By Marika Sboros
There’s something absolutely “fabulous” about the ferocity with which the Health Professions Council of South Africa (HPCSA) has prosecuted Prof Tim Noakes. I don’t mean fabulous in the informal sense of “very good” – as in a “fabulous holiday” or “fabulous riches”.
I mean the Oxford dictionary’s formal definition of fabulous as “extraordinary”, especially “extraordinarily large”. Most of all, fabulous as having “no basis in reality”. In other words, something mythical, the stuff of fables.
For more than three years now, the HPCSA has waged a titanic battle against Noakes over the tiniest of provocations. It began with a single tweet he made in February 2014. In it, he said that good first foods for infant weaning are LCHF (low-carbohydrate, high-fat).
Thus, April 21, 2017, has become the day of reckoning for a ferocious scientific fable.
The HPCSA has reacted in extraordinary ways in conducting its case. It has pulled patients out of a hat. It has made witnesses appear and disappear at the drop of the same hat. The HPCSA has demanded evidence from Noakes that his tweet won’t kill infants and adults on a genocidal scale. Noakes obliged with the evidence – over 40 hours, with 1163 slides and 5093 pages, citing 354 publications and/or materials. When he gave the evidence, the HPCSA turned a jaundiced, bleary eye.
Perhaps the most fabulous thing about this saga really is the HPCSA’s response to the science for LCHF. It tried arguing that Noakes’ evidence is all irrelevant. It presented a single, solitary, highly flawed study purporting to debunk LCHF. The study does nothing of the sort.
Noakes’ legal team argued that there’s a far more likely reason why the HPCSA has ignored the evidence for LCHF: It cannot answer the science.
Thus, April 21 has become its day of reckoning. On that day, the “judge” in this case, the HPCSA’s Professional Conduct Committee, will rule. Committee chair, Pretoria counsel Joan Adams will read the ruling. The Committee will decide whether Noakes is guilty as charged of “unprofessional conduct for giving “unconventional advice on a social network”.
In two days of legal argument on April 4 and 5, 2017, HPCSA counsel Dr Ajay Bhoopchand argued that the case is about infant nutrition only. Therefore, most of the evidence for the defence is irrelevant because it is on adult nutrition only. That turned out to be magical thinking.
Counsel for Noakes, Michael van der Nest (SC) and Dr Ravin “Rocky” Ramdass, argued that the case is about adult, not infant, nutrition. After all, the HPCSA’s own Preliminary Committee of Inquiry based its decision to charge Noakes in September 2014 on evidence on adult nutrition only.
It also based the charge on a secret report it commissioned from North-West University nutrition professor Hester “Estee” Vorster in June 2014. That secret report is on adult, not infant, nutrition. In her report, Vorster refers to the flawed Stellenbosch (Naudé) Review. That review is on adult nutrition.
Vorster also refers in her report to Noakes’ “high-profile” as a “celebrity” scientist. The dietitian who started the whole case against him, Claire Julsing Strydom, said much the same thing. In her letter of complaint, she urges the HPCSA “to please take urgent action” against Noakes as he is a “celebrity” in South Africa. Strydom also says that Noakes’ tweet is “especially dangerous” for infants and can “potentially be life- threatening”.
In her evidence, Strydom conceded that she had “probably over-reacted” to Noakes’ tweet. A second HPCSA expert witness, North-West University nutrition professor Salome Kruger agreed that LCHF is “probably not harmful”.
Thus, Van der Nest argued that Strydom launched the complaint against Noakes on a whim. He said that the case is not just the prosecution of an eminent scientist for his views. It is also a persecution. Van der Nest uses the word deliberately. It is not a Freudian slip.
He argued that Strydom is little more than a “disgruntled dietitian”. She and other health professionals have gone after Noakes because they don’t like what he says. They also don’t like the fact that the public seems to listen more to him than to them. “Miraculously”, they managed to get the HPCSA to do their bidding, Van der Nest said.
“The case was never about Noakes’ conduct as a medical doctor,” he argued. After all, Noakes hasn’t practised clinical medicine for more than 16 years now. “Somehow a scientific disagreement resulted in a vigorous prosecution of someone who no longer even practises as a medical doctor,” Van der Nest said.
Noakes called three experts: Dr Zoë Harcombe, US science journalist Nina Teicholz and New Zealand-based Dr Caryn Zinn.
In his arguments, Ramdass showed direct relevance of all the evidence for the defence. He also undermined the “bedrock” of the HPCSA’s case against Noakes: South Africa’s official dietary guidelines. These guidelines are wrong in material respects, Ramdass argued. They are also industry-led. They promote low-fat, high-carbohydrate conventional thinking for weight loss and health without any science to back it up.
Click here to read: DID DISGRUNTLED DIETITIANS SET HIM UP?
The guidelines are “umbilically linked” to the US Dietary Guidelines on the causes of coronary heart disease, Ramdass said. They are based on the “diet-heart hypothesis” that saturated fat causes heart disease. Ramdass showed that Noakes presented uncontested research that there is no evidence for the hypothesis. Teicholz also showed that low-fat diets increase the risk of heart disease. Conversely, Noakes and his experts showed that a high-fat intake reduces that risk by decreasing insulin resistance
Ramdass also referred to Vorster’s many conflicts of interest. Vorster wrote the guidelines. She also wrote the recommendation for infants older than six months, children and adults to “make starchy foods the basis of most meals”. Noakes and his experts showed that there is no science for that advice.
Vorster gave evidence on how she came to make that recommendation. It was remarkable, though probably not as intended. She said that she based it on what foods poor communities eat and can afford. In the case of rural South African communities, that is “mielie pap”. Mielie pap is a traditional porridge or polenta made from ground corn. In other words, Vorster said that she based the advice on economics, not science and not safety.
Click here to read: WHO REALLY DISHES UP DANGEROUS ADVICE?
Noakes and his experts showed that Vorster’s advice is both unscientific and dangerous. They showed that for anyone at risk of insulin resistance, starchy foods are a significant health risk. They also showed that weaning babies onto mielie pap and other cereals and grains has contributed to the obesity epidemics among South Africans of all ages.
Therefore, it was not so much what Noakes said in his tweet as what he did not say that got him into trouble. He did not say that parents should wean children on to baby cereals.
Conservative estimates are that legal costs for both sides are around R10 million. (That’s around $756,000.) This case has raised many awkward questions. One is why the HPCSA, a statutory body, has spent so much time, money and resources arguing for dietitians against Noakes. And why it automatically assumes that Noakes is wrong and the dietitians are right.
Van der Nest and Ramdass have argued that the HPCSA has not proved any of the pillars of its case. Therefore, it has no case and the “judge” must rule that Noakes is innocent. Bhoopchand argued that the HPCA has proved its case “on the balance of probability. Therefore, the “judge” must rule that he is guilty.
April 21, 2017 will reveal who has the stronger argument – or whose political scientific pull is stronger.
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- Graphic courtesy of the Noakes Foundation.