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”.