WORLD-renowned scientist Prof Tim Noakes will be back on trial in October 2016 for his views on carbs and fats in the diet. The Health Professions Council of SA has charged him 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 Johannesburg dietitian, Claire Julsing Strydom, who first reported him to the HPCSA ,now gives. It’s the same advice the Association for Dietetics in SA (ADSA), of which Strydom was president at the time, now gives. Here’s an update on the case.
By Marika Sboros
It’s hard, but not impossible, to get to the real meat of the case against University of Cape Town emeritus professor Dr Tim Noakes. As the case progresses, it is becoming clearer just what the real beef is that ADSA and former president Claire Julsing Strydom have with him.
The HPCSA hearing against Noakes has been called the “Nutrition Trial of the Century” and the “Banting for Babies Trial”. It is also being called an “inquisition” because of the rigour with which the HPCSA has prosecuted the case against him.
The HPCSA is legally obliged to be impartial and dispassionate when conducting hear against health professionals. There has been nothing dispassionate or impartial about the way it has conducted this hearing.
Strydom’s charge against Noakes can seem frivolous. After all, Noakes is a medical doctor and one of few scientists in the world with an A1 rating by the National Research Foundation for expertise in both nutrition and sports science.
It may be that it wasn’t so much what Noakes said, as what he didn’t say, that got him into so much trouble. He didn’t tell the breastfeeding mother to give her baby cereal. The cereal companies that sponsor ADSA don’t like that.
Of course, not all experts agree the charge is frivolous.The HPCSA has mustered a motley crew of “expert witnesses” – two nutrition professors from NorthWest University, and a paediatrics professor now with the Medical Research Council. That was for its first hearing against Noakes in Cape Town in November 2015.
At the February 2016 hearing, it added a surprise witness, Stellenbosch University psychiatric professor Willie Pienaar. None of the witnesses fared well under cross-examination by Noakes’ legal dream team.
The HPCSA tried and failed to get what it probably hoped would be a key surprise expert witness to 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 day.
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, so he could easily have attended.
Rossouw has declined all requests for an interview on the evidence he would have presented.
My guess is Rossouw didn’t want to expose himself and his research to the same gruelling treatment other witnesses experienced at the hands of Noakes’ legal team.
Noakes’ lawyers are working pro bono. They are incensed at what they see as persecution of a world-renowned scientist because he dared to challenge conventional “wisdom” on nutrition.
The charge of unprofessional conduct can seem like a gross 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 person registered under the Act or any other Health Act”.
Noakes didn’t mention any dietitian by name. Quite how he contravened that rule then is unclear. The HPCSA could not clarify.
The HPCSA made a “preliminary finding” in August 2015. It found him guilty of unprofessional conduct by committing a “minor transgression”.
The council informed Noakes and Pereira that the matter was resolved – unless he chose not to accept its finding within 14 days. Presumably, the HPCSA wasn’t too surprised when Noakes did just that.
The HPCSA is pursuing the charge against Noakes.
Yet if the HPCSA had properly investigated Noakes’ comment, it might have noticed that many dietitians don’t say things that food companies don’t like. My experience of conventional dietitians over more than 30 years is that they trot out platitudes about “moderate” junk-food consumption and “balanced diets”.
Strydom, ADSA and the HPCSA have all resorted to semantic gymnastics when asked for explanations about why they are targeting Noakes. Strydom laid the complaint first in her personal capacity, but later told me in an email she would “prefer” I say she laid it as ADSA president. Any attempt to get clarification on her curious use of the verb “prefer” was stonewalled.
It’s also difficult to determine the extent of ADSA executives’ support for and involvement in Strydom’s complaint against Noakes. 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 after the fact. In it they acknowledge that Strydom as president had “a right to file any query on behalf of ADSA”. They make no reference to Noakes.
Gallagher also said ADSA now “acknowledges appropriate use of low-carbohydrate, high-fat diets”. But that’s only under “specific circumstances or for specific medical conditions and under supervision of an appropriate health professional”.
She has since said that ADSA is “fully behind” Strydom and the HPCSA.
It can look like Strydom is using ADSA to muzzle Noakes because he has taken 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 – mostly the sugar and breakfast cereal industries that stand to lose if Noakes’ views on LCHF ever become mainstream.
Cape Town attorney Adam Pike, of Pike Law, who heads Noakes’ legal team says Strydom’s charge has no merit whatsoever. He says the hearing has become “an extraordinary opportunity for the issues in question to be ventilated in public”.
It has created much-needed debate about evidence-based medicine. It is highlighting the doctor-patient relationship. It is also spotlighting the role of doctors, academics, scientists, nutritionists and dietitians in giving “the best diet and nutrition information available, not just information in official dietary guidelines”.
“The hearing is also about freedom of speech,” says Pike.
Pike says the hearing is showing up “the disruptive effect of social media and information technology and 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 their organisations who don’t move with these exciting times will become increasingly irrelevant – and a public health hazard.