The random thoughts of a sceptical activist

OfQuack: protecting the public from quack nutritional therapists?

There are many nutritional therapists who will give responsible, evidence and science-based advice. What is OfQuack doing to ensure their nutritional therapists don’t mislead the public? Their new ‘therapy descriptor’ needs careful analysis.

I blogged a few days ago about the investigation by the consumers’ organisation Which? that revealed nutritional therapists giving dangerous and misleading advice — most of those investigated were members of the British Association for Applied Nutrition and Nutritional Therapy (BANT).

In 2009, BANT passed any regulatory responsibilities they had on to OfQuack, aka the Complementary and Natural Healthcare Council, and they have just published a revised ‘therapy descriptor’ for nutritional therapy.

This version has been revised — and the previous one removed — after discussion with the Advertising Standards Authority. Presumably this new one is accepted as being compliant with the CAP Code — the Code all advertisers have to abide by in their advertising, whether in the media or on their own websites.

On their website page dedicated to the therapy descriptors, it gives little clue as to their status. All it says is:

CNHC has developed discipline descriptors for each of the disciplines which it registers. See below for descriptors currently available.

However, a member of the public, a client or ‘patient’ looking for information on the website is directed to the page What should I look for when choosing a complementary therapist?:

The purpose of the CNHC Register is to enhance public safety, by giving the general public access to a list of complementary therapy practitioners that have been assessed as meeting national standards of competence and practice.

and

The CNHC quality mark provides an independent seal of approval to well-qualified, responsible professionals in the complementary healthcare field.

…and links to the therapy descriptors for each therapy (except they haven’t yet updated this page to link to the new descriptor for nutritional therapy).

Clearly, these descriptors are intended to be the key resource for a member of the public to use to understand what a CNHC member provides as a service: it is the definition of the service and defines the limits of practice for the protection of the public. Or so it should.

Essentially identical information now appears on the website of the Nutritional Therapy Council (NTC) and on yell.com. However, BANT still has some of the old text (cached) on their website and claims:

Nutrition and lifestyle approaches to healthcare have been shown to support the health of all the major systems of the body (skeletal, muscular, nervous, respiratory, cardiovascular, digestive, excretory, endocrine, immune, reproductive and integumentary [skin, hair, nails]). Typical priorities in nutritional therapy consultations are support to achieve optimum energy levels, healthy blood sugar balance, emotional and pyschological wellbeing, optimum gastrointestinal health and tolerance to a broad range of food groups.

The devil is in the detail

It’s worth looking at this in more detail because it’s fundamental to what customers can expect from an OfQuack-registered nutritional therapist and it sets the boundary for what is acceptable.

First, the version that was removed from OfQuack’s website a few months ago described nutritional therapy:

What is nutritional therapy

Nutritional therapy is the application of nutrition and health science that seeks to enable individuals to maximise their health potential. It may help alleviate a wide range of conditions and assist in the recovery from many ill-health situations.

Nutritional therapists recognise that each person has unique dietary and nutritional requirements and will assess the nutritional status and functional capacity of each individual. They recognise that each person’s needs may be dependant on a number of factors from inherited weaknesses, to the influence of diet, lifestyle and environment.

In addition to dietary and nutritional advice, recommendations may include guidance on natural detoxification, methods to support digestion and absorption, and procedures to promote colon health.

The new (ASA-friendly) one (cached) now says:

The basis of nutritional therapy

Nutritional therapy is the application of nutrition science in the promotion of health, peak performance and individual care. Nutritional therapy practitioners use a wide range of tools to assess and identify potential nutritional imbalances and understand how these may contribute to an individual’s symptoms and health concerns. This approach allows them to work with individuals to address nutritional balance and help support the body towards maintaining health. Nutritional therapy is recognised as a complementary medicine. It is relevant both for individuals looking to enhance their health and wellbeing and for those with chronic conditions wishing to work with or ‘consult’ a nutritional therapist in collaboration with other suitably qualified healthcare professionals.

Practitioners consider each individual to be unique and recommend personalized nutrition and lifestyle programmes rather than a ‘one size fits all’ approach. Practitioners never recommend nutritional therapy as a replacement for medical advice and always refer any client with ‘red flag’ signs or symptoms to their medical professional. They will also frequently work alongside a medical professional and will communicate with other healthcare professionals involved in the client’s care to explain any nutritional therapy programme that has been provided.

The title of this section now shies away from trying to describe what nutritional therapy actually is; instead it says it’s about to give the basis for it.

Science and nonsense

It’s good to see the word ‘science’ has remained right at the start, setting the tone, but it will be interesting to see how they actually interpret that and whether or not they clamp down on registrants using pseudo scientific diagnostic methods — all it says is they use a ‘wide range of tools’, so it’s not at all clear what they do see as scientific and what they don’t.

BANT’s Chair of Council, Catherine Honeywell (cached), appears to use iridology (cached) in her own business. It would be interesting to know whether OfQuack finds such pseudo scientific nonsense acceptable — the Advertising Standards Authority certainly doesn’t think much of it:

Iridology claims to use changes in the eye to diagnose illness. CAP has seen no evidence to prove that it works and practitioners should limit themselves to claims of availability only.

They use these tools “to assess and identify potential nutritional imbalances”. Not that they use these tools to identify imbalances, just ‘potential‘ imbalances. How odd. What then do they use to verify these ‘imbalances’?

The details

Now it gets more interesting:

It is relevant both for individuals looking to enhance their health and wellbeing and for those with chronic conditions wishing to work with or ‘consult’ a nutritional therapist in collaboration with other suitably qualified healthcare professionals.

This is an important sentence, so let’s split some of that out to better understand what it says:

1. “[Nutritional therapy] is relevant…for individuals looking to enhance their health and wellbeing…”

I’m not sure what this really says, but there are many other things relevant for anyone who would like to ‘enhance their health and wellbeing’ without having to bother with a nutritional therapist. Like having a varied and balanced diet or taking regular exercise.

2. “[Nutritional therapy] is relevant…for those with chronic conditions wishing to work with a nutritional therapist…”

This is a circular definition that really says no more than nutritional therapy is what you get if you go to see a nutritional therapist.

3. “[Nutritional therapy] is relevant for those with chronic conditions wishing to work with…a nutritional therapist in collaboration with other suitably qualified healthcare professionals.”

In summary, there are two instances — and only two — where nutritional therapy is relevant:

a) where an individual is “looking to enhance their health and wellbeing”;

b) where an individual who has a chronic condition — presumably previously diagnosed by a properly qualified medical practitioner — “in collaboration with other suitably qualified healthcare professionals” (my emphasis).

That seems pretty restrictive and is good as far as it goes in protecting the public from nutritional therapists doing stuff on their own and using bogus diagnostic techniques, but it all hinges on how well OfQuack enforce it.

It goes on to say:

Practitioners consider each individual to be unique and recommend personalized nutrition and lifestyle programmes rather than a ‘one size fits all’ approach.

Yep! People are unique and have to be treated individually — it doesn’t take a nutritional therapist to work that one out. It’s what any good healthcare practitioner does day in, day out.

Practitioners never recommend nutritional therapy as a replacement for medical advice…

A very sensible constraint and I would certainly interpret that as saying they should not be treating people for medical conditions. Hopefully, this will prevent nutritional therapists giving the bad advice found by Which?.

…and always refer any client with ‘red flag’ signs or symptoms to their medical professional.

I would hope that any responsible nutritional therapist would do that, but, on the evidence presented by Which? and the recent Daily Mail investigation, it would seem that some do need to be reminded of this.

They will also frequently work alongside a medical professional and will communicate with other healthcare professionals involved in the client’s care to explain any nutritional therapy programme that has been provided.

Again, all responsible nutritional therapist should be doing this, but it’s good that it’s being emphasised.

The rest of the ‘therapy descriptor’ simply says stuff about “What a nutritional therapy session typically involves?” and “Choosing a practitioner”.

“Practitioners never recommend nutritional therapy as a replacement for medical advice and always refer any client with ‘red flag’ signs or symptoms to their medical professional.”

Overall, it’s woolly about what a nutritionist actually does and what diagnostic methods are allowed, but it does go some way to keeping in check the more extreme end of the spectrum. I’m sure there are many nutritional therapists who will have no problem basing what they do on science and keeping within this descriptor.

However, that still leaves the question about how rigorous OfQuack will be in ensuring this really is what their registrants do and  what they do about those who go beyond this descriptor eg those who use nonsense like iridology and hair mineral analysis. And selling possibly unnecessary food supplements at high prices.

But now that this descriptor has been published by OfQuack and the NTC, it is to be hoped that all their members will amend their websites accordingly.

The ball is still very much in their court.

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