Month: October 2021

For most Americans, a daily multivitamin is an unnecessary habit.

Are you among the one in three Americans who gulps down a multivitamin every morning, probably with a sip of water? The truth about this popular habit may be hard to swallow.

“Most people would be better off just drinking a full glass of water and skipping the vitamin,” says Dr. Pieter Cohen, an associate professor of medicine at Harvard Medical School and an internist at Harvard-affiliated Cambridge Health Alliance. In addition to saving money, you’ll have the satisfaction of not succumbing to misleading marketing schemes.

That’s because for the average American adult, a daily multivitamin doesn’t provide any meaningful health benefit, as noted recently by the US Preventive Services Task Force (USPSTF). Their review, which analyzed 84 studies involving nearly 700,000 people, found little or no evidence that taking vitamin and mineral supplements helps prevent cancer and cardiovascular disease that can lead to heart attacks and stroke, nor do they help prevent an early death.

“We have good evidence that for the vast majority of people, taking multivitamins won’t help you,” says Dr. Cohen, an expert in dietary supplement research and regulation.

Who might need a multivitamin or individual supplements?

There are some exceptions, however. Highly restrictive diets and gastrointestinal conditions, or certain weight-loss surgeries that cause poor nutrient absorption, are examples of reasons why a multivitamin or individual vitamins might be recommended. A daily vitamin D supplement may be necessary when a person gets insufficient sun exposure. Your doctor may recommend an iron supplement if you have a low red blood cell count (anemia).

Why is it hard to give up the habit of a daily multivitamin?

Surveys suggest people take vitamins to stay healthy, feel more energetic, or gain peace of mind, according to an editorial that accompanied the USPSTF review. These beliefs stem from a powerful narrative about vitamins being healthy and natural that dates back nearly a century.

“This narrative appeals to many groups in our population, including people who are progressive vegetarians and also to conservatives who are suspicious about science and think that doctors are up to no good,” says Dr. Cohen.

Unproven marketing claims for dietary supplements

Vitamins are very inexpensive to make, so the companies can sink lots of money into advertising, says Dr. Cohen. But because the FDA regulates dietary supplements as food and not as prescription or over-the-counter drugs, the agency only monitors claims regarding the treatment of disease.

For example, supplement makers cannot say that their product “lowers heart disease risk.” But their labels are allowed to include phrases such as “promotes a healthy heart” or “supports immunity,” as well as vague promises about improving fatigue and low motivation.

“Supplement manufacturers are allowed to market their products as if they have benefits when no benefit actually exists. It’s enshrined into the law,” says Dr. Cohen. It’s wise to note the legally required disclaimer on each product: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

But even the strong language in this disclaimer — “not intended to diagnose, treat, cure, or prevent” — doesn’t seem to affect how people perceive the marketing claims.

Although multivitamins aren’t helpful, at least they’re not harmful. But the money people spend on them could be better spent on purchasing healthy foods, Dr. Cohen says.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

More than five million Americans use wheelchairs. Getting one repaired is hard.

Wheelchairs restore mobility to people who are unable to walk or have limited ability to do so. Over a lifetime, this may describe many of us due to changes in health, injuries, neurological conditions, or disabling conditions like arthritis. So, when wheelchair technology or parts quit working, a quick fix would seem essential, right?

I know this firsthand. Unable to walk from decades with multiple sclerosis, I keep small scooters on every floor of my 1911 home, which is further adapted for accessibility with stair lifts and ramps. One day when I turned on my second-floor scooter-type wheelchair, sparks arced from the tiller opening atop the steering column, followed by smoke and the acrid smell of burning electrical wires. It was late on a Friday afternoon. No emergency repair service exists for wheelchairs or scooters. Now what?

Wheelchair repair delays are far more than an annoyance

Wheelchairs allow millions of Americans with mobility disability to participate in daily activities and community life (note: automatic download). We know this improves physical and mental well-being and overall quality of life.

On that Friday, my only option was to have my husband bring my first-floor scooter to the second floor. There I stayed, awaiting repairs on the now-inoperable scooter while my husband brought my meals upstairs. Because I have used the same small assistive technology company for more than 20 years — and have the owner’s cell phone number — by midafternoon on Tuesday, I once again had functional scooters on both floors. My confinement had lasted only four days. I know I was lucky on many levels.

But what if I lived alone, didn’t have another operational scooter, or hadn’t been able to wait four days? And what about people experiencing far longer waits for help with an essential device? While the 1990 Americans with Disabilities Act (ADA) prohibits discriminatory policies and requires physical accessibility in public services and spaces, it says nothing about this issue.

How often do wheelchairs break down?

Ideally, a wheelchair should be safe, reliable, and match your activity goals and functional needs. It should provide strong postural support and seating that protects against pressure injuries. Depending on strength and endurance, you might wish to self-propel a manual wheelchair. Or you might need a mobility scooter or power wheelchair propelled by a battery-powered motor, one that might even have sip-and-puff operational assistance or a chin-operated trackball.

Regardless of complexity, however — from basic manual wheelchairs to sophisticated rehab power chairs — all wheelchairs can break down, leaving their users stranded. Factors like broken pavement, inadequate curb cuts or soft terrain, steep inclines and inclement weather, and poor wheelchair design pretty much guarantee this.

In one study of 591 wheelchair users with spinal cord injury, 64% reported needing at least one wheelchair repair in the past six months. Among users requiring just one repair, wheels and casters posed the most difficulties for manual wheelchairs (46%). Electrical systems (29%) and power/control systems (27%) caused most problems for power wheelchair users. Rates of wheelchair breakdowns have increased in recent years, and vary across wheelchair manufacturers.

Repairs are costly, in more than one way. A survey of 533 wheelchair users with spinal cord injury found:

• Out-of-pocket repair costs ranged from $50 to $620 (the median, or midpoint, cost was $150).
• Time spent experiencing adverse consequences from wheelchair breakdown before repair ranged from two to 17 days (five days was the median).
• Among those reporting adverse consequences, 27% were stranded inside their home, 12% were stuck in bed, and 9% were stranded outside their home.

Wheelchair repair delays are lengthening: Could right to repair laws help?

Lengthening repair delays (automatic download) that heighten risks to consumers’ physical and mental health have caused many wheelchair users across the US to voice their outrage. However, reducing repair wait times isn’t simple. Medicare moved to competitive bidding in 2011, causing most small vendors — like my assistive technology company — to leave the business.

The two behemoths owned by private equity firms that now dominate the marketplace focus on boosting profits and cutting costs. By reducing technician hours and parts inventories, restricting consumers’ access to parts and software passcodes, requiring pre-approvals from insurers for repairs, and other practices, these companies virtually ensure delayed repairs.

Furthermore, Medicare and other insurers do not pay for preventive maintenance such as tightening loose bolts and cleaning casters, allowing problems to go undetected until breakdowns occur. Training can allow some wheelchair users to perform preventive maintenance tasks, but such training programs are not widely available.

Trying to reduce repair delays, Colorado’s governor recently signed the first “right to repair” law in the US for power wheelchair users. Complex software programs control many functions of power wheelchairs, and by holding this software as trade secrets, the manufacturers and large vendors have forced consumers needing repairs to use their services.

Much like recent right to repair laws for cars, the Colorado law mandates that power wheelchair owners and independent repair shops have access to the embedded software tools, parts, and other resources required to diagnose, maintain, or repair power wheelchairs. Other states, such as Massachusetts, may follow. Power wheelchair users in Massachusetts are testifying at public hearings about their repair horror stories to motivate the legislature to act.

Given the complexities of the wheelchair industry, it’s not clear whether right to repair laws will shorten repair times for power wheelchairs. Additionally, this law does not address manual wheelchairs or scooters like mine. Clearly, much more remains to be done to ensure timely wheelchair repairs. As wheelchair use surges, with growing numbers of baby boomers with mobility disability wanting to remain active in their communities, solving the wheelchair repair crisis is increasingly urgent.

About the Author

Lisa I. Iezzoni, MD, MSc, Contributor

Lisa I. Iezzoni, MD, MSc, is a professor of medicine at Harvard Medical School, and is based at Massachusetts General Hospital in Boston. Dr. Iezzoni studies health care experiences of persons with disability. She is a … See Full Bio View all posts by Lisa I. Iezzoni, MD, MSc