Health store staff hurting industry?

Retailers of health foods could present significant risks to breast cancer patients, report researchers today. They are calling for regulations to ensure that health food shops provide consumers with better information on the products they buy.

The team from the Canadian College of Naturopathic Medicine, the University of Toronto and the University of Exeter in England, says that "health food stores are recommending a variety of products, […] none of which are supported by sufficient evidence of efficacy".​

Their study, carried out in more than 30 Canadian health food shops, shows that breast cancer patients may be at risk from ineffective and potentially harmful natural remedies, write the scientists in the journal Breast Cancer Research​.

Costing on average $58 per month, with the more expensive remedies nearer to $600, the recommended products relied on "insufficient or questionable research"​, reported Edward Mills from the Canadian College of Naturopathic Medicine and colleagues.

In addition, many recommendations were unaccompanied by discussions on the possible adverse effects of the product, or its potential interaction with conventional cancer treatments.

"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,"​ said Mills.

To collect the data, eight people, who had been trained to act as customers whose mothers' were suffering from breast cancer, visited 34 stores, excluding Asian herbal suppliers, in a major Canadian city. 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.

None of the 33 different products recommended by retail employees was supported by evidence of effectiveness, reports the study. Essiac and Floressence were most widely recommended, but supplements such as multivitamins, beta-carotene and pycnogenol were also suggested. The authors claim that with the exception of small trials examining vitamin C and coenzyme Q10, none of the others are known to help treat breast cancer.

Twenty-three employees (68 per cent) did not ask whether the patient was taking prescribed medication and only three (8.8 per cent) discussed the adverse effects of the products, with eight staff (23.5 per cent) pointing 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', revealed the study.

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. There is evidence that some herbal and natural remedies may interact with drugs used in chemotherapy, by reducing their effectiveness or increasing toxicity. Such products could be the source of unexplained reactions to conventional treatment, add the scientists.

"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,"​ claimed Mills.