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Most with insurance have little to no choice. It’s 1 or two of the same PPO with different deductibles or an HMO, if you’re lucky.

This is entirely anecdotal, but I was recently prescribed 50,000 IU/wk by my doctor after blood tests. Even if I had paid for the doctor, blood tests, and prescription entirely out-of-pocket, it would've been cheaper than self-medicating at a dose like that. Most of it was out-of-pocket for me anyway because I hadn't met my deductible, and the whole ordeal set me back less than $100. If I didn't have in-network pricing, it still would've been less than the cost of one month of health insurance.

Obviously, there are plenty of regions and situations in which things don't work out that way. Asking someone to self-medicate with Vitamin D still has the potential to be expensive, and there may be better uses for that money, especially for someone in that sort of financial position.

You went to a doctor, got blood tests, and didn't hit your deductible..... and paid $100. Where exactly did you cross international borders?

That or your doctor visit had no out of pocket costs for being preventative (most insurance plans don't)

A bottle of 360 5,000 IU Vitamin D pills is $16 on Amazon. Each pill is 4.5 cents, so you’re looking at 45 cents a week for 50k IU. I don’t think you can get better insurance for $2/month.

I suppose if you're buying it online instead of locally, that's an option. If I were to buy it from a local store, though, it's a lot more expensive than that--$16 will get you 14-30 doses, even with a cheap brand. And that's assuming you can find the cheap brands in stock, which is often difficult.

I don't think it's reasonable to expect that people in financially difficult situations are able to order online. These are often people who can only pay with cash, food stamps, or other methods that Amazon won't accept. If you're shopping on Amazon, you're probably in a position whereby you have a bit more flexibility in your life.

I know that in Massachusetts (United States), you can see a PCP, get blood work, and get a Vitamin D prescription for free if you don't have sufficient income or insurance. I have friends and neighbors who don't have jobs right now; that's how they get their healthcare. Of course, they're lucky: from what I hear, it's certainly not like that in most of the US, let alone the rest of the world.

Regardless, I don't think it's constructive to insist that self-medicating with Vitamin D should be a priority for people in such a financial position. There are other priorities. If your life is comfortable enough that you can worry about supplements, you probably have enough money to get better insurance or get proper blood tests.

Edit: I don't understand the downvotes. There are an awful lot of people for whom buying medications on Amazon just isn't an option. They don't have and can't get credit cards or bank accounts. They don't have a stable place to live or a way to receive packages. "I don't understand why these people can't afford X; I can order it online for just Y cents" is entitled and dismissive: that's not the reality for many people, especially in the US.

Meanwhile, a not-insignificant percentage of these people live in places where they can, in fact, see a doctor, get blood tests, and get basic prescriptions for free (money). They often can't take advantage of these benefits--not because of the costs, but because of the time (taking a day off from work? Not an option.), bureaucratic red tape (paperwork, call random people and wait on hold for hours), and lack of awareness (how do you know these services exist, especially if you don't speak English or even know to look for them?).

I hear you.

Gentle reminder: every CVS and Walgreens I've ever gone into has Amazon gift cards someone can buy with cash and use them to pay for stuff on Amazon.

I can only speak for people I know, but I think the logistics of that are right up there with "take advantage of free healthcare that's available at your income level." They have to:

1. Know that the option is available

2. Have a stable home--Amazon doesn't work well if you're homeless or couch-surfing

3. Speak English, assuming you're in the US (this is a big one)

4. Have consistent access to a computer or a cell phone

5. Have consistent access to the internet--not a given when you keep defaulting on your cell phone payments

6. Have the time, energy, and intelligence to figure out how to get an Amazon account working via non-traditional methods--it sounds silly, but this is a real problem if you're juggling just as many jobs as kids.

#1, #2, #3 are really difficult for a lot of people. Even in places where people would be eligible for some minimal level of free healthcare, they're still significant hurdles.

I ordered off Amazon while homeless and sleeping in a tent.

Yes, there are people who absolutely cannot readily make their lives work. I still struggle to make ends meet, though it's better than it used to be and I'm at least no longer homeless.

But you seem to be pointlessly beating a dead horse here. There may be a good argument for "We should just give away help for the most vulnerable during the pandemic because protecting them protects others." but beyond that I don't know what your point is.

> but beyond that I don't know what your point is.

The ancestor to which I'm responding was suggesting that self-medicating at prescription-level doses was a viable option. It's not:

1. If you can get the tests to show that you actually need prescription-level dosing (rather than OTC dosing), then you can get the prescription far cheaper than the OTC medication anyway.

2. If you can't get the tests, then you shouldn't be taking a higher-than-OTC dose without a damn good reason, and we sure as heck shouldn't be encouraging that here or treating it as a priority--although I think the ancestor was half-joking.

This particular branch of the discussion isn't about OTC dosing. If you want to just take normal supplements at normal doses, go right ahead. Don't think you need to allocate money to go higher than that, especially when there isn't really a guarantee that it will even be safe, much less necessary.

All I'm seeing is this statement which is factually correct: 50,000 IU dosages aren’t really available by prescription only when 5,000 IU pills are OTC.

A lot of people on this forum are very comfortably well off. I'm not one of them and I do what I can to educate people, both here and elsewhere, about the reality of what a lot of poor people live with. But that seems to mostly be irrelevant to the points people here are making today.

I'm not sure why you seem to feel so compelled to argue so strenuously that everyone here is missing some important details about how the poorest of the poor live in the US. I really don't think they are. I think that's just mostly got nothing to do with this discussion at the moment.

I also think HN is fairly well informed these days overall on such topics because they put up with me being openly homeless for nearly six years and I still sometimes write about that and sometimes hit the front page on such topics. So the crowd here isn't generally all "la la la, not listening." This just seems honestly not relevant to the discussion, at least not in the way it is being approached.

Yeah, you seem to have gotten my original point and I’m super surprised where this discussion turned. It was just a normal hacker spirit response to “You can only get X from Y” with “I can get Z and make X easily”.

Indeed, I apologize--I certainly did get carried away with a hypothetical. The mere thought of someone actually going out and doing that triggered all kinds of panic.

> All I'm seeing is this statement which is factually correct: 50,000 IU dosages aren’t really available by prescription only when 5,000 IU pills are OTC.

I think it was probably intended to be somewhat humorous, and yes, it's technically correct. However, it makes little sense if taken as factual rather than humorous: you shouldn't be exceeding the OTC dosage unless you know you need to; you can't know you need to exceed the OTC dosage unless you are tested; if you're tested, you're eligible for a prescription to get it cheaper anyway.

> I'm not sure why you seem to feel so compelled to argue so strenuously that everyone here is missing some important details about how the poorest of the poor live in the US.

Money is only one factor, and I think that's something people on HN tend to forget.

> I'm not sure why you seem to feel so compelled to argue so strenuously that everyone here is missing some important details about how the poorest of the poor live in the US.

I should clarify that this is largely anecdotal. I only know a handful of people who have been in these situations. I wouldn't even say they're the poorest of the poor: there are often other factors at play, be it mental disorders, language barriers, or a combination thereof.

> I also think HN is fairly well informed these days overall on such topics because they put up with me being openly homeless for nearly six years and I still sometimes write about that and sometimes hit the front page on such topics. So the crowd here isn't generally all "la la la, not listening."

I would agree; it's certainly one of the better communities in that regard.

> This just seems honestly not relevant to the discussion, at least not in the way it is being approached.

Quite possibly, especially considering that the ancestor was probably joking. Still, I can't help but cringe at the thought of someone I care about hearing that the solution to their COVID troubles is to waltz into the nearest pharmacy, spend their food money on a bottle of vitamin D, and down 10 of them at once.

The original commenter was not joking and not recommending anything: https://news.ycombinator.com/item?id=25620199

I think you are just reading in something that wasn't intended. That's not at all uncommon. HN is somewhat prone to being more literal than a lot of people expect other people to be.

Anyway, in the interest of not putting more focus on this, I don't intend to reply further.

> I think you are just reading in something that wasn't intended.

Almost certainly, as I'm wont to do. I appreciate you humoring me and taking the time to explain regardless.

I think you’re very in touch with reality of people who are unbanked and have access to free healthcare, and very out of touch with people outside of that group. There are a lot of Americans who could swing $2/month and can order on Amazon (which accepts gift cards you can buy for cash) but wouldn’t be able to upgrade insurance plans (upgrade often meaning “get insurance”).

While that does include a significant percentage of America, I would argue that, for the time being, that $2 is better spent elsewhere. Unfortunately, this part of the argument is fairly subjective. Is $2/mo/person on vitamin D worth it? ...maybe, but do we really know that yet? Would that $2 be better spent on something else that would have more definitive long-term benefits?

Ultimately, I don't see the logic in encouraging people to prioritize self-medication with vitamin D. Of all the issues about which we could raise awareness, that seems like one of the most misguided and short-sighted: it's focused on the pandemic of today, not the healthcare of tomorrow. Of course, it's possible to raise awareness about multiple issues, but to me this feels like one of the most out-of-touch with reality. As a concrete, one-step-up example, what about vitamin C? I would assume you're more likely to get scurvy than rickets as a working-class Westerner, though I haven't checked the numbers.

Uh, the pandemic of today is pretty important. I’m not sure I would characterize trying to slow it down as “shortsighted”.

And, the point of vitamin D supplementation isn’t to avoid rickets. That’s what the RDA is based on and there’s increasing evidence that while that’s an easy threshold to cross, it’s way too low. People don’t get enough sun and low vitamin D levels seem to have a serious negative impact on health.

Perhaps, and taking a normal OTC dose of vitamin D might be prudent. My argument here is exclusively with regards to encouraging people to self-medicate at higher-than-OTC doses when they don't even know that they need such a dose in the first place. Encouraging people to pop 10x 5,000 IU pills seems like a recipe for disaster.

One a day is fine, as it recommends on the label.

Have you considered the risk of receiving counterfeit goods in this suggestion? There are numerous threads on this board, and numerous articles on the internet, detailing the dubious quality of goods coming out of Amazon these days. With co-mingling of stock, it’s not even possible to pick a “reputable” seller to avoid this risk.

How does an ordinary person test that we’ve actually received the supplement that was ordered, and not something else entirely? Amazon is the Wild West compared to a drug store.

At least personally, I don’t worry about it. Fraud seems more common with supplements with high material cost and low manufacturing, like a bulk powder of something exotic.

If I were on a tight budget and didn't have a prescription, I'd definitely get mine from Amazon. It's a relatively cheap, generic product. I'd be a little worried about other unexpected chemicals being mixed in, but food is probably even more of a concern in that regard. On the scale of things to fret over if you're short on cash, vitamin D sourcing is probably pretty low.

Besides, what are the chances that a local store's vitamin D is actually higher-quality? It wouldn't surprise me in the slightest if they both ended up coming from the same place.

It's $5 a season at Trader Joe's.

As far as I can tell, that’s for 1,000 IU. You’d have to take 50 pills per week to achieve the dose described here. That would be more like $3/wk.

As others have pointed out, Vitamin D is extremely cheap regardless of where you get it if you buy the higher strength pills. You also don't want to overdo it over the long term.

If you're deficient, many doctors will prescribe some large loading doses, but from the studies I've seen, going above 10,000 IU/day over the long term has the potential for hypervitaminosis. Also from the studies I've seen, 2,000 IU/day long-term is enough to prevent deficiency.

Lots of people don't like Amazon, but you can get a bottle of 250 or so 5000 IU tablets for about $20. This is enough to last a couple of years at 2000 IU/day. There are few people in the U.S. that cannot afford something that costs $1/month.

A lot of places gouge on the prices. Trader Joe’s and Walmart are two that don’t.

Nope, they have a 5k for the last two to three years and the higher dose has largely taken over the shelf. I know because I have bought about a dozen of them this season at $4.99 and given them out as holiday presents.

https://www.traderjoesreviews.com/product/trader-joes-vitami...

Forgot, Walmart is another place with good prices on vitamins.