By Marika Sboros
If the Health Professions Council of South Africa (HPCSA) hearing against Prof Tim Noakes succeeds, it could strike him off the roll. Whether that will happen is anybody’s guess right now. My guess is it won’t.
My guess also is that the HPCSA is marshaling a host of orthodox forces that will go down fighting to ensure it will. That’s why I call trial that begins on June 4, 2016 a “nutrition inquisition”. Here’s a look at how this trial came to be:
It all started way back in February 2014 when Johannesburg dietitian Claire Strydom reported Noakes to the HPCSA. She was “horrified” at a couple of tweets advising a mother to wean her baby onto low-carb, high-fat (LCHF) foods. If you know anything about LCHF (aka Banting), Noakes was recommending meat and veg.
You might not think that was such terrible advice for Noakes to give. After all, he is both a medical doctor and a world-renowned scientist. The National Research Foundation has rated him A1 in both nutrition and sports science. That’s a rating few scientists in the world manage to achieve.
And anyway, Strydom now advises the same thing. So does the Association for Dietetics in SA (ADSA) of which Strydom was president at the time. So do doctors and other nutrition organisations worldwide.
It’s why many now call this case the “Banting for Babies trial”. It’s the way women in traditional societies have raised their babies for centuries . If you doubt it, ask Canadian physician Dr Jay Wortman and others who have extensively researched traditional diets.
That makes the notion that Banting is potentially a “dangerous experiment” – as one dietitian put it – seem overly alarmist.
The case raises the question of the legality and reasonableness of the HPCSA keeping this sword of Damocles hanging over Noakes’ head for close on 18 months.
I can’t tell you exactly why Noakes’ tweet so horrified Strydom, she felt the only avenue open was to report him to the HPCSA. And why she reported him in her personal capacity first, then the HPCSA changed that to ADSA. And whether Strydom ever had a mandate to do what she did.
Strydom confirmed in an email that she laid the charge but would “prefer” I say that ADSA laid it. I asked for clarification of the use of “prefer”, but got none. After that, Strydom went mum on me and has stayed that way since.
I also can’t tell you why the HPCSA has chosen to go after Noakes. Both Strydom and the HPCSA have refused to answer most of a long list of questions, even those unrelated to the merits of the case. Both have stonewalled me throughout, citing the sub judice rule. Yet anyone with half a legal brain knows it doesn’t apply in this case.
Johannesburg attorney Neil Kirby, Werksmans health legal eagle, said diplomatically in an email that he was “not aware of the application of the sub judice rule to matters before the HPCSA”. Other lawyers say the same thing.
The fact is the HPCSA is a public body, not a court of law. It is constituted in terms of the Health Professions Act. Consequently, it is a public body as the Promotion of Access to Information Act (PAIA) defines. I requested information from the HPCSA according to my rights under PAIA but got nowhere.
HPCSA hearings are also not supposed to be adversarial. The council is supposed to exercise its powers openly, transparently and accountably, and be fair to both sides. So far, I haven’t seen any evidence of that. I couldn’t even get the HPCSA to come clean on the exact wording of the charge against Noakes.
All HPCSA communications manager Priscilla Sekhonyana would say was: “Currently, HPCSA cannot provide the details of the charge/s.” She said the HPCSA has not yet disclosed the details to its Professional Conduct Committee that will hear the charge against him. Sekhonyana did say that on June 4, 2015, the HPCSA would disclose the charges to the committee.
One would think the HPCSA’s Professional Conduct Committee would want to know the charges well in advance.
And if anyone is fiddling with the wording, or making substantial changes to charges at this late stage, it doesn’t augur well for a fair hearing.
I asked Noakes’ attorney, Adam Pike, of Pike Law, for comment on whether the HPCSA had supplied specifics of charges. He confirmed that it had but declined to comment. He has clearly decided to say as little as possible so as not to prejudice his client’s case in any way.
I’d say the HPCSA’s deafening silence is doing that all on its own. Ditto for ADSA and its continuing silence.
I haven’t been able to find out from the HPCSA who their “expert witnesses” are. Or whether the charge will include “unconventional advice” and the delivery method – Tweeting.
In fact, I haven’t been able to find out much about this peculiar case.
It seems that the HPCSA has already made up its mind on key issues. One of those is the safety and efficacy of LCHF even though it is evidence-based.
The HPCSA is already on record warning the public against LCHF. In an unusual move in October 2012, the chairwoman of its Professional Board for Dietetics and Nutrition, Prof Edelweiss Wentzel-Viljoen, issued a statement.
She doesn’t mention Noakes by name. She expresses “concern” over the “controversial unhealthy diets” that” individuals who are not specialized in the dietetics and nutrition fields” have recommended. The HPCSA was making it pretty clear who it believes should be handing out dietary advice.
However, if Wentzel-Viljoen did mean Noakes, she got her facts wrong about his expertise in nutrition. As a sports scientist for decades, Noakes’ specialty has always been in nutrition. And it isn’t possible to be an expert in nutrition for elite athletes if you don’t know about general nutrition.
He has studied infant nutrition for the past four years and will bring out a book soon on nutrition for babies, titled Raising Superheroes. Medical specialists, including a paediatrician, have denounced it even before publication. If that isn’t a sign of territoriality, I don’t know what is.
But it was probably just an example of the dietetic world busily marshaling its forces against Noakes after Strydom laid the charge.
Here’s another: In July 2014, nutrition researchers at Stellenbosh University’s Centre for Evidence-Based HealthCare published a hastily cobbled together meta-analysis. In the online journal, PLOS One, they conclude that low-carb diets were no better than “balanced diets” for weight loss. International obesity researchers come to very different conclusions.
ADSA and the HPCSA issued a joint statement on the Centre’s research, along with the Nutrition Society of SA and the Heart and Stroke Foundation of SA. That was unusual behaviour for the HPCSA given that it was investigating a complaint against Noakes. It looked suspiciously as if the ADSA and HPCSA were colluding and attempting to fortify their positions in some way.
There are many other key scientific questions the HPCSA appears to have answered for itself.
One of those is the role of saturated fat and the diet-heart hypothesis. That’s a sacred cow which US science writer Nina Teicholz slaughters in her groundbreaking bestseller, The Big Fat Surprise.
Recently, the US-based Academy of Nutritionists and Dietitians (AND), of which ADSA is a member, declared that we should all “de-emphasise” saturated fat as a nutrient of concern.
That’s a big problem not just for the HPCSA, but for all vested interests in the food and pharmaceutical industries ranged against Noakes. These industries have made fortunes from low-fat, high-carb foods, and drugs to lower cholesterol. They clearly want to continue doing so.
The HPCSA also has to define low-carb. Good luck with that one.
It has to decide whether carbohydrate really is an essential nutrient. Research shows it isn’t. That isn’t a message dietitians and Big Food likes to hear. It’s no coincidence that these members of what I like to call the “CarboNostra” are all in bed with Big Food, and that Big Food desperately wants to silence Noakes.
If the HPCSA does strike Noakes off the roll, it will open up its own medical can of worms. It will also open up scrutiny of its close ties with ADSA and Big Food. And if you think the medical and dietetic professions are above dirty tricks typical of corrupt politicians, you might think differently after this case.
It will be interesting to see if this really is a fight between Big Food and Big Pharma against Noakes, with the HPCSA and ADSA as their proxies. All it requires, as they say on Twitter, is to #followthemoney.