Have you seen the virtual issue?

From 2013, the Journal publishes Virtual Issues, which are collections of related articles, offered as free accessImage. The first of these virtual issues is on Gastroenterology, Malnutrition and Nutritional Support and features articles on cancers of the GI tract, inflammatory bowel disease and enteral feeding. You can also find the British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults at this site.

Have we lost to the quacks?

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As a generally professional and mild-tempered individual I was quite shocked to find myself locked into a bit of a “brawl” on Twitter a few days ago with Mr Ben Goldacre. Goldacre is famous for his highly skilled and entertaining attacks on bad science, with incredibly insightful dissections of poor experimental design, the misuse of statistics and false medical claims. The nutrition profession in particular has been frequently challenged by Goldacre, who has relentlessly pursued of the quacks, charlatans and downright crooks who prey on the public in the name of nutrition. On the one hand Goldacre is on the same side as the academic/professional nutritionist in that he despises false scientific claims and people making money out of advice which is at best nonsense and at worst dangerous to health. However, on the other all nutritionists tend to be tarred with the same brush in Goldacre’s hands and the learned societies which make up the nutrition establishment in the UK (BDA, Nutrition Society, AfN) have not always responded to Goldacre’s complaints and issues in a full and timely manner.

So, why the Twitter brawl? Well, I came across a statement from Mr Goldacre that basically amounts to “nutritionist=quack”. His contention is that the public now so firmly associate the word nutritionist with “person making schmaltzy public claims about diet, selling diet books and pills, offering charismatic personal consultations with wildly specific advice”, that those of us who work in academic or clinical settings have lost ownership of the word nutritionist and need to think about calling ourselves something different.

Is he right? Well maybe if we were to take a random sample of the general public we would find a majority which reflects this view. The majority of people have never encountered a dietitian and will be blissfully unaware of the academic nutritionists who provide the evidence base that underpins contemporary health promotion and population-level dietary advice. However, whilst the public may associate the word “nutritionist” with individuals spouting non-scientific nonsense and spruiking supplements to go with their latest diet book, we would also find that they are aware of the need to consume less salt, to control their body weight and to eat their five-a-day. We have not lost this battle. Although the charlatans will bank their ill-gotten gains, their prey are the minority.

More importantly we could argue that the issue Goldacre has identified applies to almost any respectable scientific or medical discipline. The views of the public are influenced heavily by the media that they experience and unless they come into contact with practitioners they are unlikely to have a good understanding of the real science. Under the influence of TV soaps and dramas, the UK public may well be under the impression that midwives spend more time cycling and mingling with nuns, than delivering babies; that surgeons plot their complex love-lives over an open chest cavity and; that pathologists spend their working hours in direct pursuit of terrorists and murderers, whilst simultaneously offering care and counselling to bereaved relatives. It is perhaps pertinent to consider the eternal confusion between astronomers (scientists) and astrologers (quacks) which has never been adequately addressed in public perception. Should we therefore be confused that for some people in our society nutritionist does equal quack. We are not alone as a profession!

Personally I do not agree with the Goldacre thesis on this. Nutritionists should however regard this kind of comment as a warning shot across the bows. I renew my call for researchers to deal in quality. Give the people who work on the ground with patients and populations, a robust and appropriate evidence base to work from. Moreover, as a discipline we must fight fire with fire. The quacks and the cranks are charismatic and they speak freely with no restraining issues (such as have to speak the truth). Where are the Brian Cox figures for our discipline? Who are the people who can ignite the imagination of the public and translate what is often a mundane message of uncertainty and caution, into the memorable and engaging?

Any volunteers? In the meantime I will desist from public brawling…

Aside

Successful use of a wiki platform for international promotion of guidelines for management of cancer.

Using a wiki platform to promote guidelines internationally and maintain their currency: evidence-based guidelines for the nutritional management of adult patients with head and neck cancer

http://onlinelibrary.wiley.com/doi/10.1111/jhn.12036/abstract

T. Brown, M. Findlay, J. von Dincklage, W. Davidson, J. Hill, E. Isenring, B. Talwar, K. Bell, N. Kiss, R. Kurmis, J. Loeliger, A. Sandison, K. Taylor, J. Bauer

Background

The present study describes the development of evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer using a wiki platform to enable wide international stakeholder consultation and maintain currency.

Methods

A dietitian steering committee and a multidisciplinary steering committee were established for consultation. Traditional methods of evidence-based guideline development were utilised to perform the literature review, assess the evidence and produce a draft document. This was transferred to a wiki platform for stakeholder consultation and international endorsement processes in Australia, New Zealand and the UK. Data were collected on website traffic utilising Google Analytics.

Results

In addition to broad stakeholder consultation through the steering committees, an additional twenty comments were received via the wiki by twelve individuals covering six different professions from three different countries, compared to four comments by e-mail. The guidelines were subsequently endorsed by the dietetic associations of Australia, New Zealand and the UK. During a 4-month period monitoring the use of the guidelines, there were 2303 page views to the landing page from 33 countries. The average number of pages accessed per visit was five and the duration of time spent on the website was approximately 6 min.

Conclusions

Using a wiki platform for guideline development and dissemination is a successful method for producing high-quality resources that can undergo wide international stakeholder review and include open public consultation. This can replace conventional methods whereby guidelines can quickly become outdated.

What do the Editorial Board do?

edbdJHND announced the new Editorial Board last week. For everyone on the outside of the journal, the significance of this might be a little obscure, so it is important to explain what the EB actually do.

Nature of the role
Being a member of the Editorial Board is a voluntary position, and there is no remuneration related to the post. The Editor-in-Chief and the team of Associate Editors take day-to-day responsibility for handling manuscripts submitted to the journal, appointing reviewers and making publication decisions. The main role of the Editorial Board is to advise and support the Editor-in-Chief, Associate Editor-in-Chief and Associate Editors, who have responsibilities relating to the content and strategic direction of the journal. Editorial Board members are expected to make contributions to peer review, promote the journal to the nutrition and dietetics communities and to actively use the journal for dissemination and research.

Editorial Board members:
• Review papers for the Editor and Associate Editors on a regular basis, with the normal expectation being no more than three papers per year.
• Help the Editor and Associate Editors to identify suitable reviewers for submissions
• Provide second opinions on papers (e.g. where reviews are incomplete, or rejection of a commissioned article has been recommended)

Board members should also be active in promoting the journal to authors. JHND aspires to be a high quality journal in the field and so Editorial Board members should encourage colleagues to submit their best work to the journal. Contribution of content is also an important means of promoting the journal and Board members are asked to consider the journal first for their own research article, and contribute ideas for commissions, particularly for high quality review articles.

The Editorial Board should provide advice to the Editor on a range of subjects and this is best achieved through attendance at Editorial Board meetings, which will be held on an annual basis. Key areas of input would include:

• Future direction of the journal
• Feedback on past issues
• Competitor comparisons
• Ideas and innovations