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…

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7 thoughts on “Have we lost to the quacks?

  1. I think it’s a bit odd that you describe our twitter discussion as being “locked into a brawl”. You sent some rather abusive and intemperate tweets, quite late at night, which you’ve now deleted. Perhaps you woke up feeling regretful the morning after. I don’t know.

    Here’s the only one you’ve left undeleted, in context. Mine are all still there.

    More importantly, it’s quite troubling – in the blog above – to see someone with your position in the nutrition profession misrepresenting concerns that outsiders have raised.

    You say “all nutritionists tend to be tarred with the same brush in Goldacre’s hands”, as if I’ve damned the work of serious nutrition researchers. This is, as you must surely know, quite untrue. My initial concern was clear: I explain that there are two camps: people who use evidence responsibly in the field of nutrition, and people who don’t. I also explain that the Nutrition Society has a good history, but that they seem to be squandering it, by indulging some very silly notions and then failing to manage concerns appropriately.

    http://www.badscience.net/2006/07/the-red-baron/
    http://www.badscience.net/2006/06/the-two-headed-food-monster/

    Reading these articles back a few years later, the issues I set out about the Nutrition Society seem entirely valid. A few years later, I posted the letter that drove you to post your late-night tweets (which you have now deleted).

    http://bengoldacre.posterous.com/sometimes-proper-nutrition-researchers-compla

    It makes one very simple point. There are serious academic researchers in nutrition, but if they want to differentiate themselves from crystal healers and people making outlandish claims about food, then they might do well to consider using a different word, because “nutritionist” is one that they have demonstrably failed to defend as their own.

    I should lastly say: if you ask around, I think you’ll find you’re wrong about other professions’ titles. People know what a midwife and a surgeon do: they know very well, and they know that midwives and surgeons are different from crystal healers. If you ask about nutritionists, on the other hand: they’ll name Gillian McKeith and Patrick Holford. If you want to be differentiated from those two – perhaps you don’t – then you’ll need a different word.

    This is not an attack on a profession. This is friendly advice to a profession: that they might achieve their own stated objectives better if they use a word that delineates more accurately what they do, in popular parlance, and sets them apart from people they claim to regard as “other”.

  2. Do you have an evidence base to support your assertions, or is this simply your strongly held opinion?

    You say you are not attacking a profession, but when you are on this side of the argument, that isn’t the way it feels.

      1. It’s not clear who your system would protect from whom, or why it would be better than the Nutrition Society has proved itself to be.

        http://www.badscience.net/2006/07/the-red-baron/
        http://www.badscience.net/2006/06/the-two-headed-food-monster/

        More than that, it seems unrealistic. “Doctor” isn’t a protected title, I can’t picture serious legislative time being given to this, and in any case, it seems quixotic to try and fight a language community of 60 million UK citizens with a petition, or legislation.

        http://bengoldacre.posterous.com/sometimes-proper-nutrition-researchers-compla

  3. As far as I know, this ePetition is the initiative of a group of nutrition students. I support their initiative (far more sensible than some that are initiated at the direct/gov site) as it shows that the practitioners of the future value their professional status and all that the term “nutritionist” really stands for.

    Do you have a better suggestions for how the nutrition community can protect itself from the encroachment of woowoo? I personally remain to be convinced that you place any value on the work of genuine nutritionists and actually regard your public pronouncements and merchandising (http://badscience2.spreadshirt.co.uk/sophisticated-visual-gag-A18169393/customize/color/1) as part of the problem we face. It is easy to criticise, less easy to offer up a practical solution or support.

    I don’t think that you and I will ever see eye to eye on this. I wonder what other people think?

    1. i think you’re being silly now. i’m perfectly clear, at length, in my writing linked above, and in the book Bad Science, that i think good nutrition research is good. i also explain the benefits and pitfalls of different research methods in that book, to an extremely wide audience.

      we disagree about the use of a word, you’ve gone a bit personal.

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