food store for breast cancer patients, part 3

food store for breast cancer patients, part 3

Discussion

Several important messages emerge from this analysis of
advice provided to breast cancer patients in health food
stores. These stores are recommending a variety of products,
none of which is supported by evidence of benefit. In
many instances the stores do not discuss the potential for
adverse effects of these products or the possibility of drug
interactions. In addition, in at least one instance in this
study, an employee recommended that a conventional
medical therapy (Tamoxifen) be discontinued. The findings
of our study are consistent with previous reports on the
practice of natural health food stores [12–19]. Other
studies examining advice provided about CAM on the
Internet, another readily available source, find that this
advice can also be misleading and could seriously harm
consumers [20].

All these findings highlight the importance of physicians’
awareness of the possibility that their breast cancer
patients are seeking advice and treatment from alternative
medical sources such as natural health food stores.
Patients might not disclose this information to their traditional
health care providers. However, the advice they
seek could have a negative effect on their response to
medical treatment and be the source of unexplained
reactions [21]. This study also highlights the vulnerability of
patients with breast cancer to potentially misleading information
from health food employees. Advice presented by
health food employees was authoritative and could be
misconstrued by patients as evidence-based, particularly
when books are consulted or literature is provided on the
products. This was illustrated by the two employees who
suggested that their recommended products could cure
the patient of cancer. It is important to note that, with the
exception of small trials examining the efficacy of coenzyme
Q10 [22,23] and vitamin C [24], there is no evidence
from clinical trials to support the use of the recommended
products by patients with breast cancer [25–27]. The distrust
of conventional medical treatments by individuals
who seek CAM might also be reinforced by dispensers of
CAM [28,29]. This was illustrated in our study by the
single employee who suggested that the patient discontinue
her chemotherapeutic drug (Tamoxifen) because it
was ‘poisonous’.

Many patients are attracted to NHP use because it is
natural, which is suggestive that this is less toxic than prescription
medication. Recent reports on adverse effects of
NHPs identify that several products once considered safe
might be harmful [5,10,30]. These risks are increased
when the products are used in large doses or chronically.
The heterogeneity of information about dosages increases
the likelihood for misuse. Recommendations such as
‘immune-boosting’ and ‘cleansing’ can be misleading to
patients as to the aetiology of their disease. The education
of employees about NHPs was also variable, with several
employees indicating that formal education was unnecessary.
Others considered that working in the health food
environment for several years was experience enough.

Breast cancer patients are susceptible not only to adverse
health effects owing to advice and treatments provided by
natural health food stores but also to incurring significant
costs from purchasing natural health food products. The
monthly cost of products ranged from $5.28 (CAD) to
$600 (mean $58.09). The products that were most
expensive, such as the herbal teas and mushroom
extracts, rely on insufficient or questionable research and
evidence based on folklore.

Our study has some important limitations. The consistency
of data might be limited by approaching only one
employee at each store; however, we believe that this is
the closest to a real-life situation that can be replicated for
a study. It is difficult to measure employees’ knowledge of
cancer through a brief encounter, and the quality of informative
literature varies substantially. It is possible that the
responses from employees varied according to each data
gatherer. It might be that gatherers presenting themselves
as breast cancer patients would have elicited different recommendations.
Although this study was conducted in one
city in Canada, we believe that the results could be widely
transferable, because several of the stores were national
chains. All research assistants were trained and had followed
a structured questionnaire; they had completed the
questionnaire immediately after leaving the store, to avoid
inter-observer variation in collection and recall.

A potential concern to the conduct of this study relates to
its ethical implications. In essence, this was an investigation
on human subjects without consent. Informed consent
is the cornerstone of research ethics [31]. However, there
are situations in which informed consent is not a necessary
precondition. This study might be such an exception:
first, there is little conceivable harm in not obtaining
consent in this particular setting; second, with informed
consent the investigation would not have been possible;
third, our aim was to investigate an area of potential harm
to consumers, which can be viewed as overriding concerns
about the potential of harm to shop assistants in this
setting. We therefore feel that, on balance, the study was
ethically justifiable, a judgement shared by the review
board that approved it.