American Dietetic Assn. tries to block 'Alternative' Nutrition Providers

[ecoli]

or so says the alarmist headline over at Forbes.

 

Curious to hear others' thoughts on this. Should dispensing out nutritional advice be under the protected domain of those licensed to do so or is this a violation of free speech?

 

My take: nutritional advice given by a "registered" dietitian is probably no better than picking out a nutrition blog at random: ie - mostly bunk and not research-based.

[Appolinaria]

If the sole intention is to limit competition, I see that as disturbing. Not surprised, though.

[Moontanman]

This is disturbing and NC is rapidly becoming a crazy place...

[Greg H.]

Well, you can't say that they're an impartial observer - they get paid a fee when you register through their credentialing arm, the Commission of Dietetic Registration. That aside, in North Carolina, you have to be certified to be a nutritionist, which is not the case in all states.

 

According to the CDR's website, here's the list:

 

Alabama (1989)* - licensing of dietitian/nutritionist

Alaska (1999) - licensing of dietitian/nutritionist

Arkansas (1989) - licensing of dietitian

California (1995)* - registration* of dietitian

Connecticut (1994) - certification of dietitian

Delaware (2009) - licensing of dietitian/nutritionist

District of Columbia (1986) - licensing of dietitian and nutritionist

Florida (1988) - licensing of dietitian, nutritionist and nutrition counselors

Georgia (1994)* - licensing of dietitian

Hawaii (2000)* - certification of dietitian

Idaho (1994) - licensing of dietitian

Illinois (1991) - licensing of dietitian and nutrition counselors

Indiana (1994) - certification of dietitian

Iowa (1985) - licensing of dietitian

Kansas (1989)* - licensing of dietitian

Kentucky (1994)* - licensing of dietitian and certification of nutritionist

Louisiana (1987)* - licensing of dietitian/nutritionist

Maine (1994)* - licensing of dietitian and dietetic technician

Maryland (1994)* - licensing of dietitian and nutritionist

Massachusetts (1999) - licensing of dietitian and nutritionist

Minnesota (1994) - licensing of dietitian and nutritionist

Mississippi (1994)* - licensing of dietitian and nutritionist title protection

Missouri (1998)*-certification of dietitian

Montana (1987)* - licensing of nutritionist and dietitian title protection

Nebraska (1995)* - licensing of medical nutrition therapists

Nevada (1995)* - certification of dietitian

New Hampshire (2000) - licensing of dietitian

New Mexico (1997) - licensing of dietitian, nutritionist and nutrition associates

New York (1991) - certification of dietitian and nutritionist

North Carolina (1991) - licensing of dietitian and nutritionist

North Dakota (1989)* - licensing of dietitian and certification of nutritionist

Ohio (1986) - licensing of dietitian

Oklahoma (1984) - licensing of dietitian

Oregon (1989) - certification of dietitian

Pennsylvania (2002) - licensing of dietitian-nutritionist

Puerto Rico (1974)* - licensing of dietitian and nutritionist

Rhode Island (1991)* - licensing of dietitian and nutritionist

South Dakota (1996) - licensing of dietitian and nutritionist

Tennessee (1987) - licensing of dietitian/nutritionist

Texas (1993)* - licensing of dietitian

Utah (1993) - certification of dietitian

Vermont (1993) - certification of dietitian

Virginia (1995)* - certification of dietitian and nutritionist

Washington (1988) - certification of dietitian and nutritionist

West Virginia (2000) - licensing of dietitian

Wisconsin (1994) - certification of dietitian

Wyoming (2012) - licensing of dietitian

Edited July 10, 2012 by Greg H.

[swansont]

Is this substantially different from having to have a license to practice medicine?

[Greg H.]

Is this substantially different from having to have a license to practice medicine?

 

No idea. But they license barbers these days too.

[Appolinaria]

Medical malpractice numbers are much higher than deaths or injury associated with reading someone's blog, no?

Edited July 10, 2012 by Appolinaria

[ecoli]

Medical malpractice numbers are much higher than deaths or injury associated with reading someone's blog, no?

 

Yes, I think there's got to a be an understanding that dispensing general advice is not the same as treating a patient. I mean, whats the logical conclusion here... journalist licenses and a ban on unofficial news blogs?

[imatfaal]

Is this substantially different from having to have a license to practice medicine?

 

The licence to practice medicine is normally only granted after extensive study and rigorous testing; and further entails longterm supervision and continuous monitoring. without that level of care and attention isn't licensing really just a trade association looking to restrict entry and form a cartel?

 

 

Yes, I think there's got to a be an understanding that dispensing general advice is not the same as treating a patient. I mean, whats the logical conclusion here... journalist licenses and a ban on unofficial news blogs?

 

Definitely. But there is a marked tendency for those on the internet and in the self-help areas of the bookshops to pass themselves off (either deliberately or by omission) as medical practitioners - and these guys do cause a lot of harm, mainly by stopping people from seeking advice from those who know what they are talking about http://whatstheharm.net/

[ecoli]

The licence to practice medicine is normally only granted after extensive study and rigorous testing; and further entails longterm supervision and continuous monitoring. without that level of care and attention isn't licensing really just a trade association looking to restrict entry and form a cartel?

I think a trade organization CAN be that even if the field requires rigorous training. In an ideal world, dieticians would be trained like doctors (or at least, doctors would recognize nutrition as a vital part of their practice).

 

 

Definitely. But there is a marked tendency for those on the internet and in the self-help areas of the bookshops to pass themselves off (either deliberately or by omission) as medical practitioners - and these guys do cause a lot of harm, mainly by stopping people from seeking advice from those who know what they are talking about http://whatstheharm.net/

People have always been bad at evaluating the quality of evidence. What's the difference now? Just that so much more noise is available thanks to the web?

Dispensing bad medical advise is one thing though (taking snake oil rather than cancer drugs is obviously bad). I'm not so clear that unlicensed nutrition advice is so much worse (or even often better) than "official" nutrition.

 

Just take the old school food pyramid: for years and years nutritionists recommended supported your diet with carbs and lumping in all oils, fats and (somehow) sugary foods. There was some common sense to it, but it wasn't based off any cohesive research. I'm not even entirely convinced that the new pyramid (which still emphasizes grains over veggies) is all that great.

 

Now, "alternative" dietiticians have been pointing this out for years and years. I'm just not sure that silencing unlicensed dieticians would do more good than harm.

[imatfaal]

I think a trade organization CAN be that even if the field requires rigorous training. In an ideal world, dieticians would be trained like doctors (or at least, doctors would recognize nutrition as a vital part of their practice).

I quite agree that doctors spent too many years understating the importance of proper diets - and mocking those who believed difference could be made to major health issues through diet alone. My problem is with certification/licensing/accreditation without proper training - membership, the nice crest and links to a website of the British Association of Blah or the American Certified Blah-ists should be backed up with minimum standards.

 

People have always been bad at evaluating the quality of evidence. What's the difference now? Just that so much more noise is available thanks to the web?

Dispensing bad medical advise is one thing though (taking snake oil rather than cancer drugs is obviously bad). I'm not so clear that unlicensed nutrition advice is so much worse (or even often better) than "official" nutrition.

I think unlicensed is fine - it's pseudo-licensing that I was moaning about - My "definitely" was meant to be agreeing with the spirit of your posts - but it reads as if I was agreeing with the horrible logical conclusion.

 

Just take the old school food pyramid: for years and years nutritionists recommended supported your diet with carbs and lumping in all oils, fats and (somehow) sugary foods. There was some common sense to it, but it wasn't based off any cohesive research. I'm not even entirely convinced that the new pyramid (which still emphasizes grains over veggies) is all that great.

 

Now, "alternative" dietiticians have been pointing this out for years and years. I'm just not sure that silencing unlicensed dieticians would do more good than harm.

I too think a lot of both mainstream and alternative systems of nutrition, especially that which makes it to the media, are based on 'gut instinct' and guesswork rather than research. My other problem with established ideas is that many of them are based on arbitrary rules that have taken on the mantle of proven science whereas they are nothing of the kind - in fact some have been shown to be either far from the mark.

[CharonY]

My other problem with established ideas is that many of them are based on arbitrary rules that have taken on the mantle of proven science whereas they are nothing of the kind - in fact some have been shown to be either far from the mark.

 

That is unfortunately true. Many of these rules are extrapolations limited association studies. Hardly anything is based on mechanistic knowledge, for example.

There is simply a huge knowledge gap regarding the interaction of the genomic background of an individual, diet, and health outcome.

 

For the most part it seems that one can give general guide lines, as well as certain reasonable set of rules for specific conditions, but other than that there is a lot of guess work. Some are doing a better job by actually taking metrics (other than just weight) while applying certain diets, but there are far too few of these around.

[ecoli]

The first lawsuit has arrived:

 

http://reason.com/blog/2012/08/07/paleo-diet-lawsuit-hits-the-new-york-tim

[imatfaal]

Further, the state board told Steve it is a crime in North Carolina to offer dietary advice for free in private phone conversations with his readers and friends.

http://www.thefreemanonline.org/headline/free-speech-licensing/

 

I have just invited a friend out for dinner tonight telling her a decent meal will cheer her up - and that's breaking the law in NC!

[ecoli]

http://www.thefreemanonline.org/headline/free-speech-licensing/

 

I have just invited a friend out for dinner tonight telling her a decent meal will cheer her up - and that's breaking the law in NC!

 

ARe you sure? I think the law is specifically about publishing that viewpoint and pointedly on the internet.

[imatfaal]

That quote was from the Freeman.org site supposedly describing a NCBDN message, I see no reason for them to fabricate to such an extent.

 

As far as I can tell the governing statute does not mention the internet - but I gather it has been the proliferation of internet sites, and the ease of mass-market reach of the web that has brought this to a head. No court would ever convict for a chat to a friend - I was being facetious, but the Board (presumably under legal advice) were representing the state of law to Steve Cooksey "Further, the state board told Steve it is a crime in North Carolina to offer dietary advice for free in private phone conversations with his readers and friends"

 

I think this is the ruling statute http://www.find-laws.com/statutes/north-carolina/Chapter_90 section 90-350 onwards

 

</h2>

<h2>§ 90-365. Requirement of license.

After March 31, 1992, it shall be unlawful for any person who is not currently licensed under this Article to do any of the following:

 

(1) Engage in the practice of dietetics/nutrition.

 

(2) Use the title “dietitian/nutritionist”.

 

(3) Use the words “dietitian,” “nutritionist,” or “licensed dietitian/nutritionist” alone or in combination.

 

(4) Use the letters “LD,” “LN,” or “LDN,” or any facsimile or combination in any words, letters, abbreviations, or insignia.

 

(5) To imply orally or in writing or indicate in any way that the person is a licensed dietitian/nutritionist. (1991, c. 668, s. 1.)

 

 

SSSection (3) is a real doozy. BTW the definitions can be found in SS352

[Greg H.]

That quote was from the Freeman.org site supposedly describing a NCBDN message, I see no reason for them to fabricate to such an extent.

 

As far as I can tell the governing statute does not mention the internet - but I gather it has been the proliferation of internet sites, and the ease of mass-market reach of the web that has brought this to a head. No court would ever convict for a chat to a friend - I was being facetious, but the Board (presumably under legal advice) were representing the state of law to Steve Cooksey "Further, the state board told Steve it is a crime in North Carolina to offer dietary advice for free in private phone conversations with his readers and friends"

 

I think this is the ruling statute http://www.find-laws...lina/Chapter_90 section 90-350 onwards

 

</h2>

 

SSSection (3) is a real doozy. BTW the definitions can be found in SS352

 

So wait...according to a strict interpretation of SS3, it is illegal for me to advise a friend to consult a dietitian or nutritionist. I can't use those words at all.

 

 

 

 

[imatfaal]

So wait...according to a strict interpretation of SS3, it is illegal for me to advise a friend to consult a dietitian or nutritionist. I can't use those words at all.

 

Very poor drafting. How poor would depend on the instructions NC judges are given about interpretation of statute - many jurisdictions have interpretation rules/guidelines that will always err on the side of not creating new offences; ie the statute will be interpreted to limit rather than expand the criminal code "if parliament wanted to create a new crime they should have been explicit"