BANT and Conflict of Interest: YorkTest and Similar Commission

BANT has a sufficiently flexible code of ethics that nutritional therapists are allowed to earn commission from selling tests and pills. That in itself is not particularly striking. What is unusual is that the therapist is under no obligation to declare this commission to the client (pdf):

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. [pg. 9; S 7.3 a); emphasis added.]

We don’t know what the commission is for targeted marketing such as that practised by nutritional therapists but there is a web affiliate programme. The current web commission is 20% per test and the tests range from £10-260 or so. It’s just slightly odd because in other industries, such as the finance industry, financial advisers are legally obliged to inform you about whether they are independent or tied.

Independent financial advisers are supposed to choose the companies they use from all the ones available and only to recommend the best products for each particular client’s circumstances. Don’t expect to get good advice from a tied adviser, who can only offer a few products which may be the best he has but they almost certainly will not be the best available…

Despite all the rules, advisers still tend to go for products which pay them good commission. The better ones will offer you a discount by letting you have some of the commission but you should regard this really as a sales incentive – as the adviser is still motivated by generating commission.

So, if you were to (say) visit a nutritional therapist to whom you had paid a £180 fee for the initial consultation, the therapists might garner another £150 pounds through a common spectrum of tests, assuming 20% commission although it might be more. E.g., the foodSCAN 113 test (£265); the gut health test (£220); the MAST classical allergy test (£89.50); the homocysteine test (£75); the liver check test (£99). In addition, there may be more commission from the sales of recommended supplements. Nutritional therapists may promote particular brands/products for a number of reasons that do not necessarily need to be independently validated such as bioavailability; cost/benefit; larger dosages in smaller number of capsules; taste (may be important for children) etc.

All of which may be well and good but it does seem a little odd that nutritional therapists are not governed by similar codes of conduct as that for independent financial advisers. Is it acceptable that members of BANT are not obliged to declare that they may have a conflict of interest for tests or supplements that they recommend, nor are they obliged to disclose any commission payments to the client? Particularly when some high-profile nutritionism experts frequently castigate medical professionals for their perceived conflict of interest. Yet, as Wulfstan recently pointed out, doctors are reprimanded for selling supplements to their patients.

Similarly, listening to the coverage of the Cochrane Review of antioxidant supplements last week, it was interesting to note the number of times that various commentators challenged the findings of the review without mentioning their own conflict of interest, or attempting to downplay their financial benefit when challenged about it. E.g., Professor Patrick Holford characterised his direct financial benefit from supplement sales as roughly 1/5th of a drug reps salary. Of course, he did this without telling the audience whether he spends more or less than 1/5 of a drug rep’s normal working week to earn this sum, and without mentioning the unconditional £200,000 payment he is scheduled to receive in July.

Update: Gimpy asks whether BANT consider profit profit more important than ethics. Gimpy notes that there was an interesting change in the BANT code of ethics after a “trade association complaint about the apparent constraints placed on their membership set by the BANT codes”.


Filed under allergies, Holford, patrick holford, supplements

9 responses to “BANT and Conflict of Interest: YorkTest and Similar Commission

  1. gimpy

    It’s fascinating how the role of organisations like BANT seems to be to maximise the profit making potential of the business side of the business/customer relationship. It does seem to indicate that the supplements market is a cosy little world where unprincipled salespeople fleece the public while loudly projecting their own unethical behaviour on to businesses that they see as their competitors.

  2. it really is all very seedy and money oriented isnt it. an affiliate program for blood tests!

    being an nhs-only boy i don’t know enough about private medicine to know if this would happen with medical doctors. anyone? or i can ask around. although thinking about it – and this is probably only age – i don’t think i have a single friend who does any private work. i really am quite evidently a total loser.

  3. Like Montmorency (chapter 2), you are obviously too good and pure for this world.

    To look at Montmorency you would imagine that he was an angel sent upon the earth, for some reason withheld from mankind, in the shape of a small fox-terrier. There is a sort of Oh-what-a-wicked-world-this-is-and-how-I-wish-I-could-do-something-to-make-it-better-and-nobler expression about Montmorency that has been known to bring the tears into the eyes of pious old ladies and gentlemen.

    When first he came to live at my expense, I never thought I should be able to get him to stop long. I used to sit down and look at him, as he sat on the rug and looked up at me, and think: “Oh, that dog will never live. He will be snatched up to the bright skies in a chariot, that is what will happen to him.”

    But, when I had paid for about a dozen chickens that he had killed; and had dragged him, growling and kicking, by the scruff of his neck, out of a hundred and fourteen street fights…then I began to think that maybe they’d let him remain on earth for a bit longer, after all.

    To be fair – I’ve no idea what the usual emoluments would be, given that these blood tests aren’t available in bricks and mortar stores near you, so they have to recruit an independent, commission-dependent, sales team.

  4. haha yeah yeah YEAH.

    seriously though, i’ve been thinking, and i can’t even think of a consultant i’ve worked for who does private work. i have literally nobody to ask about this, except relative strangers who will regard me with total suspicion (and that’ll be fun). this will all change when the NHS is dismantled over the next ten years of course.

    if there are any doctors who do private work reading this can you ping me an email?, off the record etc. i’d really like to know what the deal is with docs getting kickbacks from labs and pill companies.

  5. UK dietitian

    well, I can tell you of a London based gastroenterologist who recommends the Biocare (TM) range of supplements to her private patients. Have no idea whether she takes kickbacks for doing so….

  6. Professor UK dietitian, how very interesting. If she doesn’t take the commission, I wonder if she passes on the discount to her clients/patients? Given that an extensive supplement packages can work out at £400+ per month, a discount might be very helpful.

  7. LeeT

    I am currently trying to make a claim on my health insurance. It is becoming clear they really don’t like paying out for things unless they really have to! It is quite unlikely that an insurer would pay for supplements and the vast majority of people referred to private consultants would be coming from insurance plans like BUPA and Standard Life.

    Possibly some consultants are recommending supplements to earn themselves a little bit extra? They will presumably be paid a fixed daily rate by their hospital or the insurer for their work. I would not imagine a consultant can pass on the discount to his/her patients as only a very tiny proportion of them will be visiting him/her on a pay-as-you-go basis.

    The glossary of Standard Life’s policy defines a homeopath which rather makes me think they are not concerned about the evidence base of treatment being offered.

  8. Pingback: My (Paid) Friend Says This Product Is Really Good: FFTB and Cherry-Picking « Holford Watch: Patrick Holford, nutritionism and bad science

  9. Pingback: Patrick Holford and Other GMTV Pundits Should Be Glad That They Don’t Work for German TV « Holford Watch: Patrick Holford, nutritionism and bad science

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