UPDATE: World-renowned scientist Prof Tim Noakes was back on trial in Cape Town on April 4 and 5, 2017 for legal argument for both sides. On April 21, 2017, the Health Professions Council of SA announced a comprehensive not guilty verdict. That’s for his views on carbs and fats in the diet. Here’s what I wrote as a preview to the October 2016 session. It covered the real beef that some dietitians have with Noakes. I also looked at the case against him so far.
By Marika Sboros
It’s hard, but not impossible, to get to the real meat of the trial of Prof Tim Noakes. It’s not even supposed to be a trial. However, the Health Professions Council of SA (HPCSA) has turned it into one.
As the case progresses, it is becoming clearer just what the real beef is that dietitians behind this case have with him.
The public quickly dubbed the hearing against Noakes the “Nutrition Trial of the Century” and the “Banting for Babies Trial”. They have also called it an “inquisition”. That’s because of the HPCSA’s peculiar “prosecutorial zeal” in this case, as one legal expert described it to me.
The HPCSA is legally obliged to be impartial and dispassionate when conducting hearings against health professionals. There has been nothing dispassionate or impartial about the way it has conducted this hearing.
The hearing resumes on April 4 and 5 for heads of argument for both sides. Click here to read more on who holds the key to his fate.
The HPCSA has charged Noakes with unprofessional conduct. That’s for giving ‘unconventional advice’ to a breastfeeding mother on a social network (Twitter). He said good first foods are low-carb, high-fat. In other words, he was saying meat, dairy and veg. Ironically, it’s the same advice the dietitian who first reported him to the HPCSA, now gives. Claire Julsing Strydom was president of the Association for Dietetics in SA (ADSA) at the time.
Strydom’s charge against Noakes can seem frivolous. After all, Noakes is a medical doctor. He is also one of few scientists in the world with an A1 rating by the National Research Foundation. He is rated for both sports science and nutrition. All he said was that good first foods for infant weaning are LCHF (low-carb, high-fat). Anyone who knows anything at all about LCHF knows what the means for babies. It means meat, fish, chicken, eggs, dairy and vegetables.
Yet it now appears that it wasn’t so much what Noakes said in the tweet. It may be more what he did not say that had Strydom’s knickers in such instant knots. He did not tell the breastfeeding mother to give her baby cereal. That antagonises cereal companies that sponsor ADSA. He also did not tell the mother that it’s fine to give her baby some sugar now and then. The sugar industry is a major sponsor of ADSA. All the HPCSA’s expert witnesses have strong links to these industries. Most rely on the sugar industry for research funding.
Of course, not all experts agree that Strydom’s charge is frivolous.The HPCSA has mustered a motley crew of “expert witnesses” – two nutrition professors from NorthWest University, and one with the Medical Research Council. That was for its first hearing against Noakes in Cape Town in November 2015. All support Strydom’s complaint.
So too did the HPCSA’s last witness at the February 2016 hearing. That was Stellenbosch University psychiatric professor Willie Pienaar. None of the witnesses has fared well under cross-examination by Noakes’ legal dream team.
The HPCSA probably hoped that a key surprise witness would seal the case against Noakes. That was South African-born Prof Jacques Rossouw. He recently retired from the US National Institutes of Health (NIH) Women’s Health Institute.
Rossouw just happens to be one of Noakes’ most vocal opponents and a staunch supporter of official dietary guidelines. He agreed to be a witness but failed to show up on the opening day in February.
Repeated attempts to get him and the NIH to explain why were in vain. All both would say was that Rossouw could not get permission in time from the NIH to attend. Yet he had lots of time to get a simple yes or no answer from his employers.
He was also, according to reports, in Cape Town at the time of the hearing. Thus, he could easily have attended.
Rossouw has declined all requests for an interview on the evidence he would have presented. My guess is Rossouw declined to expose himself and his research to cross-examination by Noakes’ legal team.
Most of Noakes’ lawyers are working pro bono. From the outset, they have seen this as a persecution of a world-renowned scientist for challenging conventional “wisdom” .
Certainly, the charge of unprofessional conduct can seem like an overreaction. Strydom even admitted as much during cross-examination.
Both Strydom and the HPCSA insist they are not deliberately targeting Noakes. Yet the HPCSA has taken up another complaint by an ADSA dietitian that can seem even more frivolous than Strydom’s. Catherine “Katie” Pereira complained to the HPCSA over a comment Noakes made in a Sunday newspaper in July 2014.
He said: “So who is standing up for the poor? Show me the dietician who is saying they shouldn’t be eating chips and Coke and let’s do something about it? No one.”
The HPCSA charged Noakes under its Ethical Rule 12. It states that members should “not cast reflections on the probity, professional reputation or skill of another (health professional)”.
Yet Noakes did not mention any dietitian by name. Quite how he contravened that rule then is unclear. The HPCSA could not or would not clarify.
The HPCSA made a “preliminary finding” in August 2015. It found him guilty of unprofessional conduct by committing a “minor transgression”.
It informed Noakes and Pereira that the matter was resolved – unless he chose not to accept its finding within 14 days. Presumably, the HPCSA was not too surprised when Noakes did just that.
The HPCSA is now pursuing the charge against Noakes.
Yet many dietitians involved in this case just don’t say things that food companies don’t like. My experience of conventional dietitians over more than 30 years is that most trot out platitudes. They speak about “moderate” junk-food consumption and “balanced diets”. They also tell diabetics it’s fine to eat carbohydrates “moderately”. British GP Dr David Unwin says that just leaves diabetics “moderately poisoned”.
Why would any dietitian want to do that to diabetics?
Strydom, ADSA and the HPCSA have resorted to semantic gymnastics when asked for explanations about this case. Strydom laid the complaint first in her personal capacity. Later, she told me in an email that she would “prefer” I say she laid it as ADSA president. She stonewalled any attempt to get clarification on her curious use of the verb “prefer”.
It’s also difficult to determine the extent of ADSA executives’ support for and involvement in Strydom’s complaint. And whether Strydom ever had the mandate to involve ADSA as she has done.
ADSA’s new president Maryke Gallagher told me via email that she and other executives signed a letter in 2015. In it, they acknowledge that Strydom as president had “a right to file any query on behalf of ADSA”. However, they make no reference to Noakes.
Gallagher also said that ADSA now “acknowledges appropriate use of low-carbohydrate, high-fat diets”. But that’s only under “specific circumstances or for specific medical conditions. It’s also only under supervision of “an appropriate health professional”. Presumably, that means a dietitian only.
That is another sign pointing to a trial rather than a hearing. And one that has become a turf war. Dietitians don’t want Noakes straying onto their turf. They don’t want him giving dietary advice to the public. They definitely don’t want him giving dietary advice that conflicts with theirs. These dietitians believe that only registered dietitians should give dietary advice to the public.
Gallagher has since said that ADSA is “fully behind” Strydom and the HPCSA in its case against Noakes.
It can look like Strydom is using ADSA to muzzle Noakes because he takes business away from her and other dietitians. Or she, ADSA and the HPCSA could just be proxies – witting or unwitting – for powerful vested interests. These interests are in the medical profession, the pharmaceutical industry, especially drugs companies making billions from cholesterol-lowering drugs known as statins. They are also in the food industry. That’s mostly the sugar and breakfast cereal industries. These all stand to lose billions in revenue and profist if Noakes’ views on LCHF ever become mainstream.
Cape Town attorney Adam Pike, of Pike Law, heads Noakes’ legal team. He says that Strydom’s charge has no merit whatsoever. He also says the hearing has become “an extraordinary opportunity” to ventilate the issues in public.
It has created much-needed debate about evidence-based medicine. It is highlighting the doctor-patient relationship. The hearing is also spotlighting the role of doctors, academics, scientists, nutritionists and dietitians. That’s around the best diet and nutrition information available, not just information in official dietary guidelines.
“The hearing is also about freedom of speech,” says Pike.
It is showing up “the disruptive effect of social media and information technology”. It also highlights the transformative effects these are having on the role of doctors and dietitians.
Social media are increasingly empowering the public, Pike says. This trial shows that dietitians and organisations who don’t move with these exciting times will become irrelevant. They may also be a public health hazard.