Edward Mills from the Canadian College of Naturopathic Medicine carried out the research with colleagues from University of Toronto and University of Exeter. The aim was to find out what advice health food store employees give people who seek alternative treatment options for breast cancer. The researchers found that, "health food stores are recommending a variety of products, […] none of which are supported by sufficient evidence of efficacy ".
The average cost of these products was $58 per month, with the more expensive remedies of up to $600 relying on "insufficient or questionable research". In addition, many recommendations were unaccompanied by discussions on the possible adverse effects of the product, or its potential interaction with conventional cancer treatments.
To collect the data, eight people, who had been trained to act as customers whose mothers' were suffering from breast cancer, visited 34 Canadian stores. They browsed the store until approached by an employee and then asked for product recommendations, giving information about their mothers' treatment regime only when asked. They then followed a memorised questionnaire to get information about the costs involved, the usage, effectiveness and safety of the product offered and the relevant education of the employee.
33 different products were recommended, none of which was supported by evidence of effectiveness. 23 employees (68%) did not ask whether the patient was taking prescribed medication. Only three employees (8.8%) discussed the adverse effects of the products and only eight employees (23.5%) pointed out that the products might interact with prescribed drugs. Two employees suggested that the products may cure the breast cancer, and one counselled to cease conventional treatment with Tamoxifen because it was "poisonous".
Only three of the employees had had any formal education in complementary and alternative medicine. Several said that formal education was unnecessary, and others that working in the health food environment for several years was experience enough.
The authors ask for educational initiatives to be aimed at health store workers to create a safer and more evidence-based health food business. They say that many patients are attracted to natural health products because they consider them natural and therefore less toxic than prescription medicine. Yet, recent reports suggest that these products may interact with drugs used in chemotherapy, by reducing their effectiveness or increasing toxicity. Mills and colleagues urge physicians to be aware that their patients could be taking natural health products and that these may be the source of unexplained reactions to treatment.
Mills and his colleagues believe that action is needed: "Governing bodies should consider health food stores as commonly utilised, yet unregulated, sections of the health care system…Regulators need to consider regulations to better protect vulnerable patients from incurring significant costs due to their purchasing of natural health food products lacking evidence of benefit and of questionable safety."
Mills said, "Patients with breast cancer are in the difficult situation of seeking treatment options and are susceptible to misinformation. It is unfortunate that we do not have better evidence of risks or benefits of natural health products to guide decision making for this vulnerable population".
This article is freely available online, according to Breast Cancer Research's policy of open access to research articles.
Health Food Store Recommendations: Implications for Breast Cancer Patients
Breast Cancer Research Vol. 5 No. 6
Edward Mills, Edzard Ernst, Rana Singh, Cory Ross and Kumanan Wilson.
Published 6th August 2003
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