A while back, I asked BANT - which promotes itself as “The Professional Body for Nutritional Therapists”, and has made Holford a Fellow - to see a copy of their ethics code. They refused, citing concerns that people might misquote or steal their ethics code. I was therefore delighted to see that BANT’s ethics code is now available on their website [PDF]. However, I was disappointed to note some of the content of the code: BANT allow members to earn profit and commission from selling products to their clients. This is not appropriate behaviour from want-to-be healthcare professionals.
To quote from the BANT ethics code (p. 9):
7.3 Trade discounts and commission payments.
The main income, generated as members of BANT, should come from consultative, advisory, educational and promotional aspects of Nutritional Therapy. (G).a) In addition to supplying supplements as an integral part of a consultation, the Member may also act as a supplier of laboratory tests, or any other products related to Nutritional Therapy. The member may choose to benefit from trade discounts and commission payments when offered by the supplier on products purchased by him for such use. The member decides whether such payments, in whole or in part, are retained in his Nutritional Therapy business, or passed onto the client. (B).
b) The Member may accept commission directly from the supplier. This can also apply when repeat orders for products prescribed by the Member, are placed directly by a client with the supplier, with the prior agreement of the Member. However, to protect both the Member and the client, both parties must be in a formal client relationship and implementing the prescribed programme of treatment, timings, review meetings and record taking as arranged initially between the parties. (B).
In other words - a BANT-registered nutritional therapist can also sell (either as a retailer, or for commission) all kinds of nutritional pills and tests. This gives them a financial incentive to ‘prescribe’ unnecessary products for their clients.
This type of behaviour - want-to-be healthcare professionals profiting from selling pills and tests to their patients - makes big pharma look positively cuddly. But, according to BANT’s ethics code, it’s perfectly OK for nutritional therapists to earn money this way.
Personally, I think that it is BANT’s ethics that need supplementing.
28 responses so far ↓
gimpy // April 7, 2008 at 10:13 pm
That’s quite staggering. Imagine if doctors were on commision from Big Pharma for prescribing drugs? There would be a massive outcry, not least from the CAM Lobby. It beggars belief that an organisation set up to maintain standards and ethics in a profession would cement in its own Code of Ethics a provision, approved by the organisation, that explicitly sanctions collusion between its members and multinational vitamin corporations to profit at the expense of the patient.
Wulfstan // April 7, 2008 at 10:18 pm
There was a recent item in the BMJ about a doctor who has been reprimanded for selling supplements to patients.
BANT, BANT, forgive us this rant,
There’s little to your code, beyond pious cant….
bengoldacre // April 7, 2008 at 11:21 pm
wow, they get kickbacks for the pills and tests. my lord that’s foul.
are they compelled to declare these financial kickbacks from the companies concerned?
venal.
Dr Aust // April 7, 2008 at 11:32 pm
I would suggest the verb “BANT-ing” as a synonym for:
“pretending to be an independent advisor whilst flogging people worthless crap you get a kickback on”
.. except that Dr Banting was the co-discoverer of insulin …. …and he deserves better.
Of course, one would hardly have expected anything different. All that BANT are really saying is:
“This is what many of our members have always routinely done, and do, and therefore we are going to retrospectively declare it fully compliant with our ethics code - you know, that one we just wrote so we can insist, whilst pulling unmelted pats of (fully GM-free organic) butter from our mouths , that we are not a bunch of hucksters.”
superburger // April 7, 2008 at 11:43 pm
If this is true it makes business sense to cut out the middleman - start ones own pill peddling empire then sell those pills to customers.
Surely such a businessperson would be guilty of chutzpah of the highest order if they implied or insinuated that healthcare professionals were in the pockets of multinational drug companies.
Are holfordwatch aware of any BANT members , or indeed fellows, who have a financial interest in the sale and manafacture of pills and potions and tests?
Wulfstan // April 8, 2008 at 7:05 am
Superburger, are you, by any chance suggesting that HW may know of any FBANTs “who have a financial interest in the sale and manafacture of pills and potions and tests?”
That’s a tough one. That may even involve HW examining their raison d’etre.
Andy Lewis // April 8, 2008 at 11:20 pm
There is nothing surprising about this whatsoever. It is perfectly consistent with the conclusion that ION is nothing more than a sales force training school for vitamin pill companies.
Graduate from ION, join BANT, and start picking up the commission cheques. Kerching.
dvnutrix // April 9, 2008 at 12:03 pm
So, if IONistas or MBANTs should ever manage to persuade an NHS GP practice to employ one of them will this require a different code of ethics? One in which they only recommend the use of NHS supplements in the presence of a clear clinical history with appropriate tests?
And, about those tests, will they still be allowed to recommend hair mineral analysis to test for deficiencies? Or the IgG tests to assess for food intolerances? Who will pay for those? Who will get the commission?
LeeT // April 9, 2008 at 1:14 pm
My understanding is that if a GP refers some one to a profession regulated by the Health Professions e.g dietitian the GP cannot be held responsible for what happens. However, if the GP refers some one to a nutrition therapist and things could go wrong the GP could be sued.
It would be interesting if some one could explain the code of conduct regarding dietitians in private practice and product promotion.
ben goldacre // April 9, 2008 at 8:11 pm
as wulfstan points out above this kind of corporate activity would be unacceptable for a doctor in the nhs.
http://www.bmj.com/cgi/content/full/336/7646/689-e
i don’t know whether nutritionists could hope to maintain these lucrative kickbacks from the $56bn food supplement industry if they were working in the context of conventional medicine. i suspect that this is one of many conventions which doctors might have great difficulty compromising for the nutritionists “alternative” ethical framework.
The pill pushing proselytising of Patrick Holford « gimpy’s blog // April 13, 2008 at 5:27 pm
[...] clearly allows its members to earn commission and profit from selling products to clients which, as Holfordwatch point out, is inappropriate behaviour from want-to-be healthcare professionals. However, despite its faults, [...]
dietitian in the north // April 15, 2008 at 11:33 am
Mmmm -I wonder - Does the guidance on nutrition and health claims made on foods published by the FSA yesterday (14/4/08) apply to vit pills and supplements I wonder http://www.food.gov.uk/foodindustry/guidancenotes/foodguid/192420006complianceguide
this guidance is re the EU legislation that has come in recently on this and which prohibits individual doctors and health professionals making certain claims or recommendations about food products -the guidance seems to say that for the purposes of this legislation anyone who claims to be a health professional is one and is so bound by the legislation!!!
What is a health professional? (section 9.7 para 36)
In the context of the Regulation, the Agency takes the view that this would include anyone who is presenting themselves, or is understood by the consumer, as having expertise in the field of health or nutrition.
For those with a high media profile perhaps they can maintain their endorsements and business by quietly forgetting that they want to be seen as health profs or ‘Dr’s and fall back on their celebrity careers instead as ‘celebrity endorsements do not appear to fall within the scope of the prohibition’ …as long as they make it absolutely clear to the consumer that they have no ‘ expertise in the field of health or nutrition’!
(section 9.7 para 44)
Can I use a celebrity endorsement? Celebrity endorsements do not appear to fall within the scope of the prohibition in Article 12(c) (unless the celebrity is a doctor or health professional). However any nutrition or health claim made in a commercial context would need to comply with the requirements of the Regulation in the same way as any other nutrition or health claim.
However -National associations of medical, dietetic or nutrition professionals can make claims….not sure what the definition of a national association is but can see BANT making a play for a large range of branded foods –although I think the point is that nutrition and health claims have to be justified -prob ways round it if you read it all …..
dvnutrix // April 15, 2008 at 4:19 pm
Thanks for the link to the FSA, DitN - it is certainly interesting reading. It would be both novel and entertaining if Professor Patrick Holford were now to abandon his “I am a scientist and a nutritionist by stint of my 30 years research even if not be accredited study or qualification” stance for the more lucrative, I’m no expert but I approve this product” approach.
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HappyGilmore // April 24, 2008 at 10:18 pm
May I just inform you a bit better?
BANT does not promote this behaviour, it is an offer by the supplement companies. As far as I am aware 95% of the practitioner refuse to take this income, while others order supplements for a cheaper price (practitioner’s price) and sell them at their practicies for that same price, so that patients can get a better deal….
Have you asked your self how many GPs receive commission by the pharmaceutical companies, if they push their products? Loads……more then you can think of
LeeT // April 24, 2008 at 10:31 pm
HappyGilmore
Where do you get your figure of 95% from? I had a consultation with a nutrition therapist four years ago. The therapist told me she made a bit of money from supplements she “prescribed” to people.
It would be interesting to know if there are any therapists out there who do NOT recommend supplements. I can’t imagine many sell them at cost price - that would rather be going agains their financial interests!
dvnutrix // April 24, 2008 at 10:31 pm
We are entirely open to being better informed. It would be helpful if you were able to cite a source for your statements about the 95% refusal for the income (in which case, however did BANT pass it at the meeting where this was agreed?). Similarly, for the other 5% passing on the discount to their clients.
If you have a source for the number of GPs who “receive commission by the pharmaceutical companies, if they push their products” then please let us know as we would be interested.
[Edit, I see that LeeT and I must have crossed.]
gimpy // April 25, 2008 at 9:41 am
HappyGilmore it is interesting that you say that BANT does not promote this behaviour when my own blog has shown that the evidence suggests that BANT modified their Code of Ethics under pressure from trade organisations to permit acceptance of commission from sales. To me this suggests that BANT do promote such activities but I would welcome an alternative explanation if you have one.
superburger // April 25, 2008 at 4:02 pm
“Have you asked your self how many GPs receive commission by the pharmaceutical companies, if they push their products?”
A GP would face severe disciplinary action, the results of which would be made public, by the GMC is they were taking commission payments from drug companies.
The (freely available) GMC ‘good medical practice’ paragraph 74 makes the position unequivocal.
“You must act in your patients’ best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues.
”
http://www.gmc-uk.org/guidance/good_medical_practice/probity/conflicts_of_interest.asp
It is interesting to compare on contrast the GMCs attitude to publishing its codes of conduct (freely available), the manner in which its hearing are conducted (openly), the stance of accepting financial inducement for offering goods or services (forbidden) with that of BANT.
HappyGilmore // May 12, 2008 at 7:30 pm
Yes, there are therapist that don’t prescribe supplements. And believe it or not, many are not interested in making money out of it.
95% is an estimate based on about 50 practitioners I know. Not much of a precise statistic, I know, but I doubt there are also precise statistics out there about how many GPs prescribe antiacids as a first step in differential diagnosis of anyone presenting any abdominal symptoms (too many, trust me)
If BANT accepts this kind of behaviour, it does mean it promotes it…there is difference in this vocabulary.
I am completely familiar with GMC’s code of ethics, but its existance doen’t mean that all members attain to it (experience from colleagues)
I apologize for harshness of my previous post, although I was a bit diasppointed at some comments.
I haven’t said and I’ll never say that Holford is a great nutritionist, to me he is a great businessman although there are many, many nutritional therapists are there that are far more prepared then nutritionists or dieticians…maybe you should get in contact with some of our collagues teaching the MSc in Nutritional Medicine at the University of Surry and ask for feedback on this.
Best of luck
John
UK dietitian // May 12, 2008 at 9:09 pm
Happy Gilmore says - ‘95% of therapists don’t prescribe supplements’
Ever?
I have NEVER experienced a patient informing me that they have seen a nutritional therapist and NOT been prescribed supplements. Thats probably around 70+ consultations, and every one on at least one supplement - usually from Solgar (We Reward Therapists Who Recommend Clients To Us) or some Great Smokies Laboratory tests, recently superceded by the ‘need’ for a YorkTest…
your quote ‘many nutritional therapists are there that are far more prepared then nutritionists or dieticians’ defies belief.
But I guess you need to define what nutritionists are ‘better prepared’ to do? If you mean to practice their extended occasional weekend courses (held over 3 years to make sure you are easily confused with the full time BSc Hons Nutrition degrees at Uni’s like Surrey) and ‘practice’ being a pseudo-dietitian then I guess you’re correct - IONutritionists are great at inferring they’re better qualified than they are. Patrick is the epitome of marketing over qualification.
Now, if you are a nutritional therapist yourself - which I presume you are from your comments as you’re unable to match dietitians knowledge so best defence is offense - then the only people you can be referring to at Surrey are Neil Ward (Patricks supervisor for his defunct MSc) or Emeritus Professor of Clinical Biochemistry Vincent Marks, erstwhile lecturer on ION courses which of course means nothing other than - like many of his ilk- are willing to lecture to whoever is happy to pay an appropriate fee… participation does not equate to endorsement.
HappyGilmore // May 12, 2008 at 9:43 pm
Will answer this for the last time as, to be honest, I don’t have time to waste on a blog of people ranting at facts they don’t know
1) I, sincerely, didn’t have any intention to offend you as a dietitian
2) 95% nutritional therapist don’t take a percentage out of the supplements they prescribe, basically they don’t make money out of it, I didn’t say 95% of NT don’t prescribe supplements. Many do, and unfortunately some do too much.
3) Solgar is no good, in my own opinion
4) Great Smokies Lab is Genova Diagnostics now, to be precise, and many of their tests are very reliable, you can’t contradict me on that
5) You are implicitly suggesting I support Holford and ION. Well, surprise, I don’t. Also ION people don’t have access to the MSc in Surrey, FYI. I am talking about those out there, including this blogger and the people he links, who are totally disrespectful of those people who gain BSc in NT, where differential diagnosis, pathophysiology, nutritional therapeutics, etc. are thought.
I am a dietician too, but also a nutritional therapist. My experience has thought me that, in certain occasions, I have met nutritional therapists who were definitely more knowledgeable of subject compared to nutritionists and some dieticians.
This is my opinion from direct experience, I accept your opinion on the basis of your experience.
Regards
John
HappyGilmore // May 12, 2008 at 9:53 pm
Moved to off-topic by moderator
Susan Bradley // May 27, 2008 at 1:07 pm
It is a pity that the medical profession is collaborating with the rich pharmaceutical companies to keep the truth from the general public. The upright and brave physicians who have a conscience are persecuted for their honesty! Shame on the medicaql profession! It is time that everyone be informed that glyconutrients are the newly discovered simple nutritional sugars that support the immune system enabling the body to repair itself! Thousands of people have used glyconutrients to great health benefits!
dvnutrix // May 28, 2008 at 8:09 pm
Susan Bradley, did you realise that the BMJ link posted above was to an item detailing the reprimand given to a locum
Do you have any clinical evidence to support your claim of health benefits or is your assertion based on your own experience/anecdote or those of others?
You & Yours on Barbara Nash and the risks of nutritional therapy Updated « Holford Watch: Patrick Holford, nutritionism and bad science // July 18, 2008 at 12:29 pm
[...] As per the JKN comments, it might have been more useful if BANT were to review their membership requirements and assure the public that they were reviewing their safety procedures and minimal training requirements for membership. After all, this might have been a better use of their discussion time than amending their ethics code to permit commission payments from supplements sales. [...]
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