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Choosing between food or medicine: Underuse or overprescribed?

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The term cost-related medication underuse refers to taking less medication than prescribed or not taking it at all due to financial concerns. Chronically ill adults who reported food insecurity in their household (not having consistent access to food due to lack of financial stability) were significantly more likely to report cost-related medication underuse, according to a new study, "Treat or Eat: Food Insecurity, Cost-related Medication Underuse, and Unmet Needs.” The study will appear in print in The American Journal of Medicine, April 2014.You also can read the study's abstract published online since January 21, 2014 in the American Journal of Medicine. Authors of the new study are Seth A. Berkowitz, MD, Hilary K. Seligman, MD, MAS, and Niteesh K. Choudhry, MD, PhD.

Adults with chronic disease are often unable to meet medication and/or food needs, but no study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample, says the new study's abstract. Researchers examined which groups most commonly face unmet food and medication needs.

Certain drugs can keep you alive. For example, a type 1 diabetes patient needs insulin to stay alive, and there are other conditions that require other medicines to keep patients alive.

If you had to choose between choosing a healthy food to use as folkloric medicine or to fulfill a nutritional deficiency, such as cod liver oil to get a small amount of DHA into your body, if you had a deficiency, or choosing a prescription drug and only had the money to pay for one or the other, which would you choose?

Food insecurity linked to cost-related medication underuse in chronically ill Americans. Treat or eat: Many are forced to choose between food or medicine, reports The American Journal of Medicine. Then again, there are people who have a lot of money to spend on organic food who have walked away from conventional medicine if there's a nutritional way to get at the root cause of a health problem caused by deficiencies or environmental pollution.

For example, take the very food secure using fresh, organic food as medicine as compared to those with enough money who spend the money on prescription medicines instead of changing their diet and lifestyle. Now, in a new study, researchers have found that chronically ill adults who reported food insecurity in their household (not having consistent access to food due to lack of financial stability) were significantly more likely to report cost-related medication underuse, according to a new study in The American Journal of Medicine. Elsevier Health Sciences.

The term cost-related medication underuse refers to taking less medication than prescribed, or not taking it at all due to financial concerns. It's as if underuse of medications is described as a deficiency of a certain expensive drug rather than trying to fix the problem with a change of diet or supplements specifically tailored to an individual instead of drugs with severe side effects.

Despite renewed optimism about the economy, many people in the United States continue to feel financial hardships

In 2012, 1 in 5 Americans reported having trouble meeting basic needs, and on top of that, 1 in 6 people reported having no form of health insurance. For the chronically ill, the difference between paying rent or putting food on the table may be the cost of their medication.

In order to explore the possible link between food insecurity and cost-related medication underuse, investigators looked at 9696 adult participants in the National Health Interview Survey (NHIS) who had reported chronic illness. They found that 23.4% of the chronically ill study participants reported cost-related medication underuse, while 18.8% reported food insecurity and 11% reported both. This means that 1 in 3 chronically ill NHIS participants are unable to afford food, medications, or both.

Underuse of medication is studied rather than underuse of the healthiest super foods

Investigators also looked at ethnicity and found that participants with both medication underuse and food insecurity were more likely to be Hispanic or non-Hispanic black. They were also more likely to have several chronic conditions versus those participants who reported no food insecurity or medication underuse and a lack of insurance was more prevalent in groups with medication underuse.

"The high overall prevalence of food insecurity and cost-related medication underuse highlights how difficult successful chronic disease management in the current social environment is," says lead investigator Seth A. Berkowitz, MD, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, according to the March 21, 2014 news release, Food insecurity linked to cost-related medication underuse in chronically ill Americans. "These findings suggest residual unmet needs for food-insecure participants and thus have clear implications for health policy."

This link between food insecurity and medication underuse can help guide future public policy by targeting groups susceptible to both

For example, researchers found that respondents who participated in Medicaid or the Woman, Infants, and Children (WIC) food and nutrition service were less likely to report both food insecurity and cost-related medication underuse. "The observations that Medicaid and WIC participation is associated with lower odds of both food insecurity and cost-related medication underuse suggest that there may be important 'spill-over' effects from programs that target food insecurity or cost-related medication underuse, by freeing up available resources," adds Dr. Berkowitz, according to the news release.

This study pinpoints populations that can benefit from policy changes influenced by this new data. Investigators noted that participants with incomes 100%-200% above the Federal Poverty Line, who are not always eligible for government assistance, reported high rates of food insecurity and cost-related medication underuse. This information is important to consider when setting program eligibility rules in the future.

"We report an association between public insurance programs, such as Medicaid and owed cost-related medication underuse compared with private insurance prescription benefits," explains Dr. Berkowitz, according to the news release. "Low- or no-cost sharing prescription drug benefits have been associated with improved health outcomes in a general population, as well as the reduction of socioeconomic disparities in health outcomes."

For policy makers, food insecurity represents an easily identified risk factor for cost-related medication underuse, making it simpler to find programs and strategies to address this endangered group in a meaningful way

"Food insecurity is strongly associated with cost-related medication underuse, and approximately 1 in 3 chronically ill NHIS participants are unable to afford food, medication, or both, despite participation in assistance programs," concludes Dr. Berkowitz, according to the news release. Interventions targeted to under-resourced groups who may face 'treat or eat' choices could produce substantial health gains for these vulnerable patients." You may also want to see the abstract of another study by different researches, "The Placebo Effect: The Good, The Bad And The Ugly."

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