The Health Professions Council of South Africa (HPCSA) resumes its hearing against University of Cape Town professor emeritus Tim Noakes in Cape Town from February 8 to 18. Noakes is charged with unprofessional conduct after Johannesburg dietitian Claire Julsing Strydom, then president of the Association of Dietetics (ADSA), laid a complaint against Noakes with the HPCSA for a tweet to a breast-feeding mother in February 2014. In the tweet, Noakes opined that good first foods for infants were low-carb, high-fat (LCHF), in other words, meat and veg. This is advice that ADSA routinely gives. However, ADSA also advises cereals for infants and mostly high-carb, low-fat (HCLF).
The hearing, variously called the ‘Banting for Babies Trial’, even somewhat hyperbolically the ‘Nutrition Trial of the Century’, certainly is controversial. Noakes has been pilloried as much praised, the HPCSA and ADSA are mostly ridiculed locally and internationally for what can look like an extraordinary over-reaction to a world-renowned scientist’s opinion. (Noakes is one of few scientists in the world with an A1 rating from the National Research Foundation.) ADSA and HPCSA seem to see themselves as heroes protecting an ignorant public from a dangerous man with dangerous views on butter, eggs, bacon and broccoli. In the first of a four-part series (maybe more) for BizNews, science and business writer Rob Worthington-Smith gives his perspective on this strange scientific saga. (In his bio below, Worthington-Smith discloses his interest: he is undecided on all aspects of LCHF v HCLF but is working with Noakes to bring much-needed perspective to the current debate over official dietary guidelines.) – Marika Sboros
By Rob Worthington-Smith*
The Health Professions Council of South Africa’s (HPCSA) hearing relating to Prof Tim Noakes’ professional conduct has now entered its third chapter, fully two years after the initial incident.
The charge brought against Noakes is firstly that he abused the doctor-patient relationship by offering medical advice on social media to a patient and her infant without first examining the healthy infant. Secondly, that the advice given on Twitter was not only unconventional, but also dangerous.
The first hearing, scheduled for June last year, was immediately terminated when it was found that one of the adjudicating panel had to be disqualified on the grounds of conflict of interest.
The second hearing in November 2015 was to all intents and purposes a mistrial. The HPCSA showed itself to be unprepared, disorganised and lacking both the technical and legal knowledge required to probe its own witnesses in its case against Noakes.
Even though seven days had been scheduled (the HPCSA asked for five, Noakes’ legal team suggested seven), the HPCSA conducted its prosecution so unprofessionally that the hearing ran out of time before the defence could begin to conduct its case.
Now, in February 2016, for the first time since the allegations were made, Noakes has the opportunity to take the stand. What is the basis of his defence?
The first part of the allegation has to do with professionalism, the second gets to the nub of the issue: dieticians overwhelmingly promote the so-called balance diet based on the classic food pyramid in which carbohydrates should contribute most of the body’s energy requirement.
The traditional view of fat, especially of animal fat, is that it causes cholesterol, which clogs up your arteries, leading to atherosclerosis and of course, to increased risk of heart disease.
All very obvious, a belief system most of us know to be true; after all, every health message on the packaging of every food product proclaims this to be so.
However, proponents of the low-carb, healthy/high-fat (LCHF) diet have challenged this view. And in South Africa, the campaign is led by Noakes.
The stakes are high, far higher than even the reputation of one of South Africa’s foremost scientists – one of few rated A1 in the world.
For LCHF, by arguing against processed carbohydrate-based food (mostly grains) and for a lifestyle that should reduce the demand for expensive drugs to treat metabolic diseases, such as Type 2 Diabetes, attacks the very lifeblood of both the food and pharmaceutical industries.
This series of articles digs through Noakes’ writings and his presentations over the past four years. It puts together a train of argument he is likely to present at the February hearing in support of the case for the LCHF diet as being a far less dangerous alternative to the high carb diet, not only for adults, but for infants and children too.
But what of the first allegation that Professor Noakes was unprofessional in his conduct on Twitter? From what we have already heard during cross-examination of the HPCSA’s star witnesses, it seems that the hearing’s adjudicators are unlikely to deliberate long before dismissing this first charge.
NorthWest University Prof Este Vorster, upon whose report both charges were based, turned out to be far from an expert witness on the subject of Twitter, neither having a Twitter account herself, nor understanding its use as a social media platform. Indeed, the same can be said of all the members on the panel at the preliminary hearing.
Unfortunately, Noakes was not invited to answer the allegations against him at this most appropriate stage in this saga, and indeed did not even have sight of Professor Vorster’s report. If he were given this opportunity, much of the HPCSA’s subsequent embarrassment could have been spared.
The main point that emerged from the November cross-examination of the HPCSA’s witnesses is that Twitter is a public forum for the exchange of ideas. It is not a private and confidential room in which a doctor-patient relationship is expected to develop. People ask questions and others weigh in with their ideas.
The only measure of “performance” is popularity. The more followers, the more interesting the content being posted by the author.
Ironically, the originator of the charge, Claire Julsing-Strydom, actually propositioned the mother who started the Twitter conversation and ended up giving her advice.
And she did so without any attempt at a professional handover from the mother’s primary consulting physician. Strydom was thus at least as guilty as, if not far more so than, Noakes in relation to the first charge brought against him.
Further grievances that emerged from both Strydom’s and Vorster’s evidence, was that Noakes was using his controversial “fad” diet to attack the dietetic profession unfairly, and to profit from the media exposure, even if this resulted in potential danger to the health of infants.
Here the record needs to be put straight. It is certainly true that Noakes has been an extraordinarily successful scientist and campaigner for the LCHF cause. He has earned three doctoral degrees, overseen 40 PhD graduates, is a National Research Foundation (NRF) A1 rated scientist (meaning that he is regarded as an uncontested world leader in his field – indeed, two fields, sports science and nutrition), has published more than 550 scientific papers (150 on exercise and nutrition) and been cited 16 454 times.
He has a Twitter following of 67 000 (ranked the 38th most followed scientist in the world) and is the author of Lore of Running, Challenging Beliefs, Real Meal Revolution, Raising Superheroes and Always Believe in Magic.
Yes, this record suggests that he is undoubtedly highly successful, and in terms of public profile, possibly the second most recognised medical scientist in South Africa after heart surgeon Prof Christian Barnard himself.
However, all proceeds from his work are donated to the Noakes Foundation, whose mission as a non-profit, public benefit organisation, is “to advance medical science’s understanding of the benefits of a low-carb (LCHF) diet by providing evidence-based information on optimum nutrition that is free from commercial agenda.”
Ah! “Free from commercial agenda.”
Now that would be in interesting subject to explore, especially relating to the Association for Dietetics in South Africa (ADSA), the primary organisation represented by the complainant and its primary expert witness.
- Rob Worthington-Smith is a science and business writer. While his day job is to analyse companies’ non-financial capitals for the responsible investor, he also pursues a wide range of interests including evolutionary biology and behavioural economics. He enjoys the challenge of bringing perspective to contentious issues such as the moral landscape, how to address inequality in a developing economy, progressive approaches to education, parenting (as a widowed, single parent of four), and the science and pseudo-science behind health and nutrition. He holds a BSc Honours degree in Agricultural Economics from Stellenbosch University. Disclosure: While as yet undecided on every aspect of the issue, Worthington-Smith is currently working with Prof Tim Noakes to bring perspective and balance to the current debate on dietary guidelines.