Nutritionists Come With Pitchforks!

OK, so maybe they don’t.  In fact, everyone was pretty civil in the comments to my nutritionist series last month, and I’d like to thank all the commenters for that…it doesn’t always happen in the blogosphere.  I recognize that I ruffled some feathers, and now that the dust has settled, I wanted to address some of the common themes in the feedback.

Meta Issues

Many of the comments related to the process of researching and writing this piece, rather than the substantive points I make about nutritionists and their accreditation, so I thought we should get these out of the way first.

1. Why Did I Write This?

Ana asked about my inspiration and Anon wondered what happened to me that I hate nutritionists so.   The fact is, I don’t hate nutritionists – the article may have been snarky, but it was not meant to be venomous.  With a few exceptions for the shadier accrediting organizations I call out, I’ve found most nutritionists honestly believe what they do is valuable, and that’s not the type of thing that draws my hatred.

As for inspiration, I really hadn’t given the issue much thought until a relative started a nutritionist program in the States last year.  In exploring what she was doing, I was struck by both the questionable science in the school’s philosophy, as well as the non-accredited nature of her diploma.  It started me wondering whether the same was true in Canada, and one day I decided to look into it more deeply – the result of which was this series of articles conveying what I found.

2. Did I Conduct Myself Ethically?

Eleanor Healy at CAHNPro, with whom I spoke in preparation of this series, complained that I was not above board for failing to disclose during our discussion that I was researching an article.   This is a fair charge – I told Healy and others I talked to that I was researching schools and trying to understand how the various designations work, and asked for their help figuring it out.  This was of course perfectly true, while not being the whole truth, and I was aware that Healy and others probably assumed I was a prospective student.

I gave the matter a lot of thought before I started making calls.  Professional journalists sometimes commit much graver dishonesties than this in pursuit of a story – going undercover, etc.   The voluntary ethics code from the Society of Professional Journalists explicitly permits this sort of thing when more open methods are unlikely to yield information the public has an interest in knowing.  While I was only really looking for publicly available information, I thought it unlikely I’d get even that if I identified myself as a writer from a Skeptic journal.  By allowing their misperception of who I was to persist uncorrected, I was able to access such public information as they would openly tell a prospective student, and no more.  This seemed like slim damage to achieve a great benefit, and while I still wasn’t completely comfortable with the deception, I decided it was justified.

In a related charge, Wendy Gibson of CANNP, with whom I also spoke, said that I misrepresented our discussion.  This is untrue.  Not only do I recall the conversation clearly, I took detailed notes, and I stand by what I wrote as an accurate reflection of our talk.  She  may have misspoken – people sometimes do – but the words were hers.  Nonetheless, she’s clarified her position in the comments.

3. Am I neutral?  Am I biased?

This struck me as odd, but it was pointed out several times, so I feel the need to address it.  I’m not sure where readers like Kate, Anon, and Anonymous got the impression that I’m supposed to be neutral, but that’s a fundamental misunderstanding of what skepticism is.  Skeptics absolutely take sides – we just take them based on the best data available, with a conscious attempt to overcome bias in our analysis, and a respect for the fact that as the span of human knowledge grows, sometimes we have to revise our assessments.  So no, I was not neutral, nor was I attempting to be.

But I also do not believe – as was charged – that I was biased either against nutritionists or in favour of Dietitians.  My assessment of both the differences in the certifying regimes and the value provided by each may have been unwelcome to the nutritionist community, but as I hope to show in the rest of this post, they were indeed fair and unbiased.

Substantive Issues

Now for comments on the meat of the articles…

4. On the State of Nutritionist Certification

By and large, there was little debate that the current situation is less than ideal – in fact, most of the comments even from nutritionists supported my assessment.  Laurene Sauro, Director of CAHNPro, describes the impetus behind creation of the organization as an attempt to clean up much of the mess I describe in the article:  “…we decided we are not going to give them any silly initials after their name because they are meaningless to the public and everyone else and we learned the government prefers schools to give designations, not associations. “

Wendy Gibson of CANNP writes, “Yes, the different ‘letters’ used within our industry can be confusing, and I actually do agree that this is not the best state of affairs.”

Lisa Baston wrote, “unfortunately it’s true that nutrition isn’t strictly regulated in this country, and like you – I wish it were!”  Nutritionists seem to want the imprimatur that a single national certification would provide — with the irony that their organizations are multiplying in pursuit of such unity.

5. On the Value of Nutritionists

Here I think many of the respondents mistook my position.

I do not believe that there’s no value in consultative services to improve one’s diet.  Of course there are best practices for eating supported by science, and to the extent that people aren’t getting that message, there’s certainly a role for someone to help them.  In that Laurene, I agree with you.

I also do not believe that there’s anything wrong with eating a diet full of vegetables, fruits, nuts and whole grains, or in moderating meat consumption.  So Sarah, there’s nothing wrong with the diet you’ve outlined — I try to eat that way myself, though perhaps not with the consistency you seem to.  I even have the odd smoothie now and again.

My objection is not to the science-based advice nutritionists give – they give lots of it.  It’s to the non-science based advice they give alongside it.  And to their seeming inability to tell the difference.

One doesn’t need to look farther than the commenters themselves: Lisa and Ilona both couple their nutrition advice with magical nonsense like Reiki.  The nutritionists at D’avignon Digestive Health Centre I referenced at the start of the first article offer placebo treatments like colon cleansing and coffee enemas, for which there is no evidence of efficacy.  And I already pointed out that the schools themselves teach courses on homeopathy and aromatherapy — wishful thinking masquerading as treatment.

I’m sorry, but nutritionists can’t have it both ways.  You can’t say there’s science behind what you do when it’s convenient, and then practice non-scientific treatments, all packaged up as a “cleanse”.  At least not if you want to avoid the type of criticisms I make in these articles, or public mockery like this:

In Closing

Clearly nutritionists are passionate about their profession, and I can respect that.  As I’ve said above, I don’t believe many of them operate with malintent, but I also don’t think many of them have been trained to consistently give science-based advice.  And that’s ultimately my biggest concern, because at the end of the day, it doesn’t matter whether you believe deeply that a treatment works.  If you don’t require proof that it does, or you willfully ignore evidence that it doesn’t, you’re committing fraud.

Still, I actually do believe that there’s a place for science-based nutrition consulting in the world, separate from the domain of the Dietitian, and that such a service can be valuable.  Unfortunately that’s not what we have in Canada today.  Instead, we get well-meaning individuals who mix fact and fiction, ostensibly with little understanding that they’re doing so.

If organizations like CAHNPro and CANNP are actually going to fix that problem, they’ll have my full support.  Until then, I remain highly, justifiably, skeptical.

Photo courtesy of Hourman via Flickr under Creative Commons

41 Responses to “Nutritionists Come With Pitchforks!”

  1. Glenn Rumbell says:

    While I too disagree with many of the observations contained in your main article, I applaud you on the even handedness of your response. Very good.

    One criticism you continue to pursue, however, is the unscientific nature of some of the collateral advice provided by some nutritionists. In my experience, many nutritionists do provide treatments that are outside the boundaries of conventional science. For a person who believes science is the sole legitimate perspective from which to understand the world, I understand how this can be troubling. However, I would point out that yesterday’s magic is very often today’s science. 150 years ago people who advocated the washing of hands and surgical tools were seen to be outliers. Yet patient recovery was enhanced. Magic? It no doubt seemed so at the time, but that was before science understood the role germs play in infection.

    In today’s world there are many alternative therapies that appear to have no scientific basis but which anecdotal evidence suggests somehow work. Homeopathic remedies, acupuncture and Reiki, for example, all fall into this category. Yet they are also part of conventional treatment. Homeopathic remedies are legally available in Canada and are prescribed by the regulated health profession (in many provinces including Ontario) of Naturopathy. Traditional Chinese medicine is poised to become a regulated health profession in Ontario, notwithstanding its reliance on herbal remedies, massage and acupuncture. And Reiki is used in many hospitals to assist patients. The Princess Margret Hospital Lodge in Toronto, for example, advertizes on its web site that its nurses use “complimentary therapies such as Therapeutic Touch, Reflexology, Healing Touch and Reiki” to “assist patients in managing the side effects of treatment.” Here is the link: http://www.uhn.ca/Clinics_&_Services/services/pmh_lodge/services.asp.

    Modern western science is a massive storehouse of knowledge. But it is not an exhaustive storehouse. Criticising nutritionists for embracing alternative therapies that are used and valued in other places around the world and even within regulated health professions in Canada, is not a fair line of attack.

    Glenn Rumbell
    Director, CANNP

    • Dianne Sousa says:

      Glenn,

      It is entirely fair to criticize nutritionists for their promotion and use of alternative therapies, because they do so without reasonable evidence to support their claims. Homeopathy, reiki, acupuncture,therapeutic touch, reflexology and the like have been studied scientifically and have been found to not work. When considering the value of a therapy you must look at the totality of the evidence, not just what supports the anecdotal accounts.

      Nutritionists who use these therapies do not do so on the basis of anecdotal evidence alone, as if the claims are outside what can be studied scientifically. Rather, they do so while ignoring the good scientific evidence that shows that they’re ineffective.

      It is not appropriate to promote a medical intervention until you have a good scientific basis for doing so. Otherwise you put your patients time, money and health at risk. Promoting therapies that have already been shown to not work, I’ll leave the labelling of that to you.

      • Glenn Rumbell says:

        There are many millions of people across Europe, the Far East and throughout North America who would disagree with you; including no doubt the well educated and regulated nurses who work at hospitals such as Princess Margret’s and the doctors who oversee programs like the one I referenced. It is one thing to say we don’t know why something works. It is quite another to reject it because there is not yet a scientific explanation.

        I would also note that nutritionists do not “promote a medical intervention”. Medicine is the exclusive realm of doctors. However, the ability of nutritionists to explore alternative remedies with clients who are seeking an alternative approach, is one of the chief benefits they bring to the table, provided of course they are properly schooled in the disciplines they practice.

      • Dianne Sousa says:

        Glenn,

        What I said was that these therapies don’t work. You can see that very plainly in what I wrote. I didn’t say that these therapies should be rejected because we have no scientific explanation of why they do work. This is a strawman of your own creation. There are very good scientific explanations of why they don’t – chi doesn’t exist, neither do acupuncture points, nurses can’t send or sense ‘energy’ through their hands; etc.

        Whether millions of people disagree with me or whether they are educated or not matters little as well, since whether these therapies work or not is dependent on the evidence and not preference.

        I have no idea what the practical difference between promoting a medical intervention (which is what alternative therapies claim to be, homeopathy claims to be medicinal) and ‘exploring’ it is. If you say that an alternative therapy is an option worth ‘exploring’, you imply that it works. I think that this is a way of distancing nutritionists from responsibilty for what they tell clients.

        Frankly, I’m becoming more concerned that nutritionists are unable to tell fact from fantasy since they seem so willing to accept any claim – no matter how contradictory to others they also accept – on the basis of weaker than weak evidence.

      • Anon says:

        Diane,
        I am so sad for you that you actually believe what you’re saying. Maybe you’ve never had an experience in any of the therapies and techniques you are negating…but they work, hard scientific, empirical proof or not. It’s not “magical thinking” by any means and while I fully admit and loathe those who take people’s money for some of the more hokey scams out there, treatments and therapies that have been around for centuries and that have helped millions of people is all the proof you need to say that they have value in the medical/therapeutic world.
        Health isn’t about exact numbers and nothing works for everyone every time. Look at chemotherapy for instance. While one cancer patient may do very well and take to the treatment with success, another very similar patient may get worse and actually have that treatment kill them. Would you say that THAT means it doesn’t work? Probably not.
        I think you need to open your mind a bit more and relax. Your comments on this paticular issue on the website are so angry, I wish you well.

      • Larry says:

        You say that the alternative therapies have been shown “not to work” and that is untrue. For example a few studies popped up after a quick search for accupuncture.

        headaches, backpain, hemoroid surgery
        http://www.ncbi.nlm.nih.gov/pubmed/22330010
        http://www.ncbi.nlm.nih.gov/pubmed/15527670
        http://www.ncbi.nlm.nih.gov/pubmed/16095547
        http://www.ncbi.nlm.nih.gov/pubmed/17893311

        Schizophrenia (doesn’t work)
        http://www.ncbi.nlm.nih.gov/pubmed/22076901

        Also for Reiki and other touch therapies:
        http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006535.pub2/abstract
        A Chocrane review of 24 studies involving over 1000 participants that met stringent inclusion criteria states

        “Although the lack of sufficient data means that the results are inconclusive, the evidence that does exist supports the use of touch therapies in pain relief”.

        How can you possibly say that they “don’t work” unless you have tried it and found that “it didn’t work” for you?

      • Dianne Sousa says:

        Larry,

        Study 1 showed that the acupuncture was no better than the conventional care control.

        Study 2 had no sham control.

        Study 3 had no sham control.

        Study 4 received critical commentary from other researchers. You can see this lsted under the abstract. Concerns include a priori plausibility and problems with employing sham controls.

        Study 5 did not show evidence of effectiveness. Apparently you saw this, yet included it as a rebuttal to my contention that these therapies don’t work.

        Study 6 admits insufficient data for analysis. I’ll also note that the inclusion criteria allowed from either a sham or ‘no treatment’ control. It’s possible that the modest effect that was seen was due entirely to the inclusion of data from studies that had only a ‘no treatment’ control.

        My contention stands.

  2. Shawn says:

    “It is one thing to say we don’t know why something works. It is quite another to reject it because there is not yet a scientific explanation.”

    Dianne is saying studies found the referenced alt med treatments do not work. She is not saying “they shouldn’t be used because science can’t explain how they work”. You don’t need the underlying mechanism to identify an effect.

    Science is pretty good (and far better than any other mechanism I’m aware of) at identifying whether things work independent of any knowledge of why they should or shouldn’t work. The fact is, when homeopathy and acupuncture undergo rigorous scientific testing, they show no effect beyond placebo (I’m not versed enough in the other treatments to comment).

    • Glenn Rumbell says:

      I understand what Dianne is saying. However, I have a different perspective. If you say it does not work, but millions of people say it has achieved results for them, to the point where we find it used in places like hospitals because they find it achieving results – I say, it works but science has not yet determined how. Just as sterilizing hands and surgical instruments worked even when science, at the time, could not explain how. You may say they have disproven it, but I believe this is an overstatement, particularly with respect to acupuncture and homeopathy. Reiki, I don’t know.

      • Moderation says:

        It is not about “perspective”. If I told you that in my “perspective” the sun rises in the west and sets in the east, would that make it so? If I could convince “millions of people across Europe, the Far East and throughout North America” that if they hold ther breath gravity will cease to exist, would that make me any more correct? Not everything in the world is about “perspective” or “opinion”, somethings are demonstably true or false on the basis or research and evidence. And the evidece has shown that homeopathy, reike and accupuncture don’t work any better than placebo … which means they don’t work.

      • Shawn says:

        Nobody but you is talking about ‘how’. You’re still talking about how even after saying you understood Dianne’s point. If you do a double blind study of sterilized vs. unsterilized instruments, the sterilized will have better outcomes. We don’t need germ theory to recognize this. The simple fact of it being efficacious will be recognized in the study without any need of an explanation for it. Homeopathy, etc. fail in this regard, demonstrating they are a result of bias.

        Millions of people repeating the same mistakes proves nothing (see bloodletting, flat earth theory, young earth creationism, demonology, phrenology, dowsing, palm reading, voodoo, Mikey eating Coke and pop rocks, etc.). Science is very good at removing bias. Once bias is removed, homeopathy and its ilk are exposed as nothing but wishful thinking.

        Just because a treatment is offered in a hospital doesn’t make it effective. Hospitals are vulnerable to woo proponents. We see it used in some hospitals because some people involved in the decisions 1) surrender to pressure, 2) are as vulnerable to undisciplined or wishful thinking as the next guy or 3) don’t have ethical issues with placebos.

      • Dianne Sousa says:

        Glenn,

        “You may say they have disproven it, but I believe this is an overstatement, particularly with respect to acupuncture and homeopathy. Reiki, I don’t know.”

        I’m going to continue to put your feet to the fire. If you argue that it is an overstatement that acupuncture and homeopathy have been disproven, then you concede that there is at least reasonable evidence that put these methods in doubt. With reiki you admit that you do not know the state of the research. So here is my question, why do you accept that reiki works and/or are comfortable with nutritionists advocating it with their clients, when you have not looked at the scientific research?

      • Dan Listoen says:

        Even if you could, and I doubt you can, demonstrate that “millions of people say it has achieved results for them, to the point where we find it used in places like hospitals because they find it achieving results” it still doesn’t prove it works. Placebo effects haven’t been accounted for. Reiki, you don’t know, but you’re ok with acupuncture and homeopathy. Check them and more here http://www.skepdic.com/ or just sit back and have faith that you can’t be wrong. I for one, would be happy to change my mind with better evidence than just your statements or poor studies.

  3. Richard says:

    On Eleanor’s charge in #2 – had you said you were writing an article, would she have said things differently that she would have to a member of the interested public?

    • Erik Davis says:

      I thought it a strong enough probability when I decided how I’d approach her (and others). There’s of course no way of knowing for certain.

  4. Glenn Rumbell says:

    I think we need to move away from this distraction back to my main point.

    Nutritionists were criticized in the article and within this chain of comments for embracing alternative therapies that you say do not work. I don’t agree, but let’s move that debate to the side for a moment. My point was that these therapies are embraced and used by members of regulated health professions – with government approval. Naturopaths are licensed and allowed to prescribe homeopathic remedies which are sold with the approval of Health Canada. Traditional Chinese medical practitioners (soon to be a regulated health profession in Ontario) are allowed to diagnose on the basis of Chi and treat using acupuncture, massage and herbs. And Reiki is used within Hospitals, by nurses (another regulated health profession) and under the watchful eyes of doctors (still another regulated health profession). Criticizing nutritionists for also bringing these modalities into their practices (where they are qualified) and arguing they are promoting magical nonsense (i.e. a fraud – and I appreciate this is my word not yours) is holding them to a higher standard than members of government regulated health professions. Unless of course you also say all of these professionals (including members of such science based professions as medicine and nursing) are knowingly peddling remedies that science has proven do not work, with government approval, in which case your concern should be much broader than nutritionists. All of this leads me to conclude (1) you are unfairly singling out nutritionists for criticism, and (2) you are overstating the evidence about the efficacy (or lack thereof) of these alterative remedies.

    • Dianne Sousa says:

      Glenn,

      Take some time to read other articles on this blog and you will find that we take all regulated and non regulated health professionals to task for promoting magical nonsense.

      We are also strong critics of Health Canada and other government bodies as well. So (1) we are not unfairly singling out anybody – everyone is held to the same standard (2) alternative therapies still do not work.

      • Larry says:

        “Dianne is currently a student pursuing certification as an addictions counsellor.”

        Diane, it is highly amusing that the certification you are receiving is in an unregulated industry with numerous certification bodies such as with nutritionists. I’m sure you have good intentions however is it a 4 year program with a 1 year supervised work?

        http://www.caccf.ca/
        http://www.ccpcprofessionals.com/certified-addiction-counsellor-ii-cacii
        http://www.cnsaap.ca/ENG/EDUCATIONANDTRAINING/GETCERTIFIED/Pages/default.aspx

        … to name a few.

        Wonder if anyone here can you provide any further information on these organizations and if they ensuring quality standards of the educational programs and the indvidual trainees?

      • Dianne Sousa says:

        Larry,

        That profile description is outdated. I’ve in fact abandoned pursuring ceritification precisely because the profession is insufficiently regulated, and also because the instruction I was receiving (and approved by the CACCF, by the way) was substandard in my opinion. In fact, it was this experience that drew me into the skeptical movement.

        I continue to hold everyone to the same standard. Still amused?

      • Larry says:

        Sorry that you lost your interest in the field. Now I am upset but it’s not an uncommon situation. I am sure that I could find a list of 20 professions which have duplicate and somewhat incesteous relationships with career organizations. Even professional bodies like the SEC had an overly cozy relationship with the management of the companies they are supposed to supervise. Governments and lobbying bodies are swapping spit. An individual integrity is the only thing left and ultimatly is all that we can depend upon, when no one else is looking.

  5. No Glenn, Don’t change subject. You can’t Gish Gallop out of this. Dianne asked a good question @ 1:44. Why not address it?

    • Glenn Rumbell says:

      I am happy to respond to Dianne ‘putting my feet to the fire.’ And by the way, I respect her position, even though I disagree with it.

      I am comfortable with my position that “individuals” (I want to expand this discussion beyond nutritionists because, as Dianne pointed out, she is critical of anyone who provides these services including members of regulated health professions) have the right to provide treatments even where there are advocates on the other side who claim they have been disproven scientifically for several reasons:

      1. I don’t believe science always has all of the answers. Time and again advances in science have forced us to change our position on matters that were once considered scientific fact. Dianne’s rigid certainty does not take this into account. So it doesn’t bother me if, as Dianne says, for example, the existence of Chi cannot currently be proven.

      2. I respect the anecdotal evidence of others. Millions of others. This leads me to believe the scientific tests people such as Dianne rely upon, either are not as conclusive as she (and others at this site) would have us believe, or are limited by the current stage of scientific knowledge, as per my point above.

      3. I am 50 years old and have pursued sports and athletics my whole life. I have many aches and pains and have experimented with Reiki, Acupuncture, Chiropractory, Naturopathy, Massage Therapy, and herbal treatments and have found them to work – in many cases better than the magic pill prescribed by my doctor. You may say I am accepting the placebo affect – but I disagree.

      4. These treatments are legal.

      5. Prohibiting the exploration of new techniques or therapies that are not dangerous or harmful stifles innovation and learning.

      6. People have the right to choose. If I wish to pursue treatments that you don’t believe in, that is my right. Just as it’s your right to pursue the treatments you believe in.

      7. For me to have the freedom to choose, individuals must exist who are fee to provide these services to me.

      Having said all of this, I also believe it is inappropriate for individuals to promote alternative remedies as ‘cures’ where there is mixed evidence as to their efficacy. Several years ago my mother was diagnosed with a brain tumour. The doctor recommended she undergo chemotherapy for it, but was honest that given the state of her tumour its ability to help her was a long shot at best. We both appreciated his honesty. I believe proponents of alternative remedies owe the same honesty to their clients. Consumers do need to be told when they are dealing with a treatment where the evidence is mixed, or is based upon quasi-spiritual philosophies such as Chi, or is derived from anecdotal evidence and not the lab. But once an informed decision is made in favour of a treatment, whatever its nature, people such as Dianne have no right to prohibit the consumer, or the practitioner, from pursuing it.

      • Shawn says:

        1. Science adjusts its views when it proves itself wrong. It happens. And science learns. Alt med practitioners tend to pursue their beliefs dogmatically, independent of evidence (except when the evidence agrees with them).

        My own views are not rigid (can’t speak for Dianne). I will support anything that has an appropriate level of evidence. You say you own a pair of brown shoes? I will take your word for it. You say that water communicates with other water molecules, understands and remembers the intent of a homeopath who put a bit of goose liver into a cup and washed and shook the cup 30 times, and also has the ability and inclination to cure disease? I’ll need you to show your work, please. =]

        2. This would suggest you believe in alien visitation, the Earth is flat, demons cause headaches, ghosts exist, we all get reincarnated, the Titans were overthrown by the Olympians, etc. If that isn’t the case, you may need to revise your statement. Though I agree that no one study is ever conclusive, multiple, well-conducted studies are “pretty conclusive”. Keeping an open mind about everything, no matter how thoroughly debunked and implausible, is no way to go through life.

        3. There are more effects than just placebo that can falsely suggest something is working. Regression toward the mean, selective recall, etc. But yes, I find it very implausible that these things worked for you and others, but that they stop working when there’s someone is a labcoat around.

        4. Agreed.

        5. I agree we shouldn’t prevent people from exploring alt med as research. If treatments have been shown not to work, or haven’t been shown to work, then medical professions shouldn’t be doing them. If they’ve not been shown to be harmful, then let people do them without the endorsement of any kind of medical or government body, within the scope of false advertising laws.

        That said, I do consider promoting woo to be harmful to society in general, but I don’t think that’s specific enough to legislate against.

        You said people shouldn’t be prohibited from pursuing new techniques that aren’t harmful. How do you know that a new technique doesn’t give you cancer 20 years down the line?

        6 and 7. Agreed, as long as you haven’t unknowingly decided based on implicit or explicit claims contrary to scientific evidence. You seem aware of the lack of evidence, so I’d have no problem with you pursuing these types of treatments. I think most people taking alt med would assume they wouldn’t be allowed to operate if they didn’t work, based on the protections the government provides in most other circumstances, which complicates matters a bit.

      • Jaker says:

        Glenn:

        1. Science doesn’t have all the answers. It never purports to. Science is by definition, “systematic knowledge of the physical or material world gained through observation and experimentation”. Note the word “observation”. Science doesn’t discount anecdotal evidence. It uses anecdotal evidence to build hypotheses which are later rigorously tested to determine whether they hold true.

        2. We all respect the anecdotal evidence of others. But who are these millions of people that you speak of? You are making a fallacy in extrapolation. You’re taking a few anecdotal accounts and extrapolating them well into the millions. Have you personally accounted for the number of positive AND negative anecdotes for a given alternative therapy? In order to make sense of any anecdotes, you need to systematically assess them. This is exactly what medical researchers do.

        What would you do if your wife told you that homeopathy cured her of bacterial meningitis (a life threatening infection of the brain) but your uncle told you that his wife died of bacterial meningitis because she sought homeopathic care instead of antibiotics? This is why anecdotes cannot be accepted at face value.

        3. It doesn’t matter whether you agree or disagree, by your own account you have experimented with various different therapies and cannot specifically identify what has worked for you. Massage therapy, meditation and other relaxation therapies are in fact supported by evidence. Traditional medicine doesn’t rail against alternative medicines just for the fun of it. It supports them where the evidence is supportive. It negates them where the evidence is negative. But traditional supporters still accept that we have a long way to go. Topics like chronic stress and nutrition/gastrointestinal disorders are poorly understood.

        4. Which treatments? You are lumping everything together into one. The regulation of a therapy does equal legitamization.

        Homeopathic remedies, for example, are basically water. Simple as that. It is based on the idea that like causes like. It takes plant, animal or mineral substances which are thought to inflict harm and dilutes them within water until, in some cases, there literally is not a single molecule of the substance left in that solution (in other words, all that remains is water). The water is then said to confer healing properties.

        Homeopaths believe that the HIGHER the dilution (i.e., the less amount of a substance in a solution) the MORE POWERFUL the remedy is.

        Many of those in favour of alternative medicine on this message board are calling for common sense. To those, I ask you: which is more likely to get you drunk: a) 1 litre of pure vodka or b) 100 ml of vodka diluted in 900 ml of water. If you are a homeopath, you would believe that the answer is b. How’s that for common sense?

        Regulation of the homeopathic industry stems from the fact that the government needs to ensure that what homeopaths are selling doesn’t harm individuals — it needs to regulate the ingredients. In 2004, the Natural Health Product Regulations (NHPR), under Canada’s Food and Drugs Act, became a reality. Rather than fully regulating these products as drugs, or leaving them virtually unregulated (as is done in the United States), the NHPR were a regulatory compromise: Implementing manufacturing quality and safety standards, while significantly relaxing the standards for product efficacy claims.

        HELLO! IT WAS A POLITICAL COMPROMISE — likely because of political pressure from various lobbying groups and because the resources required to regulate the claims of homeopathic and other natural remedies would be nearly impossible because there are so many of them.

        Health Canada still requires proof of EVIDENCE for claims to be made — but it acknowledges that the evidence for homeopathy is of the lowest quality.

        http://sciencebasedpharmacy.wordpress.com/2010/04/14/remedy-regulation-homeopathy-in-canada/
        http://www.hc-sc.gc.ca/dhp-mps/prodnatur/legislation/docs/ehmg-nprh-eng.php

        5. No one is prohibiting the EXPLORATION of new techniques. EXPLORATION means RESEARCH. You are free to research whatever methods you like. You are not however free to make unsubstantiated claims.

        6. Yes, people do have the right to choose. Freedom is in our constitution. But, people don’t have the right to call themselves medical practitioners and prescribe therapies that a) may not be effective and b) may in fact be harmful. Just as you have anecdotes that something works, there are countless individuals who sought alternative care for infections or other diseases/disorders and in fact worsened or died as a result of avoiding traditional care. Life is about balance. No one is telling you to avoid alternative care, just to use your head. The ENTIRE INDUSTRY loses legitimacy when it creates false legislative or regulatory bodies and designations. It’s the same as me suddenly calling myself an RHCP just because I feel like it (RCHP = Red Hot Chilli Pepper).

        7. Again, YES — you have the freedom to choose. You have the freedom to seek ADVICE from an individual who provides alternative care. HOWEVER, the individual who is providing you that advice SHOULD NOT have the right to provide false or misleading statements to the without evidence. It’s as simple as that.

        FINAL THOUGHTS

        The problem with individual such as yourself is that you lump all “alternative” therapies into one envelope. Homeopaths like to call their remedies “natural” or “alternative” because simply slapping the word “natural” onto something confers “effective” in the public conscience nowadays. We have ALL had bad experiences with traditional medicine, but that doesn’t simply mean that “natural” = “effective”/”healthy” or that “traditional” = “bad”/”unhealthy”. We should all strive to eat better and be healthy.

        However, you should recognize that many of the criticisms of traditional medicine — like “big pharma lobbying and funding” for example — are just as rampant in the alternative therapy industry, if not more so. It’s quite the conflict of interest to have a homeopath prescribe a medicine which they also happen to sell, don’t you think?

        Oh, and the next time you pick up an alternative remedy, research a bit about the parent company — you might be surprised to learn that its owned by the same big pharma company you so insistently despise.

        It all comes down to money Glenn.

  6. RD vs RHN courses says:

    This is regarding Lisa Tsako’s post under the “Part 3″ article: “…subtract the electives (not related to nutrition) from a dietetics program at any university from the actual nutrition courses. Now perhaps you can make a fair comparison between university nutrition programs and CSNN or IHN…”

    I’m utterly confused as I don’t see very many elective credits. Aside from the nutrition courses, the Dietetics program includes Cell Biology, Microbiology, Genetics, Biochemistry, Organic Chemistry, Physiology, Research Methods, etc – they all sound like extremely important courses to me for understanding how the human body works – the fact that the RHN diploma can be completed in as little as one year frightens me. Now, if we are talking about an RHN with a previous degree in Human Biology, Physiology etc, that is a completely different story as they have the fundamental knowledge of how the body works and may further have the ability to critique studies.

    Bottom Line: if I were seeking nutritional advice, I would definitely want my provider to, at LEAST, have a university education…. but that’s just me.

    • Samisra says:

      I would go one step further anad say that “If I were seeking nutritional advice, I would definitely want my provider to, at LEAST, have a university education that was geared around nutrition”. I imagine that there a few “nutritionists” that have university degrees in philosphy, art, or business.

  7. gmcevoy says:

    Mr. Rumbell said:

    Having said all of this, I also believe it is inappropriate for individuals to promote alternative remedies as ‘cures’ where there is mixed evidence as to their efficacy.

    and

    I believe proponents of alternative remedies owe the same honesty to their clients.

    Ya know, because you have said all this, I know you don’t believe either of those things – efficacy & honesty.

    If you did, you’d know that Emily Rosa ran a wee science fair experiment with the help of local healthcare “professionals” who manipulate the life force energy field or qi or prana or…

    They were all too happy to help the cute nine year old with her schooling. Wee Emily figured if these government approved & regulated “pros” could manipulate this energy field curatively, they could feel the presence of her hands without seeing them. She even let them have a go at her hands before the test to determine which one was emanating more energy.

    She ended up trying this on two groups of healthcare “providers” where she found them to be less than impressive for self proclaimed enlightened professionals. In fact, they did worse than guessing.

    With only two hands to choose from, you could be right 50% of the time and you’d expect a “professionally trained and regulated” professional manipulator of the human energy field to do far better than that.

    44% Forty Four Percent. Less than half right AND less than what a mundane like myself might do when playing just for giggles.

    Hardly inconclusive and no doubt the result, or very near, every time.

    Acupuncture has little to no relation to human anatomy and you can use toothpicks anywhere with the same placebo effect. Ancient “needles” resemble the bloodletting tools of “western” yore.

    If you look around this site, you’ll find video of two “professional” naturopaths laughing at homeopathy as they lump it under the bus with crystal healing and chiropracty. Funny how homeopathy is a large part of the curriculum for these “pros” and one of them is responsible for it at their lurnin place.

    I made my coffees this morning with a single granule of instant per avg. sized cuppa. I’ll be awake for days.

    So no, foodiologists aren’t being unfairly singled out…

    • Glenn Rumbell says:

      How do you know what i believe? You are free to call me naive, or duped or a fool. Never call me a lier.

      • gmcevoy says:

        1300 words or so over 5 comments which contradict your concern for efficacy and honesty

        if individuals want to be treated with witchcraft out of their own pocket, fine

        problem is, they form loud groups that whine for health coverage for their favourite dark art and they get it

        now everybody pays higher premiums and the cost of healthcare is driven up

        snake-oil isn’t free

  8. Thomas Doubts says:

    I think Dianne, Shawn et al have the addressed the salient points of Glenn’s criticisms, but there is one thing he argues that should be addressed as well, and that is Health Canada’s/Ontario Ministry of Health’s approval of homeopathic “remedies”, naturopathy etc.

    Glenn, do not mistake legislative approval for scientific acceptance. As I’m sure you would acknowledge, politics underlie virtually all decisions made at higher levels of government. Giving a nod to homeopathic treatments, allowing naturopaths to prescribe certain medications or considering regulation of traditional Chinese medicine must not be understood as approval for the supposed mechanism by which said modalities function.

    There are two factors to consider here. One, the treatments/medications themselves are relatively harmless in most cases (it is the selection of a magical over a medical intervention that can be dangerous).

    The second factor is the big one here. Alt med is lucrative, which means tens of thousands of people are paying for what we skeptics would call nonsense. That is an awful lot of voters. Catch my meaning?

    Politicians hate doing anything that could cost their party support. Tacit approval for alt med must be viewed in this light.

  9. gmcevoy says:

    UK Homeopathic solution to Advertising Standards complaints?

    Evidence of efficacy?

    Nope.

    The race card:

    “Chatting with my husband last night about the complaints by the Advertising Standards Authority here in the UK agans homeopaths, we think we have come up with a plan to put an end to this nonsense. We can play the race discrimination card if we get this right. Please bear with me whilst I explain.

    If we can find some British Indians/Pakistanis or Bangladesh’s they can complain to the ASA explaining that homeopathy is a prefered system of medicine in their contries of origin, used to treat a wide range of illnesses. The current wave of complaints against homeopaths would therefore seem to be an attack on their culture and beliefs and therefore discriminatory. (I know homeopathy is not a belief system but many think it is, so why not use that to our advantage.) If we can get figures for the numbers of people using homeopathy as their primary healthcare in India and the rest of the sub-continent, even better!”

    from – http://skepchick.org/2011/05/homeopaths-we-can-play-the-race-card/

  10. student says:

    As a current student of dietetics I loved this series of articles! I always get asked what the difference is and am told about different books people have read on nutrition and I heard you need this that and the other. I am young and not finished my education and inexperienced still so I don’t always know what to say except, are you kidding? You think nutritionists and dietitians are the same?! I am so jealous of the writer’s ability to concretely explain things with reason and facts!
    Regarding the comment about free electives in the bachelor of science in nutritional science major, I’m trying to think of the electives I was allowed to take. Mostly food related but I took psychology or different specific physiology courses, community nutrition or nutrition in chronic disease etc. My program was not that flexible until closer to the end when you could select from a designated list of nutrition related courses.

  11. AG says:

    I have read the comments regarding the article, and all I can say is, both RD’s and Holistic Nutritionists have had “enough” education on NUTRITION, Yes I capped “nutrition” All this talk about alternative therapies is going away from the course material that both camps have learned.
    Dietitians do have extensive knowledge about nutrition, which is based on scientific research, but so do Nutritionists. All the faculty at IHN (the Institute of Holistic Nutrition) have had a science background relating to nutrition. And, it depends on the student(dietition.nutritionist) on how they distill the information presented. How the person applies what they have learned will make a good or bad dietition or nutritionist.

    • Larry says:

      I agree with this, and please note that I have no training in nutrition however have been looking into it. Both main schools offer a science based programme, though obviously not as deep as can be provided in 4 years.

      But let’s be real too – many potential clients of nutritionists will be “alternative” types and it’s incumbent to speak their language. I don’t believe it is required to recommend therapies that serve no purpose, however if someone were using onand believed it was of assistance, why should it be changed? The placebo effect is real and does require someone to believe that therapy will work. If nutritionist training requires their use however I would question that.

      The author’s argument with nutritionists seems to be based on their acceptance of these alternative practices. That IS unfairly singling out nutritionists, because many medical practitioner groups do also accept their use, as mentioned above.

      Further the situation with multiple certification bodes is common for unregulated industries. Smearing nutritionists for this is unwarranted. As mentioned above for “addiction counsellor”:

      “Six Canadian organizations offer certification to substance abuse and allied professionals with the general aims of providing protection to their clientele and recognition for the practitioner”. There are many different letters that can go by each group’s certificate.

      Canadian Addiction Counsellors Certification Federation (CACCF)

      Canadian Council of Professional Certification (CCPC)

      Canadian Counselling and Psychotherapy Association (CCPA)

      Canadian Society of Addiction Medicine (CSAM)

      Employee Assistance Professionals Association (EAPA)

      First Nations Wellness/Addiction Counsellor Certification Board (FNWACCB)

      Likewise the situation exists in “Personal Training” where
      there are around a dozen certification bodies, and a few
      are considered superior. Some more advanced certifications require a degree (in any field for some reason). The government
      may get involved, at least in the USA in regulating the industry further. I’m not sure really that government can do a much better job than individuals.

      Ultimately it any field it is the individual practitioner, their understanding and what they bring to the table that matters. For example, there is an former Olympic PHD sports nutritionist charging clients to eat a certain way based on the results of 1 weak study (small population with a self-reported diet), which he himself wrote. Yet he is the author of numerous textbooks and has a strong theoretical foundation. Yet (it appears) that he is basing his practice on a scientifically weak principle in order to cash in. Should the designation of PHD be held questionable because of this, or should people do their own research into what he is recommending?

      The author’s assumption that most people cannot tell the difference between science and magic is condescending. People who
      use alternate therapies choose them not because they believe
      they are science based, but precisely because they are not. They often are given and received with a free flowing heart – and love has been shown to have healing properties.

      If the author’s problem with nutritionists is their acceptance of these therapies, it is simply imputing guilt by association. Looking at the basis for alternative therapies and studies of them is worthwhile; singling out a group for their acceptance is not.

      • Dianne Sousa says:

        Larry,

        There are serious ethical problems with allowing a person to believe that some quality of the particular treatment they are receiving is the true cause of their recovery. How can you be sure that a science based treatment wouldn’t be better for a person than the placebo effect they’re experiencing from a worthless treatment?

        I don’t know why you think it’s reasonable that nutritionists should escape criticism, simply because other groups also deserve the same type of criticism. This is like suggesting that someone should not be charged with robbery, because others need to be charged with murder.

      • Larry says:

        Dianne,

        Scientific, like legal proof, is not incontravertible. There is no certainty, though there may be evidence for and against. Because not everyone responds identically to even proven formulas. A flu shot does not guarentee one will not get the flu, though overall an epidemic/pandemic is less likely to occur providing enough people do get them. Fewer people may respond to unproven therapies, but it does not mean that no one finds benefits. It is not as black and white as you make it sound.

        In any event I simply point out that the treatment is quesiton is the subject, not nutritionists. Whether a nutritionist, a nurse or clinician uses an unscientifically based treatment is up to the indviduals involved and not ANY group. If you choose to focus on one particular group, it will not prevent the use of the treatment.

  12. Lauren says:

    I am researching to decide between holistic nutrition schools and found this article very useful, though slightly under-informed in part 3. Nutritionists are not dieticians, and I rarely hear of people confusing the two. Dieticians, in general, do not practice holistically, and have medical training that is based on the Canada Food Guide – the reason I removed myself from this training.
    People who understand this will seek out one over the other.

    • Samisra says:

      Agreed, nutritionists are not dietitians, unless they have completed the requirements to become dietitians. I hear people (some with a lot of education, some without) confusing the two titles all the time. They seem to be practically interchangeable at times to some people! There needs to be more awareness on the differences between the two.
      In my experience, practicing holistically or not, dietitians have the duty to consider the entire lifestyle of the client when making assessments, evaluations and care plans for their clients. If not, they are at least held accountable for their actions.

      Also, dietitians do not have medical training that is based on Canada’s Food Guide. The Food Guide is a tool, in addition to otehr tools that can (not will always) be used to help illustrate a point, or simplify an explanation. There are many other tools that dietitians will use as well to help them with their practice. None of the course descriptions in any of the accredited university programs I have looked at, or any of the accredited internship programs I have seen, list “training on Canada’s Food Guide” either as the name of the course or as a phrase in the description. If you find such a course or internship program, please let me know! Instead I see courses like clinical nutrition, food science, nutrition and physcial activity, community nutrition, nutrition and world issues. I would have to surmise that you have either not finished researching to make your decision, or you did not do a thorough job.
      Please do not reduce an entire profession down to “medical training on Canada’s Food Guide” unless you have the proof to back it up.

  13. Jenny says:

    I appreciate your candidness in your original article and I like the way you handled your criticisms. Everyone are entitled to their opinions, and your views are well justified. I found myself agreeing on most of the points you had about nutritionists.

  14. Bell Aegerter says:

    The roof! The Roof! THE ROOF IS ON FIRE!probably.

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    Erik is a technology professional based in Toronto, focused on the intersection of the internet and the traditional media and telecommunications sectors. A reluctant blogger, he was inspired by the great work Skeptic North has done to combat misinformation and shoddy science reporting in the Canadian media, and in the public at large. Erik has a particular interest in critical reasoning, and in understanding why there’s so little of it in the public discourse. You can follow Erik's occasional 140 character musings @erikjdavis