In Response: Next Stop: Supplements

There’s a train about to leave the station, and I sure want dietary supplements to be on it. That train is healthcare reform, or at least a substantial rethinking of the approach to healthcare in this country. Whether it’s change by statute, such as the federal overhaul of healthcare coverage signed into law earlier this year, or macroeconomic forces that preclude continued spending on healthcare the way we’ve done it for the past 50 years, or mandates from employers who simply have to reduce costs to stay in business, the reality is that America can’t afford to continue paying for a healthcare system that focuses on treating patients rather than keeping them well in the first place. The switch from “sick care” to “well care” is on.

We can already see the headlights of that train barreling toward us. A major component of the new healthcare law involves prevention and wellness. The changes will encourage earlier access to diagnostics, “well visits” for children, and behavior changes to curb smoking and obesity. Healthcare insurers are implementing wellness programs for their insureds that incentivize exercise, maintaining healthy cholesterol levels, keeping blood pressure down, and staying on one’s prescription medication. Even large employers-who ultimately bear the costs of providing healthcare insurance to their employees-are getting involved. Many employers have instituted wellness measures that include everything from organized lunchtime walks, exercise rooms, and healthy cooking demonstrations to prenatal programs, early screenings for cancer, nutrition newsletters, and programs to encourage weight loss.

By most accounts, these programs are providing a return on investment. Various studies investigating the effects of workplace wellness programs have found reduced insurance claims, boosted productivity, and a cut down on sick days. Still other studies have demonstrated that the expense of wellness programs is offset by dollar savings on healthcare expenses to both the employer and the healthcare insurance provider. A three-year study in Minnesota found that $5.93 is saved in medical costs, absenteeism, and workers’ compensation for every $1 invested in a company wellness program.

So, switching tracks back to dietary supplements, the question is, how do we best seize these opportunities and get on the train before it leaves without us? The new healthcare law includes a provision that authorizes local community health centers to test approaches to improving wellness among at-risk populations with such interventions as folic acid for women of child-bearing age, calcium and vitamin D for women at risk for osteoporosis, omega-3 fatty acid supplements for men with risk factors for heart disease, and daily multivitamin-mineral supplements for general health. These pilot studies have the potential to not only demonstrate the value of these supplements for prevention and wellness, but also to expose the benefits of these products to a broader audience.

At the Council for Responsible Nutrition (CRN), we believe there are three primary audiences that need to be convinced of the value that dietary supplements provide if we are going to ensure supplements a good seat on the prevention and wellness train. They are healthcare professionals, health insurers, and employers.

First are the doctors, nurses, nurse practitioners, pharmacists, and registered dietitians who regularly counsel their patients about prevention and wellness. Over the past three years, through CRN’s “Life…supplemented” program, we’ve surveyed these groups and found that all these healthcare professionals are favorably disposed toward dietary supplements. Some even use them themselves at higher rates than the general adult population.

Even within specialty practices, doctors are using dietary supplements. Fifty-seven percent of cardiologists and 73% of orthopedists say they use dietary supplements. Ninety-five percent of nurse practitioners and 96% of registered dietitians also say they use dietary supplements. What all this demonstrates is that even in these days of practicing “defensive medicine,” many healthcare professionals intuitively understand the benefits of supplements for themselves.

What is needed is more publishable research on the health benefits of dietary supplements that will give these practitioners “cover” to make more recommendations to patients: replacing the old advice, “I guess it can’t hurt,” with “Absolutely, you should take an omega-3 supplement every day.”

In order for healthcare professionals to do that, they want more evidence-based research. That will not come cheap, though. Rigorous, high-quality studies are expensive and must be well-designed-but they are not cost-prohibitive, especially if we know that the payoff is increased physician recognition and more product use. At CRN, we are starting to bring together academic researchers who want to investigate the effects of supplements with companies who make those products and want to see sound, objective research performed on these ingredients that will stand up to industry critics. This is a long-term effort, but one with tremendous potential rewards.

The second group is health insurers. As much as doctors influence consumers’ thinking about their own health and methods to help stay healthy, insurers also have the ability and the responsibility to help consumers understand the role supplements can play in good health. Insurers often determine what protocols will be followed, what diagnostic tests will be performed, and what specialists can be accessed. But even more importantly, health insurers are becoming a primary source of healthcare information for consumers.

As insurers try to change unhealthy behaviors and incentivize healthy ones, they are finding creative ways of communicating with their insureds-through websites and newsletters to PDA messaging and daily e-mail reminders. More and more, insurance companies are shaping consumers’ views of how to get and stay healthy.

At CRN, we have begun to partner with America’s Health Insurance Plans (AHIP) to communicate the benefits of supplements to these insurers. After all, if we can help keep their patient populations healthier, they lower their costs. By inviting their representatives to our events, participating in their educational programming, and promoting our research to insurance companies, we can influence how they discuss supplements with their members. Wouldn’t it be great if some of the major insurers started encouraging supplement use as part of their wellness toolkits?

Now, some have suggested that what we need is full insurance coverage for dietary supplements. I’d offer a few words of caution here. If you think doctors are data-driven creatures who insist on well-controlled clinical studies before they will recommend a product, then just talk to an insurance company about its coverage decisions. We will need a lot more research that demonstrates cost-savings before we are likely to see widespread coverage of supplements in formularies. And another reminder: insurance coverage usually means that the payers will insist on the lowest-cost alternative. In an over-the-counter marketplace with a wide disparity between premium brands and generic offerings, having insurance companies pushing their insureds toward the lowest-cost alternative may not be in the best interest of the marketplace. I’d rather see insurers recommending supplement usage generally and then allowing consumers to select the brand of their choice.

Regardless of your views on coverage, however, I think we can all agree that if we want to ride the prevention train, engaging with healthcare insurers and convincing them of the value of supplements will be critical to the trip.

Lastly, we must also focus on employers who, more than ever, are searching for ways to keep their employees healthy. They see not only the effects of higher insurance premiums, but the effects of absenteeism, lost productivity, and business disruptions that result from health crises in their work forces.

Like medical professionals and insurers, employers will want good research to justify including supplements in their wellness program. But again, the payoffs are substantial. Imagine if a major big-box retailer encouraged all of its employees to take a multivitamin every day, or if a leading software producer urged its 30,000 workers to begin a supplement regimen for heart-healthy benefits, or if a major defense contractor incorporated recommended bone and joint supplements into its exercise and weight-loss programs. Supplement companies could develop couponing programs, or discounts for employees of these firms, or affinity programs specific to a particular employer. The supplement maker gets increased sales, the employer touts the program as a wellness benefit for its staff, and the employees reap the health benefits of including supplements in their wellness regimens (and save a few dollars at the drugstore).

My point is this: supplement manufacturers and traditional supplement users have known for a long time that including supplements in a health regimen promotes wellness, helps reduce the risk of chronic disease, and in some cases, can actually help improve quality of life for people managing disease. We’re at a crossroads in this country (or, continuing my train metaphor, a track turntable). Dietary supplements are uniquely positioned to benefit from this change if we identify the key audiences for our message, develop sound research to support our claims, and can position our products as contributing to a healthier lifestyle. Will we jump on this train, or let it pass us by?