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 literat.

1. 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

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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?

10. 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

11. 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

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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,

18. 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

19. 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
considerations of the use of oral nutritional supplements.
Clinical Nutrition Supplements,
(2), 25-32. doi: 10.1016/j.clnu.2007.04.002
Skinner, R.A. & Smith, J.C. (2008). Dietitian management of
oral nutritional supplements
prescribing is cost effective and improves quality of care.
Proceeding of Nutrition Society,
120 (67). doi: 10.1017/S0029665108007520
Soni, M.G., Thurmond, T.S., Miller, E.R., Spriggs, T.,
Benedich, A., & Omaye, S.T. (2010).
Safety of Vitamins and Minerals: Controversies and
Prospective. Toxicology Sciences, 118
(2), 348-355. doi: 10.1093/toxsci/kfq293