People who had trouble affording food were four
times more likely to skip some of their medications due to cost than
those who got plenty to eat, researchers found.
"This leads to an obvious tension between 'milk' or 'med,'" said Dr.
Niteesh Choudhry, who worked on the study at Brigham and Women's
Hospital in Boston. "If you have a fixed income, should you treat or
should you eat?"
The findings are based on data collected by the 2011 National Health
Interview Survey, a questionnaire that offers a snapshot of the U.S.
population as a whole. Nearly 10,000 people age 20 and up filled out
the survey and reported having one or more chronic illnesses like
cancer, asthma, emphysema or a psychiatric illness.
Among those participants, 23 percent took their medication less
often than prescribed because of the cost, 19 percent reported
difficulty affording food and 11 percent said they were having
trouble paying for both food and medications. In the end, about one
in three had trouble affording food, medication or both.
These rates are high but are similar to figures found in previous
studies, said lead author Dr. Seth Berkowitz, from Massachusetts
General Hospital in Boston.
Yet the link between difficulty paying for food and for medications
is a novel one.
"The idea of tradeoffs that people might make (between buying
medications or food) is something we haven't seen before," said
The researchers also found that patients who had difficulty paying
for both food and meds were 58 percent more likely to be Hispanic or
With each additional chronic illness the patients reported, their
risk of having a tough time affording those items went up by 56
percent, according to the findings published in The American Journal
Finally, people having trouble affording medications and food were
30 percent less likely to have public, non-Medicare insurance like
Medicaid, and about 60 percent less likely to participate in the
Special Supplemental Nutrition Program for Women, Infants, and
Children, known as WIC. This program provides supplemental food and
healthcare referrals for certain women and children up to age five.
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By removing some of the financial pressure from people struggling
to afford food, assistance programs like WIC may also help them
afford their medications, Berkowitz said.
For that reason, for people struggling to pay for either food or
medications, the authors recommend looking into eligibility for food
assistance programs, such as the Supplemental Nutrition Assistance
Program (SNAP) and WIC, along with community support services like
When it comes to medications, there may be cheaper alternatives or
assistance programs for the medication a patient is already taking.
"The most important thing people can do is talk with their
doctors about it," said Berkowitz.
It's also important for people to be honest with their doctor if
they are unable to afford enough food, since that may affect which
medications and dosages are best.
"If you are eating very irregularly, a medication that might be
perfectly safe when you are eating regularly could cause low blood
sugar," or other complications, Berkowitz told Reuters Health.
If patients don't bring up the fact that they are struggling to
afford medications or food, Berkowitz said, the doctor won't know to
adjust medications accordingly.
He said people should "not be embarrassed or ashamed" to bring up
the topic with their doctor.
The American Journal of Medicine, online Jan. 21, 2014.
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