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Dynamic Chiropractic – January 15, 2004, Vol. 22, Issue 02
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Dynamic Chiropractic

Time for More Vitamins, Less Drugs

Study Shows Multivitamin Use by the Elderly Has "Potentially Powerful" Impact on Public Health, Medicare Expenditures

By Editorial Staff

As you age, your immune system weakens, leaving you more vulnerable to infection and disease. This is especially true if you're over the age of 65. Unfortunately, evidence suggests that up to one third of all elderly adults in the U.S. fail to get the amounts and types of food necessary to meet essential nutrient and energy requirements, leaving them open to a wide range of infectious and noninfectious diseases, including heart disease, osteoporosis and various forms of cancer. These findings have prompted some scientists to recommend that all adults, and especially members of the elderly population, take a multivitamin supplement daily to help fight off disease and keep the immune system functioning optimally.

A study presented at an October 2003 meeting in Washington, D.C. suggests that daily multivitamin use by older adults is "a relatively inexpensive yet potentially powerful way to improve one's health," and that the health effects from vitamins are particularly important for improving cardiovascular health and immunity. The study also suggests that over a five-year period, taking a multivitamin can lead to considerable savings associated with health care costs - more than $1.6 billion over the next five years, even after adjusting for the cost of providing vitamins to every elderly person in the U.S.

"A Study of the Cost-Effects of Daily Multivitamins for Older Adults," was conducted by The Lewin Group, an internationally known consulting firm, on behalf of Wyeth Consumer Healthcare. The goal of the study was to develop estimates on the impact daily multivitamin use by the elderly could have on the costs of health insurance. To achieve its objective, The Lewin Group reviewed more than 250 published studies on various aspects of diet and nutrition, from case series and reports on single vitamins to randomized, controlled trials that involved tens of thousands of subjects.

The group studied the effects of taking vitamins on five specific diseases prevalent in the elderly population: coronary artery disease, diabetes, osteoporosis, prostate cancer and colorectal cancer. It also analyzed literature discussing the effect multivitamin use might have on improving immune function in older adults, and the potential health care savings that could result from avoiding hospitalizations, nursing home stays and home health services associated with infectious diseases such as pneumonia and septicemia.

To estimate the costs and potential savings derived from multivitamin use, The Lewin Group used an analysis of Medicare claims files to treat selected disease conditions, and cost-accounting methods used by the Congressional Budget Office. Estimates included the total costs associated with giving vitamins to the elderly, along with potential savings in health care costs. Any high-quality studies that used cost estimates on multivitamin use and health expenditures were also considered in the cost estimation design.

Results

Providing the entire geriatric population with multivitamins would be no small task: The report estimated that over five years, it would cost $2.3 billion to provide a daily multivitamin to every elderly person in the United States. The cost would be "incremental," rising from $149 million in the first year to more than $900 million in the fifth year, due in part to an increase in the number of elderly Americans.

However, analysis of the data found that the cost of providing multivitamins to the elderly would be more than offset by the savings that would result from reduced hospital stays and related services. The savings from costs associated with myocardial infarction-based hospitalizations alone would save more than $2.4 billion. Another $924 million would be saved due to a reduction in hospitalizations, nursing home stays and home health care associated with infections, and more than $580 million would be saved in costs related to insurance premiums.

The estimated savings derived from multivitamin use were termed "conservative" based on several potential limitations noted by the authors. For instance, savings from ambulatory care (health services provided on an outpatient basis, compared to services rendered at home or in a hospital) were not included in the analysis. According to the National Center for Health Statistics, elderly people (65 or older) made more than 231 million ambulatory care visits in 2000, an average of 7.1 per person - nearly twice the national average. Ambulatory care visits also are considered one of the largest components of all medical spending; in 1987, approximately $90 billion was spent on ambulatory care, most of which was spent on the elderly.

In addition, the study assumed that only 50 percent of adults over age 65 would take the vitamins at first (this number would increase to 85 percent after five years), and that only one-third of all elderly people would show any appreciable benefit from daily multivitamin use. If a higher percentage of the elderly population took (and benefited from) multivitamins, and if the savings from reduced ambulatory care were added to the equation, the potential savings would be significantly higher than projected.

Costs and Potential Savings from Improved Immune Function and Reduced Risk of Coronary Artery Disease in the Elderly
Potential Costs/
Savings by Year
2004 2005 2006 2007 2008 Total
Cost offset from potential avoidance of hospitalizations, nursing home stays, and home health services for infections $83 million $129 million $180 million $236 million $296 million $924 million
Cost offset from potential avoidance of hospitalizations due to fatal and nonfatal myocardial infarction (heart attack) $215
million
$314
million
$469
million
$636
million
$818
million
$2.452
million
Premium offset $37
million
$58
million
$101
million
$158
million
$230
million
$585
million
Projected savings $335
million
$501
million
$750
million
$1.03
billion
$1.344
billion
$3.961
billion
Gross cost of providing daily multivitamins to older adults $149
million
$232
million
$406
million
$632
million
$920
million
$2.339
billion
Potential net savings from providing daily multivitamins to older adults $186
million
$269
million
$344
million
$398
million
$424
million
$1.622
billion

In spite of this, the report states: "The evidence strongly indicates that daily use of multivitamins by the elderly is nearly risk-free and is potentially associated with significant health improvements. "Based on the available evidence regarding risks and benefits, we concur with other researchers that use of daily multivitamins by the elderly has the potential for conferring substantial benefits to any public health initiative."

As recently as the 1960s, the American Medical Association's official stance was that diet did not play any appreciable role in health and disease. While this view has changed in recent years, the chiropractic profession has always emphasized the importance of diet and nutrition in the maintenance of health and well-being.

Nevertheless, nutritional counseling remains a somewhat enigmatic component of the chiropractic practice. According to the latest estimates from the National Board of Chiropractic Examiners' Job Analysis of Chiropractic, more than 90 percent of chiropractors utilize nutritional counseling, therapy or supplementation in their practices, making it the third most common form of passive adjunctive care among practicing doctors of chiropractic. Chiropractors also consider knowledge of nutrition and diet "very important" - on the same level with physiotherapy and ergonomics. Yet surprisingly, nutritional counseling appears to be underutilized: According to the Job Analysis, only 36.6 percent of chiropractic patients receive nutritional counseling or supplementation.

Global health care costs are spiraling out of control, and the dangerous side-effects of many drugs are becoming more apparent: Research provides ample evidence of the dangers of nonsteroidal anti-inflammatory drugs (NSAIDs), including over-the-counter varieties such as Ibuprofen and Advil that many people use every day. Thousands die in hospitals annually due to drug reactions or dosing errors. One pharmaceutical company executive even admitted recently that most of his firm's products "work in (only) 30 to 50 percent of people."

As leaders of the natural healing and wellness movement, doctors of chiropractic are in a position to provide their patients with safe, natural options that will not only allow them to lead healthier, drug-free lives, but will help reduce hundreds of millions of dollars in health care costs down the road. The Lewin Group's analysis reinforces this fact, and encourages health care providers from all disciplines to talk to their patients about the benefits of a balanced diet and proper nutrition - and to recognize that in many instances, the benefits of drugs espoused by the pharmaceutical industry simply do not outweigh the risks, especially when natural alternatives exist.

Resources

  1. U.S. study shows vitamins save health care costs. Reuters, Oct. 2, 2003.
  2. A Study of the Cost-Effects of Daily Multivitamins for Older Adults. Submitted by The Lewin Group, Inc. to Wyeth Consumer Healthcare, Oct. 2003; presented at "Multivitamins and Public Health: Exploring the Evidence," Washington, D.C., Oct. 2, 2003.
  3. Medical Care Spending - United States. Morbidity and Mortality Weekly Report Aug. 19, 1994; 43(32):581-586.
  4. Health, United States, 2003. Published by the National Center for Health Statistics (www.cdc.gov/nchs/hus.htm).
  5. Cerhan JR, Anderson KE, Janney CA, et al. Association of aspirin and other non-steroidal anti-inflammatory drug use with incidence of non-Hodgkins lymphoma. International Journal of Cancer, June 2003;106(5):784-88.
  6. Li DK, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and the risk of miscarriage: a population-based cohort study. British Medical Journal, Aug. 16, 2003;327(368).
  7. Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. The New England Journal of Medicine, April 27, 2003;348(16):1556-64.
  8. Connor S. Glaxo chief: Our drugs do not work on most patients. The Independent (www.independent.co.uk), Dec. 8, 2003.
  9. McGreevey R. Prescription medicine is hit or miss. The Australian Dec. 9, 2003.

Editor's note: Direct your patients to www.ChiroFind.com to learn more about the benefits of chiropractic and natural health and wellness. You can also subscribe your patients to To Your Health (TYH), a newsletter that gives them all the information they need on exercise, nutrition and other health topics. To learn more about TYH, or to receive a free sample copy, call 1-800-359-2289.

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