By Marika Sboros
When the Dietitians Association of Australia (DAA) isn’t dishing up fake nutrition news to the public, it makes up fake news to try to discredit dietitians who cross it, say critics. It’s probably no coincidence, that those dietitians support low-carb, high-fat (LCHF) diets to treat obesity, diabetes and heart disease. And/or these dietitians criticise Australia’s dietary guidelines and DAA’s food industry links.
Critics say that DAA’s Big Food sponsors don’t like those dietitians either as they affect product sales. In the final of a four-part series on DAA’s conflicts of interest, Foodmed.net looks at the cases of three dietitians who fell foul of DAA and its long-time CEO Claire Hewat. DAA also thought nothing of going after one of the dietitians in another country. It tried and failed to silence a top dietitian academic in New Zealand for her views on LCHF.
Hewat flatly denies that LCHF or its industry links had anything to do with actions against the dietitians below. Here, Foodmed.net looks at whether that claim stands up to scrutiny.
The first case involves dietitian Jennifer Elliott. In 2014, Elliott was quietly minding her own professional business. She had worked for Southern New South Wales Local Health District (LHD) for over 25 years. She also worked for Medicare Local for 10 years with unblemished service.
For more than 10 years, Elliott had recommended carbohydrate restriction to patients with type 2 diabetes (T2D) and insulin resistance (IR) with excellent results.
Out the blue in July, a DAA dietitian lodged a complaint against Elliott with the LHD. The dietitian alleged that Elliott gave low-carb advice to a patient that was “not evidence-based”. She later expanded the complaint to include a letter from the patient, who DAA described as “a disgruntled former patient”.
In late 2014, Elliott’s workplaces and DAA investigated the complaint. Elliott was confident all would vindicate her. After all, she did ongoing research into safe, effective diets for T2D. She had published a peer-reviewed paper in October 2014 on facts and fallacies behind the diet-heart hypothesis that saturated fat causes heart disease.
As well, none of Elliott’s patients had ever complained. On the contrary, workplace Client Surveys showed overwhelming appreciation for her service. She also closely followed the latest guidelines from the American Diabetes Association, as is recommended practice for Australian dietitians.
US nutrition specialist Prof Richard Feinman wrote to Hewat, offering to provide scientific evidence on LCHF benefits. Feinman is professor of cellular biology at the State University of New York Downstate Medical Center in Brooklyn, where he has been a pioneer in incorporating nutrition into the biochemistry curriculum.
Hewat refused the offer, telling Feinman: “Unfortunately, you are obviously not in possession of all the facts in this matter, nor can I apprise you of them as this is part of a confidential complaints process.”
Click here to read what Hewat could have learned from Feinman.
In early 2015, Elliott received a directive from Southern New South Wales LHD that “nutritional advice to clients must not include a low-carbohydrate diet”. It also issued a memo to dietitians in the area instructing them to follow DAA guidelines from its “nutrition manual”.
That manual closely follows Australia’s high-carb, low-fat guidelines. Thus, it excludes LCHF as an option to treat obesity, diabetes and heart disease despite compelling evidence-base as a safer, more effective and inexpensive alternative to conventional treatment.
In May 2015, Elliott was stunned when DAA summarily expelled her for reasons that are still unclear. DAA added her name to its website list of expelled dietitians. Thereafter, her employers terminated her employment.
Hewat insists that DAA did not expel Elliott for recommending low-carb diets even though that was the dietitian’s complaint. Instead, Hewat informed me via email through DAA’s national office, that Elliott was expelled for “professional misconduct” but declined further details citing privacy issues.
However, DAA disclosed all details publicly on its website. Click here to read DAA public statement on Elliott’s expulsion. It contains a shotgun list of allegations against Elliott. None relates to the dietitian’s original complaint. There are allegations of misconduct for “either a substantial or consistent failure to maintain a standard of competence”. There are also references to inadequate note-taking, which wasn’t the dietitian’s complaint.
Elliott insists that her note-taking was adequate. Yet, abbreviated note-taking for one client, and by comparison to what’s expected from a newly graduated dietitian, seems to be the most that DAA could muster against her. That raises the question why it didn’t just give her a tip or two on improved note-taking instead of taking the drastic step of expulsion.
Click here to read: WHY DAA MAY REGRET ‘SLEEPING WITH THE ENEMY’
Critics say that given DAA’s food industry links and Elliott’s open criticism of Australia’s dietary guidelines, she didn’t stand a chance. They say that her expulsion was a warning to other dietitians of the consequences of recommending LCHF to patients with diabetes.
The irregularities have led them to describe DAA’s case against her as “a stitch-up”, effectively a kangaroo court.
Feinman says that Elliott’s case is one of several examples of establishments resorting to “brute political force to stifle dissent” when faced with the efficacy of low-carb diets. He refers to DAA dietitians’ involvement in the case of orthopaedic surgeon Dr Gary Fettke, the involvement of the heavily conflicted Association for Dietetics in South Africa (ADSA) and its former president Claire Julsing Strydom in the case against scientist Prof Tim Noakes, and Dr Annika Dahlqvist in Sweden.
Hewat also appeared to disapprove of Elliott’s views expressed on social media. That’s a thread running through DAA’s attacks on all the dietitians mentioned here. (Strydom started the case against Noakes by complaining about a single tweet in which he said good first foods for infants are LHCF.)
DAA has also said that Elliott declined to attend its hearing against her or appeal the decision to expel her.
Therein probably lies the rub to this case and the biggest problem for DAA’s credibility. My research shows that there were many irregularities during DAA’s complaints resolution process, and critics say it’s not surprising that Elliott felt it was unwise to participate.
“All parties in any complaints process should be treated fairly,” Elliott says. “I expected as a DAA member to be fairly treated by my own association.”
However, due to the irregularities, Elliott judged that the communication from the DAA was “not open, honest and fair”. She felt it was untenable to be involved in the hearing and any appeal. She has been advised not to go into detail about irregularities because they may well be the subject of future legal action against the DAA.
Elliotts believes that most DAA members would be “horrified” to see the details of the process which she “enjoyed”.
“They certainly all know the effect,” she says. Her case is used as a salutary lesson to dietetics students not to “rock the boat”. Surprisingly, no one has contacted Elliott to clarify before presenting the case to students – or invited her to speak and present issues.
Critics also point to DAA’s use of social media to undermine Elliott’s professional reputation further. Legal analysts say that the vocabulary and insinuations have at times come close to defamation.
In one tweet in 2015, for example, DAA hinted darkly at “far deeper issues”, which it said were “not revealed publicly” in Elliott’s case.
US public health specialist Adele Hite has described DAA’s attacks on Elliott as “Orwellian double-speak”.
UK obesity researcher Dr Zoë Harcombe says that in deregistering Elliot, an experienced, research-driven practitioner, DAA effectively “declared war” on its own member. It took away the job, income and livelihood of a committed professional “whose only crime was to try to improve the health of her clients”.
Elliott helped her patients, Harcombe said, “against all measures that matter”: reliance on medications; blood glucose levels; blood lipid levels; health; energy and more.
Harcombe believes that Elliott sealed her fate when she published her paper in October 2014.
“DAA executed (its) revenge soon afterwards,” she said.
(Click here to read more details from Elliott’s perspective in Babyboomers and bellies blog).
DAA’s action against prominent dietitian academic Melanie Voevodin was arguably just as bizarre as in Elliott’s case. DAA may say that it “hates to lose a member”. It appeared actively to lose Voevodin.
Voevodin, a health economist, is completing her PhD at Monash University exploring whether dietitians can “improve Australia’s food-health”. She believes that her profession can lead many options to achieve the DAAs mission of “healthier people, healthier nations”.
However, the first step is to “disentangle the profession from conflicts of interest”.
Voevodin’s cardinal sin appears to have been to criticise DAA’s ties with industry in a closed online discussion group for subscribed dietitians. In 2012, she had been a DAA member for 14 years.
She had followed due process in “advocating for change from within” on three main topics:
- DAA’s position as self-regulated rather than coming under the Australian Health Practitioner Regulation Agency ( AHPRA) jurisdiction;
- Conflicts of interest in corporate sponsorship;
- Improved transparency of DAA decisions on behalf of members.
Voevodin got nowhere.
Based on her historical analysis of the profession, teaching on professional integrity and ethics, and involvement with the Therapeutic Guidelines group, she felt able to “advocate” more inclusively. She posted her thoughts on these topics as they arose in these member-only closed online discussion groups.
Many dietitians contributed and debate was robust, interesting and exciting, Voevodin says. She and colleagues believed that change was in the air.
It wasn’t. Hewat had Voevodin firmly in her sights.
Click here to read: DAA CLUELESS ON LCHF – DIETITIAN DOWN UNDER
In February 2013, Voevodin received the first “formal warning” on her activity in the discussion groups. She heeded the warning. She then received an official letter of “suspension from discussion groups” via email from Hewat. Her access to the discussion groups was “cut off” before she was informed of the suspension.
Voevodin responded that she had received no notice or warning. Thus, DAA had not followed proper procedure. Hewat disputed that in an email.
On March 10, 2013, Voevodin received a letter of complaint via registered mail. Two paid DAA staff members who worked with Hewat signed the letter. Voevodin knew one but by name only. Hewat wrote a covering letter alleging “breach of the Code of Professional Conduct”. She also claimed “unethical behaviour, repeated unsubstantiated accusations in a public forum (emphasis mine) and dealing unfairly with professional colleagues”.
Voevodin responded via registered post on March 26, 2013. The Australia Post tracking summary shows that DAA received the registered post in the afternoon of Thursday, March 28, 2013. The next day was Good Friday.
On midnight Saturday, March 30, Voevodin’s DAA membership lapsed, as is standard. However, membership dues were “not on my mind”, Voevodin told me. As an aside, when her membership lapsed previously, DAA always sent her a “friendly reminder”. This year was different.
On Tuesday, April 2, 2013, the day after Easter Monday, Voevodin’s name appeared on DAA’s website, ironically under the Find an Accredited Practising Dietitian (APD) section.
A statement at the bottom read: “The following members are not permitted to use the APD post nominal as they have rendered themselves ineligible for reinstatement due to an unresolved complaint and disciplinary process:”
Voevodin’s was the only name at the time, with no date or expiry date. This was also the first time this type of posting had happened in her 16 years as a dietitian. The placement of her name singled Voevodin out and contrasted with publication of names of expelled dietitians. Legal analysts have suggested that the placement is defamatory.
Voevodin emailed Hewat and her supervisor at Monash to ask why her name was publicly listed. Hewat responded via email citing “failure to engage” and lapsed membership. Voevodin responded that she was actively engaging and following due process. Hewat was undeterred.
Voevodin engaged a lawyer who had previous experience with the DAA. The most they could achieve was to get DAA to move Voevodin’s name from the Find an APD section to a link one click away – in line with the “expelled” list.
Voevodin probably hasn’t endeared herself to Hewat since then, hence DAA’s reluctance to let her back in. US public health lawyer Michele Simon interviewed Voevodin for her report in February 2015, titled And Now A Word From Our Sponsors. She quotes Voevodin saying that each individual dietitian bears “the public scrutiny of the actions of the DAA and their continued financial relationships with the food industry and their front groups despite the evidence of a conflict of interest”.
She also said that “conflict exists whether real or perceived, whether denied, acknowledged or managed”. As long as DAA maintained these financial relationships, every individual dietitian would bear the public scrutiny, Voevodin said.
“It is, therefore, reasonable to suggest DAA is now the single greatest barrier to the credibility of the profession.”
Voevodin received a letter from DAA’s lawyers telling her to desist from “defamatory” comments.
Even more bizarre were DAA attempts to silence New Zealand-based dietitian academic Dr Caryn Zinn. Zinn is a registered dietitian in private practice and a senior lecturer and researcher at Auckland University of Technology. She is also an expert in low-carb therapies for obesity, diabetes and heart disease. Zinn says it’s unethical for dietitians who know about LCHF not to offer it as an option to patients.
DAA lodged a complaint against her with the New Zealand Dietitians Association. Hewat and DAA board members signed the letter. One was Dr Sara Grafenauer, Nestlé Brand Manager from 1999 to 2004. Grafenauer’s LinkedIn profile shows that she is – or was – also a private consultant to Nestlé Australia at least until 2012. This does not appear on DAA’s website.
The letter complained about comments Zinn made about low-carb diets on her own Facebook page. Hewat also criticised a post that Zinn created about a New Zealand nutrition researcher in who had defamed her site and called for the New Zealand Dietitians Board to deregister her. Thus, Hewat effectively objected to Zinn coming to her own defence on her own Facebook page.
Hewat’s letter also included fake accusations of conflicts of interest between Zinn and celebrity Australian Paleo chef Pete Evans. DAA and Hewat’s antipathy towards Paleo – and Evans – are well known.
Zinn says that the complaint DAA lodged against her had “no basis whatsoever and some of the allegations were incorrect”. She was amazed that DAA felt able to cross international boundaries to complain about her.
The New Zealand Dietitians Board Professional Conduct Committee (PCC) considered DAA’s complaint and cleared Zinn of any wrongdoing. It required her to undergo “social media counseling”.
Zinn says that DAA will probably never admit the truth about Elliott’s case. “I seriously doubt that there would have been any investigation if this were not related to low-carb,” she says.
Czech solicitor Jan Vyjidak is similarly skeptical. He is a medical lawyer and management consultant, focusing on patient outcomes and quality of care in Europe and Latin America. Vyjidak works to build bridges between data, people and health practice.
He says that professional bodies have a duty to make charges clear when dealing with complaints against individual members.
“This is a basic principle of law best known from criminal proceedings,” he says. “Defendants have a right to know what the accusation is so that they can bring evidence to refute it.
“Likewise, if a professional body intends to expel a member for any reason, it should clearly outline that reason in an initial letter,” says Vyjidak. “Failure to do so could breach that member’s right to a fair trial.”
If a professional body believes that there has been a breach of its rules, it must also make punishment proportional to the alleged misconduct.
“Putting patients at serious risk by prescribing the wrong treatment is not the same as minor administrative errors in managing case records, for example,” he says.
These issues are precisely why professional bodies should be governed by law, Vyjidak says. This forces these bodies to follow proper rules and procedures when disciplining members.
“It also provides protection for individual members when unlawful decisions affect them. They can seek court protection of their rights, for example, and can sue for damages, an apology and a full reinstatement as a member.”
In any area of human activity and knowledge, progress depends on several freedoms and principles that many take for granted, he says. This is especially the case in medicine and nutrition. For example, academic freedom allows scientists to pursue new findings and freedom of speech guarantees access to uncensored information, Vyjidak says.
Just as important is the first principle of medicine: “first do no harm”. It requires everyone involved in advising patients to challenge established practices that have limited effectiveness and to seek improvements to prevent harm, he says.
“A culture of fear and censorship is an excellent recipe for worse patient outcomes, as we know from research.”
Critics have accused Hewat of creating a fiefdom as DAA CEO and say that a weak board facilitates this.
Feinman says that positive messages about LCHF “will get out eventually”. Before then, all that establishments can accomplish is “personally hurting somebody who has provided health care for people with diabetes and other medical problems”.
DAA’s procedure in Elliott’s case has not involved any kind of due process, Feinman says.
“It seems personal, petty and vindictive.”
Those who know intimate details of Voevodin’s and Zinn’s cases say that “personal, petty and vindictive” apply to DAA’s treatment of them as well.