200640 Advice from Complementary and Alternative Medicine Retailers and Pharmacists to Consumers with Symptoms of Undiagnosed Diabetes

Tuesday, November 10, 2009

Dionysios Kavalieratos, BPhil , Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
Jaya K. Rao, MD, MHS , Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
Morris Weinberger, PhD , Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
Purpose: In 2007, nearly 40% of American adults reported using a CAM product within the previous year. Some consumers may substitute CAM and advice from CAM retailers for traditional healthcare. This may result in increased morbidity and mortality due to delays in diagnosis and treatment, along with potential interactions between CAM and standard medical therapy. Prior studies document striking variability in the recommendations provided by CAM retailers, some egregiously divergent from standard practices, to persons with documented conditions such as HIV/AIDS, depression, and breast cancer. Our study sought to examine the advice provided by CAM retailers when approached by a consumer with symptoms of undiagnosed type 1 Diabetes Mellitus. Additionally, we examined the advice provided by retail pharmacists, as they frequently provide health information to consumers.

Methods: A standardized actor visited 12 CAM retail stores (6 independent and 6 chain) and 8 chain retail pharmacies in Pittsburgh, PA and Chapel Hill/Durham, NC between December 2008 and February 2009. The actor, a 22-year-old thin Caucasian male, used a standardized script in which he casually described the classic symptoms of type 1 Diabetes Mellitus and asked for advice and product recommendations from the salespersons and pharmacists. The actor also asked whether he needed to see a physician and the potential diagnoses for his symptoms.

Results: Recommendations varied by venue. Ten of 12 CAM retailers recommended dietary supplements and multivitamins, whereas only 1 of 8 pharmacists recommended a product. The monthly cost of products recommended by CAM retailers varied widely (range: $8.33 - $119.98). Every pharmacist recommended that the actor see a physician, with 75% encouraging a visit within 1 week (i.e., urgent). Of the 12 CAM retailers, 4 recommended that the actor see a physician; of these, only 2 recommended an urgent visit. Of the remaining 8 CAM retailers, 2 explicitly advised against seeing a physician, and 6 stated that a physician visit was unnecessary. Five pharmacists suggested Diabetes as a potential diagnosis, whereas only 2 CAM retailers mentioned this diagnosis. One pharmacist and 3 CAM retailers refused to offer a diagnosis.

Conclusions: Our findings suggest a potentially serious safety issue for health consumers seeking advice from pharmacies and CAM retailers. Pharmacists and CAM salespersons varied in their ability to recognize classic symptoms of a common chronic condition, indicating a need for educational interventions. Additional research is necessary to confirm these findings in a larger and more diverse sample.

Learning Objectives:
1. Describe the roles that CAM retailers and pharmacists play in providing health information to consumers. 2. Identify potential hazards specific to diabetic patients seeking health advice from CAM retailers and pharmacies.

Keywords: Alternative Medicine/Therapies, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD student in the Department of Health Policy and Management at the University of North Carolina School of Public Health. I have been involved in all aspects of this research project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.