Shaun Holt of Natural Remedies That Work fame has been at it again. He has just published a study detailing the type of advice from health shop attendants given to a “client” who was pretending to have severe, untreated blood pressure. Only one of 26 attendants suggested seeing a doctor. Most suggested a garlic-containing compound of some sort. Unfortunately, while garlic may be useful in hunting down vampires, it is of very limited use in hypertension (high blood pressure). In fact the only non-medical treatments shown to be unequivocally effective in treating hypertension are exercise and weight loss. Salt restriction also sometimes helps.
Here is Shaun’s conclusion:
“To provide quality advice to customers, staff working in health food stores need to give accurate and safe information on a variety of medical ailments. We recommend the implementation of a formal training programme for health food store staff, and to improve the quality of health care advice including referral to a medical practitioner where appropriate. We also recommend that complimentary and alternative medicines use in New Zealand is regulated.”
Actually, these two suggestions are indivisible. There is no way the health shop owners will train their low-paid shop assistants unless the entire Complimentary and Alternative Medicine (CAM) industry is regulated properly. While the industry is regulated by the wholly inadequate food legislation, no employer will waste money on training, simply because it neither increases his/her profitability , nor does it decrease his/her liability and risk, because CAMs are classified as food supplements. The law does not expect health shop assistants to be knowledgeable on medical matters.
One could be cynical about this and ask what person in his right mind would ask for advice on a true medical condition in a health shop? Unfortunately, the answer is that many people do indeed see a health shop as a place that dispenses proper health advice. Many of these people view CAM therapies as a viable alternative to conventional treatment rather than as a supplement to a health lifestyle. While many CAMs do indeed have therapeutic uses, some real knowledge of disease and diagnosis is needed before they can be used appropriately.
A big part of the problem is the strange kind of war that is played out between alternative and conventional medicine. Both sides tend to be dismissive of one another and go out of their way to undermine the other’s value. The result of this internecine struggle is that people become polarised and the necessary co-operation between doctors and alternative medicine required for the safe therapeutic use of CAMs is lost. Even Shaun’s study is somewhat confrontational, using an “entrapment” technique rather than a more up-front questionnaire style.
The reality is that CAM therapies are unlikely to ever be 100% accepted in medicine. Academic medicine is besotted with the “double-blind randomised controlled trial”, an expensive device in which few CAM therapies can afford to partake. Drug companies rarely fund CAM trials except to pace the CAM therapy against the latest super-duper drug; hardly a “fair fight”. There is little money in the CAM industries to do worthwhile trials and the effect of CAM therapies is usually small but cumulative – needing very long trials, which are even more costly. The consequence of this is that most of the studies on alternative therapies are small and equivocal, making doctors wary of their value.
Regulation of the CAM industry will probably make little difference to this situation. It is unlikely to end the “war” and unlikely to gain any respect for CAMs amongst the medical profession. The only real value I can see in regulation, apart from avoiding the odd poisoning of a client by an over-enthusiastic health assistant, is that cheaper products will be forced out of the market. One of the biggest problems with vitamins and supplements is the millions of dollars wasted ever year on poor quality product that are poorly made and poorly absorbed. At least these pathetic excuses for supplements will cease to con people and allow them to take decently made products.
And at least we won’t be trying to kill the vampire of hypertension with a little bit of garlic and horseradish…
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Apr 25 09 3:04 am
I’m doubtful any kind of questionaire could give an answer to exactly what advice is dispensed at these shops, way to easy to lie.
I’d say training would be of little to no value in this situation and wouldn’t change a thing because first and foremost they are there to peddle their largely valueless wares and secondly, their training would consist of the same pseudo-scientific nonsense that leads to the sale of garlic for hypertension. The GIGO principle is in operation here – an iridologist can be ‘well trained’ but because it’s no better than a random guess the result is still garbage, same as training them in the folklore that surrounds much of what they sell. I think expecting them to be trained at any level that requires that they assess people and recommend appropriate treatment is well beyond practicality. You’d be wanting something more akin to the training a pharmacist gets. I’d also disagree that the multi-billion dollar CAM industry can’t afford to fund a few studies, surely they could use some of their profits for that. The reality is that organisations like NCCAM in the US have been given millions in funding to do studies with largely negative results which then are ignored by the industry. Echinacea for colds was one of these if I remember correctly.
Looking at the way the industry with a few notable exceptions reacted regarding the Therapeutics act I don’t think they want regulation, even if it protects the consumer. I didn’t realise expecting that products are standardised, not spiked with real pharmaceuticals and safe was such a big ask. Far from being dismissive, I’d perceive that there is a lot of antipathy towards medicine from so-called alternatives probably as a result of competing for health consumers money. A recent article in Stuff describing a woman who went to a light therapist to treat breast cancer (now receiving palliative care) who she said “…the therapist told her doctors were “medical mafia and butchers”… http://www.stuff.co.nz/national/1396697 If that is any example, along with them being able to promote it as natural and effective with no side-effects what person would refuse, after all what everyone wants is the quick and easy way to good health that doesn’t require they get off their butts and actually do something like diet and exercise. The conspiracy theories feeding into everyone’s natural suspicion of government and corporate control are just icing on the cake in that situation.
I think it’s time that doctors and pharmacists, instead of trying to engage should speak out about the evidence because of the risk of harm. The term alternative medicine is really an oxymoron anyway, because medicine consists of proven treatments and therefore by definition any alternative is unproven. Because the ‘treatment’ promoted is often ineffective leading to disease progression or because of the various known problems with many products including the way they are marketed it’s high time something was done to address this. Instead I feel depressed every time I walk past my pharmacy with the big signboard touting a iridologist and shelves full of nonsense next door to real medicines, and that’s even before I get to the health food shop happily selling colliodial silver and garlic etc etc as treatments for whatever ails you.
Apr 25 09 7:58 am
Hi Macdoctor – nice post, I agree with most of your comments and also most of Michelles. Just a few things that I’d add….
In terms of natural products for hypertension, there are some with reasonable evidence: Coenzyme Q10 particularly, and to a lesser degree Omega-3, Magnesium and Calcium. I list some of the studies here…
http://www.thevitaminlab.co.nz/high_blood_pressure_ebr.html
The recomendations were those of the group of authors, but I actually don’t favour regulation. As a libertarian, I prefer the free market to sort things out and this study helps that process by giving people the information they need to make informed choices, which this study does. This clip from TV3 news has an example of a natural health person who wants to train her staff:
http://www.youtube.com/watch?v=meyt9dTPed8&feature=channel_page
Yes, I agree its confrontational, but its the only way to find out what happens in this situation in real life, and you’d be amazed how many laypeople think that health food store staff know what they’re talking about, as they’re usually very pleasant
Thanks again
Shaun
Shaun Holt’s last blog post..Another of our studies on Health Food Store advice
Apr 25 09 9:19 am
There are some books out there that recognise people *will* try alternative medicines for their conditions, and simply point out the safety of each product along with whatever trials have been done.
To be honest, I think thats about all that can be done for a great many people, ie keep them from harm until its appreciated that apart from pills and potions the alternative people are selling hope and some sort of spiritual nourishment.
Keep up the Prozac, Mac
JC
Aerial spraying of prozac, that’s the ticket…
Apr 25 09 9:50 am
Michelle: I’d also disagree that the multi-billion dollar CAM industry can’t afford to fund a few studies, surely they could use some of their profits for that.
The problem is not the lack of money, but the lack of patents. A study on Vitamin C, say, would not benefit a single company. The answer, of course, is for the CAM companies to join together and fund studies. Unfortunately, they seem to be as much at war with themselves as with conventional medicine.
I’d perceive that there is a lot of antipathy towards medicine from so-called alternatives probably as a result of competing for health consumers money.
The attitude you describe is bilateral. I have been using Vitamin D for years and, until two or three years ago, was mostly laughed at by my colleagues. Even your view is polarised into the “all our treatment is proven, while all yours is fake” myth. There is stuff we do in medicine that is dubious to say the least. There are CAM treatments which actually work.
Apr 29 09 11:39 am
If my view is polarised, what stuff do Health food shops sell have any kind of decent evidence for and what CAM does work? I know Homeopathy would require rewriting the laws of physics, Iridology, that promising to talk to your DNA and chelation (with a pharmaceutical drug no less) for heart disease is a load of tosh. Acupuncture, if it works has nothing to do with Chi, because fake acupuncture works just as well as real acupuncture. Even then, there’s nothing really there to suggest it does much other than possibly helping for some pain conditions. Still doesn’t stop all of it being offered though. It’s not noticeable that there is much there, particularly in the herbal remedy side of things where much of the folklore I’m talking about comes into it. I don’t know if taking a vitamin tablet is a good example really – this has been well studied and there are a number of things for which supplementation is recommended like the benefits of iron if you are deficient or folic acid before/after you get pregnant. I was urged to take folic acid to prevent neural tube defects, no one had a problem with it. Actually standard diet advice has been co-opted as well, that not alternative either. My mum was telling me to eat my vege’s when I was a little kid. Didn’t need a whole industry for it back then. It’s about being realistic about the claims similar to “boosting the immune system!!!” I don’t what that means, and even if the product does this, is this a good idea? I thought auto-immune diseases were the result of an overstimulated immune system which might be a bit simplistic but hopefully it’s in the right ball park (I hope so anyway).
Maybe there is some scepticism from some but as a health consumer, I have to say I don’t see antipathy from health care workers on CAM – some embrace it, others are agnostic and there’s a few that are doing the work Shaun Holt is and actually looking at the evidence for and against. The difference I see is that a doctor, if a treatment is found to be useless (cough mixtures are a good example) they won’t recommend it but on the other side, there seems to be nothing that won’t be sold. You just don’t see doctors running around alleging conspiracies or that CAM practitioners are some kind of mafia out to kill you.
Getting on to patents, that isn’t a barrier as far as I can tell. Despite the lack of patentable ability there are certainly a number of companies profiting from selling CAM preparations and people are buying them. You might not be able to patent something like Vitamin C, but you can certainly patent a compound or specific preparation with that in it. There are also other protections such as trade marking/brand names, where I could brand some Vitamin or supplement as something like “Vitamin X” and gain protection that way. To compare, pharmaceuticals like Penicillin and aspirin are not under patent either, but the pharmaceutical industry happily makes money from generic preparations. That of itself doesn’t prevent them manufacturing and selling the product. I know they make hay while the sun shines while a product is on patent but there is the issue that they have fairly hefty R&D costs to cover. The CAM industry as a whole doesn’t do R&D – all that is required is to bung something into a pill, slap a label on it, make up a health claim and sell it. It’s taken outside funding, like NCCAM in the US to have a look at this stuff which could have and should have been done by the companies themselves. The CAM industry gets a free pass IMO, there isn’t any excuses for the lack of evidence for much of it.