Shopper: Will [fish oil] get you off the meds?
Seller: Yeah, bud.
Shopper: I’m currently on medication … aspirin, sometimes Tylenol. Is [taking gingko biloba concurrently] safe?
Seller: Yeah, yeah, it’s completely safe because it’s all natural. It’s an herb. This one is actually on sale. Buy one, get one free.
Shopper: So [phosphatidylserine] also helps with Alzheimer’s?
Seller: It does. It prevents it and if someone’s already at that stage, this might gradually reverse it.
For responsible natural product retailers, these conversations raise obvious red flags. And these are just a few of the interactions between supplement retailers and “elderly customers” that the U.S. Government Accountability Office (GAO) secretly recorded last year. To determine whether sellers use “deceptive or questionable marketing practices,” undercover GOA investigators visited or phoned 22 supplement retailers to solicit health care advice, inquire about product safety profiles, and ask whether certain supplements could prevent or cure diseases.
Clearly, the GAO found what it was looking for. These supplements sellers, along with others featured on the recordings, violated Dietary Supplement Health and Education Act (DSHEA) guidelines that prohibit retailers (who don’t have proper medical credentials) from dispensing medical advice, diagnosing conditions, sharing testimonials and discussing drug-supplement interactions.
However, while these tapes are incriminating, industry leaders believe such misguided interactions are far from typical. “I don’t think the findings are representative—even the GAO didn’t claim that they were,” says John Gay, executive director and CEO of the Washington, D.C.-based Natural Products Association (NPA). “Yet, this issue affects us all. If there’s a story in the media about someone not following the rules, it impacts everyone.”
Steve Mister, president and CEO of the Washington, D.C.-based Council for Responsible Nutrition (CRN), agrees: “You can’t deny what’s on those tapes, but I don’t put a lot of stock into them. We don’t know how many stores the GAO visited—they could’ve gone to 100 stores that all passed [the GAO’s test]. We don’t for a minute think the tapes represent the mainstream of the industry. I think most stores are aware of these responsibilities.”
But even if the GAO findings aren’t in line with the majority of retailers, the industry should not dismiss them, Mister cautions. “Even though I don’t believe the Food and Drug Administration (FDA) or Federal Trade Commission (FTC) has it on top of their priority lists to keep going in and making examples of people, that doesn’t mean we should ignore this,” he says. “It’s a wake-up call that problems do exist, and we’re trying to clean it up.”
Retailers also are in favor of enforcing supplement-selling guidelines. “I feel that this is a good thing for retailers, since we should be ethical and responsible about this topic,” says Lynn Ellen Schimoler, grocery and wellness manager at City Market/Onion River Co-op in Burlington, Vermont.
The importance of obeying the law
Supplements make up a significant chunk of many natural products stores’ business, often without demanding much shelf space. “Supplements are 50 percent of my store’s sales, from approximately 25 percent of my linear shelf space,” says Denise de la Montaigne, owner of Better Thymes Natural Foods in Front Royal, Virginia.
In addition, many retailers use their supplement sections to build solid and loyal customer bases. According to Wendy McLain, health and beauty aids merchandiser for PCC Natural Markets, the Seattle chain’s supplements business stays strong because customers trust its quality product selection, knowledgeable staff and in-store educational tools.
Since maintaining healthy sales and retaining customers in this profitable department is often key to retailers’ success, it’s all the more crucial that they operate within the scope of the law—and understand why such laws exist.
According to Mister, strict restrictions on what retailers can and can’t say to customers simply comes with the territory of promoting health care—which is essentially what supplement sellers do. “We really need to appreciate that we’re not selling just another packaged consumer good like office supplies or silverware. We’re selling health care,” he says.
Gay agrees: “A tire store doesn’t have these regulations of what you can and can’t say. This is an obvious challenge that our industry has that others don’t,” he says.
Why the missteps?
Even though most retailers understand and follow DSHEA guidelines, seller-customer interactions like those the GAO recorded do still occur.
When it comes to staff members offering testimonials or sharing personal experiences with customers, “it’s absolutely understandable why some of these things happen, since people have positive experiences with supplements and want to share them,” Mister says. “But as a retailer, you have to control that enthusiasm. You can’t say the things you’d say in your living room. You have to appreciate that there’s a body of regulation and live within it.”
Staff turnover can also increase stores’ potential to break the rules. “Think of the amount of staff turnover in retail,” Gay says. “There’s always going to be a need for education.”
The GAO tapes shed light on a serious issue, and both CRN and NPA have responded with attempts to address it. “Yes, CRN represents manufacturers and ingredient suppliers, but if we’re going to be good stewards for our products, we need to work our way down the chain,” Mister says. “Retailers are the ones who interface with the ultimate consumer.”
In January, CRN published “Roadmap for Retailers: Safely Navigating What You Say About Dietary Supplements.” The six-page booklet offers an easy-to-read primer onthe history of supplement laws, a guide to understanding supplement labels, an overview of retailer responsibilities, a chart of do’s and don’ts, and a glossary of key terms. The roadmap is free to download at crnusa.org, and bulk quantities of the roadmap in a tri-fold pamphlet form are available for purchase. Mister says his organization is promoting the roadmap to CRN members, who have access to retailers, and will present it at Natural Product Expo West on March 11.
The NPA generated its own educational package last October, entitled “Retailer’s Staff Education Toolkit,” which anyone can download for free at npainfo.org. The kit includes a 15-page Dietary Supplement Claims Handbook, which discusses how supplements are regulated, what manufacturers can claim and what retailers can say, and provides guidelines for offering customers third-party nutritional information and for handling FDA inspections. The kit also contains a two-page tri-fold brochure that summarizes the handbook, a two-sided wallet card for quick reference, and an informational shelf-talker, flyer and poster to share with customers.
NPA members can download a members-only version of the toolkit that they can brand with their company name and logo and use for staff training and customer education. “We thought this info had to get out as widely as possible,” Gay says. “But we wanted to give members some additional benefit.”
Both Mister and Gay say that they hope their organizations’ educational materials reach as many retailer eyes as possible.
How top retailers educate staff
Many retailers have begun incorporating the new CRN and NPA tools into their training programs. And for stores like Better Thymes, PCC Markets, City Market/Onion River Co-op and Boulder, Colo.-based Pharmaca Integrative Pharmacy, these documents serve as complementary tools for long-standing, multi-pronged, rigorous staff-education initiatives.
“PCC’s health and beauty aids department offers ongoing staff training, including at least two vendor trainings each month,” McLain says.
“Upon hire, each new employee receives a Better Thymes Natural Foods handbook that clearly states the regulations for what we can and cannot say to customers regarding dietary supplements,” says Better Thymes owner de la Montaigne. “I also give each staff member a copy of the FDA Handbook for Retailers and now the NPA’s new toolkit. [Staff members] also attend as many educational sessions as possible at Expo East and West and NPA MarketPlace.”
Schimoler says that City Market/Onion River Co-op now uses the CRN’s roadmap to help train its supplements staff, along with holding regular reviews of DSHEA laws, assigning required reading materials, conducting staff-customer role-playing exercises and facilitating manufacturer-led training sessions. “Knowing how to read labels and understand what manufactures can claim is also part of the training,” Schimoler says. “We always encourage the importance of practitioner-consumer relationships when making decisions about dietary supplement use.”
Perhaps one of the most thorough training programs belongs to Pharmaca, which staffs two to seven practitioners (pharmacists, naturopathic doctors, herbalists and nutritionists) at each of its 23 stores, with one practitioner designated as lead. “We have a weekly call with the lead practitioner in each store in which they get trained by all brands of supplements we carry,” says Don Summerfield, Pharmaca’s vice president of integrative medicine. “We require that they’re trained by a medical practitioner that has relationships with brands we carry—not by a brand’s sales team.”
According to Summerfield, “Pharmaca does a fantastic job with education and continues to invest resources. We hold a summit for our lead practitioners each year, where we fly them to key manufacturers, and the whole focus is on education and learning supplements’ features, benefits and safety profiles.”
For new staff practitioners, Pharmaca provides a 77-page integrative-medicine training manual that’s largely devoted to practitioner-customer engagement guidelines. “This year we formed our first integrative health advisory board,” Summerfield says. “One of the board’s primary goals is to ensure that all Pharmaca’s training materials are vetted so that they can feel comfortable that all of our practitioners are operating within DSHEA.”
Non-practitioner Pharmaca staff members are considered “customer service.” They can read labels and help shoppers find specific departments and products, but they must call a practitioner or pharmacist over if a customer seeks more info on a supplement, Summerfield explains.
And when customers ask questions that would require straying from DSHEA guidelines to answer, Pharmaca practitioners and PCC Markets staff members are trained to lead shoppers to in-store Healthnotes computer kiosks, which let them browse for third-party health information. “There’s no reason to violate DSHEA when you have Healthnotes, which provides customers the info they’re looking for without us having to say anything we shouldn’t.”
Do's and don'ts of discussing dietary supplements
- Stick to the claims in the manufacturer's written materials.
- Discuss ingredient content of products, as provided on their labels.
- Discuss structure/function claims based on the claims on the label.
- Stick with only those health claims that are on the product (i.e., "reduces the risk of …").
- Suggest customers talk to a health care professional for diagnosis and treatment options.
- Claim the product can treat, cure, mitigate, diagnose or prevent disease.
- Instruct customers regarding prescription drug use unless you are a qualified health care professional.
- Offer advice about drug-supplement interactions (or lack thereof) unless you are a trained health care professional.
- Practice medicine, nursing or dietetics (or any other medical specialty) without a license—in essence, don't diagnose.
- Don't use testimonials unless they are typical of what consumers can expect or they are properly qualified as required by law.
Source: Council for Responsible Nutrition's "Roadmap for Retailers: Safely Navigating What You Say About Dietary Supplements"