Clinical Briefs
With Comments from John La Puma, MD, FACP
Health Store Products for Breast Cancer
December 2000; Volume 3; 143-144
Source: Gotay CC, Dumitriu D. Health food store recommendations for breast cancer patients. Arch Fam Med 2000;9:692-699.
"Despite cancer patients’ widespread and growing use of complementary and alternative medicine, minimal attention has been paid to the role of health food stores in the supply side’ of this phenomenon. In the summer of 1998 in Oahu, Hawaii, a research assistant posed as the daughter of a breast cancer patient with recurrent disease with bone pain on tamoxifen, and surveyed health food store personnel on their product recommendations for cancer care.
"The assistant visited all health food stores (n = 40) offering products for cancer patients. She indicated that this was the first store she was visiting and that she was here to gather and record information for her mother and not to purchase any products at this time. She rehearsed a script, to include six questions: (1) How does the product work? (2) Do you recommend any particular brand (if more than one brand available)? (3) Could I write down some prices? (4) How much of the product does my mother need to take per day? (5) Can the product(s) be taken together with the medication my mother is receiving from her physician? and (6) Is there anything else you can recommend?
"Personnel at four stores did not make any product recommendations, whereas in 36 stores, 38 different products were recommended for breast cancer. Only five stores (13%) asked the customer questions about her mother, such as her age, more information about her cancer site, and time of diagnosis, before making recommendations. Eight stores suggested that the customer’s mother participate in a structured program usually provided by the store, such as consultation with a store-employed specialist, a personalized program of products, or diagnostic tests. Twenty-one stores (53%) directed the customer to books, articles, and brochures, including promotional material with ingredient lists, physician and/or patient testimonials about a product’s effectiveness, and general health advice (e.g., information about blood analysis, parasite treatment). The most popular in-store reference or suggested book purchase was Prescription for Nutritional Healing.
"Suggested mechanisms of action drew on traditional healing, scientific, and pseudoscientific rationales. Costs for recommended dosages varied widely across stores and brands. No salesperson mentioned any potential adverse effects of using store products alone or in combination with conventional cancer treatments.
"We conclude that retailers supplying supplements can play an important role in the network of authorities’ for patients with breast and other cancers, as they readily provide advice and recommend products. The reasons why patients seek health food store remedies are useful in developing approaches to patient education."
COMMENT
This novel, fascinating study from Hawaii has some glaring methodologic flaws: no truly standardized template; no consistently identified responsible store employee, such as a manager; geographic isolation and bias; small sample size. But it makes up for these problems by presenting new hands-on, practical information.
Health food stores—not doctors’ offices—are where cancer patients get their information about alternative therapies. Fully 17 of 36 stores recommended shark cartilage...even with phase 1 and 2 studies showing its lack of effectiveness. Eight recommended Essiac, a combination of herbs with precious little supporting data; and seven recommended maitake mushroom extract. Several recommended known toxins (germanium) and at least one recommended a supplement which, in very large amounts, has been shown to increase the incidence of lung cancer in smokers—beta carotene. (See Table 1.)
| Table 1-Products most frequently recommended by health food store personnel for metastatic breast cancer patients |
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| Herbal Product | # of Stores | ||
| Essiac | 8 | ||
| maitake mushroom | 7 | ||
| flax seed oil | 3 | ||
| pau d'arco | 3 | ||
| pine bark extract | 3 | ||
| wheatgrass | 3 | ||
| clorophyll | 2 | ||
| garlic | 2 | ||
| huang chi (Astragalus) | 2 | ||
| red clover | 2 | ||
| una de gato | 2 | ||
| Nutritional/ Food Supplements |
|||
| coenzyme Q10 | 5 | ||
| vitamin C | 5 | ||
| germanium | 4 | ||
| IP-6 (vitamin B derivative) | 4 | ||
| vitamin A | 3 | ||
| multivitamin | 3 | ||
| selenium | 2 | ||
| vitamin E | 2 | ||
| Pharmacological/ Biological Agents |
|||
| shark cartilage | 17 | ||
| pancreatic enzyme | 2 | ||
| parasite-killing agent | 2 | ||
| shark liver oil | 2 | ||
| Adapted from: Gotay CC, Dumitriu D. Health food store recommendations for breast cancer patients. Arch Fam Med 2000;9:692-699. |
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The investigators calculated the annual cost of a course of shark cartilage treatment ($499-$1,066); Essiac ($360-$3,433), and maitake ($300 to $1,050). The oft-used quasi-medical concepts of cleansing and balancing can correlate graphically with the diuretic and emetic properties of some of the recommended supplements (astragalus, and pau d’ arco and wheatgrass, respectively).
The investigators did not report the mean time employees spent per customer; calculate the clinical effect of employees wearing white lab coats, or of using charts, graphs, and physician testimonials; or assess the impact of excerpts from scientific journals. But the authors do recommend, presciently I think, joining health food stores (instead of opposing them) in patient education:
"Health care organizations might consider educational activities aimed at these individuals and the general public to increase knowledge and promote cooperation rather than antagonism. Such education could increase the probability that both consumers and sales personnel would consult providers about possible drug interactions and other concerns related to health product use in the future."
Recommendation
Ask your breast cancer patients exactly what else they are taking—most are taking herbs and nutritional supplements for immune modulation. Ask them to bring the bottles. Give them reliable sources to get better information than they’ll get at the health food store. Use www.aicr.org (The American Institute for Cancer Research) to start.
December 2000; Volume 3; 143-144
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