Registered Dietitians get continuing education credit for questionable courses on "toxins"

Registered Dietitians get continuing education credit for questionable courses on "toxins"

​Just this past Thursday, I wrote a post about medical doctors getting Continuing Medical Education credit for courses that taught quackery.  The courses were presented by organizations and medical schools accredited by the American Association for Continuing Medical Education (ACCME), a non-profit group that accredits over 2000 such organizations and schools offering CME. AACME's policies state that the CME courses offered must be science-based in order to get and maintain accreditation, but apparently that rule is not enforced. 

The next day, I got a very nice email praising my post.  But the warm glow faded as I read on. My correspondent had complained to the Commission on Dietetic Registration (CDR) about similar courses offered for Continuing Professional Education for Registered Dietitian Nutritionists (RDN).  (CDR is the accrediting agency for the Academy of Nutrition and Dietetics, the professional association for RDNs.)  To my knowledge, RDNs are the science-based nutrition professionals, as opposed to a plethora of silly advice about paleo diets, detox smoothies, dietary supplement mega-dosing and all the myriad other forms of nonsensical dietary advice out there.

Unfortunately, pseudoscience is creeping into this profession as well. My correspondent politely pointed out to CDR that CPE credit was being offered for an Institute of Functional Medicine conference called "The Detox Summit," which, in his words, "aims to promote unproven claims about nutrition and dietetics by individual with questionable résumés" who are not RDNs and who promote nutrition and health claims not based on scientific evidence. 

He continued, quite correctly, bringing to CDR's attention that:

  1. the scientific community regards these sort of detox claims as scams;
  2. "functional medicine" is meaningless pseudoscience;
  3. the claims that the body needs help to rid itself of toxins is unsubstantiated; and
  4. gluten, GMOs and sugar are not, as claimed, toxins.
CDR replied, also politely, through Sebastian Orr, CDR Senior Manager, Recertification and Professional Development. Mr. Orr defended CDR's awarding CPE credit on the ground that, while the Detox Summit lasted several days, only 5 CPE units were approved.  The approved sessions, he said, were "in keeping with CDR's core standards for Continuing Professional Education."   Mr. Orr also said that approval doesn't mean that CDR endorses the ideas presented. 

I looked at the standards and thought this, from CDR's checklist for CPE activities, went to the crux of my correspondent's complaint:

  • "Demonstrate that content, quality, and scientific integrity of the activities and materials are maintained.
  • "Presentation and materials that are clinical in nature are evidence based."
  • "Controversial or disputed issues are presented as such and supported by documentation from current and reputable, refereed, scientific journals." 

So what were the sessions CDR found acceptable?

Toxicity in Autism, Martha Herbert, MD, PhD

Cardiovascular Disease and Heavy Metal Toxicity, Joel Kahn, MD

Transgenerational l Epigenetic Effects of Toxins, Soram Khalsa, MD

Dietary Approaches for Autoimmune Toxicity, Terry Wahls, MD

Toxins and Neurological Diseases, David Perlmutter, MD

I did not hear these presentations so I don't know whether they met CDR's standards. But circumstantial evidence raises doubts in my mind. 

Dr. Herbert is connected to the questionable autism "biomed" movement. (A few years ago, a court rejected Dr. Herbert's  testimony that mold growing in a condo had triggered a child's autism as not accepted in the scientific community.) She handed out a flyer promoting her book, The Autism Revolution, which a Washington Post reporter didn't find particularly "revolutionary."  She basically admited to the reporter that her ideas are anecdote-based.  

Dr. Kahn recommends infrared saunas for removal of "toxins" from the body as well as removal of amalgam fillings because they contain mercury.  He thinks the TACT trial supports the use of chelation therapy for cardiovascular disease even though, in the studies he cites, the authors themselves say that no such recommendations can be made.  Dr. Khalsa is an "integrative medicine" practitioner who has his own on-line dietary supplement store, where he sells supplements for "detoxification," among other things. Dr. Wahls claims she "reversed" her severe MS with her own version of the paleo diet.  

Finally, Dr. Perlmutter is the author of the bestselling book, Grain Brain. His questionable ideas about diet and health were nicely dissected in a New York Magazine article by Alex Levinovitz, author of The Gluten Lie: and other myths about what you eat

All of the presentations (some more than others) are related in some way to the unorthodox (putting it nicely) ideas that are promoted by these speakers. Even if CDR wasn't aware of the speakers' backgrounds, the subject-matter of the presentations should have alerted them that further investigation was warranted. And if they'd done their homework (all it takes is a few Google searches), I think they would have come to a different decision on CPE credit. 

Points of Interest 08/24/2015
Oregon Health & Pseudo-Sciences University