Having just had a baby girl and moving house, I thought I would subscribe to Which? magazine as I knew I needed to make a few critical spends over the coming months. Which? is a consumer rights organisation that publishes reports and reviews into consumer issues.
Online reviews of products and services can often be misleading as you do not know anything about the reviewers motives and depth of experiences. More often than not, I find myself wondering if reviews say more about the reviewer than the product. So, it’s good to see independent consumer organisations such as Which? systematically review and rate competing products.
One thing did strike me though, and that is that Which? tend not to focus on dodgy health product claims. I had put this down to simple commercial reasons. When you write a bad review of a bogus toaster which has a tendency to burst into flames, or a pushchair that happily chops off babies fingers, you are unlikely to get cancelled subscriptions from people who own those products. But those who have bought into the cult-like beliefs of much alternative medicine are going to get angry, upset and believe Which? is now in cahoots with Big Pharma.
So, I am very pleased to see that Which? have done some great investigative journalism into nutritionists. The results are shocking.
Well, they will not be shocking to you if you have been reading stuff like Ben Goldacre’s Bad Science.
Nutritional therapy is a form of karaoke medicine. The practitioners go through all the motions of looking like they know about science, diet and health, but what they actually do is spout painful nonsense. Sometimes dangerous nonsense.
Which? sent five of their reporters undercover to pose as patients. They visited a total of 15 nutritional therapists. The reporters posed several health issues such as having breast cancer, suffering from long lasting fatigue or having problems conceiving.
Out of the 15 therapists, 6 of them gave advice that Which? scored as a ‘dangerous fail’. This included advice to delay radiotherapy treatment and instead try to cure the cancer by cutting sugar out of the diet. Another advised the reporter not to report feeling unwell to their GP as they would not understand the diet they were to be placed on.
A further 8 therapists gave advice classed as a ‘Fail’, including offering quack diagnostic tests such as Hair Mineral Analysis and Iridology. One woman was told she could not conceive as she was suffering from a ‘leathery bowel’.
Twelve of the consultations resulted in patients being sold vitamin and mineral supplements costing up to £70 per month. In general, Which? said,
Most therapists over-simplified symptoms and failed to recognise important ‘red flag’ symptoms requiring proper medical attention. Their medical explanations, understanding of how the body works and their knowledge of vitamins and minerals was also poor. One therapist told Mark that weight had nothing to do with type 2 diabetes and another told Helen that alcohol is not a risk-factor for breast cancer.
Out of the 15 Nutritional Therapists visited, only 1 gave ‘Borderline Pass’ advice.
Which? is now demanding the government properly regulate the sector. Their Executive Director, Richard Lloyd said,
We found some shocking examples of irresponsible advice given by nutritional therapists. Our research shows that not only were they a waste of money, but some of their recommendations could seriously harm people’s health.
This is largely a self-regulated industry where anyone can set up and practice as a nutritional therapist, meaning there is no real protection for consumers. While the majority of the therapists Which? visited were registered with the industry body, BANT, our findings show that it is failing to police these practitioners effectively.
“Which? wants the government to take action to stop nutritional therapists putting people’s health at risk.
There is a huge danger in advocating ‘better regulation’ for practitioners of superstitious and pseudoscientific therapists. In short, regulating nonsense just results in legitimising nonsense.
Nutritional Therapists claim to be regulated right now. BANT, the British Association for Applied Nutrition and Nutritional Therapy, claims to have a code of conduct and regulate practitioners. BANT did not respond to Which? when challenged about these results. That is, I believe, because Nutritionists see this type of advice as good advice. Nutritional Therapists have cult-like and conspiratorial beliefs that mean they think mainstream doctors know nothing about nutrition and are covering up ‘natural’ health cures to protect pharmaceutical company interests.
And while they look to the money obsessed evils of Big Pharma, BANT specifically allow kick backs from vitamin pill sales to their customers. No wonder this survey saw so many being sold.
Of course, there is a proper statutory regulator for those wanting to give dietary advice in a clinical setting. The Health Professions Council regulates dieticians – it is illegal to call yourself a dietician without being registered. In contrast, anyone can call themselves a nutritionist regardless of training or affiliation with any so-called regulator.
Several government attempts have already been tried to create regulators for quack therapies. Ofquack, or the Complementary and Natural Healthcare Council, was set up by Prince Charles and funded by the Department of Health. The CNHC have been limping along for years now and have failed to persuade many nutritionists to be their regulator.
The CNHC (http://www.ofquack.org.uk) have also been a complete failure in understanding how they need to protect the public. They have decided that they cannot make their registrants to stop making misleading claims. They also appear to have a problem finding fault in their members if they have been trained to believe their own misleading claims. As such, Ofquack are incapable of protecting the public from the sort of problems raised by Which? Nutritionists are trained to believe all sorts of nonsense about diet. Regulating them without considering whether what they believe to be true is giving them a fig leaf. Clearly any form of voluntary regulation would fail.
But what of statutory regulation? That has problems too. Chiropractors have also been statutorily regulated. But as another placebo therapy, regulation has not stopped them making very serious bogus claims over the years. It was only when the chiropractors decided to sue Simon Singh for pointing this out that all this came to public attention. Since then, the British Chiropractic Association has been humiliated and their regulator, the General Chiropractic Council exposed as a chocolate teapot.
Such situations are bound to occur when you attempt to regulate nonsense. You don’t stop the nonsense being believed and practiced, and any attempt to clear it out would quickly result in the end of the regulator.
So what to do? It is worth pointing out the vast gulf between Dieticians and Nutritionists. Should statutory regulation of some sort be placed over nutritionists, we would essentially have two regulators for people who wish to offer healthy eating advice to the public based on very different worldviews and attitudes to evidence.
I feel it worth repeating some words I wrote several years ago when I was writing about Patrick Holford.
So, we have two worlds in the UK. Worlds with very different views on how food and diet affects our health and how we can manipulate diet to improve our health.
The first world is typically populated by scientists and dieticians. They take an evidence-based approach to understanding food and are cautious in coming to conclusion where there is insufficient data. They work in clinical practice, in hospitals, universities and on an NHS wage. They advise on good, affordable and understandable diets, and treat patients who are sick and need careful advice on their road back to health. They concentrate on the overall diet and not on an obsession with nutrients. They are regulated under law, have transparent and meaningful governing bodies. They are accountable for their actions and can be struck off if they fail in their duties. They promote their work in science journals. They share their canteens with nurses, surgeons, medical students and doctors.
The second world is populated by lawyers, accountants and journalists that have undertaken a career change. Younger students enter independent nutrition colleges and need little scientific training to do so. If they don’t get training, they add ‘Dr’ to their name anyway and get a contact with Channel 4. They selectively pick evidence that suits their alternative philosophies and learn to be suspicious, if not downright hostile, to science and medicine. They work in private practice and sell food supplements, questionable allergy tests and hair mineral analyses. They confuse allergy and intolerance, and fetish on vitamins and minerals, whilst advising clients to remove whole food groups from their diets. They sell their business to the worried well and poke around in their poo. They are not statutorily regulated and so lack that accountability. They promote their work in newspapers and magazines. They share their Richmond bistro with reflexologists, personal trainers, homeopaths and TV producers.
One way out would be to include the words ‘Nutritionist’ or ‘Nutritional Therapist’ in exactly the same legislation as exists for Dieticians. Nutritionists would require the same education, standards of professionalism and approach to evidence. This would essentially immediately criminalise the second group and ensure the public are never confused about the two groups.
Such a move would be very heavily resisted by the nutritionists of course. They would not want to abandon their unevidenced and whacky beliefs about vitamin pills. And I suspect, the government would have no appetite to increase the burden of legislation on them.
I fear, that although this Which? report has been very good, it may well hasten government action towards mere legitimisation of dangerous health beliefs through ill thought through regulation. And that will not be in consumers’ interests.
David Colquhoun, who helped advise Which? on this report, has also written about their findings here.
I didn’t realise nutritionists were as bad as that. I wonder what the Which legal service would advise to anyone who feels they’ve been ripped off or given crap advice by one of these posers
By the way, “the second world is populated by lawyers, accountants and journalists that have undertaken a career change”. You need at least some brains for the first two of those. More “legal secretaries, bank clerks and journalists,” I would have thought.
Possibly the nutritionist who advised delaying radiation therapy and seeing if diet could work instead, could be prosecuted under the Cancer Act — for claiming to be able to treat cancer
There is another regulatory body for Nutritionits, called the Association for Nutrition, which insists on scientific training. Please don;t think that all Nutritionists are as bad as the Nutritional Therapists that are discussed here.
As someone interested in Complementary and Alternative Medicine, I do not want to be deprived of choice – and of having the opportunity of choosing an alternative to a regulated practitioner.
Nutritionists provide a service to many people who want, and feel they benefit from, having an alternative to rational evidence-based medicine. Such patients should not be denied their right of free choice to consult with an unregulated practitioner.
Any nutritionist that wants to be regulated can join one of the regulated health professions. If for any reason they would like to, but are simply not up to it, that is because the regulated professions set high standards of entry. And practice after qualification.
Nutritionists do not want to be regulated, save by themselves. They provide an alternative which is wanted by many patients. Even if others might regard them as deluded. Providing there is compliance with present rules and regulations on fraud, advertising, passing off, and criminal activity – leave it that way.
Which? must of course do all it can to ensure that clients/patients are properly informed about the issues and give consent.
The concept of choice is meaningless where the choice is exercised in an information vacuum. Most people lack the qualifications to objectively assess the quality of advice a given provider is likely to offer, and it is clear that many quacks (yes, quacks) are adept at putting on white coats and a show of sciencey-sounding steg dressing. That is why we have regulation. Regulation was not introduced because someone thought it would be fun to poke the alt-med crowd, it was introduced to protect the public from quacks.
There is no way, in a civilised society, that “choice” can legitimately trump protection of the consumer from exploitation and possibly lethally bad advice. That is why we have, for example, the Cancer Act.
If people want to give diet advice then they are free to train as dieticians – it’s pretty clear that training and regulation are necessary; after a number of years of public critique of the likes of Patrick Holford and Gillian McKeith (or to give her full medical title, Gillian McKeith) nothing has materially changed and it’s not going to change without some sort of intervention.
In a highly competitive environment there are many claims, mostly false, each promising more than the other product. Such was the case in the 1800s that eventually led to regulations. Note that almost all the potions were either addictive or worthless. Regular medicine had few solutions, not even a germ theory. Competition is not a viable economic model for medical solutions as evidenced above and the lack of a viable economic basis for opponents of quack medicine; other than a book or two. Diatribes do not make a debate nor characterizations of opponents as pointy headed, drooling ogres.
The “information vacuum” is truly the biggest impediment to learned decision making. I don’t think anything will ever trump anecdotes told be people who are friends and loved ones. Unfortunately, second hand anecdotes from a friend of a friend are powerfully persuasive. Clive R. Boddy states that “Psychopaths are the 1% of people who have no conscience or empathy and who do not care for anyone other than themselves.”
People enter medical and pseudo-medical careers for selfless, pecuniary, delusional and many other reasons. Mix a few psychopaths into the pot and you may have problems. The United Kingdom even considered creating the Dangerous and Severe Personality Disorder (DSPD)
Classification. Robert Hare created a diagnostic tool called the Psychopathy Checklist (PCL-R). In the article by Robert Hercz at http://www.hare.org/links/saturday.html, he describes the lack of empathy, lying and drive to be noticed as characteristics of psychopaths. There are 40 traits on the PCL-R which are used to assess the emotional status of people. No one should ever call anyone a psychopath casually. The point is to learn the characteristics and protect yourself and others from people who cannot empathize. I daresay almost all people who enter health related careers are highly empathic, even to their detriment such as burnout.
So you have this mix of people offering advice for a price. Some are well informed, some are misinformed and some don’t care as long as you purchase something. All one can do is hope to get advice from people who are well informed and not psychopathic. I think a lot of regulation has come about to protect us from psychopaths in the health fields.
@ Alan Henness
You’ve done a brilliant job attempting to educate the masses on the Which? bulletin boards, but I think we have to acknowledge that the site is being stalked by those very people who have most to lose by this objective report criticising their practice. Have posted a few comments but consider it akin to ‘futile cycling’* at the moment
*note to enthusiastic-amateur-nutritionists: bit of an in joke here. Could be defined as just repeating the findings which are unacceptable to those ‘practicing’ as nutrition experts, but for the dietitians and kosher nutritionists with biochemistry under their belt its occurs when two metabolic pathways run simultaneously in opposite directions and have no overall effect other than dissipate energy as heat’. See – we dietitians do have a sense of humour! 🙂
@ Dr Rawlins
I agree with you if we were discussing which anti-aging cream to buy in Boots – the one that reduces the ‘7 signs of skin aging’ or that ‘perfect serum’ that will knock years off your appearance.
I disagree that it is fine for nutritionists – self styled or with a degree in the subject – to set themselves up as experts in clinical nutrition and offer advice to manage medical conditions. To do so puts the innocent client at potential risk – as was found in the Which? report.
I have seen clients who eventually end up in conventional healthcare with a year of detoxing, gluten free, milk free, supplement loaded with a sheaf of ‘diagnostic tests’ that have helped the therapist maintain their veneer of respectibility (whist generating a little ‘kerching’ on the side) by recommending tests whose companies helpfully give a differential diagnosis at the bottom of their analysis.
It is amazing how tenaciously these patients cling to their ridiculous dietary restrictions, and believe me, there is nothing sadder than a palliated cancer patient who says their one desire is a slice of fresh baguette with butter but who must resist for fear of accelerating their demise.
We would not tolerate such amateurism as pseudo-medics, pseudo-dentists, yet the appeasers would seem to accept these practitioners as if their ‘treatment’ is benign. It is time for their profession to be seriously scrutinised. If you want to practice clinical therapeutic nutrition, re-train as a dietitian. Nutritional therapists that have committed to the 4 year, full time BSc(Hons) degree are amazed at how unconciously incompetent they were in their previous career
I don’t suppose you’d like to post a similar comment on the Which? website on their discussion about this? I’ve been battling away (over 10% of the comments there are mine!), but it is full of anecdotes, possibly encouraged by the Alliance for Natural Healthcare’s article this afternoon.
“The second world is populated by lawyers, accountants and journalists that have undertaken a career change.”
The bit about accountants hurts, and I would very much hope it to be largely untrue. Accountants are trained to evaluate evidence and spot discrepancies, even if it’s nothing like as rigorous as scientific research. For what it’s worth, a degree in Economics or Business Administration does not make you an accountant. In fact, people who have qualifications in business admin tend to be salesmen, in my experience. Anecdote of course, YMMV, offer may not be available at all outlets.
Signed, an accountant making a career change
Hope not offend! I am making the point that that there are a lot of second careerists out there in nutrition – and a good former job or education appears to be no barrier. All of us can slip into karaoke given the right nudge.
The patient has already been given the option to radiate. Cutting sugar out of the diet is one of the most important protocols in fighting cancer or any other disease. In my country, USA, over 100,000 people die each year from Legal Pharmacutical drugs. Can the death rate of alternative medicine be compared? I think not. As far as Dieticians go, there lack of understanding proper nutrition for health and disease healing is worse than the average nutritionist. We need a blend of both. Allopathic to use in triage and emergency and good nutrition for healing.
”When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need.” – Ayurvedic Medicine Proverb
You are precisely the sort of person with misleading ideas that needs to be stamped out.
Andre Chimene said:
If you want to do any proper comparison (not that it has anything to do with dangerous advice given by nutritionists, of course), please only do so if you also detail the numbers of lives saved by conventional medicine, the number of people living longer and with a higher quality of life because of conventional medicine, the number of babies who survive birth because of conventional medicine and the number of those who are suffering less and in less pain because of conventional medicine.
And then give the same numbers for alternative therapies.
We have the longest lifespan in recorded history, which is not a result of following Ayervedic mantras.
Where to start with your sugar recommendations? So many possibilities in shooting down this canard
That whether you eat sugar or not, your body will maintain blood sugar levels by digesting starches, or de novo from glucogenic amino acids where necessary?
That insulin resistance/ metabolic syndrome/ inflammation are likely to be important contributors, but all are possible with a high fat, low carb (yes, low sugar and starches) diet providing an excess energy that is stored as body fat, especially in the US immobile population. Ooh, especially if the fat is of the saturated/ omega-6 PUFA varieties.
That by the time someone HAS cancer, blood tests may not be representative of the condition that initiated the cancer in the first place and more likely represent an altered miieu with the cancer-in-residence – despite the common association of post-diagnosis food intake/ blood test results made by self-styled therapists/ nutritionists.
That, for example, insulin production generates IGF-1. Many cancer patients have higher levels of IGF-1. Therefore a high sugar/starch diet must make you develop cancer as tumours need IGF-1 to help them grow, and by eating sugars you make more insulin blah-di-blah. Pity you overlook the fact that tumours can generate their own IGF-1 to guarantee their survival, and for example, in a study of breast cancer, IGF-1 levels plummet to normal levels post lumpectomy/mastectomy. you remove the source of IGF-1, you lower the blood levels.
enough for now. I’m sure we’ll debate further. Your comments about dietitians doesn’t require debate. You obviously have no knowledge at all about how we work. I suggest you check out my American colleagues at ADA at http://www.eatright.org
Have you worked in the field? No, I thought not. I am a type 1 Diabetic who travels the world working with charity cases up the 4th Wealthiest family in the world. I fix diabetics and get them normal blood sugars. I work with Dr. Ron Rosedale, the worlds leading authority on Insulin and Leptin. We fix people of many ailments, from diabetes to cancer. How dare you insult what I have done or who I am. If you would like to rectify this, here is my email…[email protected]. I am happy to give it out to the world because I stand on 20 years of field work. If you have helped more people than I have, If you can normalize blood sugar and give a diabetic a new healthy life, as I do…I will gladly concede the floor to you. You do not have the guts to put your real name to this. I do. If you dont, you lose.
‘Allopathic to use in triage and emergency and good nutrition for healing.’
That sentence is very appropriate.
1) Medicine is just medicine, allopathic was a word made up by Hahnemann to distinguish between treatment (medicine) and non-treatment (homeopathy).
2) While nutrition is necessary for healing and health it is not the only component of treatment.
3) Nutritionists would be last group to go for advice on either nutrition or treatment. To increase their income, not only are they ignorant of medicine and nutrition but many are into such delusions as aromatherapy, reiki etc.
andreboco/Andre Chimene said:
Alan, no they are not won on whether a person signs his name. Good point. I am not defending charlatans or quacks. Perhaps, I am at fault. I did not make my point clearly enough. My point was merely that I have heard and debated Registered Dieticians who make just as stupid and ignorant staements on proper nutrition statements as “nutritionists”. To suggest that a person is going to get better care from a Registered Dietician than a nutritionist is not based on the truth. To have an oncologist recommending chemo to a stage 4 pancreatic patient is just as dumb as having the patient do colonic therapy and some carrot juice. I am not defending “quacks” in either world. I will read more of the blog posts here. I am as much of a sceptic as the next sceptic. However, when I personally attacked by the author…”You are precisely the sort of person with misleading ideas that needs to be stamped out. I am from Texas and them’s “fightin words”. I do stand by my other point that anyone may call into question my credentials or my methods if they have also worked in the field of health with similar or better results. An arm chair healer, allopathic or alternative, holds no weight with me. We are all experts on PubMed.
Yes, but some of us even know how to interpret Pubmed entries and recognise the limitations without reading the whole paper
“The patient has already been given the option to radiate”.
How does this justify giving them duff information? If I had a serious medical problem and a doctor told me I needed to undergo a well-established treatment; and then someone else who kind of looked like a doctor [nice office with fancy-looking certificates on the wall] told me to ignore that advice in favour of whatever quackery they subscribe to, then it is not entirely my fault if my medical condition gets worse. Hiding behind the notion of “choice” is a VERY dangerous extension of “caveat emptor”. I don’t have a background in science and medicine and to a great extent need to rely on others to give me high quality information. The argument in favour of regulation is that I can trust that the service I am being given is based on established evidence and standards. It’s not perfect, of course, but quackery brings the average down a whole lot more than the imperfections of regulated, evidence-based practice.
I also fail to see how the [reported] success of a dietary treatment for diabetes is evidence for the efficacy of a wholly-dietary treatment for cancer. “Cutting sugar out of the diet is ONE OF the most important protocols in fighting cancer…” [emphasis added]. Radiation therapy is another one of these important protocols: the doctor prescribing radiation therapy should give advice on sugar as well if there is good evidence for it, and would also understand the weightings of importance [eg. they might suggest that radiation plus cutting sugar is better than radiation alone; but not that cutting sugar alone is better than radiation alone].
Just a comment on the byline: “But calls to better regulate them may do more harm than good.”
I think this rather misrepresents the content of the article a bit. LCN regularly makes the valid point that self-regulation of nonsense by people who believe in nonsense is itself nonsense. But unlike reiki or homeopathy, diet can have an influence on medical conditions — not in isolation from medical treatment, but at least there is an active ingredient!
The article points out the distinction between dieticians and nutritionists, and tacitly supports regulation which would bring the latter under the same training and code of conduct requirements as the former (effectively making synonyms of the terms, and criminalising the quack variant). This would be a very different thing to self-regulation by the quacks, which I assume is what’s being referred to in the sceptical byline.
I think the issue here is that Nutritional Therapists will want to be seen as a distict discipline from Dieticians and will want separate statutory regulation. That is where the massive danger lies in that regulation legitimises the karaoke version of nutritional advice.
NT’s do indeed work in a very different way from Dieticians. Their business model is typically to use quack diagnostic schemes to prescribe huge tubs of ‘individualised’ vitamin pills. And pretend that it is medicine. This is pretty much backed up by what Which? found.
Either existing laws need to be used (such as the Trading Standards laws -which are sufficient, but TS do not go after quacks), or, as you say, criminalise them by enforcing one high standard on them.
You get bet though that a fudge will happen which will suit the nutritionists and fail to protect the public from the problems seen by Which?.
Very well said Catherine. I’ve seen young children seriously malnourished because some “nutritionist” persuaded their parents that some fad diet along with expensive fake allergy testing and supplements would improve their asthma/eczema.
People have to realise that you cannot simply invent your own healthcare profession, and no, just because some unscrupulous university has put bucks before academic rigour and given you a “degree” it does not mean you are a HP.
Firstly well done to Which? for uncovering such unscrupulous practices. I totally agree with Catherine Collins comments.
As a Registered Public Health Nutritionist with the Association for Nutrition I really take offence to the quacks referring to themselves as “Nutritionists”. I wouldn’t dream of working as a “self styled clinician” Dieticians are the experts in clincal nutrition.
I always use an evidence-based approach to the healthy eating advice I publish based on eating a healthy balanced diet which can be easily prepared and affordable. It is time for the professionalism of properly qualified Nutritionists to be protected from such charlatans masquerading as “Experts” in order to peddle unnecessary supplements and often harmful advice to vulnerable people.
yes, you can subscribe in a magazine and to make a fwe cirtical spends over the coming months for having a baby girl.
Im sure you get good and bad ones. People need to use their common sense and do research before they spend their money. I dont think all vitamin pills are bad, afterall doctors use them to treat deficiencies. And a lot of our food is lacking in vitamins after its been processed to shit! Sure we should all eat a healthy balanced diet, but some choose not to, and if they then need to take vitamin supplements to replace whats been taken out of their food, i think that option should be there. Esp as its the poor and uneducated that follow that diet as its cheap! Notice our foods have ‘supplements’ in them too nowadays. I also have found benefit from taking magnesium for insomnia, which i had for ten years and so am a believer in vitamins, but i do think they should be regulated on quality…. As certain disorders do benefit from vitamin supplements, and to regulate too much could force people to take more dangerous drugs… The FDA seem to regulate vitamins in the US? Do FDA do the same here? People should have some choice as the placebo effect can also help people get better. Most antidepressants are only marginally better than placebo, is that good enough, considering the sideeffects?