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It promises to be a revelation and not just about nutrition science. The Health Profession’s Council of South Africa’s hearing against world-renowned Cape Town scientist Prof Tim Noakes begins on November 23, on behalf of the Association for Dietetics in SA (ADSA). Noakes, who is also a medical doctor, is facing a charge of unprofessional conduct for giving “unconventional advice” on breastfeeding over a social network. Here’s a sneak preview of what’s really behind this peculiar case, and why dietitians are so threatened by him and Banting, as low-carb, high-fat (LCHF) diets are also known.
By Marika Sboros
It’s hard, but not impossible, to get to the real meat of this matter. And to know what the real beef is that former president of the Association for Dietetics in South (ADSA) Claire Strydom has with Cape Town University emeritus professor Tim Noakes.
And why the Health Professions Council of SA (HPCSA) is so enthusiastically marinading that meat on Strydom’s behalf.
The council is legally obliged at least to show a semblance of impartiality when conducting inquiries into the conduct of health professionals. Yet it is enthusiastically, if not particularly quickly, pursuing two charges of unprofessional conduct against Noakes, a medical doctor and internationally renowned, award-winning scientist.
Both charges are by ADSA dietitians; both appear frivolous in the extreme to experts internationally.
Of course, not all experts agree the charges are frivolous. The council has mustered expert witnesses for the first hearing against Noakes in Cape Town on Monday, November 23, 2015.
One problem with determining the real agendas here is that Strydom and the HPCSA act so dumb. Both have stonewalled most of my questions, staying silent, claiming the matter is sub judice. It isn’t since the council is not a court of law.
Strydom first set this very odd ball rolling in February 2014 by reporting Noakes to the council for a single tweet saying good first foods for infant weaning are low-carb, high-fat (LCHF, aka Banting) foods.
If you know anything at all about LCHF or Banting, you know that means meat and veg.
The council says that means unprofessional conduct for giving “unconventional advice on breastfeeding over a social network”.
Ironically, both ADSA and Strydom now give the same advice, a fact that has escaped the attention of the HPCSA as well as the ADSA dietitians serving on the council’s Professional Dietetics and Nutrition Board.
The HPCSA and its Board also appear not to have noticed that Strydom hasn’t reported any of the other doctors and dietitians in SA who now support LCHF on and off social media. Just Noakes.
The charge of unprofessional conduct has puzzled me from the start. It seemed somewhat hyperbolic, as if the HPCSA were filled with instant resolve to find Noakes guilty. After all, it usually reserves unprofessional conduct for doctors who do really bad things – like injuring or maiming patients for life, sticking hands up their skirts, or in the case of apartheid doctor Wouter Basson, murdering them with chemical poisons on the whim of the ruling party.
Both Strydom and the HPCSA insist they are not deliberately targeting Noakes, although he has been on ADSA’s radar for some time.
In July 2014, ADSA dietitian Catherine Pereira, now an executive member, reported Noakes to the HPCSA for a quote in the Sunday Times saying “So who is standing up for the poor? Show me the dietician who is saying they shouldn’t be eating chips and Coke and let’s do something about it? No one.”
The HPCSA immediately accepted Pereira’s complaint, citing Ethical Rule 12 that its members should “not cast reflections on the probity, professional reputation or skill of another person registered under the Act or any other Health Act”.
Quite how Noakes contravened that rule without mentioning any dietitian by name is unclear and the HPCSA is unwilling to clarify.
The HPCSA also appears oblivious to the many libelous statements dietitians and doctors have made against Noakes by name in public, which he hasn’t reported.
If the HPCSA did even cursory investigation of Pereira’s charge, it might have noticed a distinct reluctance among most dietitians, especially those linked to food companies and the sugar industry, to discourage people actively from ever consuming sugary products, including Coke and chips.
In my own experience of dietitians over more than 30 years, I’ve never met one who says that people – rich or poor – should never drink Coke or eat chips. They just trot out platitudes about “moderate” junk-food consumption and “balanced diets”.
The HPCSA made a “preliminary finding” on Pereira’s charge in August 2015 without Noakes being present, finding him guilty of unprofessional conduct by committing a “minor transgression”.
The council informed Noakes and Pereira, saying the matter was resolved – unless he chose not to accept the finding within 14 days. Presumably, the HPCSA wasn’t too surprised when Noakes did just that: refused in writing what in effect was the finding of a kangaroo court.
The council quickly made it clear in writing to Noakes that it will pursue the charge. It has refused to combine the two charges for the November 23 hearing, saying it needed time to find expert witnesses. Again, the hyperbolic over-reaction could seem comical, were it not meant so seriously.
The council hasn’t informed Pereira, who tells me she considers the matter “resolved”. She had been in email correspondence with Noakes, and says she does “not intend to pursue (it) further”.
It will be fascinating to see if the HPCSA pursues the charge, as it would then have to subpoena Pereira. That could look as if the council were indeed conducting a vendetta against Noakes as has been suggested.
Of course this may not be evidence of vendetta, just of more glaring incompetence that the ministerial task team investigating the HPCSA since March has identified in a damning report.
The team found that three of the council’s executives, including the GM of legal services, are “unfit to hold office”. It also found that there are more lawyers working for the HPCSA than doctors, and that hearings are becoming increasingly adversarial, not unbiased inquiries aimed at resolving disputes between two parties.
So far, the November 23 hearing against Noakes bears all the hallmarks of adversarial hearings favouring one party only, and it certainly isn’t Noakes.
It’s not really surprising then that Strydom, ADSA and the HPCSA have resorted to semantic gymnastics when asked for explanations about why they are targeting this internationally renowned scientist.
Strydom laid the complaint first in her personal capacity but later told me she would “prefer” I say she laid it as ADSA president. Any attempt to get clarification on her curious use of the verb “prefer” was stonewalled.
The council insists, somewhat anthropomorphically, that ADSA is the complainant, not Strydom.
It’s also difficult to determine the extent of ADSA executives’ support for and involvement in Strydom’s actions against Noakes.
ADSA’s new president Maryke Gallagher told me via email that she and other executives signed a letter in 2015 acknowledging that Strydom as president had “a right to file any query on behalf of ADSA”. Curiously, the letter makes no mention of Noakes.
Gallagher also said that ADSA now “acknowledges the appropriate use of low-carbohydrate, high-fat diets under specific circumstances or for specific medical conditions and under supervision of an appropriate health professional”.
There have been questions around undue influence of ADSA dietitians on the HPCSA’s Professional Dietetics and Nutrition Board.
According to Gallagher, Strydom informed her that she consulted the Professional Dietetics and Nutrition Board before reporting Noakes to the council. One would have expected the council to deal harshly with those board’s members, as they should have recused themselves.
However, as the ministerial task team has identified, the council is in disarray, which presumably makes internal ethics and professional conduct not the council’s highest priorities.
Pereira has said she consulted “ADSA management” before reporting Noakes, but wouldn’t say whether this was Strydom.
The HPCSA has also tried hard – and failed miserably thanks to Noakes’ legal team who are acting pro bono, so strongly do they believe he is being unjustly treated – to load the panel hearing the charge against him with dietitians, in contravention of statutory regulations.
A week before the shambolic June hearing, for example, the council informed Noakes’ lawyers that North West University dietetics professor Edelweiss Wentzel-Viljoen, chair of its Professional Board for Dietetics and Nutrition, was on the panel.
Wentzel-Viljoen is on public record in 2012 saying that LCHF diets are controversial, unhealthy, dangerous and would have “severe health consequences for those who follow them long term”. Where she gets the science to prove that is anyone’s guess, as is quite how the council imagined she qualified as any kind of legal or impartial panel member
Wentzel-Viljoen initially resisted polite requests from Noakes’ lawyers to recuse herself, but later saw the light.
Undeterred, the HPCSA inserted another former chair of its Professional Board for Dietetics and Nutrition – Stellenbosch University Associate Professor in Therapeutic Nutrition Prof Renée Blaauw – onto the panel.
Noakes’ legal team objected and Blaauw was soon history.
With expert guidance from Noakes’ lawyers, the council has managed to constitute the panel properly for the November 23 hearing.
When it comes to Strydom’s motivation, it can look like she is using ADSA to muzzle Noakes because he is affecting her and other dietitians’ business.
Or it could just be that she, ADSA and the HPCSA are proxies – witting or unwitting – for powerful vested interests that Noakes threatens. Among these are Big Food (especially the sugar industry), Big Pharma (especially drugs companies making billions from cholesterol-lowering drugs), medical doctors (especially cardiologists and endocrinologists wedded to the discredited diet-heart hypothesis) and medical and dietetic academics (who are increasingly seen as scientific dinosaurs for clinging to dogma).
All demonstrate varying levels of opposition and not just anger – but often incandescent rage – at Noakes for his views, despite the growing science showing that an LCHF diet safely and effectively treats obesity, diabetes and heart disease, to name but a few advantages for people of all ages.
In an earlier post, I made the point that Noakes could have made this all go away simply by deregistering as a medical doctor, thus removing the HPCSA’s jurisdiction over him. Noakes has explained in his own words, in another post on BizNews why he chooses to go ahead with this “trial”.
Cape Town attorney Adam Pike who heads Noakes’ legal team says they don’t believe Strydom’s charge has any merit whatsoever. They see the hearing simply as “an extraordinary opportunity for the issues in question to be ventilated in public”.
It will create much-needed debate regarding evidence-based medicine, nutrition as well as the role of doctors, academics, scientists, nutritionists and dietitians in ensuring that the public has access to “the best diet and nutrition information available, not just information contained in official dietary guidelines”, says Pike.
Exactly how the content Noakes’ tweet could be interpreted as dangerous and unprofessional conduct will be a focus of the hearing, as will be issues such as what constitutes a patient, and the difference between opinion and advice.
The hearing will also be about freedom of speech. Strydom and the HPCSA appear to believe Noakes has no right to express his opinions on nutrition freely, and shouldn’t be giving dietary advice if it differs from officially accepted dogma.
It’s almost as if they believe dietitians’ degrees confer some sort of nutrition omniscience, a divine, monopolistic right to advising people on healthy eating.
Pike says the hearing will highlight “the disruptive effect of social media and information technology and the transformative effects these are having on the role of doctors and dietitians”.
Clearly, the role of the dietitian is rapidly changing. Google and social media are empowering the public. Dietitians and their organisations that don’t move with these exciting times and acknowledge the science are becoming increasingly irrelevant – and a public health hazard.