Blame everyone but yourselves

July 25th, 2008 by Ben Goldacre in alternative medicine, BANT, dangers, detox, media, nutritionists, regulating nonsense, telegraph | 55 Comments »

Ben Goldacre
The Guardian,
Saturday July 26 2008

image Like many professions who kill people with some regularity, doctors have elaborate systems for seeing what went wrong afterwards, and the answer is rarely “Brian did it”. This week the papers have been alive with criticism for quack nutritionism after the case of Dawn Page, a 52 year old mother of two who ended up being treated on intensive care, with seizures brought on by sodium deficiency, and left with permanent brain damage, after following the advice of “nutritional therapist” Barbara Nash. She denies liability. Her insurers paid out £810,000.

I will now defend the nutritional therapist Barbara Nash.

There is no doubt that people who declare themselves to be healthcare practitioners are a risk, by virtue of sheer uncallibrated self-belief. It takes strong nerves to tell a customer, as they are following “The Amazing Hydration Diet” – dramatically increasing water intake, and reducing salt intake – that their uncontrollable vomiting is simply “part of the detoxification process” (with shades of the doctor’s reassuring tones). In fact, Mrs Page’s lawyers explained, at this point she was told by Ms Nash to increase her water intake to six pints a day.

But I put it to the kangaroo court of the international news media – since this story has now spread as far as America and Australia – that Barbara Nash’s confidence in her own judgement cannot be seen outside of its social context, and will doubtless have been bolstered by a number of different factors.

After completing the rigorous training at the “College of Natural Nutrition” anyone would naturally believe themselves to be appropriately qualified, and able to give advice confidently. That is certainly the impression I have from reading their website. Barbara Nash’s confidence in her own abilities seems entirely congruent with that world view.

Then there are the professional bodies. They have been rather keen to distance themselves from Barbara Nash. In the Daily Telegraph, for example: “The British Association for Applied Nutrition and Nutritional Therapy (BANT) which has its own code of conduct, said Mrs Nash was not a member.” This is not the entire truth. Barbara Nash is advertised on as a member of BANT. In fact, she was indeed a member of BANT, until 2007.

Membership of BANT carries such privileges as “a listing in the BANT Directory of Practitioners, which is available to the public and entry on the BANT web site” and “acknowledgement of professional status by the Nutritional Therapy Council”. So endorsed, Barbara Nash would once again have perfectly reasonable grounds for a strong faith in her own abilities. The episode with Dawn Page on intensive care occurred in 2001. These honours were conferred upon her by BANT in 2005.

And of course, we should not forget the wider social context: food has become the bollocks du jour, with no regard for accuracy whatsoever. As I said last week, this stuff has become so prevalent I have given up trying to document it: the Daily Telegraph was printing advice from a self-declared nutrition therapist on folic acid in pregnancy that may actually increase the risk of disabling neural tube defects in babies, in the same week that it ran a news story telling women that red wine prevents breast cancer when actually it increases it, and the sofas of daytime television are filled with self-declared nutritionists, because they give us what we want to hear: technical, complicated, sciencey-sounding health advice.

Looking at Barbara Nash’s website, I see she carries testimonials from her own appearances on ITV Central’s Shape Up For Summer slot: “When I met Barbara (who was the nutritionist for this Central T.V. program), I wasn’t really sure how her eating plan would help me…However, it did involve one aspect that I found very difficult to follow, drinking 4 pints of water a day. I would be the first person to say that I was sceptical but as I had volunteered to take part, I felt that I at least owed it to everyone to try. Was I surprised by the results!”

Promoted, endorsed, trained and buoyed, Barbara Nash had good reason to think that what she was doing was sensible and correct. Dawn Page, for all that you might think, in an unkind moment, that she was a little gullible, similarly had every reason to believe that Nash was competent. They were both reinforced in these views by the College of Natural Nutrition, the British Association of Nutritional Therapists, Central TV, and every single journalist, editor, commissioner, and producer who has shepherded this bizarre world of made up nutritional nonsense into our lives. The specific harm done in this one episode is tragic. It always is. The real measure of professionalism is how you investigate, and what you change: no system would be perfect, but in this case, everyone is queueing up to hold out Barbara Nash as solely responsible, and there is not one single crack of critical self-reflection.

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55 Responses

  1. macklin_uk said,

    October 2, 2008 at 12:57 pm

    I do not know enough about the details of this patient’s case and the recommended treatment to comment. However, I think it is appropriate to remind everyone that even doctors make huge mistakes and there are an average of 10,000 deaths per year due to the adverse effects of prescribed drugs. To put that into perspective, this is more deaths than are caused by road incidents.
    Something for you to think about!

  2. JMS said,

    October 3, 2008 at 2:38 pm

    @ macklin_uk

    Hmmm, so if doctors kill their patients its OK if Nutritionist do too?

    I think you missed the point of the article. Yes, doctors do occasionally injure and sometimes even kill their patients. The point is that they are not complacent about this but make strenuous efforts to do better next time. Shouldn’t Nutritionists and other CAM therapists try to do better next time too?

  3. mv said,

    November 12, 2008 at 1:58 pm

    This is why I always tell people: if your nutritionist is not a registered dietitian, AND/OR a registered CNS (from CBNS, not some made up organization), AND/OR does not have a graduate degree in nutrition from a real, accredited university, run for the hills and don’t look back. Any one of these three qualifications will ensure to a certain degree that the person with whom you are dealing is not a quack.

    That being said, I think, in most cases, quacks really believe what they are doing is correct, and since no law exists to keep them from practicing, can they really be blamed for their own ignorance? If they’re not smart enough to understand what is wrong with their particular brand of lifestyle/nutrition choices, can we really expect them to be smart enough to realize it would be best not to push said choices unto others?

  4. Nutritional Therapy said,

    November 11, 2009 at 1:59 pm

    I have read alot of comments with unjustified opinions based on an irrational view of nutitional therapy ‘quackery’. I do agree that there is a long way to go in terms of protecting the title of ‘nutritional therapy’ and developing the profession to the level it needs to be at. But you are missing the point, the reasons behind nutritional therapy clearly fills a void not covered by dietetics (please do not misconstrue this as me denouncing dieticians). I also know of GPs and other qualified dieticians who are also qualified nutritional therapists. Make what you will of that information.

    Currently at the University of Worcester a minimum 2 years (Full Time) MSc in NT, (entry requires; a first or second-class Honours Degree in a relevant, cognate discipline or Professional qualifications in an appropriate area or Relevant practical experience). In the case of other practical experience and qualification an access course is needed to be passed.

    (very similar to dietetics Msc entry requirements)

    I can assure you, everyone would be suprised at the scientific content of the course, we dont just say “ahhh just chuck 50 pints of water down ya, that’ll sort you out” as some may think.
    The in depth analysis of an individuals dietary intake, symptoms, family history, medical history, drug nutrient interactions, nutrient interactions etc (all specific to the indvidual, not as applied to the general population) requires a great deal of time and expertise. The assumed nutritional knowledge upon starting the course is very extensive and very biochemistry and anatomy heavy, rightly so.A profile submitting proof of learning for this knowledge is required.

    I welcome criticism as this is the only way BANT/NTC are going to iron out the shortcomings and improve standards (i.e. clamp down on the wishy washy courses!). NT is not protected and this is a problem, allowing individuals to misrepresent and drag the profession down. Needs to be sorted really because the individuals who are well educated and do have the potential to offer quality nutritional advice are dragged down.

    Its a bit of witch hunt instigated by an influential individuals’ views, most of you on this site have no idea the amount of scientific, evidence based work involved in NT. But I guess i can only speak for myself on that part, there are are more than questionable ‘universities’ which provide NT courses. In that sense i guess this is where the people who have studied for at least 5 years in nutrition get tarred with the same brush as the quacks.

    I would love Ben oldacre to have a discussion with a few of the more reputable people in NT (not Patrick Holford!), i think the lack of understanding of what we actually do combined with a, lets face it, poor regulatory body makes us an easy target.

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