By Marika Sboros
Prof Tim Noakes has been found not guilty of unprofessional conduct for a single tweet in February 2014 saying that good first foods for infants are low-carb, high-fat (LCHF). When Pretoria advocate Joan Adams announced the verdict yesterday, the hearing erupted into applause and cheers.
(Noakes is pictured above with one of his legal team, Johannesburg advocate Michael van der Nest, SC.)
Adams chaired the Professional Conduct Committee that the Health Professions Council of South Africa (HPCSA) sets up to hear disciplinary hearing on charges of this nature. Thus, she effectively acted as the “judge”and her committee as the “jury” in this case. All set up by the HPCSA.
She said that her five-member committee had ruled four to one in Noakes’ favour.
In reading the ruling, Adams said that the HPCSA had not proved any of the main pillars of the case against Noakes on a balance of probabilities. It had also not proven any harm from his tweet or that he had breached any norms or standards of the medical profession.
The ruling could not have gone more in Noakes’ favour if he had scripted it himself.
How it all began
The hearing against him arose after Johannesburg dietitian Claire Julsing Strydom reported him to the HPCSA for the tweet.
The HPCSA then charged Noakes on three major counts. That he:
- Had a doctor-patient relationship with the breastfeeding mother (Pippa Leenstra)
- Gave medical advice, not information
- The medical advice was unconventional, as it was not evidence-based. Thus, it could have been dangerous. (Strydom had claimed that his tweet was potentially life-threatening.)
Adams was critical, at times, scathing of the HPCSA. She said that her Committee “was not a rubber stamp” and would not “set nutrition guidelines for the whole world”. Her ruling covered 10 points of the pillars of the charge against him.
Click here for a full transcript of her ruling.
Absence of guidelines for conduct on social media
Crucially, Adams pointed out that HPCSA had no guidelines for conduct of registered practitioners on social media. Therefore, it could not prove that Noakes had breached them.
HPCSA advocate Ajay Bhoopchand had referred to the absence of guidelines as the “elephant in the room“. However, Bhoopchand also tried arguing that a liberal interpretation of the guidelines could include conduct on social media. Adams and her committee rejected the argument.
Adams said that the case was the first of its kind involving the HPCSA and social media. It was also one of the first of its kind in South Africa involving social media in general.
HPCSA legislation, regulations, ethical rules or guidelines did not directly regulate the use of various platforms of social media by healthcare professionals, she said.
“As an aside the HPCSA would appear to be seriously lacking in this regard.”
No doctor-patient relationship
The HPCSA had also not proved a doctor-patient relationship. On the contrary, “circumstantial evidence showed the opposite”, Adams said. The HPCSA had also not proved that Noakes was guilty of misconduct “independent of the relationship”.
Leenstra had said nothing in her tweet to indicate that she wanted to be or was Noakes’ patient. The HPCSA could not infer that “she was hoping for a free medical consultation”, Adams said.
The HPCSA had also not proved that Noakes was acting in his capacity as a doctor. Instead, the evidence was that he acted as an author and scientist.
Most people at the HPCSA and its Medical and Dental Board were well-aware that Noakes was a scientist, author and LCHF proponent, she said. “Perhaps (they would have known or assumed) that he was acting in his capacity as such due to his public status.”
The HPCSA had also not proved that Noakes had given Leenstra medical advice or medical nutrition therapy rather than information. The Committee agreed with the HPCSA legal team that there was ambiguity in Noakes’ quote. However, at worst, it was only “confusing and unclear”.
Adams repeatedly referred to Leenstra as a “consumer of information”, not Noakes’ patient. She said that Leenstra had asked an open-ended, general question.
Click here to read: Did disgruntled dietitians set him up?
Hindsight not allowed
The HPCSA had made many assumptions on how Leenstra would have interpreted Noakes’ tweet, Adams said. However, this was “not an ex post facto” enquiry. The HPCSA could not make assumptions based on hindsight. Also, Leenstra had not testified. Therefore, “we will never know”, Adams said.
The HPCSA had failed to show that merely by answering Leenstra’s tweet, Noakes had performed any “affirmative action” as a medical doctor. There was no indication that Leenstra and her baby required medical services. There was also no reason to assume that Leenstra may have had a medical emergency with her infant.
Although Leenstra referred to “worry” about “baby winds”, one could not assume that she was “worried” in the strict sense of the word.
Baby winds ‘not an illness’
Worry is “a subjective state of mind”, Adams said, and “baby winds are not an illness”. It was also safe to assume that Leenstra “would not have wasted time tweeting if her baby really were seriously ill”. Contrary to Bhoopshand’s assertions, if Leenstra was so “worried” about her baby’s condition, she would not have waited three days for a response to her alleged cry for help, Adams said.
The HPCSA should have been cautious about assuming that Leenstra was vulnerable, ignorant and did not understand the basics of LCHF. The same applied to anyone else who read Noakes’ tweet.
It was not reasonable to assume that most users (on social media) were “ignorant, vulnerable and in need of the protection of others”.
“The public is far more enlightened and informed than in the past,” Adams said.
She also said that the law “does not and cannot protect every user in cyberspace from themselves”. Those who randomly followed any online advice without context did so “at their own peril”.
Unconventional versus unprofessional
Adams said that “unconventional” does not equal unprofessional, “per se”. Context and facts of the matter were important, she said. Crucially, the Committee found that the HPCSA had not proved that Noakes’ tweet was unconventional, not evidence-based or dangerous. On the contrary, based on the facts, Adams said that the HPCSA had not proven harm or potential harm. It had not proved that Noakes’ tweet was dangerous or life-threatening, as Strydom had claimed.
LCHF is the acronym for low-carb, not no-carb, Adams said. Thus, it was not reasonable to assume that Leenstra might have interpreted LCHF as a ketogenic diet. “It is difficult to fathom how anyone can read Noakes’s tweet or his letter of reply in context to mean or intend to convey a no-carbohydrate diet for babies.”
The Committee also disagreed with the HPCSA’s claim that Noakes could not be an expert witness in his own defence. The HPCSA had also not proved that the case was about infant, not adult, nutrition.
Adams said that her Committee would not rule on the credibility of any of the expert witnesses. However, the Committee accepted that all of Noakes’ witnesses had given evidence that had “logic”
No breastfeeding advice
She dismissed out of hand the HPCSA’s claim that Noakes was advising Leenstra to stop breastfeeding. There was nothing to suggest that he was advocating immediate cessation of breastfeeding. He was also not attempting to dilute the message of the benefits of breastfeeding. On the contrary, Noakes was well-known for his support for breastfeeding.
Interestingly, Adams made the point that Strydom had tweeted to Noakes from her personal Twitter account. Adams made no mention of ADSA as the complainant.
The HPCSA has gone to great lengths to obscure Strydom’s role as complainant. That’s likely because of the legal implications for Strydom. Those are becoming clearer now that the ruling has gone in Noakes’ favour.
The ruling has vindicated Noakes. However, the HPCSA has 21 days to decide whether or not it will appeal the Committee’s decision. ADSA president Maryke Gallagher said in a TV interview after the ruling that ADSA won’t be changing its advice to the public anytime soon.
Battle won, war goes on
Noakes said that the outcome of the case “could not have been better”. However, he said that he looked forward to the day when the HPCSA investigated the veracity of the “evidence-base” on which universities train dietitians.
He would also like to see the HPCSA investigate the effects of orthodox dietitians’ advice on the obesity and diabetes epidemics. These epidemics “are crippling the health of populations in South Africa and elsewhere”, he said.
Clearly, while he has won an important battle, the nutrition war in South Africa goes on.
- Click here for full coverage of The Noakes Trial
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Will this change them?
Albert Einstein: The First sign of insanity is when you keep doing the same thing over and over, expecting a different result.
I was at school with Tim for many years. He’s a person of great integrity and it is a disgrace that the HPCSA allowed itself to be used as a weapon to attack Tim with. I’m really delighted at the outcome for Tim and hope no appeal will be lodged. Credit is also due to Marika for keeping the public up to date and it is also due to the skill and diligence of the legal team. Well done to all
At least scientist ProfTim Noakes could defend himself in a public ‘court’, whereas here in Australia orthopaedica surgeon Dr Gary Fettke is pilloried in private by our equivalent body…
James, you’re quite right. Gary Fettke and Jennifer Elliot had no justice at all. Tim Noakes had to fight to force them to do it right, but Fettke was just tried and convicted behind the scenes by the useless dietitians he was embarrassing.
Maybe we need to change the job title of dietitians to Kellogg’s. Maybe it should just be their middle name. Claire Kellogg’s Julsing sounds completely appropriate.
Congratulations! A triumph in part for justice. Now, the difficult step of recriminations, if chosen.
Well done Prof Noakes. I’ve always said that most people just follow whatever bad science is published in the local magazine. I’ve never found it easier to make people healthier and slimmer with this way of eating. Proof is in the pudding! Keep up the good work of making us all healthier
Was overjoyed to hear the news! In my kitchen you’ll see no margarine, skim milk, whole wheat bread, sugar etc – all that poisonous stuff that some (sponsored?) dieticians keep advising as part of a “balanced” diet. Well done to Prof Tim and his legal team – I do hope he sues for damages.
Just had a look at the HPCSA website and not a word about the Noakes judgement. Contrast that to the speed with which they posted their story some months ago announcing a “guilty” verdict that wasn’t. How can anyone take them seriously? Seriously? Not really
Interesting that in their official response, ADSA said that this was all about protecting children and yet: “HPCSA did not prove that the case was about infant, not adult, nutrition”, said the judge. Just plain weird.
And thanks again for keeping the information about this flowing so brilliantly Marika.
Thanks, Marika. Wonderful coverage and insight. I have just been studying the ADSAs website. Very interesting reading. They go to about us then sponsorship and there about 8 pages on fees levels and benefits for sponsoring them. Why would anyone pay R85,500 Rand to be a Diamond sponsors if it doesn’t help you sell your product…. Unilever …. Flora ??? Also about 16 pages of risk assessment around the sponsorship situation. Come on Claire and Cotton Tail. Grow up,g et real,get responsible.
Thanks, Patricia. Even more interesting is that ADSA current president, Maryke Gallagher, told ETV presenter Annika Larsen – and with a very straight face – that ADSA has not received and does not receive any funding from the sugar industry. Not sure why she said that, but I will be following up with her soon as I’m back from vacation. All Larsen has to do to check the veracity of that comment is to look at ADSA’s website, as you point out.
Marika,I think a lot of their sponsors have gone !
I looked today they hardly have any ,
Unilever being the biggest I could see,
Still there ….Flora must be hurting with so many of us now enjoying real butter !
ADSA has done lots of sanitising of its website over the past year! Former president Claire Julsing Strydom sanitised hers to remove all reference to her consultancy for Kellogg’s. However, the Internet has archives. Very difficult to delete from cyberspace.
Claire Julsing Strydom’s close friends at Kellogg’s featured in an article in yesterday’s Sunday Times in the UK showing how they’re trying to undermine health messages on sugar and cereals. No wonder discredited dietitians are trying to hide their involvement with junk food.
Thank you Marika for keeping us posted so eloquently throughout the “trial”. This is wonderful news
So Dietician Claire will NOT be studying science any time soon? Or losing weight? Quel surprise . . .
Have a good holiday but keep away from the chocolate bunnies!
Thanks Marika, I’ve been able to follow this case thanks to your endeavours. So pleased Prof Noakes has at last been vindicated. I really wasn’t sure that justice and truth would prevail! Did Dr Liddle hear any of the Prof’s evidence?! Even if he thought there was a dr/patient relationship then prof should still be innocent due to him giving evidenced based advice!
Hi Marika., Thank you for your wonderful coverage of this case. I’ve been an avid follower of the developments mostly thanks to your informed writing. Keep up the great work.
Over 3 years, the disruption of a good man’s life, 10 million rand and countless hours of time wasted to reach a conclusion that any sane person saw from the very start. Incredible. The complaint should have been thrown out when it was made as frivolous. I would have very much liked to see the ruling include a strong rebuke to the HPCSA for allowing this to proceed and for wasting so much time and so many resources. I do hope that Professor Noakes will go after them for his legal fees, although I would certainly understand if he just wanted to put this behind him and go on with educating the world about LCHF (no, I’m not implying ketogenic here).
I’m so pleased for Tim Noakes, his wife, family and legal team. Yesterday was a good day for South Africa, freedom and scientific inquiry. A bad day for stupidity, venality and vested interests.
Joan Adams gave an impressive summary. I loved the mention of Ignaz Semmelweiss on the televised verdict. I think it showed what she thought about the bringing of this foolish case. An intelligent man persecuted for standing up for patients and the truth.
Medical orthodoxy changes. It’s changed on many issues in my life and nutrition will undoubtedly follow because eating a diet low in carbohydrates and high in natural fat has the great virtue that it actually works, unlike the backward nonsense trotted out by frightened mediocrities like Claire Strydom Julsing. Yesterday’s Times reported that more than half of NHS staff are overweight or obese. That says everything about the failure of current guidelines.
Who was the inarticulate, bumbling dissenter on the panel? What was he trying and failing to say? Thank goodness the rest of the panel were capable of rational thought.
What happens about costs?
Thank you Marika for your outstanding reports on this hearing and its background.
Fantastic result congratulations Doc. ADSA president Maryke Gallagher said in a TV interview after the ruling that ADSA won’t be changing its advice to the public anytime soon.” Well it is apparent that despite all the evidence that was supplied this ignorant association and its antiquated message will persist. Hopefully members of the public will see through the garbage they spout. To the individual who started this fiasco, CLaire Julsing Strydom, I hope you hang your head in shame. However I somehow don’t think this will happen. Because of you, you have given publicity to LCHF that is priceless and worth more than you can ever imagine.
The only possible logical result based on the evidence. Now perhaps it is time to tackle the real elephant in the room i.e. The sugar, food ,pharmaceuticals industry represented by organizations like ILSI , the university departments and their staff who have produced “fake” research and who are funded by the above industries as well as the professional journal who publish their articles without roper peer review. Have our professional bodies now become part of the general corruption that is engulfing our land?
“The Committee had ruled four to one in Noakes’ favour.”
So, who was the one?
Dr AS Liddle, a GP. He cried as he delivered his verdict.
Listening to him bumbling brought me close to tears.
Thank you Marika for your fabulous coverage of the trial.
And my congratulations to Prof. Noakes.
Do they publish the ruling, and the minority view too ?
Transcripts of all the hearings are available through the HPCSA, including the minority view. It was from Dr AS Liddle, a GP. He didn’t have much to say, apart from that he thought Prof Noakes did act as a doctor and gave medical advice, etc etc …
Shame on him!
what is the link to the transcripts?
Transcripts are part of the public record. Available through the HPCSA.
Wonderful coverage, Marika! And a wonderful conclusion to @ProfTimNoakes’ longest ever marathon!
“You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time.” Lincoln.
Dear Marika…..thanks for keeping everyone informed in such superlative fashion. Is there book hidden in their somewhere
At last does justice come to pass
Long litany of spite,
Rank ignorance on full display
Then failed to get it right.
Decimation thus achieved
An aura of deep shame
The end result is plain to see
Just who must take the blame.
Much squandering of finite wealth
Betrayed their members trust
On any measure of the facts?
Unfettered power lust.
She made her plaint – they ran with it
Sheer ignorance writ large
The sub-text of their every word
To prove that they’re in charge.
So what then of the future
Is reckoning in sight?
Can they be trusted to prevail
Or ever do what’s right?
Their standing long in tatters
The time comes to disband
Return the high-ground to the best
All those who understand
Who work towards what’s right for all
To use their skills with care
With no agendas to protect
This lifts us from despair.
Brilliant. Post this on the HPCSA Facebook site.
The HPCSA claims that Professor Noakes advice was not ‘evidence-based’ therefore ‘dangerous’. So the dieticians use ‘evidence-based practices’ based on what? A flawed 1950’s ‘study’ by Ancel Keys? The only evidence they have is the dramatic rise in obesity and type 2 diabetes … That is ‘vidence-based’ practice, indeed!
I can think of someone else who gave “unconventional advice” contrary to entrenched dogma and was proved correct. We are grateful that Prof Noakes has been vindicated and not pursued to destruction – as was Semmelweis . . .
A great result! Thanks Marika for keeping us all up to date on the proceedings. I found your blog because of the Noakes trial and will be a regular reader from now on.
Thanks Marika @ Foodmed for keeping us informed. That’s all of us News Hungry LCHF lifers. It’snow time time for Dr Fettke, South Australia, to be found innocent. Shame on AHPRA. Shame on Diabetes Australia. They are so far behind the times and that is unforgivable.
Not only is he not guilty, he is right.
That’s absolutely wonderful news for everyone around the world. Prof Noakes thank you for having the courage ad integrity to make this information known. We are all much healthier. All the very best to you and your wonderful wife.
Brilliant result. Well done Prof. Tim Noakes for persevering. Presume that costs have been awarded to Tim? Would be great to see Tim and his crew prosecute the DA .
Hope the good Doctor takes the HPCSA to court for damages. Now that would be interesting. Two years of bullshit and stress.
Actually, it was more than three years!