The Good, The Bad and The Ugly

[28-Jan-12] The year 2012 started with some turbulences in the Nutrition Health arena (in the USA and European-wide), with media articles and various blogs running over with comments and opinions from both public and different health care professionals. Most of our clients often seem confused, with a common question: “I just want to eat well and be healthy, what’s the big fuss and what really IS the difference between a dietician, nutritional therapist (NT) and nutritionist?” (a place to find out may be here and here).

 

And why all this competitive bickering when ideally we should all aim to work together, specialising in our own areas of expertise, while respecting and enhancing each others strenghts – together – rather than against each other?  There was a nice e-bulletin last week on ‘Recognising Diversity‘ between these professions.  Reading through some of the blog comments (Which?, FSA, and various others online), it poses the question – is this predominantly about egos, politics, and vested interests while it should really be about the patient and consumer seeking better long-term health outcomes?

 

Some of the bias made by the recent Which? article was recently reviewed succinctly by a well respected Nutrition Consultant (MSc Nutritional Medicine, University of Surrey) here, who also did a very good job at responding to critical comments from Which? panelists and well-known professional anti-NT camp bloggers.  Also a recent article of the British Medical Journal (BMJ) tried to bash Nutritional Medicine, while even the medical professions’ own lot, for example experts like Dr Mike Stroud (FRCP Consultant Gastroenterologist and Senior Lecturer in Medicine and Nutrition, Southampton, and Chair of the NICE GDG on Nutrition Support) was expressing his opinion about the article.

 

The point is that there are indeed ‘good’ and ‘bad’ practitioners in all professions. Ideally sifting out the ‘bad’ and the ‘ugly’ from the ‘good’ should of course be a priority in ensuring patient interest and safety. However, it appeared that the Which? article contained many inaccuracies and biases. There was an enlightening article published this week, aiming to explain the difference between main-stream dieticians and nutritional therapists, giving insight into current challenges in ‘Evidence-Based Medicine’ in the current scientific paradigm and the ‘new’ (well, more than 30 years old…) Functional Medicine paradigm for improved and integrative medicine (also with a a video link to Dr Jeffrey Bland, Institute for Functional Medicine (IFM)):

 

“ANH FEATURE: Dieticians and nutritional therapists: never the twain shall meet?

As we pointed out in our article on the recent Which? investigation of nutritional therapists (NTs) in the UK, NTs and dieticians are very different animals. Although the Which? article contained many inaccuracies and biases, what shone out clearly from the investigation was that anyone visiting a dietician with a particular condition would likely receive very different advice if they went to see an NT. But why is this? This article attempts to shed some light on the different approaches of NTs and dieticians… Read more…

 

One of the comments was particularly intersting from a non-NT/non-dietican and non-healthcare professional (‘just’ a PhD Physics with 25 years of R+D experience; at the time of writing comment number 570!): Guy says,

“… In terms of confirming the effectiveness of NT, the orthodox method would be to carry out randomised trials. However these are not a suitable measurement method since NT practitioners will make a set of recommendations which are suited to each patient and in most cases these contain several different dietary/ [lifestyle and]/ supplement changes. To judge NT in a reductionist manner based on randomised trials (with a single variable) would be about as relevant as testing a car by how well it runs on rails. In the industry that I work in (IT hardware/consumer electronics) there are numerous examples of where product testing methods have been hijacked by one particular company/cartel in order to ensure their products stand out amongst rivals. Thus government regulations often end up protecting the industry against the public rather than protecting the public against the industry … The sickness (healthcare) industry is massively falling behind public opinion now that the internet has made information free to all. People are no longer accepting poor advice but are now taking control of their own healthcare. This ‘Arab Spring’ revolution in continuing to gather momentum. It would be great if the NHS could really get on board with this so that the ‘G’ in ‘GP’ can finally start to mean ‘general’ (as opposed to ‘generating wealth for pharmaceutical shareholders’).”

 

Other ‘anti-dietician’ documents are now appearing, questioning how up to date the profession’s evidence and science-based practice is and claiming vested interests from big food and pharma companies (one of them here). To the consumer’s eye, this must seem like an embarrassing and petty call for a competitive media stunt, aiming to tarr a whole profession that in their growing numbers are working all over the world now (many with excellent BSc(Hons), MSc and PhD degrees), becoming an increasing threat to the once sole professionals ‘allowed’ to give nutrition advice…

 

The final conclusion of the recent ANH article makes some valuable comments: “Dietetics and nutritional therapy are two different theories and worldviews that attempt to bring some sense to the immensely complex area of human nutrition. We shall see in time which approach turns out to be the more valid, effective and ‘evidence-based’, and also which provides the most appropriate answer to the complex epigenetics facing modern humans. In the meantime, we encourage prospective patients to follow their instincts and choose the nutritional path that feels the most appropriate to their circumstances. And to remember that the rapport between the patient and the practitioner is a key part of the process, so take time to choose the right practitioner too.”

 

For ‘patient’s’ sake, can’t we just all work together utilising the ‘good’ and positives in what all of us are striving to do?

Rather than just pointing to the ‘bad’ and the ‘uglies’ offering largely ‘generalisations’, ‘deletions’ and ‘distortions’ for our existing worldviews (‘realities’)? Would it be good if we actually moved forward AND keep improving in line with latest scientific findings for individual patient needs, keeping common goals in mind rather than just the differences? It will be the informed and educated patient and consumer who will ultimately drive demand for their own needs, whatever that may mean to them…

 

I believe we can.