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Pharmacists Versus Health Food Store Employees: Who Gives Better Advice?

The accuracy of medical advice given by staff at natural food stores is compared to that by staff at community pharmacies based on the balance of available scientific evidence.

June 5, 2012 |
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Supplementary Info

Pharmacists Versus Health Food Store Employees: Who Gives Better Advice?, 5.0 out of 5 based on 1 rating

Sources Cited

Buckner KD, Chavez ML, Raney EC, Stoehr JD. Health food stores' recommendations for nausea and migraines during pregnancy. Ann Pharmacother. 2005 Feb; 39(2):274-9.

Temple NJ, Eley D, Nowrouzi B. Advice on dietary supplements: a comparison of health food stores and pharmacies in Canada. J Am Coll Nutr. 2009 Dec; 28(6):674-7.

Acknowledgements

Images thanks to Bexley Natural Market and Melonheadz.

Transcript

Yes, as we've seen, studies have shown over and over that health food store employees, on average, didn’t know what the heck they’re talking about, but maybe nobody does when it comes to supplements. Two North American studies were recently published—one in Canada and one here in the States—comparing the advice gotten from health food stores compared to community pharmacies.
In Canada researchers went in and asked questions like will ginsing give me more energy, beta-carotene help me prevent cancer, shark cartilage help cure my cancer?
What percentage of visits to 192 different health food stores were reserarchers given advice considered accurate, or fairly accurate, based on the balance of available scientific evidence. So 100% of the time? Half of the time? No, 7% of the time.
 Pharmacists, did about 10 times better.
In the U.S. study they got actors to walk into pharmacies and health food stores feigning classic symptoms of type 1 diabetes: excessive thirst and fatigue, unexplained weight loss despite overeating, peeing like crazy all the time. They asked the health food and pharmacy staff what they thought they had, what they should take, and whether they think they should go see a doctor?
Given that type 1 diabetes can be fatal if untreated the answer to that last question is yes, they should indeed go see a doctor, and all 8 out of the 8 pharmacists got that right; good for them. But only half, 6 of the 12 health food store employees thought it necessary, and 2 of the six naysayers explicitly advised against going to a doctor, the rationale being that the physician would quote “just give them Ritalin” or miss the true diagnosis, which they felt was something like mold infestation or adrenal exhaustion--which luckily they had just the right supplements for, at a bargain for only up to $200 a month.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by Serena.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

This is the final video of a four-part series on the quality of advice given by employees of natural food stores. See Health Food Store Supplement Advice, Bad Advice From Health Food Store Employees, and Dangerous Advice From Health Food Store Employees for the first three. Health Food Store Supplement Advice covered the shark cartilage question, Is Vitamin D the New Vitamin E? mentions beta carotene, and I have yet to do a video on ginseng but will! In the meanwhile, feel free to check out my dozen other videos on Supplement Snake Oil (more on this in tomorrow's NutritionFacts.org video-of-the-day) and the hundreds of other videos on more than a thousand topics.

Please be sure to check out my associated blog posts:  Health Food Store Advice: Often Worthless or Worst and  Plant-Based Workplace Intervention.

  • Michael Greger M.D.

    This is the final video of a four-part series on the quality of advice given by employees of natural food stores. See Health Food Store Supplement Advice, <a href="Bad Advice From Health Food Store Employees“>Bad Advice From Health Food Store Employees, and Dangerous Advice From Health Food Store Employees for the first three. Health Food Store Supplement Advice covered the shark cartilage question, Is Vitamin D the New Vitamin E? mentions beta carotene, and I have yet to do a video on ginseng but will! In the meanwhile, feel free to check out my dozen other videos on Supplement Snake Oil (more on this in tomorrow’s NutritionFacts.org video-of-the-day) and the hundreds of other videos on more than a thousand topics.

    • HemoDynamic, M.D.

      Good study for me because everyday I get patients coming in saying they went to their pharmacist to see what they could take for their symptoms.  (They go to the pharmacist because they did not want to “bother” me (pay) for an office visit–Pharmacists are FREE!!).  So I feel safe that the Pharm’s are giving good outpatient advice and telling them to see the doc when they need to but I feel jipped in a way when it comes to people not wanting to pay for good information from a well informed and educated provider. Why?
      Let’s see. . .

      My grandmother passed recently and we just got the lawyer bill for the estate: $300 per hour and 31.5 hours came to $9000 and change.  Really?!?

      My wife went to a dentist recently with my two kids who just inspected their teeth and did absolutely nothing except sell my wife some oral bacterial modifier and charged $750. (Total time spent with kids 1 hour)  Are you kidding me?!?

      Patients won’t go to the educated physician who tries to get them off their medications and teach them how to make themselves better (if they’re willing to listen) for a $20-$40 copay?????? 
      Comon!  It’s obscene!
      That’s my two cents worth.
      Yes today’s vid struck discord (dis-chord) with me.

      • greenleaf

        The premium for my individual health plan coverage is $565 a month with a $5,000 annual deductible. My basic essential living costs (housing, utilities, medical insurance premiums, dentist, etc.) are so high that all costs considered, I truly can’t afford to go the so-called educated physician for troubling symptoms. As you well know, although the co-pay may appear to be reasonable, the patient needs to pay up to the deductible for lab tests and other services. And as you also know, for any visit other than a so-called wellness visit, the patient needs to pay just to get in the door (typically $85 just for the appointment). Or perhaps as an educated American physician you are simply ignorant of the real costs to patients when they come to see you. In my opinion it is obscene for educated physicians to criticize anyone but themselves for not vigorously and relentlessly working for universal health care coverage for all citizens. 

        • Ghazeltine

          The doctor is actually making a good point. We pay cash for lawyers and dentists but expect insurance to cover all other costs. As a health care professionally I run into this all the time.

          But yes, universal healthcare is what we all should be working towards. Insurance companies have no business in health care. Take out the middleman.

        • HemoDynamic, M.D.

          Nice reply.  There is a problem with our health care system and it’s me!!
          I am now $350,000 in debt and pay $3,500 per month for the next 16 years of my life with a repayment of about $672,000 just because I wanted to help people.  I am the one to blame, no one else for my altruisting thinking–The only way to make a difference is BE the difference.  I take full responsibility for being ignorant and now stupid for becoming part of “The System.”

          • Dbray80909

            The system is broken, you are to be commended on doing an honorable job. Can’t we take the best of the Canadian system and improve it? I was born and raised in Canada, my parents and extended family still live there, and we all had good care. In rural areas Drs are lacking, but not in metropolitan areas, and yes you may have to wait for a non emergency procedure, but you still have the option to go to a private clinic. And if you do get sick, you don’t lose your home! Let’s start thinking about the people we live with as WE, not ME!

        • HemoDynamic, M.D.

           Quote greenleaf: “In my opinion it is obscene for educated physicians to criticize anyone but themselves for not vigorously and relentlessly working for universal health care coverage for all citizens.”

          Who would then take care of the sick people? 

      • troy

        It’s the indeterminate wait in the waiting room I cannot afford.  All my dentists have seen me on time.

      • Thea

        HemoDynamic: I have long been wanting to reply to your posts and now seems like a good time.  I am someone who has grown frustrated and distrustful in general of physicians.  However, when I come to this site and see doctors like you, who actually take the time to educate yourself about real health solutions, I take heart.  I want a doctor just like you.  I hope you know that not all patients are dunderheads.  Hopefully you can get to a point in your career where you can find some good ones.

        Thank you for your enthusiastic participation on this website.  I know that I’m not the only one who appreciates it!

        • HemoDynamic, M.D.

          Thank you for your kind comments.  I have a thriving practice full of people who want to get better and surprizingly (not really) they do!
          I know that you can look for Doctors that follow a plant based approach/philosophy on Dr. John McDougalls website at http://www.drmcdougall.com and maybe you can find one in your area.
          Thanks again.

      • Dr. Hana

        HemoDynamo, you yourself complained that patients do not want to pay you. Your own words: everyday I get patients coming in saying they went to their pharmacist to see what they could take for their symptoms.  (They go to the pharmacist because they did not want to “bother” ME (pay) for an office visit–Pharmacists are FREE!!). 

        This is idiotic and shows ignorance. The reality is that going to see a doctor is impossible for many people. They cannot afford it. Even people who scrimp and save to buy health insurance wind up paying such costly premiums that they cannot afford to see a doctor when they are feeling ill or have symptoms. You do not seem to be aware of this. Someone commented that we pay lawyers and other professionals high prices and should therefore not complain about the cost of medical care (or words to that effect). But again, many people can’t afford those services at all and so do not get them when they are crucially needed. I say let’s question the high cost of professional care across the board. Why should anyone, the employed, the unemployed, the underemployed, pay such high costs? If medical school is so expensive, let’s make it less expensive. Isn’t that a better option to work toward?

        • Dr. Montana

          Funny Dr. Hana (Montana)!  Let me quote U: “This is idiotic and shows ignorance.”  Idiotic means stupid which is not ignorance.  Ignorant means basically Not Knowing. The definition:
          1.Lacking knowledge or awareness in general; uneducated or unsophisticated.2. Lacking knowledge, information, or awareness about something in particular: “ignorant of astronomy”.

          Stupidity definition means slow of mind. 

          So which is it?  Or are U just ignorant?

          • Dr. Hana

            Montana, I wrote “idiotic and shows ignorance.” It is both idiotic AND ignorant. 

            In fact ignorant people may well also be stupid people. The two categories are not mutually exclusive. Consider critiquing your own posting. In my opinion it is both ignorant and nasty. You have nothing better to post? This is the best you can do?

      • rocket78

        As a hospital pharmacist, I don’t always talk to patients, but do get the occasional caller from the community.  Yes, they do want FREE advice, as we are America’s most accessible health professional.   l  have ALWAYS referred patients to a physician when necessary, and it usually is. 

  • Sue, UK

    I hear a lot of raw foodists/fruitarians talk about adrenal exhaustion – it seems to be the ‘go to’ explanation for everything, but I can’t find any proper medical literature covering this. Is this just a fictitious disease?

    • Veronica

      I work with people in the raw food scene too and yes they talk about adrenal fatigue a lot. I really don’t know how they can accurately diagnose anything, but usually it’s people that claim they used to drink a lot of coffee/red bull/eat chocolate/cacao/maca frequently every day that say they have/had adrenal fatigue from too many stimulants. 

      I have never had it, but I’ve also never drank coffee nor do I eat stimulating supplements regularly. I’d be interested to know how people can actually get tested if they have adrenal fatigue. 

      Raw foodists also say everyone has candida overgrowth (may be true only if you took tons of antibiotics in your life) and thyroid problems which is tricky to prove true based on listening to symptoms alone. 

      • HemoDynamic, M.D.

        quote Veronica: “I really don’t know how they can accurately diagnose anything”

        My feelings exactly! 
         There are tests to evaluate for adrenal insufficiency and thyroid dysfunction and they are not that expensive. A Basic metabolic panel (BMP) can test for electrolyte abnormalities that are frequently seen in adrenal abnormalities and also a Cosyntropin test, and a Thyrotropin Stimulating Hormone (TSH) for a basic check on thyroid function.  However, since people without Medical Degrees cannot order these tests and to stop the guessing/theoretical game it is best to see a qualified physician (or PA or NP <–that comment will get some people goin') to be evaluated and have the proper tests ordered.

        • Dr. Hana

          Poor HemoDynamic, all that debt and so few patients, all that time on this forum spent on your own self-promotion. You seem to have an inordinate amount of free time for a physician. You might want to spend just a little of it thinking about why patients avoid coming to you. After reading your postings, I doubt that it is the cost. 

          You appear to be using this forum to get patients. Please do go elsewhere.  

          • Paul3917

             Sorry you don’t enjoy HemoDynamic’s insightful and erudite comments, Hana. I’m sure you’re in a minority.

          • HemoDynamic, M.D.

            I’m sorry you feel that way! I have never once promoted myself nor given any information as to where I practice; hence, using a pseudonym.  My time on this forum has been spent in between my patients (I see avg. 20-25 per day) in trying to help and inform patients. I apologise that this is offensive to you. 

          • DrHana

            HemoDynamic, let’s face it, your comments are self-promotional. You have a glossy promotional head shot of yourself that shows with every one of your nonstop comments, you use a dynamic-sounding pseudonym along with the glam photo, you are always the hero of your own story while others are uneducated idiots or unappreciative of your selfless dedication, and perhaps worst of all, you free ride on the reputation of Dr. Greger, who has a genuine and impeccable record of public service. I think the people who might find you most offensive are your own patients, who get the shortest possible time with you so that you can rush to promote yourself in this forum. I think good physicians spend time in between seeing patients thinking about and researching the unique issues that present with each patient. 

          • HemoDynamic, M.D.

            I’m sorry you are such an angry person.

          • Paul3917

             Hana, I don’t know what your problem is, but I’m getting sick of it. I wish you’ d crawl back into the hole you came from – and I think I speak for the majority of readers of this blog. If you had any sense you would realize not only how helpful HemoDynamic’s comments are, how they have the ring of authenticity and sincerity, and that he can’t possibly be self-promoting since he is offering his services as a physician only in his local area and not to the world-wide community which reads this blog. You make about as much sense ans a screen door on a submarine. Speaking of pseudonyms, I’d be willing to bet that the “Dr.” in yours is bogus.

          • Dr. Hana

            Do you believe your comment is useful to this forum? I am a PhD and a researcher. 
            If Dr. HemoDynamo sees 20-25 patients a day, that is already too little time spent with the patient. If while examining them his mind is on his postings to this forum, then they are even more neglected. It’s all about the patient. 

          • Ghazeltine

            I completely agree with Paul 3917. Chill Hana.

            I have really appreciated Hemodynamics comments. Keep them coming!

          • Dr. Hana

            I am sure HemoDynamo will keep his comments coming without
            your urging! I have no problem with his postings that provide useful
            information to the public. My critique was in response to HemoDynamo’s
            complaint that so many patients go elsewhere rather than to him and that their stupidity in that
            regard was incomprehensible since the cost to the patient is only a $20 copay. He needs to understand the real cost to patients and why they pay such a
            high price. I’m certain that he does, so I don’t understand why he would make such a disingenuous comment in the first place. I also critiqued him for using this forum to gripe about the costs
            of medical school. As he well knows, most of the high cost of medical education
            trickles down to the patient, or as they are now called, the consumer or
            customer, who are wisely fleeing a dysfunctional system. It is they, not the physician, who ultimately pays the price. The
            vast majority of physicians in this country are economically in the middle
            upper classes and are among the elite who can afford to live in the better
            neighborhoods and send their children to good schools and the best
            universities. So it is inexcusable for HemoDynamo to use this forum to complain
            about his financial situation.  The fact that a growing number of people are dissatisfied with the ever
            deteriorating medical services they pay such a high price for and wisely seek
            help elsewhere  is to their credit. As HemoDynamo must also know, while many physicians pay lip
            service to wanting universal health coverage, the vast majority have no
            intention of ever doing anything to make sure Americans get it.  They would rather preserve a dysfunctional health care system that does
            not serve the public well rather than make a more modest income. HemoDynamo, don’t dish it if you can’t take it. 

  • Rick

    Common sense shows this study merely proves people should do their own homework on what type of supplements they need. The bottom line is neither pharmacist nor health food store employees know much about what supplements to recommend. (For the most part anyway)

    • RFEPharmD

      Most pharmacists look to high quality resources such as the available medical literature to obtain information about supplements.  Unfortunately, I find that many laypeople who try to “do their own homework” are duped by snake oil salesmen into ingesting potential dangerous or worthless products.  If they did their “homework” on this website, though, I completely agree with you!

  • RFEPharmD

    Pharmacists have expertise in evidence-based medicine. I’m surprised this study was even done. Who would bother to compare the nutritional advice provided by a fast food employee to that of a PhD in nutrition?

    It is unfortunate to read some comments devaluing pharmacy services. Pharmacists have advanced training, usually doctorate degrees and often additional residency and followship experience.  Many pharmacists collaborate with busy physicians in outpatient clinics assisting with cleaning
    up messy medication profiles, doing quality and medication safety improvement, reducing polypharmacy, avoiding drug interactions, managing high risk medications (e.g., warfarin, insulin), and providing disease
    state education.  Some states including North Carolina recognize pharmacists as Clinical Pharmacist Practitioners, licensed to prescribe medications and manage certain diseases in collaboration with physicians. Countless studies demonstrate improved health outcomes, reduced adverse drug reactions, and decreased overall health care expenditure by having a pharmacist on the inpatient or outpatient health care team.

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