Salespeople are employed to sell goods; healthcare workers are employed to provide medical care. The line between the two becomes blurred, though, when health food store employees step out of their role as salesperson and offer medical advice to their customers. An article in a recent issue of Archives of Family Medicine highlights issues that consumers should be aware of before they listen to healthcare advice from health food store employees.

Researchers in Oahu, Hawaii identified 40 health food stores that sold herbal remedies and/or dietary supplements. One researcher visited each store, posing as the daughter of a woman with breast cancer. She described the medical problems of this fictitious cancer patient to a salesperson in each store, with all of the physical and emotional symptoms scripted so that each employee heard the same information. The researchers kept track of the number of times store clerks offered treatment advice, and noted what kinds of products they recommended to help the "patient."

Sales people in 36 of the 40 stores recommended at least one herb or dietary supplement as a treatment for cancer. They mentioned shark cartilage and oil most often, followed by wheatgrass, essiac, coenzyme Q10, and vitamin C. They described these products as "cleansing," "immune-boosting," or able to restore the body's "balance." The recommended dosages (and the cost) of these products varied from store to store. Not one of the salespeople mentioned that these therapies can have toxic side effects or interfere with conventional medications or treatments.

People turn to "natural" or "alternative" medicine for numerous reasons. They may distrust the medical community, or they may want more treatment options than conventional medicine can offer. But health food store employees do not have the training needed to provide medical advice, and much of the printed materials they rely on for information have been produced by the supplement manufacturers. The claims made in these materials may not be supported by credible scientific references.

To protect themselves, health food retailers tend to describe the products they sell in vague terms that are hard to quantify. Coenzyme Q, for example, is called an "immune system stimulant" and red clover a "blood cleanser." While these terms sound promising, they are carefully worded so as not to assure any specific medical results. As such, these claims are allowed in the US. But they have earned the supplement industry a dubious reputation among those in the scientific community, who need proof that these products are medically useful.

People with chronic illnesses or those who have exhausted conventional treatment options may be especially receptive to the implied health claims made by supplement manufacturers. But just like prescription medications, herbs and other dietary supplements may have side effects, may reduce the effectiveness of other medications, or both. That is why patients should always inform their physician before they add any herbs or dietary