• Vitamins: Enough Of “Enough Is Enough”

    Posted February 24, 2014: by Bill Sardi

    A recent editorial published in the Annals Of Internal Medicine said this about multivitamins:  “We believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.”

    I’ve already addressed this absurd report.  There are a number of hidden catch phrases in that statement, such as “well nourished.”  Is anybody really well nourished in a processed food society that over-consumes carbohydrates and sugars and brain stimulant-laden foods?  According to the US Department of Agriculture, most Americans aren’t getting an adequate supply of essential nutrients from their diet.

    Also notice “most” is in parentheses.  The multivitamins used to develop the above conclusion, while providing 100% of the Daily Value, provide paltry amounts of necessary vitamins and minerals.  This points to flawed nutrient requirements that obviously allow more nutrient deficiency-related disease to exist so the very same doctors who issued this statement can treat more patients!  But we are advised to question the motives of the vitamin companies, not these self-serving doctors.

    Third, if multivitamins were deemed by the established medical industry to prevent chronic disease they would technically be classified by the FDA as a drug since vitamin supplements are not permitted to say they “prevent, treat or cure any disease.”  That is totally preposterous.

    Hit them right between the eyes

    Allow me to aim at modern medicine and strike right between the eyes with a demand that it isn’t going to like.  Let’s go right to that temple of modern medicine that represents everything that is wrong with the self-serving healthcare system that is now in place – the American hospital.

    America now spends more than $2.8 trillion or $8,915 per person on healthcare annually.  We also know this kind of growth in healthcare spending cannot continue.  Medicare projects trillions of dollars of unfunded future liabilities.

    When analysts review where most of these costs emanate from they find considerable geographic variation in one particular cost driver – re-hospitalization.  In 2012 it cost Medicare more than $62 billion to care for patients that had recently been discharged from a hospital.  Medicare is spending nearly as much on readmissions in the first 30 days after a patient is discharged as it does for initial hospital admission.  For example, in 2008 nearly 22% of patients hospitalized for congestive heart failure were readmitted to the hospital at an average cost of $10,800.

    Something more sinister in hiding

    Some of this problem could emanate from pressure to discharge patients early so hospitals meet demands to efficiently process patients.  But there is something more sinister hiding in hospital closets.

    A report published in The New England Journal of Medicine says most acute care hospitals and physicians pay little attention to post-acute care.  The report says doctors have little financial incentive to invest in system that to ensure effective post-acute care.  Medicare is attempting to address this problem by bundling Medicare payments so the hospital and doctors share a set fee to care for the patient.

    But the report blames the problem on lack of coordination between different medical specialists.  That is kind of like blaming the crew of a ship for its poor coordination and preparation to fight an on-board fire when it would be better to prevent the fire from occurring in the first place.

    Another companion report published at The New England Journal of Medicine gets us closer to understanding the problem but sidesteps the obvious gorilla standing in the debate room.

    That report describes what it calls as “hospital-dependent patients” as “usually old, almost always having multiple chronic conditions, and having minimal physiologic reserves to compensate for acute stress or injury.”  The report goes on to say these patients are not recognizable upon initial admission to the hospital.  The patient, family members and physicians all assume the patient will be restored to health in a timely manner and sent home.  But that isn’t what happens in 1 in 5 hospital admissions covered by Medicare.

    The report says: “Medicine has yet to acknowledge the ethical and practical predicament of having created a population of incurable, fragile, but not yet terminally ill patients without concurrently developing a healthcare system that can meet their needs.”

    The hidden gorilla in the room

    While the nation’s acute care hospitals as a whole haven’t been able to identify which patients are most likely to be re-admitted, St. Francis Hospital in Wilmington, Delaware has.  They are the malnourished.

    In 1994 this hospital launched a pilot program to identify the nutrition needs of its patients within 48 hours of admission and established a committee to provide guidance for practitioners to intervene nutritionally.  Internal studies were able to increase identification of malnourished newly admitted patients from 25.9% to 86.0% and to implement corrective action in a timely way (ID time cut from 6.9 to 2.4 days).  The average length of stay at the hospital was cut from 10.8 to 8.1 days; the incidence of major complications from 75.3% to 17.5%; and the big prize, 30-day readmission rates declined from 16.5% to 7.1%!

    Any acute care hospital in America could do this if they chose to.  A hospital in Australia reports 18% of newly admitted patients were malnourished upon admission and were 3.4 times more likely to be readmitted to the hospital within 90 days.  About 3 out of 4 patients at high risk for re-admission were identified.

    Abbott Laboratories, which provides nutritional products for hospitalized patients, reports 40-55% of surveyed patients are either malnourished or at risk for malnourishment and up to 12% are severely malnourished.  Abbott Labs says hospital charges are 35-75% higher among malnourished versus well-nourished patients.  The problem is that Abbott Labs reported this fact in 1996, 18 years ago in the Journal of the American Dietetic Association!

    Physicians at the Advocate Good Shepherd Hospital in Barrington, Illinois say: “Hospital malnutrition represents a large, hidden and costly component of medical care.”  Researchers at the Center for the Evaluation of Value and Risk in Health at Tufts University Medical Center in Boston note the most costly complication associated with poor nutrition status is acute respiratory infection ($12,350-$19,530 per hospitalization).

    A call to action has been issued from the Alliance To Advance Patient Nutrition at the Department of Food Science & Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois.  Authorities there say: “malnutrition continues to go unrecognized and untreated in many hospital patients.  They call for timely identification of malnourished patients upon hospital admission and prompt intervention.

    And let’s get down to the truest measure of the value of nutrition in hospitalized patients – mortality.  Over a decade ago it was reported that mortality among malnourished patients at one hospital was 29.7% versus only 10.1% among well-nourished patients 12 months after their hospital stay!  Maybe length of hospital stay can be reduced, but that might not figure in the patients who died after hospital discharge and never made it back to the hospital.

    Stop throwing patients in dark rooms and expecting them to get well

    Let’s get specific.  Throwing acutely ill patients into hospital intensive care rooms that look like caves, devoid of sunlight and fresh air, and giving them sugar or saline drips and hospital food (one report says prisoners are given better food than hospital patients) that reflects the typical American processed food diet is not likely to result in timely restoration of health.

    Sunlight exposure, which comprises the major way humans obtain vitamin D, is obviously compromised in hospital patients.  Physicians at the University of Colorado School of Medicine report that 26% of patients newly admitted to an intensive care unit (ICU) were abjectly vitamin D deficient and another 56% were vitamin D insufficient.  More troubling, their vitamin D levels predictably declined after 3 days in the ICU.  Higher vitamin D levels resulted in lower mortality, shorter hospital stays and less hospital-acquired infections.

    Other hospitals report similar results.  Vitamin D levels are a significant marker of whether a patient will leave a hospital dead or alive.

    Isn’t it time?

    Isn’t it time we all demand that American hospitals and physicians attend to the nutritional needs of our frail loved ones who upon hospital admission have their multivitamins immediately taken away from them?

    Who will take up this cause and raise public demand that hospitals assess and correct malnutrition among frail elderly patients? Where are you Citizens for Health?  Where are you National Health Federation?  Where are you Alliance for Natural Health?

    We should demand that American medicine create a culture that values and addresses the nutrient needs of its patients.  Why is every disease treated as if it is a drug deficiency when many emanate from poor nutrition?

    America, if you want to fix healthcare spending and save lives by reducing hospital re-admission rates, then demand your local hospital form a committee to remedy malnutrition.  Take this report to your local hospital and deliver it personally to the administrator and the chief of staff.  We’ve had enough of “enough is enough!”  © 2104 Bill Sardi, Knowledge of Health, Inc.

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