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Updated 28 April 2016

Professor Noakes' ridiculous Banting trial – Part I

CyberShrink feels that a trivial complaint against Professor Noakes has grown into a real threat to freedom of speech and the proper role of any doctor in South Africa.

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The case against Prof Tim Noakes at the Health Professions Council has been grinding away for some time, and will start up again later this year.  I wasn’t paying close attention, until eventually, like the annoying buzzing of a fly against a window, the noise moved me to look closer. And I didn’t at all like what I found. 

Let me be entirely clear: this is not about whether the fashionable Banting diet Noakes has been promoting is fabulous and life-saving; not half as good as it’s made out to be; or profoundly mistaken and possibly harmful.

Who is perpetrating this inquiry?

The case is being heard before the persistently dysfunctional Health Professions Council, successor to the old Medical & Dental Council. They were always an odd bunch: medical politicians, bureaucrats and busybodies, rather than the most distinguished doctors – and always closely attentive to the wishes of the government of the day. You might expect them to be all about tackling highly dangerous and unscrupulous doctors, perilous malpractice, illegal operations etc. But alas, it’s nothing like that.

During the apartheid era, though the Council was kept well informed of what a handful of wicked doctors were doing, it never ever took action against such people. Evidence suggestive of participation in major human rights abuses and participation in torture or covering it up were all skilfully ignored.  Even where perpetrators had condemned themselves in trial transcripts, they did nothing. 

Read: We, the broken people of South Africa

I pointed out at the time that the Council could easily have ended the entire discriminatory practice of apartheid medicine and the suffering caused in the public and private sectors by simply insisting on applying internationally recognised principles and standards of ethical practice. If they’d just stated that to provide different standards of care to white and black patients, to tolerate inadequate and dangerous facilities for anyone, and to refuse to help any patient based on their race – was unethical, and that any doctor who did so would be struck off the register, the practice of apartheid medicine would have become impossible.  But of course they did no such thing. 

At all levels the Council has long been negligent. For instance, when I reported to them a doctor so devotedly alcoholic that patients complained they fell over empty booze bottles when trying to enter his office, they didn’t even investigate or respond. I also reported an old doctor, allowed to run a pharmacy, so advanced in dementia that he’d wander vaguely into my office and ask me if I knew why he had come to see me and didn’t know what day it was. Once again they felt no need to look into the matter. 

More recently, an investigatory report to the Minister of Health found the council (including its haphazard disciplinary processes) highly dysfunctional, and advised that some senior officials should be dismissed. These officials chose to investigate themselves and, finding themselves beyond reproach, ignored the report.   The mere existence of the Noakes inquiry proves the chaotic nature of these processes and the odd behaviour of some of those officials. Did any of them really think these squalid and absurd proceedings would redeem their non-existent reputations?  The person currently chairing the Noakes inquiry, Advocate Joan Adams, may be an unusual exception to the usual dismal meetings, and we may yet see a sensible result, though at huge wasted expense.

What’s the complaint?

This is remarkably hard to figure out.  He seems to have been charged for unprofessional conduct for giving unconventional advice to a breastfeeding mother (Pippa Leenstra) over Twitter,  when he suggested that she wean her baby onto low-carb, high-fat (LCHF) foods (meat and vegetables)  instead of cereal. The nature of the complaint keeps shifting, though remaining ridiculous in all of its versions.

Read: Your quick guide to Banting

The complainant, one Claire Juling-Strydom, former head of ADSA, an organisation of dietitians, said giving one-on-one nutrition advice on social media to a patient who has not been assessed was in contravention of the HPCSA’s ethical guidelines. This is utter nonsense, and if the principle were accepted, would seriously damage the health of the nation. A representative of ADSA said providing information outside the scope of practice for which one is registered with the council was what contravened guidelines. This is also untrue when applied to dietary advice, which is part of the job of every doctor.  (Maybe if dietitians started giving advice on anything other than diet, there could be serious grounds for objection.)

Astoundingly, she said he shouldn’t have mentioned “weaning”, a word she forbids us to use. This indicates more than a hint of professional jealousy and inter-professional rivalry. How on earth can she take it upon herself to forbid all health professionals from using “weaning” or any other word?  What a ridiculous complaint!

She had the effrontery to say his advice was not evidence-based, ignoring his heaps of evidence. But perhaps evidence that doesn’t support her world-view doesn’t count!  Yet, much of the dogma of dietitians is based on old and simplistic opinions, like their cherished “dietary guidelines” which have accumulated like guano on a rock, rather than on good scientific evidence. Does she never, ever give advice not totally evidence based?  If she does, she must remain silent on many important nutritional questions.  A basis in evidence is desirable, but not compulsory!

What actually happened?

In February 2014,  Strydom, then ADSA president,  formally reported Noakes to the HPCSA for issuing two tweets suggesting that in weaning an infant, good first foods would be (low carb, high fat) meat and veg. Paediatric dietitians and many others routinely do the same. She was later quoted as saying she was horrified by his comment. Her first reaction was, “I am horrified! How can you give advice like this?”

Then she tweeted: “You have gone too far; be sure that I will be reporting this to the Health Professions Council of SA.”

Within 2 days, she sent an email to the HPCSA: “To whom it may concern. “I would like to file a report against Prof Tim Noakes. He is giving incorrect medical (medical nutrition therapy) (sic) on Twitter that is not evidence based. I have attached the tweet where Prof Noakes advises a breastfeeding mother to wean her baby onto a low carbohydrate high-fat diet.

Read: Ocean View tries out the Banting lifestyle

“I urge HPCSA to please take urgent action against this type of misconduct as prof (sic) Noakes is a ‘celebrity’ in South Africa and the public does not have the knowledge to understand that the information he is advocating is not evidence based – it is especially dangerous to give this advice for infants and can potentially be life-threatening.  I await your response.

Kind regards,

Claire Julsing Strydom”

A diet of sour grapes

The complaint has been handled disgracefully from the start. Most peculiarly, and some might argue unprofessionally, Wits Prof Ames Dhai, Chairman of the HPCSA Preliminary Inquiry Committee failed to give reasons why Prof Noakes was charged. This is a denial of justice and of routine due process. How can anyone properly defend themselves without knowing the details of the charges against them and why these were brought? Fortunately, the competent current Chairman, Advocate Adams, very properly insisted that this breached his constitutional right to such details.

It’s very obvious that Leenstra was not Noakes’ patient, nor was he treating her. She asked for general advice to “breastfeeding mums” in a public forum. This was no different from someone asking a question in a public meeting.  The Council made it appear that he had given highly unconventional advice, yet the Banting diet has been around since 1890, so it’s hardly a brief fad. 

Read: ABC of breastfeeding

The ‘Banted Baby Syndrome’ 

The Council is supposed to be neutral in investigating such complaints, but has shown freakishly rare zeal in pursuing Noakes, as if there were piles of infant corpses, Banted to death. Would this be the “Banted Baby Syndrome”? They comprehensively messed up the case against Wouter Basson, “Dr Death”, in so many ways. But at least he was clever enough not to venture an opinion about infant feeding.

It gets confusing when Noakes presents the major scientific studies behind his conclusions and opinions on diet and health. The SAMDC has never ever been competent to judge scientific issues, and that’s not its purpose.  It is not a scientific body.

So why should we care?

This grubby little complaint is important to all of us because it is persecuting a professor for doing his job.  It is a professor’s job to “profess”, to learn about his subject and areas of interest, to interpret his experience and his reading of the available literature of science, and to form and offer us his opinions. We are free to accept or reject his views.

In this case it actually doesn’t matter at all whether he is right or wrong about dietary issues.  If we have freedom of thought and freedom of speech (admittedly a dodgy question in our country) he is entitled to his point of view,  right or wrong,  and to express it to others.

His scientific credentials are greater than those of the person who complained or indeed of anyone on the Inquisition he faces. The science he quotes is simply illustrative of the fact that he bases his views on a serious review of available evidence, rather than sucking it out of his thumb and it isn’t based purely on memorising the often unexamined dogma of others. 

Read: Banting or low-carbing? Watch what meat you eat!

He was asked for his opinion and gave it. That’s it. The fact that some insignificant person who may feel herself a professional rival got her nose out of joint because she doesn’t share that opinion is monumentally trivial. The world is crammed with people whose opinions I don’t share, or who don’t share my opinion. So what? We are not on this planet to tamely agree with each other. Nobody,  perhaps especially not professionals,  and still less professors, should be expected to toe some scientific party line and censor their views to ensure they fit some bullying orthodoxy,  or to suit someone else’s financial interests.  If a professional or professor does so, they are not fulfilling their purpose in society.

Note: Views expressed by our columnists do not necessarily reflect those of Health24.com or 24.com

Read more:

Professor Noakes' ridiculous Banting trial – Part II

Tim Noakes speaks out on the ‘Banting for babies' hearing

Tim Noakes to defend Banting for babies

Professor MA Simpson is Health24's CyberShrink. A South African psychiatrist, he qualified in medicine and in psychiatry in Britain. He has been a senior academic, researcher, and Professor in several countries. Read more of his columns.

 

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