A high-profile investigation into nutritional therapy by UK consumer magazine, Which?, has concluded that nutritional therapy practitioners are, “Giving out advice that could seriously harm patients’ health”. However, while the investigation raises serious questions that must be addressed immediately by the nutritional therapy sector in the UK, the Which? report contains numerous and significant flaws and biases that made it difficult to draw any solid conclusions.
‘Mystery shoppers’ visit practitioners
The Which? investigation involved three reporters posing as patients and visiting a total of 15 nutritional therapists to seek advice for non-existent conditions. These included ductal carcinoma in situ – a type of breast cancer – fatigue and difficulty conceiving. The consultations were recorded and later transcribed, and both the consultations and the advice given by the nutritional therapists were reviewed by an ‘expert panel’ convened by Which? According to the panel, eight of 15 consultations were ‘fails’, six were ‘dangerous fails’ and one was a ‘borderline pass’.
Important issues revealed
Undeniably, some of the advice given by the nutritional therapists targeted by the Which? investigation gives serious cause for concern. In particular, diagnosis of medical conditions is legally the exclusive province of medical doctors in the UK. Other issues identified in the ‘serious fail’ category include advising cancer patients to delay conventional cancer therapy and missing so-called ‘red flag’ symptoms that could indicate the possibility of a serious underlying medical condition.
Errors in judgment such as these are not made by responsible and competent nutritional therapists, which comprise the vast majority of practitioners in the UK. Code of Practice (COP) adopted by practitioner organisations, such as the British Association for Applied Nutrition & Nutritional Therapy (BANT) – featured heavily in the Which? investigation – must provide clear guidelines to their members on these and other matters if professional responsibility and integrity are to be maintained. Practitioners who flout their professional body’s COP should face severe sanction, and professional organisations representing nutritional practitioners must work swiftly to get their houses in order before public trust suffers irreparably.
An investigation set up to fail
However, the Which? investigation contained clear evidence of anti-nutritional therapy bias in the makeup of its ‘expert panel’. This panel consisted of general practitioner (GP) Dr Margaret McCartney, a Professor of Pharmacology and Catherine Collins, a registered dietician. If the aim of the investigation was to take a fair, unbiased look at the practice of nutritional therapy in the UK, it too can be graded as a ‘serious fail’ based on its panel members.
Although Dr McCartney’s presence on the panel was presumably to advise on the medical diagnoses involved in the investigation, medical doctors in the UK receive minimal training in nutrition as part of their medical studies – a mere 1 day in the entire medical curriculum. Their competence to assess nutritional therapy must, therefore, be seriously questioned.
The highly partial Professor
If there’s one person who should not even be considered for an impartial view on nutritional therapy, it’s David Colquhoun, Professor of Pharmacology at University College London (UCL), UK. Yet there he was, large as life on the ‘expert panel’ chosen by Which?. Our objections stem from the fact that Colquhoun has been a high-profile opponent of all forms of natural medicine, and especially nutritional therapy, for many years and is a leading figure in the ‘skeptic’ movement. It beggars belief that anyone wanting a balanced view of nutritional therapy would even ask his opinion, let alone choose him as a member of an ‘expert panel’ on the topic. To prove this is not mere sour grapes, below are several public quotations made by Professor Colquhoun that provide a representative view of his opinion on the topic of nutritional therapy:
- Definition from a page on Professor Colquhoun’s blog entitled ‘Patients’ guide to magic medicine’: “Nutritional therapy: self-styled ‘nutritionists’ making untrue claims about diet in order to sell you unnecessary supplements”
- “‘Nutritional therapy’, or ‘nutritional medicine’, is a relative newcomer. At their worst, they claim that Vitamin C can cure AIDS, and have been responsible for many deaths in Africa. There isn’t the slightest need for them since the nutrition area is already covered by registered dietitians who have far better training”
- “There are a large number of university courses called "Nutrition". How many of them teach properly, and how many of them teach the nonsense that prevails in "nutritional therapy", I don’t know. The term ‘nutrition’ has turned into a dangerous minefield”
- “Nutritional therapists are those fantasists who believe you can cure any ill by buying some supplement pills”
- “Everyone is for good nutrition of course, but ‘nutritional medicine’, or ‘nutritional therapy’ pretends to be able to cure all sorts of diseases by changes in diet or by buying expensive nutritional supplement pills. It has no perceptible relationship to the very important subjects of ‘nutrition’ or ‘dietetics’. ‘Nutritional therapy’ is very firmly part of alternative medicine, in other words it is largely quackery”
Fox, meet henhouse
Catherine Collins a dietician registered with the British Dietetic Association (BDA) and was, at least until 2011, principal dietician at St George’s Hospital, London, UK. She is a regular spokesperson for the BDA, whose news article covering the Which? investigation states that, “Nutritional therapists use treatments such as high dose vitamins, detox, and food avoidance for which there is little evidence. They work on the belief that the body has underlying nutritional and biochemical imbalances that are leading to poor health including mental health problems. They do not use the evidence in a robust fashion and advice is most often based on personal opinion or belief.”
That the BDA is so obviously biased against nutritional therapy is unsurprising, since dieticians are in direct competition with nutritional therapists. At best, it is naïve of Which? to expect a dietician to give a balanced opinion on the competition.
Overall, then, it is clear that the ‘expert panel’ cannot have been chosen with the intention of obtaining a balanced, fair and unbiased result.
Dietetics is very different from nutritional therapy
Dietetics, the form of nutritional management practiced by dieticians, is based on fundamentally different premises to nutritional therapy, which in turn takes its cues from the 30-year-old and rapidly developing field of functional medicine. Contrary to the BDA’s scornful description, nutritional therapy may fairly be described as, “An individual-centred approach to healthcare that employs assessment and intervention using nutritional, lifestyle-based and related health sciences in order to assist the individual to optimise his or her physiological, emotive, cognitive and physical function”.
A description of functional medicine (FM), upon which nutritional therapy is based, goes as follows: “FM uses a systems-oriented approach to engage both the patient and practitioner in a therapeutic partnership. It is an evolution in the practice of healthcare for the needs of the 21st century. FM addresses the whole person, not just an isolated set of symptoms, and practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental and lifestyle factors that can influence their long-term health. In this way, FM supports the unique expression of health and vitality for each individual.”
An ‘expert panel’ without any experts
Definitions aside, FM – although backed by a sound and extensive evidence base – has so far not found acceptance by mainstream medicine in the UK. As a result, therefore, an ‘expert panel’ comprised exclusively of proponents of mainstream medicine was always going to come to extremely negative conclusions regarding a therapy it has yet to embrace.
We also question why the Which? investigation did not think to ask a nutritional therapist to represent the profession on the ‘expert panel’. An ‘expert panel’ that does not include anyone with professional qualifications and experience in the speciality under investigation – in this case nutritional therapy – cannot in all seriousness be regarded as ‘expert’.
A biased selection process
A big question for the public, for BANT, the Complementary and Natural Healthcare Council (CNHC) and government regulators, is just how representative was Which? magazine’s sample of 15 nutritional therapists?
The bottom line is that it appears, from information that has been gathered to date, that the sample selected in each city was not chosen randomly. Instead, the selections were based on those practitioners that came at the top of Google searches in each of the three cities chosen for the study. Only a randomly selected sample could be viewed as being representative, and such sampling would have to be independent of Google rankings. Basing the sample on Internet rankings, as for any industry, might bias the selections toward practitioners that have expended more effort in trying to increase their search engine ranking, rather than offering high-quality nutritional therapy services.
To use an analogy, it would be akin to evaluating the overall safety of all over-the-counter pharmaceuticals based on those that appeared in the top 10 hits after entering a phrase such as “buy drugs online” into Google. The results from such a search would be quite different from 15 drugs randomly selected from, say, the 100 most used ones.
Here we go again
On the one hand, this Which? investigation has unearthed some awkward truths for professional bodies acting on behalf of nutritional therapists. We urge them to act quickly and decisively in order to ensure that the mistakes highlighted by Which? do not happen again – and if they do, to ensure robust disciplinary procedures are in place to deal with the culprits. All professions have their bad eggs, but what marks out a trustworthy profession is its willingness and ability to deal with them.
But – and it’s a big ‘but’ – this investigation was laughably transparent in its desire to hang nutritional therapists out to dry. Which? therefore joins the lengthening roll-call of supposedly prestigious publications that have dived head-first into the mire of unwarranted and dishonest trashing of natural therapies. As Ben Goldacre would say, over and over again, “Shame on you”.
Comments
your voice counts
Anonymous
17 January 2012 at 5:47 pm
What's the betting the "mystery shoppers" are skeptic... they are trying everything they can do to discredit anything natural!
Anonymous
17 January 2012 at 9:05 pm
this article is a nonesense.
Theresa
17 January 2012 at 9:34 pm
Professor Colquhoun, a GP not specialising in nutritional medicine and a Dietician. WHICH was clearly mounting a WHICH hunt or they would have had a more credible non-biased panel. The actions of WHICH will backfire on them. Who can trust their reviews now? As for those of us practicing Nutritional Therapy we need to really sharpen up our act.
Anonymous
17 January 2012 at 11:56 pm
So have you ever considered checking the word skeptic in a dictionary?
Try this one : Marked by or given to doubt; questioning
Surely that is a good thing, or are you only allowed to question some viewpoints (ie not yours)?
Jo
18 January 2012 at 12:59 am
Playing devils advocate do you think that would have made any difference to what the Nutritionists told them ?
Catherine Collins RD FBDA
18 January 2012 at 1:17 am
Thank you for highlighting the Which? article. FYI the panel chosen had no predetermined bias towards the therapists reviewed, which were chosen at random by Which? researchers.
Having reviewed Nutritional Therapists in a similar article a decade ago I was expecting an improvement in knowledge base, given the push to regulate nutritionists through bodies such as BANT or CNHC. It was therefore surprising to see how truly appalling the advice offered at appointments was.
When nutritional therapists such as these attempted diagnoses (with or without supportive tests) and offer dietary advice/ restrictions to manage those conditions, their practice strays into the area of clinical dietetic practice, and I am qualified to comment on the findings.
I readily agree with you that BANT must 'act quickly and decisively in order to ensure that the mistakes highlighted by Which? do not happen again', and look forward to them taking a definitive stance.
Lotte Aagesen
18 January 2012 at 10:53 am
Stop bullying natural cures and therapists!
The conventional medicin kills thousands of patients each year!
When do we ever hear of anyone dieing from natural cures? 5 people? Rather less!
My pollenallergy was cured by a natural therapist!
My depression was cured by using natural methods - positive thinking and self-care!
colloid silver cured my infections - with no risk of the germs getting resistant.
Let people choose for themselves if they want natural cures or conventional ones.
Vivien Pomfrey MSc http://www.vivienpomfrey.co.uk/
20 January 2012 at 8:26 pm
I agree largely with ANH's stance on natural preventions and therapies, and they are always my first choice, but I do share concerns about Which's findings. I have only encountered one self-styled nutritional therapist, who gave me unsolicited and wrong information which, if I had acted on it, would have stopped me from using a natural compound that I knew from scientific papers would, and still does, benefit me. In fact, without it I could suffer a recurrence of a life-threatening condition. She failed to read what I had written properly and made several claims about natural and pharmaceutical products that I knew to be wrong. I have encountered numerous conventional doctors who have been equally bad, so I'm not sure what the solution is other than perhaps more public and self-education.
Ojeronimo
20 January 2012 at 8:43 pm
Over the past 30 years, Which has demonstrated a regular lack of even 20th and 21st century advances in food testing while remaining stuck in 19th century level procedures.
It was only a few years ago that Which tested royal jelly as food by simply incinerating it to ash in order to determine the number of calories liberated! Any one who has the nous to utilise royal jelly does so for enhancement of vitality.
Given such a primitive materialistic and deliberately inappropriate approach to the the vitalistic quality of food substances, it is clear as to why it refrains from selecting even a nominal nutritional profession on its expert panel.
If one wishes to know about dents in baked beans containers or the more efficient hoovers on offer then Which has demonstrated consistent reliability in its testing and reporting articles. Other wise it is better to wade through the webb based reviews of satisfied and critical users of the products in which one has interest.
Anonymous
21 January 2012 at 12:02 pm
The Society called "Sense about Science" which Prof Colquhoun belongs to is a political organisation which is funded by Pharmaceutical Companys to destroy the Alternative Health Industry. Catherine Collins just a few years ago on the BBC Health Column stated that Vit C was dangerous. When I emailed her asking what is dangerous about Vit C she stated it could give you loose bowels. I replied that I get those from a good Curry and or a very good pint of Bitter does that make them dangerous as well ?. She didn`t have the curtesy to reply.
Just look how good Dieticians are, the NHS Hospitals are awash with patients who are malnourished. The Dieticians are the one`s in control of the diets in these establishments. Need I say more.
This is an obvious stitch-up by the Which Magazine. We now know we cannot rely on their unbiased opinion on any of their product investigations. People Beware
Anonymous
21 January 2012 at 6:06 pm
Ms Collins, we are all qualified as citizens to take responsibility for our own health. I await eagerly the day when medicine is truly evidence based rather than all too often 'pharmaceutical company evidence based'.
I salute the amazing medics who honour the Hippocratic oath and lead the way so that organic nutrition can be given its rightful place and the limits and dangers of reductionist pharmaceutical patents contextualised. From a very long list: Drs. Burzynski, Buttar, Gonzalez, Campbell-McBride.......and yes the 'heretical' Dr Wakefield. Thanks for all your brave efforts to pursue the real science, the evidence, and to heal. Despite the best efforts of those wishing to protect establishment vested interests.
Ronnie Plant
21 January 2012 at 7:14 pm
There is no need to go undercover to seek out what Which is searching for. We are a sick nation simply because all too much of the so called food we are offered is fake. Instead of it being natural much of what is being eaten and drank is factory made, additive containing, processed junk. This is what almost all dieticians and nutrionists recommend. Pure, natural, unadulterated, non-processed food, it seems is anathema to them. A balanced diet to many is a can of coke in one hand and a Kellogg's Nutri Grain in the other. I respectfully suggest that all with an interest in having good or better health, through the use of pure food, read my new book 'SELLING SICKNESS!' sub-titled How To Take Control Of Your Own Health
Anonymous
22 January 2012 at 12:34 pm
"Let food be they medicine and medicine be they food" Hippocrates adopted as The Father Of Western Medicine. Hippocratic Oath. Tenet: 'Do no harm'.
Anonymous
22 January 2012 at 8:44 pm
Maybe, "Which" would like to print an article on the "Gerson Clinic" (London) or "The Tree Of Life Clinic" (Arizona) Or Dr Bryzinski or Dr Lodi or any of the practices that have 80 and 90% success rates for cures in their fields, without the use of toxic drugs ?
Anonymous
23 January 2012 at 3:57 pm
Could there be fear brewing in the conventional healthcare providers that the natural medicine may actually take over, as more people turn to natural medicine out of choice. I think the conventional practitioners are trying to blind the nation. I thought it was about working together to help the nation not against each other. If they actually opened their eyes they may just realise that Nutritional Therapists can add value to the NHS and bring down the ever rising costs the government can’t stop talking about. People should be allowed to take care of their own health the way they want. This is what should be publicised on national TV to open everyone’s eyes http://www.youtube.com/watch?v=r4DOQ6Xhqss
Anonymous
15 January 2013 at 9:38 am
NUTRITION is what the man eats in order to keep alive the cells of the body. Aliment, food, or nourishment is the source of energy needed for the body to function. Illnesses may be prevented, mitigated, with a correct food diet.One of the most important parts of physical health is nutrition and it's even more important for those who have cancer. A healthy body is better equipped to fight the spread of the disease, recover from potentially destructive.
Amy
24 January 2015 at 1:46 am
Though there are some bad therapists out there as long as people seeking a natural remedy realises and understands the limitations of nutritional therapy there should be no confusion, they do not replace conventional medicine, it is a complementary service. Nutritional Therapists do not cure disease they merely attempt to prevent diseases in the first place or in failing that help individuals make the right choices in order to be the healthiest they can be in any circumstance.
Can you cure Cancer through nutrition? No, but you can however live the healthiest life possible, and give your body the best chance to provide a hostile environment for cancer cells to grow. That is nutritional therapy in my opinion.
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