provide a framework of reference motivations that can be compared to the results of my study.

In another view more so related to the present study, Russel’s 2007 article “The impact of malnutrition on health cost and economic considerations for the use of oral nutritional supplements,” specifically investigated the financial benefits dietary supplement use. The article outlined how malnutrition related to extended hospital stays which resulted in increased health care expenditures and subsequently how supplement usage could counteract this relationship. Meguid Corporation research reviewed in this article demonstrated that hospital patients placed on a supplement regimen had shorter hospital stays which equated to lower health care costs. This study, overall, lends credence the idea that supplement usage could be used preemptively to avoid the high costs of health care. However, the article leant itself more so to the idea that supplement usage could be used to reduce health care costs rather than eliminate them entirely.

Overall, it is evident that dietary supplement usage is a complex subject. There are multiple factors at play that define proper and effective intake of supplements. These factors, which will be re-explored in the present study, act as a framework of understanding from which new insights and conclusions can be drawn. The results of the present study must be considered in the context of accepted research on nutritional supplements.

Methodology

To answer the question of whether or not dietary supplement consumers replaced the high costs of health care with the more affordable costs of supplements, research was conducted over a four week period from February 28, 2012 to March 28, 2012. Research was conducted via a ten question survey that was completed by sixty people, an interview with Mrs. Neena Mathur, a certified Sports Nutritionist and weight management consultant, and minor observations in my field site, the independent pharmacy Dick’s Pharmacy located in downtown Altoona, PA. A survey was selected as the primary research method because it is a relatively simple vehicle to assess the various beliefs and actions of a population in a limited amount of time. Furthermore, the outcomes of surveys can be tallied into easily interpreted, comparable data. Data was concentrated into three applicable tables, and analyzed to discern any visible and relevant trends (results). The interview was conducted during week three of research via electronic correspondence due to Mrs. Mathur living and working in Massachusetts.

The Survey

The ten question survey was aimed at assessing what fraction of the questioned population consumed nutritional supplements, various motives for supplement use, and a few comparable variables evident in the literature research. Specifically, it was asked if the respondents utilized supplements to replace the costs of health care (the research question). Data was compiled so that trends and evident results could be evaluated.

The Subjects

In all, sixty people were surveyed over the four week period. Thirty were customers of Dick’s Pharmacy in Altoona, PA; the other thirty were Penn State Students from two different biology classes. The pharmacy customers were surveyed by the pharmacy staff due to their very low hourly client turnover. Pharmacy customers were chosen as the subjects for surveying due to their exposure to health products and likely interest in improving or maintaining their health beyond pharmaceutical use. The Penn State students were from the Biology 129 and 473 classes that I attended. These students were chosen for surveying because their background in the sciences likely meant they had some preliminary understandings of the benefits of supplements and could therefore make informed decisions on supplement use. Also, college students may choose supplements over health care particularly due to the difference in affordability.

The Interview

The interview with Neena Mathur (in full disclosure, she is my aunt) was done via electronic correspondence due to our lack of proximity. The interview consisted of ten questions aimed at establishing her credentials and complementing the questions and results of the surveys. Specifically, the interview questions were arranged to gain a professional insight into supplement use (benefits and drawbacks, rates of use, relevant instances for appropriate use, and if complete nutrition through supplement use can be used to avoid health care). Mrs. Mathur also added additional comments regarding her own opinions on supplement use to achieve optimum health.

Findings

Table 1. Demographic of survey respondents for both pharmacy customers and biology students.

Subjects	Pharmacy Customers	Biology Students
	x/30 %	x/30 %
Gender Male Female	5 17 25 83	14 47 16 53
Age Range 18-19 20-29 30-39 40-49 50-59 60-95	0 0 4 13 7 24 10 33 8 27 1 3	4 13 26 87 0 0 0 0 0 0 0 0
Race Caucasian African-American Asian Hispanic	30 100 0 0 0 0 0 0	24 80 0 0 4 13 2 7

The table above presents the breakdown of the demographic that responded to the ten question survey. Values are presented as values out of each group of thirty people and corresponding percentage values. This table was established by the first three survey questions.

Table 2. Pharmacy customer responses to supplement-based survey questions

Subjects	Pharmacy Customers
Do you consume any type of dietary supplement?	Yes 16/30 53%	No 14/30 47%
	Yes No	Yes No
	x/16 % x/16 %	x/14 % x/14 %
Do you take supplements to: Improve your health? Avoid Illness? Avoid the costs of health care?	16 100 14 88 2 12	0 0 2 12 14 88	0 0 0 0 0 0	14 100 14 100 14 100
Have you told your doctor about your supplement use?	16 100	0 0	0 0	14 100
Do you have insurance?	16 100	0 0	13 93	1 7
Have you ever had a negative reaction to a supplement?	0 0	16 100	0 0	14 0

The table above presents the responses of the pharmacy customers to questions regarding their use of supplements and other related factors. Values are presented as respective responses out of each sub-group people and corresponding percentage values. Data was subdivided based upon yes or no response to dietary supplement use.

Table 3. Biology student responses to supplement-based survey response.

Subjects	Biology Students
Do you consume any type of dietary supplement?	Yes 22/30 73%	No 8/30 27%
	Yes No	Yes No
	x/22 % x/22 %	x/8 % x/8 %
Do you take supplements to: Improve your health? Avoid Illness? Avoid the costs of health care?	22 100 10 45 2 9	0 0 12 55 20 91	0 0 0 0 0 0	8 100 8 100 8 100
Have you told your doctor about your supplement use?	16 72	6 28	0 0	8 100
Do you have insurance?	20 91	2 9	8 100	0 0
Have you ever had a negative reaction to a supplement?	2 9	20 91	0 0	8 100

The table above presents the responses of the biology students to questions regarding their use of supplements and other related factors. Values are presented as respective responses out of each sub-group people and corresponding percentage values. Data was subdivided based upon yes or no response to dietary supplement use.

The data above offers viable results in regards to the research question and sub-questions. Tables 2 and 3 found that 53% of pharmacy customers and 73% of biology students consumed dietary supplements; this is roughly consistent with literature data of the general public’s supplement consumption. In terms of motivations, pharmacy respondents that consumed supplements most often did so to improve their health (100%) and to prevent illness (88%). Similar results were also observed in the biology students (100% to improve their health and 55% to avoid illness). These outcomes are also in line with literature findings. Research question responses indicated that 12% of pharmacy customer supplement users and 9% of biology student supplement users did in fact utilize supplements to avoid the costs of health care. At its core, this demonstrates that people do indeed replace the high costs of health care with the more affordable costs of nutritional supplements, therefore providing a simple confirmation to the research question. Other comparable variables such as possessing insurance, communication of supplement use with one’s doctor, and negative reactions to supplements did not appear to predict or correspond to positive responses to the research question.

Interview Responses

The interview with Neena Mathur yielded a wide range of responses specifically related to the research question. In a particular statement, “I do believe that with proper nutrition and physical activity you can minimize use of medical care…” Mrs. Mathur clarified that the fulfilling the status of the research question is realistically possible. She went on to explain that proper nutrition can be used society-wide to improve overall health in the population and therefore reduce the occurrence of preventable disease (which would reduce health care costs). Mrs. Mathur also elucidated that there are only certain situations that warrant the consumption of supplements such as diagnosed nutrient deficiency, vegan diet, and digestive surgery. These statuses were not accounted for in the survey. In addition, she stated “it is never a good idea to just start taking any supplement without discussing with a physician or health professional.” Literature has shown that professionally directed supplement use results in the optimal outcomes in health and cost. Overall, the interview lent credence to the research question in that proper nutrition can lead to a state of health conducive to not requiring (to an extent) health care.

Discussion

Continuity with Literature

Data from Tables 2 and 3 present statistical results that can be compared to literature information. It was found that 53% of pharmacy customers and 73% of collegians used dietary supplements. These values are similar to the literature statistic of 48% supplement usage found by Blendon, DesRoches, Benson, Brodie, and Altman in 2001. Data comparison indicates that overall supplement usage has increased over the past decade. Moreover, it can be said that collegians utilize supplements more so than non-collegians. Numerically, it can be said that data in this study are acceptable in comparison to literature thereby validating this study.

In terms of motivations, data shows that 100% of pharmacy customer and biology student supplement users consumed supplements to improve their health. Similarly, 88% of pharmacy customers and 45% of biology students who used supplements did so to avoid illness. These figures support that these motivations still influence nutritional supplement usage. It appears that pharmacy customers and biology students who use supplements believe in the health-improving attributes of supplement use to the same extent whereas pharmacy customers believe in the illness preventative effects of supplements more so than biology students. This may be due to the fact that pharmacy customers are already using some sort of medication and are therefore inclined to seek additional health improving agents. In general, the recurrence of literature-based supplement usage statistics and motivations in this study support that any additional results can be considered consistent with accepted knowledge on nutritional supplements.

Use of Supplements to Avoid Health Care Costs

Collected data shows that 12% of pharmacy customers and 9% of biology students who use supplements do so to avoid the high costs of health care. These results act as confirmation of the main research question. These statistics, however, were not correlated with either motivation of supplement use discussed above or with any other variable evaluated in this study.

The survey variable of possessing insurance was thought to predict responses to the research question. It was hypothesized that if subjects did not possess insurance they may be likely to choose to use supplements in order to avoid health care costs that are profoundly higher when one does not have insurance to reduce out-of-pocket expenses. Results to this question depicted in Tables 2 and 3 did not correlate to positive responses to the research question. Therefore it is evident that possession or lack of insurance does not predict if a supplement user will utilize supplements to avoid the costs of health care.

The researchers Soni, Thurmond, Miller, Spriggs, Bendich, and Omaye explained that supplements can cause negative effects. This concept was developed into a survey question that asked if respondents had ever experienced a negative reaction to supplement use. Positive responses to this question equate to the opposite situation of the research question in that negative effects from supplement use may require the use of health care to resolve. 9% of biology student supplement users responded positively to this question and so this scenario is confirmed. The occurrence of the counter-case to the main research question may contribute to the low rate of supplement use to replace the costs of health care.

Professional Guidance of Supplement Usage

Tables 2 and 3 presented data on the percentages of supplement users who told their doctors of their consumption (100% of pharmacy customers and 74% of biology students). These statistics did not correlate with positive responses to the main research question. This may indicate that the supplement users attempting to bypass health costs via supplement consumption are not doing so under professional guidance. This lack of guidance is likely to reverberate into sub-optimum benefits in health and cost (Skinner & Smith, 2008). This speaks to the relative effectiveness of carrying out the scenario of the research question. It is possible that those who do use supplement to avoid the costs of health care have thus far been unsuccessful because their usage has not been tuned to maximize outcomes. One must also consider that guidance in supplement use may be avoided because of its own costs as well as because of the American ideal of self-reliance which often hinders people from seeking guidance in “simple” situations.

Referring back to the interview, Mrs. Mathur made the point that all supplement use should be directed by experts in order to achieve substantial health benefits. The lack of this in the case of positive respondents to the research question elucidates that those who do try to use supplements to avoid health care costs are likely doing so under their own interpretations of what should be done and what is effective. It is possible that this falls in relation to the very low observed rates of supplement users experiencing negative effects from supplements. This is to say, if consumers do not encounter any negative effects from supplement usage they are unlikely to think that they need guidance as “nothing bad has happened.”

Limitations of this Study

The results founded in this study must be considered in the context of their limitations. To begin, the survey samples assessed may not be wholly representative of their respective populations. The pharmacy customers surveyed may not characterize all pharmacy customers, the full Altoona, PA population, or the adult population of the United States. It is unlikely that the opinions of customers of a small, independent, downtown pharmacy speak for all pharmacy customers especially those of large, chain pharmacies that serve the majority of customers. Also, it is not plausible that one single town population (with a limited demographic) can completely gauge absolute trends across United States. However, they can provide basic insights that are likely to persist in varied settings. In terms of the college population surveyed, the fact that only biology students from two classes were questioned offers the possibility that students from different types of classes may give different responses. Moreover, students from Penn State University may not be representative of all college students

Next, the questions used in this study must be considered for their limitations. The survey used for this research was designed to reach specific goals and therefore was not comprehensive. The survey did not contain any open-ended questions to gain in-depth responses for each topic. Such responses may have assisted in explaining the trends observed and therefore elucidate the meanings of the results beyond numerical data analysis. It must also be considered that while there are many possible predictors of the research questions, the limits of time and resources that border this study prevented exploration of all possible factors. Additionally, all responses collected in this study are limited by the honesty of the self-reported behaviors of those surveyed.

Another category of limitations in this research is that of the interview. Only one professional view, that of Neena Mathur, was considered in this study. While Mrs. Mathur is a qualified consultant on the subject of nutritional supplements, her views are not comprehensive of all facets of supplement use. Further insights from economists, medical professionals, and experts on nutritional supplements would provide a well-rounded prospective to assist in results interpretation. Additionally, interviews with respondents should be considered as their thoughts would directly explain trends in results. These interviews were not conducted due to time and resource constraints. Conclusively, while Mrs. Mathur provided interesting and relevant opinions in relation to the research question, her responses should not be considered as the final word on the subject and more research is required to expose the full answers to the research question.

Conclusions

Overall, the results collected in this study successfully answer the questions posed at the beginning of this research study. Data from surveys and from the interview support that a small percentage of nutritional supplement consumers do use supplements to avoid the costs of health care. Additionally, previous motivations and trends were reestablished in the current setting and it was found that no variable that was perceived to predict the choice of supplement usage to replace health care successfully correlated to its occurrence. Despite the clearly defined conclusions that can be drawn from the results of this study, there are still questions that require further inquiry. Why do supplement consumers use supplements to avoid costs of health care? What types of people are most likely to do this? Can health care be completely replaced with supplement usage? Are there demographic variations in the occurrence of the main research scenario? In the end, the prospect of supplement use to replace the costs of health care still stands as a subject requiring further exploration.

References

Blendon, R.J., DesRoches, C.M., Benson, J.M., Brodie, M., & Altman, D.E. (2001). American’s

views on the use and Regulation of Dietary Supplements. Archives of Internal Medicine,

(160), 805-810.

Davidson, M.H. & Geohas, C.T. (2003). Efficacy of over-the-counter Nutritional Supplements.

Current Atherosclerosis Reports, (5), 15-21.

Russell, C.A. (2007). The impact of malnutrition on healthcare costs and economic

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Skinner, R.A. & Smith, J.C. (2008). Dietitian management of oral nutritional supplements

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Soni, M.G., Thurmond, T.S., Miller, E.R., Spriggs, T., Benedich, A., & Omaye, S.T. (2010).

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