31 January 2012

Which is more reliable: a registered dietician or an unregistered nutritional therapist?

This is an example of why I wrote Trick and Treat

In January 2012, The Daily Mail published an article which began:

Nutrition therapists condemned as 'quacks' who put patients' health at risk
Nutrition therapists have been condemned as quacks and accused of putting the health of the sick – including those suffering from breast cancer – at risk.
An industry has grown up based on the concept that ‘food doctor’ nutritionists can cure patients’ ills and allergies through diet.
However at least some of the practitioners, who charge up to £80 for a consultation, are providing advice that could harm health, a study by the consumer watchdog Which? found.
Read more: http://www.dailymail.co.uk/health/article-2087167/Nutrition-therapists-condemned-quacks-patients-health-risk.html

The article told readers that Which? had found nutritional therapists who gave questionable advice, had charged high fees for it and were unlicensed. Well, they might have a point but there may also be another side to this story.

Which?'s questionable methods

The first point is that Which?'s research methods and basic criteria are suspect. I have been on the receiving end of a Which? story so I can write this with some authority.

Back in 2001, Which? magazine tested the 14 best-selling slimming diet books to see if the dietary advice they gave worked. My book, Eat Fat, Get Thin! was one of those they 'tested'. But Which? did not actually test them at all. Instead, they looked to see if the books recommended 'healthy eating' and, if they didn't, they were adjudged to be of no benefit, an were not recommended. But, as I knew then, and as much more recent research has confirmed, healthy eating is a cause of obesity. So, as I was more knowledgeable, I wrote Eat Fat, Get Thin! to be of value to people wanting to lose weight, not to put more weight on. And for that reason, Eat Fat, Get Thin! did not fit with their preconceived, but totally wrong criteria. The full story is at http://www.second-opinions.co.uk/which.html

Is the same thing happening here?

Okay, I give dietary advice, if asked, but I wouldn't suggest to a breast cancer sufferer that she disregard her oncologist's advice, just cut sugar out of her diet, and keep her fingers crossed. But I might well point her in the direction of published research so that she can make an informed decision.

For example, the statistics for conventional breast cancer treatment are woefully bad at best, so a no-sugar diet might well work as effectively as (or even better than), say, chemotherapy, which is about 1.5% effective in breast cancer – and has lots of quality-of-life destroying adverse side effects. (Morgan G, et al. The Contribution of Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies. Clinical Oncology 2004; 16: 549-560. doi:10.1016/j.clon.2004.06.007)

Is registration a sign of quality?

The other point that the Daily Mail's article makes is that nutritional therapists are not registered or regulated, whereas dieticians are. And as the British Dietetic Association says: ‘Anybody can set up shop as a nutrition therapist, with no qualifications. Registered dieticians working in the UK are educated to degree level and must be registered with the Health Professions Council.’

But is that a guarantee of getting good advice? In my experience it is not.

In 2001, I was the interviewer and nutritional adviser in a documentary video which was attempting to sort out the confusion caused by books like mine and Atkins and the obvious conflict with current dietary advice. We interviewed nutritionists, dieticians and doctors as well as people attempting to lose weight. The doctors were fine: they knew that they didn't know much about diet. However, we found that registered nutritionists and dieticians were, to put it bluntly, ignorant, incompetent and arrogant. They were qualified; they knew their stuff – except they didn't! You can read about one of the interviews at http://www.second-opinions.co.uk/why-eat-5-portions-1.html.

She was not alone. We interviewed two others. Neither of them knew much about foods, nutrients and the effects on the body of even basics such as carbohydrates and fats. One openly admitted, when she asked for and I showed her the questions to come – they were about ketones and the effects of exercise – that she couldn't answer any of them! In fact, by the third interview, an NF registered nutritionist, it was obvious even to our nutritionally-uneducated production crew that the interviewees were completely ignorant of even the basic facts and could do little more than waffle. After the first three, we didn't interview any others: they were obviously going to be a waste of money.

In the end we didn't use any of these interviews in the documentary. We would have loved to, but couldn't: it would have ruined their careers.

Why are people going to unregistered nutritional therapists?

Registered nutritionists and dieticians effectively cost patients nothing: they are NHS-funded. To consult a nutritional therapist, on the other hand, is expensive. As the Daily Mail article points out, they might charge £80 ($120.00US) an hour. So why are people turning away from the registered dieticians and going to the alternatives?

There can only be one answer: They are dissatisfied with the NHS. And, from talking to many of them, I know that it is the sheer incompetence, indifference and inability to look outside the box they encounter within the ranks of registered dieticians.

I used to lecture on diabetes in hospitals to NHS diabetes staff. The NHS paid for me to do so. But the doctors, I found out, did not like what I was teaching – despite the fact that everything I said was backed by solid evidence and research published in their own medical journals. They had been taught one thing (and learned nothing) and nothing I said or was published subsequently was going to alter their minds or their treatment protocols. And so, diseases such as diabetes, obesity and other conditions associated with these diseases, continue to spiral upwards exponentially, while an ignorant and arrogant – but all powerful – regulated and registered 'health industry' bemoans the facts and suggests it's all the fault of their patients.

The bottom line

As I see it, any patient has two options: The first is to read articles on the Internet and select a nutritional therapist who might or might not know what they are talking about, or go to a qualified member of the British Dietetic Association and be sure that they don't.

20 January 2012

Doctors Threaten Strike; Others want us all to be guinea pigs

Supports Chapter One: Trick to Treat

Two pieces of news hit my computer almost simultaneously this week. One was good and one was bad. But together they illustrate what is wrong with medicine today.

The good news is that doctors, unsatisfied with a new pensions proposal by the British government are threatening to go on strike.[1]

The bad news is that a couple of very scary doctors in Oxford suggest that we healthy people should be forced to risk serious, possible fatal, illness by being injected with cocktails of bacterial and viral debris in the search for more effective vaccines.[2]

Doctors strike – and death rates fall

Doctors don’t often go on strike, but it has happened sufficiently often for a disturbing trend to be noticed. During the rare times that they have gone on strike – in several countries – the death rate has always gone down.

In 2000, Israeli doctors employed in public hospitals pursued a course of industrial action. This included the cancellation of outpatient clinics and the postponement of all routine surgery. And this limited strike action had some unusual consequences. Throughout Israel, while the doctors were on strike, death rates fell. The coastal city of Netanya has only one hospital whose staff members had a ‘no strike’ clause in their contracts. As a result, doctors in Netanya continued to work normally – and death rates remained stubbornly the same, failing to reflect the reduction that was shown in almost all of the rest of the country.[3]

And it wasn’t the first time; doctors in Israel had gone on strike in 1973, and reduced their total daily patient contacts from 65,000 to just 7,000. The strike lasted a month and during that time the death rate, according to the Jerusalem Burial Society, dropped by half.

It doesn’t just happen in Israel. The 1960s saw physicians in Canada go on strike and the mortality rate dropped. In 1976, in Bogota, Colombia, doctors refused to treat all but emergency cases for a period of 52 days, and in that time the death rate fell by 35%.[4] In the same year the death rate dropped 18% during a ‘slow-down’ by doctors in Los Angeles. After the strike, deaths rates jumped to 3% above normal for more than five weeks as the Los Angeles doctors caught up on their paperwork.[5]

And it is a standing joke among cardiologists that death rates fall during their conferences because fewer of them are attempting to cure moribund patients by doing dangerous surgery. Their treatment can be worse than the disease.

It may come as no surprise, therefore, that a major report by Australian medical researchers posed the question ‘WILL MORE DOCTORS INCREASE OR DECREASE DEATH RATES?’ The report, written by scientists at the Centre for Health Program Evaluation, hypothesized that an increase in death rates in that country was caused by an increase in the number of doctors. Although the report was concerned only with the situation in Australia, there is strong evidence to suggest that this question also needs to be addressed in many other developed countries including Britain and the US.

You may think that the question and hypothesis are outrageous. After all, Primum non nocere, ‘First, do no harm’, is a central tenet guiding medical practice, and most doctors treat this tenet very seriously. Yet the reality is that, with the state of healthcare as it is, our continual calls for more doctors, and expansion of the NHS and our dependence on it, may actually be increasing rather than decreasing illness in our lives. With the world’s highest concentration of doctors – one for every 500 people – you might expect that the US would be the healthiest country. Far from it; data from a health survey of the top thirteen wealthiest industrialized countries were published in the summer of 2000. The US came twelfth.[6]

One reason why medical care may increase death rates is the large number of adverse events associated with it. The Australian report mentions a 1995 study of 14,000 hospital admissions. Of those admitted almost 17% suffered an adverse event. One in seven adverse events resulted in a permanent disability and one in 20 of the individuals affected died.[7]

Even that may be an under-assessment. Research on under-reporting of serious adverse drug reactions in the United States and Canada suggests that formal reporting rates may be as low as 1.5% of the real total. US estimates place adverse drug reactions as the fifth most common cause of death after heart disease, cancer, stroke and pulmonary disease.[8] These figures are not always easy to acquire. It is well known that doctors and hospital consultants are notoriously bad at reporting drug side effects. Although there is a new national reporting system in the UK designed to flag potentially dangerous drugs and remedies, pharmacists said they tend not to report a side effect if patients have been harmed; they are more likely to report only those incidents where a protocol has been broken.[9] They fear that they will be blamed for any side effect, and so feel it is not worth running the risk. Why might they act in this way? It seems that they are ashamed to admit to their patients that they were wrong.[10]

In modern society there is an increasing tendency, typified by the human rights movement, to shame governments, professions and individuals into complying with a particular organization’s ideas for social change. Shame is hard to deal with. It engenders embarrassment and guilt; it makes professionals feel flawed. It is, perhaps, no surprise that they fall back on silence. Shame is probably the major reason why most doctors don’t report adverse drug effects or change their views on the usefulness and harm of drugs.

A second possibility, which the Australian researchers call ‘the dependency hypothesis’, is the idea that the more doctors are available, the more dependent on them people become to maintain their health. This leads patients to adopt an exaggerated confidence in the effectiveness of medical care and its ability to offset the harmful effects of their own self-neglect. But that is not a healthy attitude because getting involved with the medical profession can be decidedly dangerous. In 1999, doctors in the US were recognized as the third leading cause of death.[6] Four years later another review had elevated them into first place.[11] The number of Americans killed by FDA-approved pharmaceuticals is equivalent to dropping a nuclear bomb on a major US city every year.

We in Britain are not immune to this trend. On 13 August 2004, an astonishing article appeared on the front page of The Times. Based on an independent report published in the British Medical Journal, it confirmed that medical accidents and errors were directly blamed for the deaths of 40,000 Britons per year. This made them officially Britain’s fourth-biggest killer. But the report went on to state that less than a third of an estimated 900,000 medical mistakes are properly reported each year. The figure also excluded errors committed in primary care such as in GPs’ surgeries.

The following year came a Parliamentary Public Accounts Committee Report, A Safer Place for Patients: Learning to Improve Patient Safety. It stated that some 22% of medical mistakes that lead to a serious reaction or even death go unreported in the UK. This is because, while you may read ‘the patient died from complications of surgery’, the truth is often ‘the surgeon killed the patient’. Only one in four hospitals owns up to the patient (or relatives) when something goes wrong; the rest blame it on the disease itself; while just one in 25 drug reactions is ever reported. This massive under-reporting of mistakes is an acknowledged problem. It is usually because of fears of litigation.

Government officials were shocked to hear that nobody knows how many of the reported blunders end in the death of the patient. But based on the known, reported accidents, one in 10 people admitted to a hospital in Britain every year will suffer an incident that will harm them, said Tory MP Edward Leigh, chairman of the Commons Public Accounts Committee. These included 974,000 medical ‘accidents’.[12] This is a conservative estimate; government officials accept the figure is more likely to be 1,190,000. We should then add 300,000 hospital-acquired infections, and 250,000 serious adverse reactions to a prescription drug, a figure which is again a very conservative estimate as it is based only on reported reactions – a truer figure may be closer to 1,200,000 every year, according to officials. This means that some 2,690,000 people, or 4.5% of the entire population, could be harmed by medical mishaps every year. ‘The numbers of blunders could have been halved if staff had learned from earlier errors,’ the report said. Edward Leigh added: ‘No public health system should tolerate a failure to learn from previous experience on this scale.’

The lapses cost the NHS (actually, you and me, the taxpayers, of course) an estimated £2 billion in extra bed days and £540 million in litigation and compensation.

All of this may be why the late Dr Robert Mendelsohn, a physician himself, wrote: ‘Doctors in general should be treated with about the same degree of trust as used car salesmen.’[13]

So, we in the UK must be grateful if the doctors carry out their threat to go on strike. Not only will the country save money by not paying their salaries while they aren't working, it will reduce the likelihood that they will kill or seriously hurt us.

A new medical threat proposed

But there are now other threats to our welfare. We justifiably do not trust doctors, and as a consequence, people are loath to allow themselves to be experimented on. Which is proving to be a problem for the doctors. As is clearly stated in their paper, Drs Susanne Sheehy and Joel Meyer believe that we should be forced, by law if necessary, to allow them to inject us with any material they like. Mandatory participation in vaccine trials, they suggest, is no different from requiring individuals to serve on jury duty, for instance, or to serve in the military.

They also believe that forcing people to take experimental vaccines, even when such vaccines come with obvious "inherent risks," is an individual's required duty to give back to society.

Perhaps the most disturbing element of the paper, though, is its suggestion that "increas[ing] the severity" of diseases will help to facilitate 'compulsory recruitment' into experimental vaccine trials. Deliberately creating more deadly strains of disease in order to scare people into vaccine programs, in other words, is apparently considered to be a valid approach by Sheehy and Meyer, whose passionate worship of vaccines have led them to such a preposterous notion.

Just how dangerous their ideas are is evidenced in what has happened in vaccine trials in the past. I'll just list a couple:
  1. In 2008, 21 homeless individuals in Poland died during an avian flu vaccine experiment.[14]
  2. And in the same year at least 14 Argentinean children died as part of an experimental vaccine trial conducted by British pharmaceutical giant GlaxoSmithKline [15]
With that track record it is no wonder that Drs Susanne Sheehy and Joel Meyer are having difficulty finding volunteers on which they can test dubious procedures. And have they forgotten that we have a perfectly adequate immune system – if only it is allowed to do its job. And vaccines damage that capability.

Let me make it quite clear. I am very wary of going anywhere near the sharp end of a hospital. And there is certainly no way I would agree to allow myself to participate in any medical trial.

The medical profession today all seem to think we 'patients' exist to provide them with a comfortable standard of life which we can never aspire to. Well, we don't! They are our servants; we pay their salaries. And there is a limit to how much we can afford. If they cannot live with that, so be it.

So, let the doctors strike, I say. We will almost certainly be better off without their ministrations, and we will save money.

1. Doctors threaten first strike in 40 years – over £48,000 pensions, The Independent, Thursday 19 January 2012. http://www.independent.co.uk/life-style/health-and-families/health-news/doctors-threaten-first-strike-in-40-years--over-48000-pensions-6291595.html
2. Susanne Sheehy, BM BCh, MRCP, DTM&H, and Joel Meyer, BM BCh, MRCP. Should Participation in Vaccine Clinical Trials be Mandated? Virtual Mentor 2012; 14: 35-38.
3. Doctors’ strike in Israel may be good for health. BMJ 2000; 320:1561.
4. Horne, Ross. Health & Survival In The 21st Century. HarperCollins Publishers Pty Limited, Australia, 1997. Chapter 11.
5. Science News, 28 Oct 1978; 114: 293.
6. Starfield B. Is US health really the best in the world? JAMA 2000; 284: 483-485.
7. Wilson RM, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471.
8. Motl S, et al. Proposal to improve MedWatch: decentralized, regional surveillance of adverse drug reactions. Am J Health Syst Pharm 2004; 61: 1840-1842.
9. Ashcroft DM, et al. Likelihood of reporting adverse events in community pharmacy: an experimental study. Qual Saf Health Care 2006; 15: 48-52.
10. Davidoff F. Shame: the elephant in the room. BMJ 2002; 324: 623-624.
11. http://www.garynull.com/documents/iatrogenic/deathbymedicine/deathbymedicine1.htm
12. House of Commons Committee of Public Accounts. A safer place for patients: learning to improve patient safety; Fifty-first Report of Session 2005-06. 12 June 2006
13. Mendelsohn RA. Confessions of a Medical Heretic. New York: McGraw-Hill Contemporary; 1979.
14. Homeless people die after bird flu vaccine trial in Poland. Daily Telegraph, 02 Jul 2008. http://www.telegraph.co.uk/news/worldnews/europe/poland/2235676/Homeless-people-die-after-bird-flu-vaccine-trial-in-Poland.html.
15. GSK fined after over vaccine trials; 14 babies reported dead. Buenos Aires Herald. http://www.buenosairesherald.com/article/88922/gsk-lab-fined-$1m-over-tests-that-killed-14--babies