Let me tell you about a small study which we published all of 18 years ago. It was conducted in Canada, and I merely assisted in designing the protocol, interpreting the findings and writing up the paper.
For this investigation, we trained 8 helpers to pretend to be customers of health food stores. They would enter individually into assigned stores; the helpers had been instructed to browse in the store until approached by an employee. At this moment, they would explain that their mother has breast cancer and disclose information on their mother’s condition, use of chemotherapy (Tamoxifen) and physician visits, only if asked. The helpers would then inquire what the employees recommend for their mother’s condition. They followed a structured, memorised, pre-tested questionnaire that asked about product usage, dosage, cost, employee education and product safety or potential for drug interactions.
The helpers recorded which products were recommended by the health food store employees, along with the recommended dose and price per product as well as price per month. Additionally, they inquired about where the employee had obtained information on the recommended products. They also noted whether the employees referred them on to practitioners of so-called alternative medicine (SCAM) or recommended consulting a physician. Full notes on the encounters were written immediately after leaving the store.
The findings were impressive, I thought: of the 34 stores that met our inclusion criteria, 27 recommended SCAMs, and a total of 33 different products were recommended. Here are some further findings:
- Essiac was recommended most frequently.
- The mean cost of the recommended products per month was $58.09 (CAD) (minimum $5.28, median $32.99, maximum $600).
- Twenty-three employees (68%) did not ask whether the patient took prescription medications.
- Fifteen (44%) employees recommended visiting a healthcare professional; these included: naturopaths (9), physicians (5) and nutritionists (1).
Health food store employees relied on a variety of sources of information:
- 12 (35%) of them said they had received their information from books,
- 5 (15%) from a supplier of the product,
- 3 (9%) had formal education in SCAM,
- 2 (6%) had been through in-store training,
- 12 (35%) did not disclose their sources of information.
Since our paper has been published, several other investigations have addressed similar issues. Here are a few quotes:
- Pharmacies and HFS in Greater Wellington provided potentially hazardous advice, recommending products, often branded for pregnancy, which contradicted NZ MOH guidelines. Regulatory reform of CAM products and those who sell them is called for in New Zealand.
- …only about one-quarter [of health food stores (HFSs)] gave appropriate advice regarding possible interactions with warfarin and management of anticoagulation compared with two-thirds of pharmacies.
- HFS promoting herbal products for medical conditions should be regulated in a similar fashion to shops that dispense pharmaceutical products.
- Staff in 25 out of 26 health food stores did not refer the researcher to a medical practitioner; instead they recommended and sold a wide variety of compounds of unproven efficacy
- Store personnel readily provided information and product recommendations, with shark cartilage being the most frequent.
And why do I mention all this today? The answer is that firstly, it is obviously important to warn consumers of the often-dangerous advice they might receive in health food stores. Secondly, I feel it would be worthwhile to do further research in this area, check whether the situation has now changed, and repeat a similar study today. Ideally, a new investigation should be conducted in several different locations, perhaps even compare several countries. My impression is that things have gone from bad to worse in health food stores – possibly related to the pandemic?
If you have the possibility to plan and conduct such an experiment, please let me know, perhaps I can be of assistance.