Wednesday, November 28, 2012

Dieticians and Efforts to Monopolize Nutrition

By James J. Gormley

There are many healthcare professionals who provide dietary advice. One subset is “Registered Dietitians” or RDs, a private credential offered by the private trade association, the Academy of Nutrition and Dietetics (AND), formerly known as the American Dietetic Association, or ADA.

RDs typically provide government-sanctioned dietary advice, such as the USDA dietary guidelines. There is a large other set of professionals – fully 2/3 of the nutrition community!– more commonly referred to as “nutritionists” who typically take a very different approach to dietary advice (not constrained by government-imposed guidelines), and there are many other professionals who use nutrition as part of their practice.
Despite an urgent need for more nutrition therapy and advice (not less), nutritionists claim that the dietician lobby has engaged in a campaign to monopolize nutrition advice through regulatory capture, specifically state nutrition licensing laws and federal regulations.
Regulatory capture of health professions is nothing new. But this attempt is said by nutritionists to be particularly egregious, because the ‘scope’ of the so-called ‘dietetics and nutrition’ profession is not a set of competencies unique to a particular health care provider (like an MD or a nurse).

It does not involve substances that the law otherwise forbids the public to use (such as a medical license permitting the prescription of pharmaceuticals). This is the purveying of advice with regard to a substance freely available to all and consumed every day: food.

The dietician lobby seeks to not just prevent laypeople from providing dietary advice, but non-RD health professionals as well! The crux of the problem is this:

Unlike many health professions, “nutrition advice” is not a single profession, but is a tool-set legitimately used by many professionals (and the public). Those professionals include dietitians, nutritionists, medical doctors, chiropractors, naturopaths, acupuncturists, health coaches, and many more. Thus, it is much more difficult to reduce nutrition to a uniform regulatory scheme than it is for a discrete profession, such as nursing, for instance. It is like trying to license “exercise advice” – which is a tool used by many professions, not the domain of a single profession.

The dietician licensing bills make it a crime for those who give nutrition advice without a license. These laws prevent the vast majority of non-RDs from providing nutrition advice and artificially constrain the number of nutrition advisers and practitioners. In over half of states in the U.S. these one-sided licensure laws have passed, and entire segments of nutrition practitioners – such as naturopaths, nutritionists, herbalists and many others – are often barred from providing advice.

The sole beneficiaries of the dieticians’ drive for monopoly are its Registered Dietitians. And they are by no means the most highly qualified. The RD credential requires a bachelor’s degree, while several other nutrition credentials require a Masters or Doctoral level. What the dietician lobby does have is far greater financial resources.

According to the American Nutrition Association (ANA), the dietician lobby is acting as legislator, executive, judge, and jury:
  1. It has attempted to insinuate itself into federal regulations, so that only members of its professional trade group are permitted to be reimbursed for nutrition counseling.
  2. It has been fairly successful at getting state laws passed, substantially similar to North Carolina’s, that criminalize the provision of nutrition advice. This at a time when their own data show a shortage of nutrition professionals relative to the demand
  3. Those dietician-friendly state laws enshrine Registered Dietitians as the dominant force on each of these state licensing boards.
  4. The state licensing boards play a large role in determining who can and cannot obtain a license, first by drafting ‘rules’ that spell out the details of licensure requirements (which mimic the dietician group’s requirements), and second by being the gatekeeper for applicants for licensure.
  5. The association then encourages its members to file complaints with the state licensing boards
  6. Then the Registered Dietitians in the state, encouraged explicitly by the dietician lobby to police the field, report unlicensed practitioners to the state’s licensing board, which are referred for prosecution.
  7. Hearings and settlements during the course of such prosecutions are conducted by or in close contact with the particular licensing board.
Progress in Illinois
While Current Illinois law has been a near-monopoly for dietitians, I am pleased to announce that the American Nutrition Association’s bill to open up access to nutrition practitioners is up for a vote, likely by tomorrow morning, November 29th. If you are in Illinois or have a family member, friend or colleague in the state, I urge you to pass along the this link asap!

The ANA has approval of the bill sponsor, Sen. Iris Martinez, many other legislators, and the Illinois Department of Professional Regulation, on an amended bill that would:

  • Change current law from an RD-only law, to one that permits a wider variety of nutrition education and allows other nutrition exams and credentials (the CNS, CCN, and DACBN).
  • Strengthen exemptions protecting acupuncturists, health food stores and other businesses and employees who respond to consumer questions regarding nutrition and dietary supplement information.

According to the ANA, “This bill doesn’t correct every provision of current law we sought to change. However, the significance of rolling back a monopolistic RD practice law to one which includes other nutritionists and exemptions, is immense.”

Ending a dietetics monopoly and ensuring protection for a diverse range of nutrition care providers for Americans is underway. This is a huge step in the process, and I look forward to, along with Citizens for Health, working with all of you to roll back these nutrition monopolies in other states!
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