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 Table of Contents  
Year : 2017  |  Volume : 4  |  Issue : 2  |  Page : 47-49

Health supplements, patient behavior, concordance-does anybody bother?

Department of Pharmacology, Srinivas College of Pharmacy, Mangalore, Karnataka, India

Date of Submission11-Feb-2017
Date of Acceptance22-Feb-2017
Date of Web Publication15-Jun-2017

Correspondence Address:
Nagesh Kamat
Department of Pharmacology, Srinivas College of Pharmacy, Valachil, Mangalore - 574 143, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jhrr.jhrr_19_17

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Naturally available fruits and vegetables along with a healthy diet does provide all required nutrients to the body. Then why do people go behind the so-called “health supplements” - vitamins, minerals, herbal immune booster, probiotics, tonics, etc? Do you really need them? Patients in India are desperate to grab the shortcut to good health. They buy products which are unnecessary and which do not have any beneficial effect. On the other hand, health of the patient is undermined as he skips essential drugs which doctors would have prescribed according to the health of a patient. Misconceptions that herbal medicines are safe and without side effects need to be addressed. Patients need to be educated regarding health supplements, its consequences, costs and its implications, and nonadherence. The need of the hour is educating patients to be the guardian of their own health. Numerous reviews exist on health supplementation; however, many facts remain unexplored. This review focuses on what needs to be done for optimal health care.

Keywords: Adherence, counseling, education, health supplements, India, probiotics

How to cite this article:
Kamat N. Health supplements, patient behavior, concordance-does anybody bother?. J Health Res Rev 2017;4:47-9

How to cite this URL:
Kamat N. Health supplements, patient behavior, concordance-does anybody bother?. J Health Res Rev [serial online] 2017 [cited 2021 May 10];4:47-9. Available from: https://www.jhrr.org/text.asp?2017/4/2/47/208117

  Introduction Top

Call it health supplement, energy booster, endurance builder, multivitamin, mineral, probiotic, aphrodisiac, herbal medicine, etc., the never ending list, business of which is booming, and it seems unlikely that companies will ease up anytime soon on their marketing efforts.[1] Many of these are a real waste of money for a healthy individual. Fruits are rich in vitamins and minerals which are good for one's health, and studies have confirmed the benefit of eating nutritious diet with green leafy vegetables to red meat to fish, to milk, meets the daily nutritional requirements.[2],[3]

Too much of a good thing is bad. Again for the child, adolescent, pregnant, old age, men, women, senior, age above 50, etc., unnecessary diversifications/age group promotions. Not many are clinically tested. Ultimately, the benefits of supplements depend on the person, but healthy adults probably do not need to add them to their diet, nor there is any scientific evidence for many of them. It is for the general public, and not everyone should completely avoid multivitamins. Vitamin supplements are unnecessary for most people while some need them, especially Vitamin D.

Children born to parents who have migrated abroad give unnecessary vitamins to their near and dear ones, especially coenzyme Q10 and Omega-3 fatty acids. It all lies in the attitudes or perceptions that they are beneficial or the marketing strategy that exaggerates expected benefits. There is more promotion of these on the social media. However, the supplement does not cure the aging process. Need individual evaluation of diet then recommend accordingly only if there is a severe limitation of intake.[4]

Pre and probiotics are good for specific gastrointestinal symptoms.[5],[6] However, they are readily available in yogurt, kefir, sour pickles, etc. Many are promoted to build immunity and treat infections. They have also been claimed to treat obesity to allergies to cancer to everything. However, National Institutes of Health believes benefits are not well demonstrated. Of late fermented foods have been a part of regular Indian diet. With the introduction of processed foods and refrigeration, many families have stopped using fermented products. Eating a diet rich in fruits and vegetables and less in meats and carbohydrates improves the microbiome in the intestines.[7]

Plethora of advice comes in, and the public are stoked beyond belief. They are made to believe that there exists so-called “magic pill” which can do wonders. They are rarely told to train hard and exercise regularly. Many are available displayed in the local market, and common man gets easily tricked. People end up believing absolutely anything they read on the internet many of which have absolutely no authenticity yet all. What they keep hearing daily will eventually make them gain belief in it for the wrong reasons. Patients should be warned not to get fooled by advertisements. Many ask their health-care provider for a drug/supplement they recently saw advertised by a celebrity on television or other media.

There are a number of herbal drugs being promoted for diabetes mellitus, hypertension, heart, kidney, liver, lung, arthritis, thyroid disorders, cough, or stomach ailments which make false claims about cure. They may be contaminated, substituted or falsely labeled herbal products. Nobody knows what's exactly the contents of it? Moreover, they may cause more harm than benefit for the said patient. They do not have rigorous trials, toxicity studies as performed for allopathic medicines.

With very few exceptions to medicinal plants, others are done for the pure purpose of business without any other positive intention. Dietary supplement industry is growing day by day, and there is nothing which can stop or curb such malpractice. Unlicensed and unapproved drug should face civil charges and penalty. To add to this, there are so-called self-proclaimed “tantric” or “baba” or “sadhus” who are eagerly waiting for people who are emotionally down, to blackmail the common, innocent people, and cheat them. These who are believed as God-man hypnotize, keep fooling, doing wrong acts, but people continue to have blind faith in them. There is nothing that can be done, but people should be intelligent enough to know what is right and what not.

  Adherence Top

Adherence is the extent to which patient takes medicine in accordance with the guidance given by the physician.[8] Compliance is a term for the physician while adherence is a term for the patient. Adherence to drugs is vital in patient care as drug will not act unless the patient has consumed it. Patient behavior contributes to adherence. The patient is the key to decision making for his wish matters. Barriers to adherence include cost, patient memory, willingness, language, duration of treatment, complexity of prescription, knowledge about the disease, dosing regimen, psychological issues, availability of medicines, belief in the physician, perception of acute versus chronic disease, doctor-patient relationship, etc.[9],[10] These are not real barriers instead reasons which patient has when he comes for follow-up.

  Measuring Adherence Top

There are various methods to determine adherence such as 24 h recall and refill history, questionnaires, pill counts, personal interviews, insurance claims, plasma drug concentration, directly observed therapy, etc.[11],[12],[13] Many are for research purpose, none is considered the gold standard and all have their own limitations. Adherence in medicine can never or rarely be 100%. Then how do we achieve the best adherence? Do we say 90% adherence as good or even 80%?

  Newer Concept Of Adherence Top

Adherence in health is not limited to drugs but extends to visit as well. Many patients do not follow up at the clinic in the said time for review. Adherence to visit is as vital as to drugs. As the treating physician needs to modify the prescription, increase or decrease the dose, switch to new drug or may investigate further in the case of lack of improvement in symptoms. Adherence as well implies to adhering to one physician's treatment and avoiding doctor shopping.

  Misconceptions Top

Drugs resemble in form or color for which a patient's relative would have taken a similar drug for a different condition. Patients often commit this mistake of going by the color of the medicine and consuming it. Often the leftover medicines should be discarded after a course of treatment. These medicines which were once prescribed for their parents or relatives when left over are taken up by others and can cause serious problems. Patients feel that drug does more harm than the disease and skip medicines. The so-called “adverse drug reaction and drug interaction” are less common than thought of. To overcome this, patients need to discuss the same with the treating physician and clarify their doubts.

  The Perplexed Nonadherent Patient Top

No matter how much is said or conveyed some patients never understand. What is to be done to them? How do you deal with such patients? What is in store for them? Some patients need to be dealt differently. However, in a busy outpatient department, clinician often gets to see about 2 min per patient in which one has to interact with the patient, diagnose and treat. Here allied health professionals do play a vital role. Prescription needs to be explained clearly by the clinical pharmacist to the patient as well the caretaker, the need for follow-up and benefits of completing the therapy. Sometimes conveying the minimal information is essential as the patient gets confused with too much information at hand. Much is to be blamed to online data which is often misleading but freely accessible to the general public.

  The Patient's Role Top

Patients stop medicines and come for follow up. By the time their case is handled by super specialist there will not be much time for damage control. Understanding the patient needs is vital for long-term adherence.[14] Here, the concept of patient-physician relationship matters. Physician needs to prescribe considering the cost, availability, along with simpler dosing regimen for the uneducated patient. In addition, the patient needs to explain their socioeconomic status and any other issues with the treating physician so that the physician prescribes rationally.[15]

  Counseling And Patient Education-The Easy Way Round Top

Doctors are good counselors who can speak regarding its pathophysiology, causes, symptoms, treatment, purpose of medication, dosage regimen, advice on missed dose, precautions to be taken, need for long-term follow-up and benefits of completing the therapy. The patient should be warned of polypharmacy. The concept of herbal medicines being safe and without side effects need to be stressed for the patient. As even many of these drugs would have not gone through appropriate testing. Communicating is essential to success. Patients, when given a prescription, should be warned of polypharmacy. Creating mild fear in the patient does help initially about the disease and its course as patients feel if disease is serious, they pay proper attention to the treatment and complete the drug therapy. At follow-up, the patient should be questioned in a friendly way else patient might lie regarding consumption of medicines. The majority of diseases which are chronic do have good adherence rates. Patients should be said about the drug its possible side effects such as orange discoloration of urine with rifampicin, black tarry stools with iron, and anticholinergic effects with antidepressants, as these if said before, will help the patient to adhere to drugs. Patient education aids need to be used, namely, patient education material, audio-visual lectures, one to one counseling which can bring about changes in the behavior of the patient.

  What's Lacking In India Top

With more than 1.3 billion population there is no national database to update, track, analyze or report drug or patient information. There are no refill data available at pharmacy outlets. No reminders exist for refilling prescription. Way too many pharmacy outlets in a particular locality without basic amenities. Government needs to create a database wherein every patient has a unique ID and with this ID all the past medication history and other details could be retrieved. Doctors are busy with their day to day work in clinics. Many of the physician samples get discarded or expire and are rarely given to the poor patient. Whenever drug samples are available, these should be used up for the poor patient. Finally, it is the patient who is to be influenced by physician's words which can bring about changes in the thought process and adhere to medication. Achieving success with adherence needs inputs from both patient and the physician.

  Conclusion Top

People need safe, effective, therapeutically proven drugs, which are less toxic, less expensive. Old assumptions that herbs are natural, safe, nontoxic, and better than allopathic drugs need to go off. Patients and the common man should be asked to go by scientific evidence for any food or the drug that is to be consumed-education the key to sound health. Nonadherence, costs, wellbeing-how near but how far-does anybody bother? What will happen to the billion-dollar food and pharma industry if these are banned? Lawsuits or company may raise billion dollar fund for another product…

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER 3rd. Enough is enough: Stop wasting money on vitamin and mineral supplements. Ann Intern Med 2013;159:850-1.  Back to cited text no. 1
Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr 2012;3:506-16.  Back to cited text no. 2
Burns RJ, Rothman AJ. Evaluations of the health benefits of eating more fruit depend on the amount of fruit previously eaten, variety, and timing. Appetite 2016;105:423-9.  Back to cited text no. 3
Pem D, Jeewon R. Fruit and vegetable intake: Benefits and progress of nutrition education interventions- narrative review article. Iran J Public Health 2015;44:1309-21.  Back to cited text no. 4
Islam SU. Clinical uses of probiotics. Medicine (Baltimore) 2016;95:e2658.  Back to cited text no. 5
Verna EC, Lucak S. Use of probiotics in gastrointestinal disorders: What to recommend? Therap Adv Gastroenterol 2010;3:307-19.  Back to cited text no. 6
Parvez S, Malik KA, Ah Kang S, Kim HY. Probiotics and their fermented food products are beneficial for health. J Appl Microbiol 2006;100:1171-85.  Back to cited text no. 7
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487-97.  Back to cited text no. 8
Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication nonadherence: A review of the literature. J Gen Intern Med 2007;22:864-71.  Back to cited text no. 9
Kennedy J, Wood EG. Medication costs and adherence of treatment before and after the affordable care act: 1999-2015. Am J Public Health 2016;106:1804-7.  Back to cited text no. 10
McGinnis B, Kauffman Y, Olson KL, Witt DM, Raebel MA. Interventions aimed at improving performance on medication adherence metrics. Int J Clin Pharm 2014;36:20-5.  Back to cited text no. 11
Choudhry NK, Shrank WH, Levin RL, Lee JL, Jan SA, Brookhart MA, et al. Measuring concurrent adherence to multiple related medications. Am J Manag Care 2009;15:457-64.  Back to cited text no. 12
Chiolero A, Burnier M, Santschi V. Improving treatment satisfaction to increase adherence. J Hum Hypertens 2016;30:295-6.  Back to cited text no. 13
Brown MT, Bussell J, Dutta S, Davis K, Strong S, Mathew S. Medication adherence: Truth and consequences. Am J Med Sci 2016;351:387-99.  Back to cited text no. 14
Fretheim A, Aaserud M, Oxman AD. Rational prescribing in primary care (RaPP): Economic evaluation of an intervention to improve professional practice. PLoS Med 2006;3:e216.  Back to cited text no. 15


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