BANT ethics code: BANT nutritional therapists are allowed to earn commission from selling pills and tests

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.

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38 Comments

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38 responses to “BANT ethics code: BANT nutritional therapists are allowed to earn commission from selling pills and tests

  1. 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.

  2. Wulfstan

    There was a recent item in the BMJ about a doctor who has been reprimanded for selling supplements to patients.

    An out of hours GP who encouraged patients to take nutritional supplements from which she stood to profit must work under imposed conditions for 15 months, after a General Medical Council panel found she had abused her power as a doctor.

    Vivienne Balonwu gave promotional leaflets and DVDs that made extravagant claims about the benefits of glyconutrients to four patients whom she visited at their homes in the early weeks of 2006.

    BANT, BANT, forgive us this rant,
    There’s little to your code, beyond pious cant….

  3. 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.

  4. 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.”

  5. superburger

    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?

  6. Wulfstan

    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.

  7. 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.

    • El

      I’m an ION graduate. The teaching was focussed on food, not supplements.

      I recommend supplements only when they look like they’ll helpful. I don’t make any money from the supplements that I recommend.

      Whichever side you’re on, please stop this petty fighting. Couldn’t this energy be put to better use?

    • nodrande

      Unfortuantely Andy, you have the complete wrong Idea about ION graduates. Judging by the content of the course, the main areas of teaching focus on underlying causes of pathology and how food and stress management can aid the rebalancing of body systems. Heavy emphasis is on digestion/assimilation, bio-transformation/elimination, immune system dysfunction (auto-immune,allergy), endocrine and structural dysfunction. Focus is then on how these 5 systems interact with each other.
      Unfortunately GPs only focus on symptom management (take a pill that blocks a certain chemical pathway that is causing the sign or symptom) and never addresses the underlying reason why the chemical pathway has occured.
      I am not an ION grad but have a good look at the course structure and can see that it is not based on making a profit (although people like Holford do seem to be)
      The main problem with nutritional therapy is that change in diet and lifestyle is too much of a price to pay for health. People in general are so manipulated by marketing that they will forever live in the false reality that has been created.

      • We would hate to be unfair to the ION. If anyone would like to contact us – holfordwatch at googlemail dot com – with a copy of the course materials, we will offer a balanced discussion of them. If ION gives us permission to post the course materials online, we would be delighted to do so – so that readers can judge the quality of the course materials for themselves.

      • nodrande

        Am i right in thinking then that you critisise ION nutritional therapist without knowing what have they have been taught? If this is the case then this is quite simply shocking. I have noticed that a favourite topic of yours is the IgG food reaction test. Although Holford does continue to reccomend the test (as he is in no doubt connected to some company that carries out such tests) i am aware that the majority of lecturers at ION do not see any evidence for the test as the immune system is hugely complex and only elimination diets are worthy when considering food reactions.
        Im not sure of your view on gut permeability but a loss of epithelium tight junctions appears to invoke formation of IgG antibodies so a test would only show that increased gut permeability has occured. Speaking to a student only last week they informed of an experiment carried out at ION where 1 sample of blood was sent to 3 companies 6 times (i hope that makes sense) and every result was different. It appears that the course is evolving at great speed and before you critisise it is important that you keep up with the course structure. It is obvious to me that although I agree with your view regarding the need for tighter regulation of NTs, the treament of the underlying cause of patholgies is a far better approach than symptom management offered by GPs (take a drug, oops you have three side effects, take another drug and so on………)
        Dont get me wrong drugs without a doubt have their place and can save peoples lives but the ION root cause approach is heading in the right direction and if people are willing to change it will be far more effective.
        Another important focus at ION is the mind body connection or psych-neuro-immunolgy which the sciecne is developing at a speedy rate. (im sure you are aware of this) unfortunatly, mainstream medicine is lagging behind because drugs cannot play a part.
        I would if you contacted ION yourselves and enquire about posting the couse on line. But any questions, I would be happy to help.

        • nodrande

          sorry about the typos….it is early!

        • In terms of IgG testing – that’s very interesting to know. Would any ION teachers or graduates like to discuss this in a public forum? (we would happily allow them to make a guest post here, if they wanted) One of our concerns about nutritional therapy is that there’s often a lack of robust public debate about the treatments recommended…

          Am i right in thinking then that you critisise ION nutritional therapist without knowing what have they have been taught? If this is the case then this is quite simply shocking.

          The only aspects of the course which we have criticised are those which we do know about. For example, we would be cautious as to whether a 3 year part-time course is sufficiently in depth, in comparison to – for example – a 4 year full time dietetics course. I think that’s fair enough. We’re always happy to learn more, of course.

  8. 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?

  9. LeeT

    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.

  10. 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.

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  12. dietitian in the north

    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 …..

  13. 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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  17. HappyGilmore

    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

  18. LeeT

    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!

  19. 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.]

  20. gimpy

    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.

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