In the nutrition world, there’s a lot of scepticism about big pharma, conventional medicine and dietitians. People constantly asking, “why should I believe what you’re telling me?”
Since the age of WebMD, Wikipedia, and government and big Pharma mysticism, people are becoming increasingly sceptical of traditional health care providers like registered dietitians. Patients read blogs, watch Youtube videos and read up on every rare disease, diagnosing their own symptoms before arriving at their doctor or dietitian’s office. While all of this nutrition information allows patients to be informed and involved in their own health (which is great!), it also creates a whole new level of complexity for health care providers. What used to be simple counselling and education has become discussions over the wiki-style “research” patients bring in and an hour of debunking myths. We’re going to get into a few of these myths and uncover the truth behind them once and for all.
Myth: Dietitians are just the same as a nutritionist, right?
The dietitian vs nutritionist debate is real. The simple answer? A nutritionist is (likely) not the same as a dietitian.
In most provinces, any person can refer to themselves as nutritionists, whether that’s your grandmother, your little brother, or your pet rabbit. There are some exceptions where variations of nutritionist are protected such as Quebec, Nova Scotia, Alberta and New Brunswick. Now I don’t mean to paint all nutritionists with the same brush. Nutritionists can have a broad range of education ranging from a completed university degree to no formal education. To become a registered dietitian (RD), there are specific educational and licencing requirements just as there are for doctors or nurses. This is why dietitian or registered dietitian is a protected title across Canada. Plain and simple, there are a few mandatory steps to becoming a dietitian including:
- Obtaining a minimum of a bachelor degree from an accredited university program (which is very competitive);
- Completing supervised practical training from a post-degree internship or masters practicum program (which is even more competitive);
- Passing the national examination and registering with the regulatory body of the province you intend to practice in;
- Completing continuing professional educational requirements to maintain registration.
What does this mean for the public? It means you can rest assured that your dietitian’s advice is credible and valid. It also means a dietitian must follow the code of ethics set out by the regulatory body of their province, which is used to protect their profession. Protecting their profession means protecting their patients- this is a win-win in my eyes. Dietitians also must continue their professional development to maintain their registration, which is done through creation of yearly professional goals and joining nationwide professional communities such as Dietitians of Canada. This means your dietitian is always looking at new research to base their practice off and not just regurgitating old science they learned in their undergraduate degree.
Myth: Evidence-based research is always funded by the government or big pharma
Has anyone heard of the term “peer reviewed?” This is a really important point when we’re talking about research funding and validity. Peer reviewed means knowledgeable experts in the field evaluate a study for its scientific credibility. Is the methodology is valid? Are the correct statistical tests used? How are the findings interpreted? Inclusive of this, they will be looking to see if the paper explicitly states their funding and any conflict of interests. However, the funding source may not be as important as everyone thinks.
Dr. Sharma MD/PhD, FRCPC wrote a great article discussing why the authors’ personal relationship to the funding source like big pharma or government doesn’t really matter. He discuses how all funders are pursuing a goal, that’s why they’re funding the study. But if the paper can still meet all the scientific requirements, then the funding source becomes irrelevant. He goes on to discuss how industry funded studies follow the same concept. Most industries, government or big pharma will only fund a study if they believe there will be favourable results, so they will ensure extensive background research is done before funding a study and only fund those likely to succeed. It’s important not to confuse this with the concept of industries manipulating a study to produce favourable results, which would be scientific fraud.
Now I know, this sounds like the exact opposite of what everyone thinks, but logically it does make sense. Even if you’re not in sync with Dr. Sharma’s ideology, it’s important to note that any credible research article will state who wrote the article and what the source of funding was. If the authors say that there was no conflict of interest, then regardless of who funded the project the researchers worked independently of their funding source.
Myth: Dietitians simply spew out information enforced by the government
So, lets think back to when we were talking about the process of becoming a dietitian. One of the first things you learn in school to becoming a dietitian is how to critically analyze and evaluate literature . This is similar to the peer review process we were talking about earlier. Dietitians are experts in combing through journal articles and making evidence-based recommendations. This doesn’t mean reading one article and completely changing our practice- it’s a more conservative approach. We’re looking for multiple high quality articles that have found the same results before considering recommendation changes. Many of these suggestions are compiled for us already in a resource called Practice-Based Evidence in Nutrition, or PEN for short. This site gathers the latest and best evidence in nutrition to create recommendations for dietitians based on a graded scale of the quality of evidence.
Finally, the government (like big pharma) doesn’t dictate recommendations for dietitians to provide to the public and we aren’t required to give advice that we don’t believe is sound and valid. For example, the government bodies have created Canada’s Food Guide as an education tool for health care providers. Do all dietitians use it? Nope. I know a lot of them who hate it. I’m not a fan myself. This is where professional judgement and critical thinking come into play. All of our recommendations are based on providing the highest quality of care to patients while abiding the by The Jurisprudence Handbook for Dietitians in Ontario or in other provinces, The Professional Standards for Dietitians in Canada. This handbook is available to the public to ensure safety and confidentiality of patient care.
Myth: Conventional medical providers, such as dietitians and doctors, often promote specific medications because big pharma is funding them?
Now, this whole big pharma thing can be a confusing and highly controversial topic. It’s like a big, awkward, elephant in the room when you have a client who’s thinking “are they really on my side?” but never outright says it. I’m going to focus on the evidence for dietitians right now, but most of this evidence extends into many traditional professions in medicine.
In Canada, this whole big pharma issue falls under the conflict of interest section of the ethics guidelines. Dietitians are legally allowed to sell a product, although it is recommended to do so with caution and under strict guidelines. Dietitians are advised to use their professional judgement to deem if the product they’re promoting is the best choice for their client. It is prohibited under these ethical guidelines for a dietitian to be directly sponsored by a pharmaceutical company for their personal benefit. More often than not, a dietitian won’t promote any specific company or product to avoid these ethical concerns.
When in doubt, dietitians will use the DORM principle, and no, were not talking about that pizza-filled closet we called home during University. DORM stands for disclosure, options reassurance and modification. This means the dietitian must disclose the conflict as soon as possible, inform the clients of other options, reassure them that choosing another service won’t affect the quality of service the dietitian provides and make any modifications to remove the conflict of interest.
Let’s go over some important take home messages:
- Dietitian’s are not the same as nutritionists and require specific educational and licensing requirements.
- Evidence-based research is peer-reviewed and will often explicitly state their funding source and conflicts of interest so it really shouldn’t matter if it’s funded by Big Pharma or not. As long as the journal is peer-reviewed, the source of funding is less important.
- Dietitian’s analyze and interpret evidence on their own accord; they are not required to give government-based recommendations to patients. They are required, however, to practice ethically based on guidelines like The Jurisprudence Handbook for Dietitians in Ontario.
- Dietitians use their professional judgement to determine what they may promote or sell, and are not allowed to endorse products based on personal gain. As always, the client has the right choose another product or service than what the dietitian is recommending.
My hope is that this post has provided some transparency into the dietetic profession, answered some questions about Big Pharma, dietitian vs nutritionist, and conventional medicine, and alleviated the growing societal anxiety around the validity of this medical profession. Dietitians are here for the patients, and the end goal is for them to help their clients using the best resources available.
Contribution by AK Dietetic Intern Tiffany Schebesch