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| Journal of the New Zealand Medical Association,
24-April-2009, Vol 122 No 1293
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High blood pressure advice given by natural health
food stores
Robert Siebers, Shaun Holt, Bridget Healy, Richard Beasley,
Carl Burgess
Complimentary and alternative medicines (CAM) are frequently
used for prevention: as definitive treatments or as adjuvant therapies in
disease states.1–3 These agents are
increasingly being used and it has been estimated that CAM attracted sales worth
US$4 billion in the USA in 1998.4
CAM-use has proved equally popular in the UK and Australia
with one recent survey showing that 1 in 5 respondents had purchased a
homeopathic or herbal medicine in the previous
year.5–7 The number of New Zealand CAM
users is unknown, but the proliferation of health food stores suggests that
these agents are equally popular with the New Zealand public.
In New Zealand, CAM are available in health food stores,
pharmacies, and supermarkets. These products are not registered medicines,
therefore they do not undergo the rigorous scrutiny that registered
pharmaceuticals are subjected to prior to registration and marketing.
Furthermore, unlike pharmacists, staff in health food stores are not required to
undergo any formal training in regard to the physiological or pharmacological
effects of the products that they sell. Nor are they required to have training
in the disease states that some of these products might be used for. This may
place customers at risk of being given ineffective, harmful, or indirect
advice.8
In an earlier study, we showed that advice provided by
health food store staff to a researcher presenting with symptoms of unstable
asthma was inadequate and could have proved harmful. There were major concerns
about the recommendations made to the use of ineffectual products that were sold
and only one-third of the staff referred the researcher to a doctor when that
was clearly the appropriate course of action.9
As individuals seeking advice from health food stores
present with a wide variety of chronic conditions, we were interested to see if
our previous findings would be replicated with a chronic medical condition other
than asthma. We chose a hypothetical scenario of an individual with newly
diagnosed hypertension, a disorder where various treatments (both
pharmacological and non-pharmacological) have been suggested and where CAM use
is high.10
MethodsA 53-year-old male individual visited 26 health food
stores and 26 pharmacies in two cities and two suburban areas in New Zealand.
The health food stores were randomly chosen from the telephone directory and
were matched with pharmacies in the same street or one street away.
The individual presented himself with the scenario of
having recently joined a fitness centre where a routine medical check had found
his blood pressure to be raised. If specifically asked, he responded that the
measured blood pressure was 160/120. He asked staff for recommendations to lower
his blood pressure. The individual purchased any product that was recommended.
All details of the consultation including information
of the purchased products were immediately recorded after the visit. A search of
Amed, Medline, and Embase databases was performed to find evidence of the
efficacy of the products sold.
The study was approved by the Wellington Regional
Ethics Committee.
ResultsIn all 26 pharmacies, the individual was referred directly
to a pharmacist if the first contact was with an assistant.
Twenty-five of the 26 pharmacists recommended an
immediate visit to a medical practitioner. One pharmacist recommended
antioxidants and multivitamins and suggested that these together with stress
reduction, regular exercise, and a fish meal once a week would reduce blood
pressure within 2 weeks.
In the health food stores, 25 of 26 staff did not
refer the individual to a medical practitioner, rather they recommended and sold
a wide variety of products, the most frequent being garlic (Table 1) which
accounted for 16 of the 25 preparations sold.
Table 1. Products recommended and sold by
health food stores
One health food store assistant recommended consultation
with an iridologist as she could see “a white ring of salt round his
iris”. She went on to inform the individual that she was qualified in
iridology and suggested a consultancy appointment with her.
Only 1 assistant out of 26 advised the individual on diet
and lifestyle and recommended that his blood pressure be checked, preferably by
a general practitioner. This health food store assistant did not recommend any
products.
DiscussionThere are several strategies recommended for the management
of hypertension with the usual first step confirming that the patient has a
truly elevated blood pressure. This was the first major difference in the advice
by the pharmacists and staff from the health food stores with only one of the
latter recommending that the blood pressure be checked by a medical
practitioner.
Dietary advice and lifestyle changes, such as exercise and
weight loss, are appropriate areas to target in these patients and maybe all
that is required in those with mild
hypertension.11 Such advice was provided by one
pharmacist and one health food store assistant, but it was mainly health food
store staff who recommended products without first establishing a diagnosis.
The second major difference was that health food store staff
sold products that were unlikely to be effective in the management of severe
hypertension.
The majority of compounds contained garlic at varying doses.
Its efficacy in hypertension is dubious at best with one meta-analysis showing
modest benefit,12 whereas a subsequent
systematic review was unable to confirm these
findings.13
Of the other CAMS sold, only coenzyme Q has been shown to
decrease systolic blood pressure in a randomised double-blind study in
hypertensive patients, there being no effect on diastolic
pressure.14 Lastly, hawthorn may have benefits
in patients with mild cardiac failure, but we are unaware of any studies
demonstrating a benefit in hypertension.15
The fact that the majority of health food store staff
recommended ineffective products and no further blood pressure checks amounts to
potentially harmful advice.8 Inadequate advice
has also been demonstrated in our previous
study.9 In that study a 21-year-old female
presenting with symptoms suggestive of moderate to severe asthma was referred to
a doctor by 92% of pharmacy staff, but by only 35% of health food staff.
Although a number of remedies were suggested by health food staff, in none was
there good evidence of efficacy in asthma.
In another study, similar poor advice was given to pregnant
women presenting with nausea in pregnancy.16
These researchers found that the majority of health food stores failed to supply
the correct dosage or duration of the anti nausea treatment that was
recommended. Of more serious concern was the fact that 5% of the recommended
products contained potentially teratogenic compounds. Other researchers have
also raised concerns regarding the advice and use of CAM in pregnant
women.17,18
Therefore concerns relate not only to advice provided to
customers, but also to quality control of the products sold. An attempt to
introduce a superior Australian regulatory processes for CAM in New Zealand
failed in 2007.19 It is crucial that this issue
is revisited to allow for the much needed regulation of CAM in New
Zealand.
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.
Competing interests: None known.
Author information: Robert Siebers, Senior
Research Fellow, Department of Medicine, School of Medicine and Health Sciences,
University of Otago, Wellington; Shaun Holt, Director, Clinicanz, Auckland;
Bridget Healy, Medical Registrar, Wellington Hospital, Wellington; Richard
Beasley, Professor, Medical Research Institute of New Zealand, Wellington; Carl
Burgess, Professor of Medicine, Department of Medicine, School of Medicine and
Health Sciences, University of Otago, Wellington
Correspondence: Robert Siebers, Department
of Medicine, School of Medicine and Health Sciences, University of Otago
Wellington, P O Box 7343, Wellington South, New Zealand. Fax: +64 (0)4 3895427;
email: rob.siebers@otago.ac.nz
References:
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