Beware of Unhealthy Health-Store Recommendations

Aug. 14, 2000 -- A customer browsing the book section of the Sunshine Grocery natural foods store in Nashville, Tenn., will find 16 different titles dealing with alternative therapies for cancer. Some of the books tout such unproven treatments as shark cartilage supplements and mushroom extracts, while others claim that changing your diet can cure malignancies.

Some make relatively modest claims, but others promise nothing short of a miracle. The back jacket of The Cure for all Cancers, for example, boasts: "Give me three weeks and your oncologist will cancel your surgery." Its sequel, The Cure for all Advanced Cancers claims a success rate of 95%, and promises "you can count on this method, not merely hope it will work for you." To find out what "this method" is, you'll have to shell out $21.95 per book. Both are shrink-wrapped to prevent in-store perusal.

As more people turn to alternative medicines, the role of natural-food stores as conduits for these therapies has grown. And employees of these stores are often more than willing to offer health care advice and recommend specific products, even for life-threatening diseases such as cancer, according to a new University of Hawaii study published in the journal Archives of Family Medicine.

Patients' acceptance of alternative therapies, often at the expense of more traditional treatments, has become a "huge problem" in the past few years, Memorial Sloan Kettering Cancer Center researcher Barrie R. Cassileth, PhD, tells WebMD. Cassileth, who has been studying alternative medicines in cancer for two decades, says as many as one in 10 newly diagnosed cancer patients now refuse doctor-recommended courses of treatment in favor of alternative approaches.

"Whereas 15 or 20 years ago these therapies were underground, today patients hear about them everywhere -- through the books sold in these stores, on the Internet, all kinds of places," Cassileth says. "It is very common for patients with very treatable cancers to chose alternative therapies over traditional medicines. I personally know of two very educated, intelligent women who were diagnosed with early-stage breast cancer, which is entirely curable. They both went to healers, who claim to cure disease through the magical energy coming from their hands. Both of the women died."

But Mary Ann Richardson, MD, program officer for the National Institutes of Health National Center for Complementary and Alternative Medicine, says alternative approaches can enhance, rather than hamper, traditional treatments for cancers. She adds that as more patients explore these therapies, more physicians are learning about them.

"I don't think we should just uniformly discount and disregard these therapies," she tells WebMD. "I think what we need is more studies and forums where there can be an exchange of ideas and information."

In the University of Hawaii study, a researcher posing as the daughter of a woman with advanced breast cancer who had failed traditional treatments visited 40 health food stores. The researcher asked store employees to recommend alternative therapies for her mother, and to suggest specific products.

While some salespeople were reluctant to provide such information, says study author Carolyn Cook Gotay, PhD, most readily offered opinions and made recommendations about specific products. More than half of the employees who were questioned referred the researcher to books being sold in their stores, while 35% told her which products were most popular with cancer patients, and 20% suggested specific diet changes.

The health-food store employees recommended 38 different alternative products, with shark cartilage and oil recommended at 17 stores. Essiac, a blend of four herbs apparently first brewed by Native Americans, was recommended at eight stores, and capsules containing an extract from the Japanese maitake mushroom were recommended at seven.

The researchers noted that none of the health-food store employees mentioned potential side effects of using the recommended products, nor did they explain possible interactions with doctor-prescribed therapies. There is a growing body of research that shows these interactions can serious affect the outcome of treatment, and that cancer patients often do not tell their doctors they are taking alternative medicines. High doses of antioxidants taken during chemotherapy, for example, have been shown to counteract the effects of the anticancer agents.

A spokesperson for the Wild Oats Markets Inc., based in Boulder, Colo., says employees of their natural-food stores are trained in an informal way how to deal with customer inquires about chronic and life-threatening health problems. Wild Oats is the nation's second-largest natural-food market chain with 115 stores across the country, including Nashville's Sunshine Grocery.

"When someone comes in with a serious condition like cancer, it is not our place to make recommendations, and our staffers are trained to that effect," Wild Oat's vice president Karen Lewis tells WebMD. "Part of our training is to clarify the appropriate use of information. We can only hope that it is being done 100% of the time, but we can't know that."