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9/19/2000

Health Food Stores Offer Cancer Patients Comfort, Advice

Kate Traynor

Clerks in health food stores offer empathy and advice—but say nothing about potential adverse effects—when discussing alternative treatments to breast cancer, according to a recent study in Hawaii.

In this study (PDF), which was published in the August issue of the Archives of Family Medicine, an undergraduate research assistant posed as the daughter of a breast cancer patient and spoke with store staff on her mother's behalf. Before the student contacted health food stores, oncology professionals reviewed the plausibility of the fictitious mother's medical history. The student used a partially scripted dialog to elicit responses from store staff and stopped asking questions when the clerk failed to offer additional suggestions. 

The student stated that her mother was taking tamoxifen for breast cancer that had recurred and metastasized five years after a lumpectomy and radiation treatment. Chemotherapy was to be started if there was no response to the tamoxifen. This fictitious mother was disappointed that conventional treatment had not cured her cancer and willing, for now, to forego additional medical therapies in favor of lifestyle changes. The mother was also said to have bone pain. 

According to the researchers, none of the store staff mentioned potential adverse effects of alternative therapies, either alone or taken in combination with conventional drugs. One store employee informed the student that natural remedies have no adverse effects. 

A clerk in one store advised the student not to treat cancer with herbs or natural remedies, advising "heavy duty medications" instead. However, clerks in 18 percent of the stores visited spoke out against conventional drug treatment of cancer. One clerk directed the student to a book section describing the ill effects of tamoxifen. 

The most frequently recommended alternative therapies for metastatic breast cancer were shark cartilage, maitake mushrooms, and essiac herb blends. Essiac, usually consumed as a tea and reportedly first used by Native Americans, is a base of burdock root, the inner bark of slippery elm, sheep sorrel, and Turkish rhubarb, with additional ingredients sometimes added. 

Prices for alternative remedies varied among the stores visited. A year's supply of shark cartilage cost $499 to $1066. Maitake products ranged in price from $300 to $1050 per year, while essaic preparations cost $360 to $3433. 

According to the researchers, shark cartilage has been reported to cause liver toxicity and other adverse effects in some patients. Also, dietary supplements such as ginger, garlic, and wheatgrass can cause clotting abnormalities, and high dosages of antioxidants can decrease the effectiveness of chemotherapy. 

At four of the 40 stores visited, the clerks did not suggest any alternative treatments; however, most clerks recommended more than one product. Store staff recommended a total of 38 unique herbal products, supplements, and pharmacological or biological agents. 

To avoid recall bias, the student wrote down data while in each store. The student told the staff that she sought treatment and pricing information and would not purchase products during the visit. Other notes and impressions were recorded by the student right after leaving the store. 

There was no statistical analysis of study data, but the authors noted common themes in the stores. Clerks used the words "cleansing" and " balancing" to describe many alternative products. Some staff wore lab coats or used charts, physician testimonials, or excerpts from scientific publications to lend a "look of the scientific medical establishment" to the store, the researchers reported. 

In a separate commentary, the student, a co-author of the publication, remarked on the atmosphere of empathy and trust that characterized certain stores. The student speculated that past experiences in conventional medical settings might make the perceived comfort of the alternative medicine environment attractive to patients. 

The stores visited in the study were identified from a total of 103 health food stores in Oahu listed in the Yellow Pages and the Natural Yellow Pages. Independent distributors, specialty stores supplying products unrelated to cancer treatment, and stores no longer in business were excluded. 

The researchers noted that cancer patients, who may undergo debilitating treatments that do not cure, are a receptive market for companies offering alternative therapies. 

The American Cancer Society (ACS) says it recognizes both the increased public interest in alternative treatments and the potential for adverse drug interactions. To help cancer patients who are thinking about replacing medical therapy with alternative therapy, ACS has developed a list of 12 questions that a patient or family member should ask before making this decision.