‘Are Nutritional Therapists gambling with your health?’ – A response to the WHICH? report

A report released today (January 16th 2012) has pretty much slammed Nutritional Therapy as a vocation. The report details how 15 Nutritional Therapists were essentially mystery shopped by clients posing with a series of health problems.

 

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WHICH? have presented information to indicate that Nutritional Therapists were offering dangerous advice, promising to rid cancer through diet, diagnosing without consulting the client’s GP and using non-evidenced practice to diagnose. The report then calls for the government to take drastic action to regulate this business.

 A press release from the British Association of Nutritional Therapy (BANT) states:

- BANT did not decline to comment on this article but was unable to comment for the print edition because WHICH? did not provide all the promised transcripts/questionnaires in a timely fashion. It is disappointing that WHICH? appears to have little interest in conducting a genuine review of the effectiveness of nutritional therapy preferring instead to use fictitious consultations and a biased panel of ‘experts’.

- We would have hoped that the panel would have included qualified and experienced nutritional therapists who would have been able to assess the performance of the targeted practitioners against the National Occupational Standard, (Skills for Health). As in other professions, assessment of practitioner performance would normally involve experts from that profession. Concern was expressed about lack of referrals to GPs but our review reveals frequent reference to working with the client’s GP or consultant. However, several of the clients made up stories that they were either dissatisfied with their GP and did not wish to make contact, would not provide details or said that they were moving to a new GP.

- As the professional body for nutritional therapists, BANT is dedicated to the advancement of nutrition science and the safe, evidence-informed practice of nutritional therapy. Instilling public confidence and offering consumer protection is of primary importance to BANT. BANT members are bound by a strict code of ethics designed to protect patient interests and procedures are in place to deal with any complaint brought against a BANT member.

- BANT would welcome the opportunity to discuss the future of nutritional therapy regulation to further develop safe and effective practice. We agree that practitioners should come under statutory regulation. So what now?  Well to me it spells out there is a need to regulate this business to ensure consumers are getting the very best treatment with absolutely no risk. At the moment anyone can set up a clinic as a ‘Nutritionist’ without any formal qualification, so essentially I agree with WHICH? on that aspect. In order to practice under BANT there is a strict code of ethics and a Nutritional Therapist needs to show that they have completed an accredited course in Nutritional Therapy. With regulation, this will ensure the so-called quack medicine does not take place. If you are to visit a Nutritional Therapist, ensure they are a member of a governing body like BANT.

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 Now I have nearly finished my training at the Institute For Optimum Nutrition and from the beginning it has been drummed into us not to diagnose and always keep in contact with the client’s GP. As Nutritional Therapy is a Complementary Medicine, it seems it will always be under constant scrutiny. However, this is not a problem for someone who is passionate about his or her work and a productive and fair critic will be welcomed.

We are surrounded by an ill-health epidemic, proven to be linked to the modern diet. So how about some reports showing how Nutritional Therapy can benefit the health of an individual and not just slamming it? I’m sure Nutritional Therapy is not the only field that would benefit from a review. I have a friend that went to a Dietician for help with gaining weight and they were informed to eat more desserts and doughnuts – now tell me the logic in this?

I would welcome your comments on this matter as I think it’s an important topic of discussion…

- TNN

32 comments

  1. WHICH are very respected for their thorough analysis when investigating any product.

    May I respectfully suggest that the WHICH team stick to non clinical subjects as they cannot use normal comparison criteria to reach meaningful conclusions

    In this particular case, not only are they are so wide of the mark
    but they have possibly set back the nutrition revolution by years.

    The cancer treatment in this country is nothing short of criminal
    and has been hijacked for too long by a bunch of graduate robots
    who could not think for themselves if their lives depended on it.

    Until they open their ears, eyes and minds it will be an uphill battle.

    Thanks for nothing WHICH.

    Remo Campagna.

    • If Remo Campagna does indeed represent nutritionists and it is indeed true that this report has “set back the nutrition revolution by years” then Which? has indeed done a great thing.

      It also demonstrated that by merely slipping a regulating veneer over such people, all you will do is give such dangerous nonsense a imprimatur it does not deserve.

    • “The cancer treatment in this country is nothing short of criminal and has been hijacked for too long by a bunch of graduate robots who could not think for themselves if their lives depended on it.”

      Well, I am sure there is room for improvement but this seems a bit sweeping. Is there a connection to the Which report?

  2. Not a very dispassionate response to the Which report, is it?

    • Daniel O'Shaughnessy

      It’s hard to be dispassionate when discussing research that is sloppy. I have been taught to be fair and unbiased in research which is regarded valid, not a report written with the main aim to generate media interest and not presenting the findings in an accurate manner.

      • If the main aim was to generate media interest that is not very good. Can you tell me why you think this is the main aim?

        Can you say what findings were not accurately presented? Otherwise it is just a flung out assertion with no substance. As far as I can tell there was not much to present that could be inaccurate.

      • Is the Which? report biased and sloppy? Or is that just the reason you are giving yourself to ignore its shocking findings.

  3. It’s important for Nutritional Therapists to address the concerns raised by this research. What the report appears to be telling us, is that if you pick out a Nutritional Therapist, like likelihood is that you will get bad or even dangerous advice. Such a finding cannot be ‘balanced’ by a discussion of how “Nutritional Therapy can benefit the health of an individual”.

    Before pointing out the faults in other health care providers you should be worried about how this came about. What is it about training, beliefs and practices that led to this result? What needs to change? How should NT’s be regulated? These are the sort of questions that need answers.

  4. The Which? report has been completely discredited by Martina Watts MSc. Take a look at her article entitled ‘Which’s Brew’ on the website thehealthbank.co.uk
    Chris

    • Well, I had a look (at Which’s Brew) and the article is definitely anti the Which article. It does not follow that the Which report has been “completely discredited”. Trying to mock Which as only being competent to test washing machines does not give this rebuttal the air of a completely independent view.

    • It is nonsense to say that the Which? report has been ‘discredited’ by that blog post. It is a moan that the people used on the panel actually knew about science and medicine. It bleats that it wasn’t ‘scientific’.

      Anything but discuss the substantive issues that Nutritional Therapy appears to seriously off kilter.

      My personal opinion is that people who have been trained as Nuritional Therapists have been systematically misinformed during their training as to what constitutes evidence, what science is and how nutrition works. The sole aim of Nutrional Therapists appears to be to enrich those who sell overpriced food supplements.

      The Institute of Optimum Nutrition, which has trained a vast swathed of the Nutritional Therapist world was set up by a vitamin pill entrepreneur. It is his sales school – and it enlists the unwitting to become the pilotless drones of the vitamin world.

  5. Daniel O'Shaughnessy

    Essentially what it boils down to is that the Which? report looked at 15 individuals who called themselves Nutritionists. They did not conduct a study looking into qualified Nutritional Therapists therefore how can the published report be seen as a fair representation of qualified individuals. Had Which? done a report on those that just called themselves Doctors then I am sure they would have come to the same conclusion. In addition, there was no Nutritional Therapist representative on the panel to review the findings; what normally would happen in a review.

    No mention has been made in the report to the recent changes with regard to the voluntary regulation of the profession through accreditation and registration with the Complementary and Natural Healthcare Council (CNHC). The CNHC shows therapists have reached the required standard of professional competence and aim to practice in a safe, effective and integrated manner. Within this framework, it is a requirement to notify and work with a client’s GP unless the client asks you not to.

    It is slightly disheartening to see such a report published in the modern world where research is highly scientific. Time has come for Nutrition to work in synergy with medicine. Look at the obesity, cardiovascular disease, diabetes epidemics and see how much government money is being spent to combat these. Allopathic cancer treatment is invaluable. Combining this with nutritional support will not only improve success rate but will also make the patient more comfortable, a perfect example of the holistic patient-centered model.

    Importance should be placed on prevention of disease states and not just the treatment. It is essential that Nutritional Therapy and Allopathic Medicine meet in the middle and not emphasis or argument placed on which model should be adopted.

    Hippocrates: “Let food be thy medicine and medicine be thy food”

    • It seems that you are now distancing yourself from the 15 Nutritionists and suggesting they were unqualified. You appear to be discrediting them rather than just attacking the Which report. Nothing wrong with that in principle but perhaps this should be more the focus of your concern.

      ================================

      “Allopathic cancer treatment is invaluable. ”

      I think this means conventional cancer treatment? So presumably you would distance yourself from the poster who describes the cancer treatment in this country as criminal and run by graduate robots?

  6. would you trust Which to evaluate your surgeon? i think not.

    i am not a nutritionalist although i see a qualifed one for help managing an auto immune condition that i have. a condition which docters can not treat is being manged and even improved by using food. my nutritionalist has been a god send to me. anecdotal i know but thats what my experience has been

    i am shocked at just how bad this Which research is. it didnt evaluate qualified nutritionalists. They went to people who made recommendations that a nutritionalist would never make. They went to people who call themselves nutritionalists, people who are not qualified as nutritonalists. they have really showed themselves to be utterly incapable of sound research. i would go on and pick the useless piece of “research” to bits but its not even worth the bother. i wouldnt even trust them with a washing machine review from now on.

    “It also demonstrated that by merely slipping a regulating veneer over such people, all you will do is give such dangerous nonsense a imprimatur it does not deserve.” The people they looked at were not regulated or qualified and thats the point. How can nutrition and its application done by qualified and regualted professionals be “dangerous nonsense” ? we need nutrition to live. without it we die and without good nutrition we become ill. have you heard of the obeasity epidemic or the heart disease epidemic? allopathic medicine treats the disease but does it doesnt provide the prevention to disease that optimal diet does. we need specialists in the field of nutrition, qualified and reguated specialists. A thorough and detailed review into nutritional therapy would have been most welcomed. There needs to be regulation in this important and developing field and those who are qualifed should be examined, tested and held accountable by regualtors and independant review bodies that use SOUND SCIENTIFIC STUDY.

    and Andy Lewis, as someone who runs a “quackometer” website i would have thought you may favor science and decent research. Having read your website though it seems scicene and thorough sound research are about as far from you as they are this Which report… even by your own admission. i suggest you pick a different field to establish yourself in.

    • “would you trust Which to evaluate your surgeon?”

      Well, yes. In some circumstances. If they were evaluating they were unqualified and killing their patients I do not think it matters who is doing the evaluation as long as it is accurate.

      It seems to be a notable feature of these critical posters that they try and discredit the Which report rather than address the problems it raises. If the problems raised are invalid then you should have a proper case to make.

    • “and Andy Lewis, as someone who runs a “quackometer” website”

      This is another indication of someone struggling to find a valid argument in defence of their postion. Attack the individual rather than the points he is making. I think Andy Lewis made some good points which you do not address.

    • James – I think you are misunderstanding the issues. There are qualified and regulated professionals who can help advise on healthy eating and also assist with diet if you are ill. They are called dieticians.

      Nutritional Therapists, by contrast, are taught a mishmash of lore and pseudoscience that helps them sell vitamin pills. They believe they have been trained – hence all the anger here – but actually they have wasted many years learning a pseudoscientific subject. This is exactly what Which? found.

      There report is a clear indication that consumers should beware. Most commenters here though are notr concerned about consumers but only preserving the pretense that Nutritional Therapy is some sort of legitimate health care profession.

  7. There’s one question that these arguments beg: what do we know about the nutritionists that the Which? article chose? Daniel says they did not look at ‘qualified nutritional therapists’. First, what does that phrase actually define? i.e. who counts as a qualified nutritional therapist and who makes that definition? Secondly, do we know that Which? didn’t choose any such nutritionists?
    I have no axe to grind, I am trying inform myself. I’ve read the Which’s Brew article, and don’t agree that the whole venture is invalid, but it is limited. The sample size is small, but the findings worry me, especially if any of the practitioners were ‘qualified nutritional therapists’. So what I am trying to find out here is the degree, if any, of selection bias.

  8. Daniel O’Shaughnessy and James Hughes both protest that the Which? report did not look into *qualified* Nutritional Therapists. The Which? article points out that 13 of the 14 NTs visited were members of the British Association for Applied Nutrition and Nutritional Therapy (BANT). According to BANT’s website, “BANT members are qualified in both the science of nutrition as well as clinical practice,” so the assertion that they weren’t qualified according to the industry’s own standards would seem to be unfounded.

    More importantly, I understand from the conversation taking place on the Which? website, that these particular therapists were found using google and online directories. The therapists were chosen the top of the search results just as an ordinary consumer might do.

    James asks, “How can nutrition and its application done by qualified and regualted professionals be “dangerous nonsense”?”

    I’m afraid you are missing the point rather spectacularly here, James. Thanks to the Which? report, more people will be cautious about trusting the advice given by NTs. Perhaps they will seek second opinions. Perhaps they won’t waste money buying supplements they don’t need. And, hopefully, the qualifications and standards required of NTs will be subjected to closer scrutiny. Do you honestly think any of these are negative outcomes?

    James also asks, “would you trust Which to evaluate your surgeon? i think not.”

    Why not? If the Which? investigated, say, 14 private cosmetic surgeons and researchers found a majority of them were, say, telling customers that for best results they needed to take unnecessary supplements that they could purchase from the clinic, I’m sure anyone considering cosmetic surgery would be pleased to know about it. Wouldn’t you be?

  9. The problem seems to be that, however welcome the report conclusions are, if the actual study is inexcusably careless, to the extent that its conclusions can’t be proved, then its an opportunity lost which is a great shame. And to be honest, the Which? study was crap. For one major reason: the sample of nutritionists was NOT RANDOM.

    David Colquhoun says this in the comment thread on which.co.uk. (Although C.Collins, also on the review panel, says it IS RANDOM). Work that one out of you can…

    And.. if its not random, then you just cannot (scientifically or statistically) say anything at all about all the other nutritionists. The whole Which? study become an opinion piece, which everyone is free to agree or disagree with. But you can’t go the government with it without looking like an idiot.

    Now I say that’s careless (actually its a lot worse than that). All Which? had to do was take a proper random sample, and everything would be cool. But Which? couldnt even get that right.

    • @Chris James

      I think you are confusing the scientific need for random selection in double blind trials with everyday common sense. Blind application of the scientific method is not scientific.

      There was no critical statistical analysis in the Which report because it is not needed. The selection was random enough for the purpose. 5 people were asked to visit Nutritional Therapists and report their experiences. They selected Nutritional Therapists as any memeber of the public might do. Totally fitting for this study as it mirrors what people do.

      • John I don’t believe you are correct here. Randomness is a clear pre-requisite if you are going to use the study to make any generalised conclusions about the population you are studying. This means that if the sample isn’t random, your conclusions can only be held to apply to the 14 nutritionists studied.

        Any calculations about confidence limits, minimum sample size needed, etc etc are all predicated upon random sampling. The expert panel concede its not random. So it isnt.

        You state that the sample is ‘random enough for the purpose’.
        Why?, how? What do you mean by this statement?

        • @Chris James
          The study was not that complex and there were no calculations for confidence intervals or need for minimum sample sizes and there was no requirement for such statistics.

          It was random enough for the purpose because the people making the selection went about it in exactly the same way a member of the public would go about it. It would lead to the same type of selection anybody would make. So it may not be completely random in the sense that maybe they took the first BANT qualified nutritionist that came up on an internet search – which is not random – but it matches typical experience and produces a typical random sample that is representative of how you might choose a nutritionist.

          If you want to claim that Which somehow selected the only 6 rogue nutritionists in the country then you need to justify that with some confidence intervals etc etc.

  10. Which? found some nutritionists giving misleading or dangerous advice and using unproven diagnostic tests.

    If they are at all interested in protecting the public, BANT and the CNHC must now do their own – but independent – research to find out how widespread this problem is, and then fix it so that no member of the public is given dangerous advice again.

    If BANT want to be seen as in any way professional with the safety of the public in mind rather than just the pockets of their members, they must publish the Code of ethics and practice they say their members have to abide by. It is not acceptable for this Code to be kept secret – potential customers need to know that they are protected and they need to know how well they are protected.

  11. I wonder what the “Which?” Report would come up with when reviewing the trillion dollar pharmacutecal industry which loves to perscribe “A pill for every ill” – Although a totally different topic, this is certainly very relative and a I think it’s a welcome relief now that we can actually go to qualified nutritionists that mainly perscribe FOOD as their patients medicine.. NOT diet pills as a few people here mention.

    Check these stats: US Top 3 Killers
    Heart Disese (Caused by diet and stress)
    Cancer (Largely linked with diet (as well as genetics) and certain intake of animal protiens and many other food/man produced based substance)

    The third biggest killer in the US?

    Deaths from side effects to Pescription drugs.

    There is something seriously wrong with this.

    John – you mention that Nutritionists are “dangerously advising” that their clients can be cured of their Cancer by diet – Do you know the actual stats of how many patients (treated by Doctors and Surgeons STILL die of Cancer?) – If everyone is working toward the same goal – which ultimately is to make someone well again – then surely all avenues should be investigated. I feel I am qualified to say this having watched my Dad go through chemotherapy and drugs which made him more sick.

    Most Nutritionists nowadays will study bio-medicine and science on a cellular level so are certainly able to contribute and advise patients as well as any doctor could.
    “Let food be thy Medicine” Hypocretes – Perhaps he might just be right.

    • Hi Georgia

      This is a discussion from a long time ago and I cannot find in this thread the comments you say I made. (I think I am the only John in the thread so you must have meant me). But if I did say that someone is “dangerously advising” their clients that cancer can be cured by diet I would probably stand by at least the substance of that statement.

      That is not to say that diet is not very important for health and especially long term health. It is not to say that a switch to a more healthy diet cannot have beneficial effects. It is saying that to claim it can cure a serious case of cancer is bogus. Especially if it is to the exclusion of other treatments.

      I am sure it might be interesting if Which did something about the pharmaceutical industry but that is a far larger and far more complex problem.

      Not trying to be unsympathetic but your experience does not make you more qualified. Perhaps less qualified because your judgement could be skewed by the emotional involvement. Yes, of course every avenue should be explored by scientists. You, as an individual, do not have the luxury of being able to experiment. You only have one shot!

      I think you are missing the point a bit by saying how well qualified “Nutritionists” are who apparently study at a cellular level and can advise as well as a doctor. The point of the report is that there has sprung up a culture of pseudo-Nutritionists with faux qualifications who spout a load of rubbish and take money off people for expensive supplements and consultations. “Real” Nutritionists I am sure are very knowledgeable and well qualified but they understand the limits of their discipline.

      Regards

      J

    • Georgia B,

      A quick check on the Which? website would have shown you that it already carries reports and articles on various aspects of the pharmaceutical industry. For example, “Painkillers – don’t fall for pricey pseudo-science” appeared last summer.

      Nobody here has mentioned diet pills except you. And as the Which? article was about dangerously misleading advice given by people promoting themselves as nutritionists, your idea of “welcome relief” is neither here nor there, while your assertion that “most nutritionists” are “certainly able to contribute and advise patients as well as any doctor could” is unsupportable nonsense and is undermined by the very report you are trying to divert attention away from.

      The stuff about deaths from side effects of prescription drugs is a complete non sequitur that has no bearing whatsoever on the quality of advice given by nutritionists. However, assuming your claim that it’s the third largest cause of death in the US, is correct, that makes it sound as if all those people would be alive and healthy, had they not been taking prescription drugs. Do the statistics tell us why these people were taking prescription drugs in the first place? I mean, how many of them might be dead sooner from whatever was wrong with them had they not been taking medication? Without knowing all the data, you’re not telling us any more than that drugs can be dangerous, which we already know. Just like we now know that the advice given by some nutritionists can be dangerous too.

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