ANH-USA Uncovers Suspicious Activity by State Dietetic and Health Boards

May 15, 2013
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Our exclusive report reveals government surveillance, what appear to be undercover sting operations, and investigations into the alleged crime of “practicing nutrition without a license.” Action Alerts!

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ANH-USA has uncovered widespread surveillance (including undercover sting operations), aggressive investigations, and prosecutions of nutrition professionals. These actions, together with the levying of criminal penalties, have been undertaken by state health departments and state dietetics boards that are enforcing monopolistic laws sponsored by the Academy of Nutrition and Dietetics. More often than not, they are supported by local law enforcement or the offices of state attorneys general. The AND—formally the American Dietetic Association, or ADA—is not a medical organization, but a trade group that represents the interests of Registered Dietitians (RDs, who are certified by the AND’s credentialing arm). The AND has about 74,000 members.

These non-RD nutrition professionals are being targeted by these states’ RD monopoly laws, despite the fact that many of them have advanced degrees and a tremendous number of clinical hours to their credit. They are being prosecuted for “practicing dietetics without a license” or for referring to themselves as “a nutritionist” in media or marketing materials.

One of the AND’s key agenda items is to pass “scope-of-practice” laws in each state whereby only RDs can legally offer nutrition services—even basic services like providing nutrition advice or nutrition consulting. The AND describes this as a “Mega Issue” for the organization, and it was listed as priority at the AND’s recent conference in Washington, DC.

If an RD monopoly bill is passed by a state’s legislature and signed into law by the governor, a dietetics board is created to enforce the new law. Unsurprisingly, these boards are mostly comprised of RDs (on Georgia’s board, six of its seven members are RDs). They have the weight of state law behind them, and depending on the state, the dietetics boards can levy heavy fines against a nutritionist who is not an RD and can either file criminal charges themselves or can refer the case to the state attorney general for prosecution for violating the state’s law of “practicing dietetics/nutrition without a license.” See, for example, the dietetics laws in Florida (468.517: Prohibitions; penalties), Georgia (43-11A-15: Refusal, suspension, or revocation of license; other disciplinary actions) North Carolina (90-366: Violation a misdemeanor), and Ohio (4759.09: Violation procedure).

The AND defends its RD monopoly law and the creation of these dietetics boards as an effort to “protect the public health.” However, in our investigation into three years of records from four state dietetics boards, we did not find a single case of an unlicensed nutrition practitioner causing harm or engaging in a harmful nutrition related activity, and not a single case of a customer filing a complaint. Every complaint that spurred a subsequent investigation and prosecution was made at the behest of the Board itself, or from complaint forms submitted by RDs. (At least one AND affiliate has openly encouraged its members to submit complaints against fellow nutrition professionals).

Let’s be clear: ANH-USA generally supports the AND’s desire to protect the term “Registered Dietitian” or “Dietitian.” We believe it helps inform consumers as to the professional training of that nutrition practitioner. At the same time, we adamantly oppose efforts by any nutrition organization to limit consumer choice by enacting laws that benefit one particular group. We believe in a competitive and open market for nutrition professionals, with consumers and employers (including hospitals) being able to decide what credentials, education, and experience they want in a nutrition provider.

As we’ve noted, there is no evidence whatsoever that an open and competitive market for nutrition services endangers the public safety and health. But do dietetics boards improve the public health? Let’s look at a public health issue that is the sine qua non of nutrition professionals: obesity. Five of the ten most obese state (MS, LA, WV, AL, MI, OK, AR, IN, SC, KY) have RD monopoly laws. Nine of the ten least obese states (AZ, CT, NV, NY, UT, CA, NJ, MA, HI, CO) do not. It would seem that ADA-run dietetics boards are not having a positive impact on public health, and may be having quite the opposite effect.

Not only is Colorado the least obese state in the country, it’s also one of three states (Arizona and New Jersey are the other two) that do not regulate the practice of nutrition whatsoever. If the AND were correct, and a lack of regulation of nutrition endangers the public safety, then Colorado should be the epicenter of harm—yet it seems the reverse is true. In fact, in a 2007 letter, the Colorado Department of Regulatory Agencies rebuked the Colorado Dietetic Association, which was at the time seeking an RD monopoly law, for failing to provide any evidence of harm caused by the unlicensed practice of nutrition professionals.

Currently only twenty-four states have restrictive nutrition counseling laws. That’s because most states recognize that this push has nothing to do with protecting the public health, and everything to do with market share. Nearly thirty years ago, in the Journal of the American Dietetic Association 84:4, the organization’s president wrote (emphasis ours):

Like other professionals, dietitians can justify the enactment of licensure laws because licensing affords the opportunity to protect dietitians from interference in their field by other practitioners. Licensure also can protect dietitians by limiting the number of practitioners through restrictions imposed by academic, experience, and examination requirements. This protection provides a competitive advantage and therefore is economically beneficial for dietitians.

When the news broke about the investigation (and attempted silencing) of blogger and Paleo diet proponent Steve Cooksey by the North Carolina Board of Dietetics/Nutrition, we had a feeling he wasn’t the first non-RD targeted by dietetics boards. Were there people like Steve Cooksey in other states?

ANH-USA filed freedom of information requests with state dietetics boards that had histories of aggressively targeting non-RD nutrition practitioners. Our requests sought any and all information on complaints, investigations, enforcement actions, and internal communications related to RD monopoly laws.

We received thousands of pages of documents, meeting minutes, email communications, complaint forms, cease-and-desist orders, and consent decrees relating the enforcement of restrictive nutrition practice and speech laws by dietetics boards in Florida, Georgia, North Carolina, and Ohio. We also scoured the Internet for records—including those found on the boards’ public websites. Here’s what we discovered:

Florida

Florida’s Dietetic & Nutrition Practice Council is part of the Florida Department of Health; the latter carries out investigations and enforces the state’s RD monopoly law. Our investigation revealed that undercover operations—with individuals posing as potential patients or clients seeking personalized nutrition advice so as to entrap the unlicensed practitioner—were conducted by RDs who had filed complaints against non-RD nutrition professionals, as well as by investigators from the Department of Health itself.

Undercover surveillance might be excused if the public health were really at risk. But as Forbes contributor Michael Ellsberg noted, “The reason to surveil and report citizens who provide public nutrition advice (people like Steve Cooksey) is not that there’s any evidence that these citizens actually harm the public. Rather, the reason to surveil and report citizens like Cooksey is that doing so is necessary to maintain licensure laws (which were designed by the ADA explicitly to limit market competition).”

At a Dietetic & Nutrition Practice Council meeting this past January, a board member stated that in 2012, the Department of Health spent 681 hours, at a cost of $19,857, to investigate complaints of people practicing nutrition/dietetics without a license. Previous year’s totals were 191 hours in 2010, and 207 hours in 2011. That’s a 229% increase in investigations in just two years! Last year the Florida Department of Health fined at least seven people at a total of $11,672 for the crime of referring to themselves as a nutritionist or offering “nutrition services” without a license. There were no allegations of harm and not a single complaint filed by individuals who visited these “unlicensed practitioners.”

Ohio

Our investigation revealed that since 2009, there have been 349 investigations by the Ohio Board of Dietetics. At least forty-two of the investigations were of non-RD practitioners accused of practicing nutrition/dietetics without a license—including wellness centers, alternative health providers, physical trainers, and other licensed professionals. To date, seven official disciplinary actions, such as cease-and-desist orders and consent decrees, have been issued by the board.

Ohio was singled out as “a model dietetics board” for its aggressive investigations into unlicensed activity at the AND’s Public Policy Workshop this past March.

In addition to its questionable investigations against non-RD nutrition professionals, we should highlight what seems to us to be a flagrant conflict of interest on the part of the Ohio Board of Dietetics. A bill that was introduced in the state legislature, HB 259, would have allowed non-medical practitioners who do no harm to practice in Ohio. The bill was supported by health freedom advocates, but opposed by the state Ohio Dietetic Association, a 501(c)6 trade group that can legally lobby for and against bills. However, our investigation revealed that the Ohio Dietetics Board—a state government entity—actively lobbied against HB 259, which is patently against the law. This is outrageous enough, but we’ve also learned the board was coordinating its lobbying activities with the Dietetics trade group—the same group the board is supposed to regulate. The bill passed the Ohio House, but failed in the Senate, and the bill died in 2012.

ANH-USA has filed an ethics complaint with Ohio state agencies over the Board of Dietetics’ collusion with a private trade association in an attempt to limit competition. ANH-USA is also preparing materials for review by the Federal Trade Commission into possible restraint of trade actions by both the state dietetic association and the state board.

Georgia

The office of Georgia’s Secretary of State responded to our freedom of information request with the statement that “all complaints, their outcomes, and all other documents pertaining to investigations…are restricted from release” and that “deliberations, a complaint, an investigation or a disciplinary proceeding…is not subject to release.”

The Georgia Board of Examiners of Licensed Dietitians (six of whose seven members are RDs) refused to release detailed meeting minutes or a recording of recent board meetings to us—even though ANH-USA was an agenda item at its December 2012 meeting!

Georgia’s “Dietetics Practice Act” empowers the board to “enforce the provisions” of the Act—one of which is that only a “person licensed…shall be engaged in dietetic practice.” That means that only an RD can legally “assess nutritional needs or individuals” or “provide nutrition counseling.”

Although the board states on its website that “the Board has not issued Voluntary Cease and Desist Orders for unlicensed practice,” the minutes of the board’s August 24, 2012, meeting tell a different story: the board “moved to accept the Cease and Desist order, notify the Composite Board of Professional Counselors, Social Workers and Marriage and Family Therapists of the complaint, and close the case.” Why is this information buried in meeting notes, but not posted in the Cease and Desist section of the board’s website?

At its June 15, 2012, meeting, the board went into executive session—that is, all matters were off the record and visitors were not privy to the discussion—to deal with “enforcement matters, investigative reports, and pending cases.” The board “moved to schedule an investigative interview” with a holistic health coach.

As we reported last November, the Georgia board conducts undercover sting operation investigations with the full knowledge and cooperation of the Georgia attorney general’s office. We find it appalling that a government board, through a controversial dietetics law, is able to investigate and prosecute, has little to no accountability or transparency, and misinforms the public as to their actions. They’re not even required to tell you what was said when you or your organization is “reviewed and discussed” in their board meeting!

North Carolina

Most of our readers will be familiar with the story of Steve Cooksey, the health blogger that provided nutrition advice online. What you may not realize is that the Cooksey is one of nearly fifty people in North Carolina who have been targeted and investigated by the North Carolina Board of Dietetics/Nutrition over the past five years for possible violations of the state’s dietetics practice law.

Our freedom of information request found that RDs in the state are posing as patients and consumers in order entrap individuals practicing nutrition without a license. We found a litany of needless investigations into practitioners who are not even violating the North Carolina dietetics law—though the board pursued these individuals simply because complaints were filed. We view this as tantamount to harassment.

Do restrictive dietetics laws limit competition in the nutrition field? You bet. Consider the case of Liz Lipski, an expert nutritionist who was forced to leave North Carolina because the board denied her the right to practice as a nutritionist in the state. There are only 2,408 licensed dietitians in North Carolina to service a population of nearly 10 million people! By comparison, there are 119,069 registered nurses in NC.

Media inquires please contact:
Darrell Rogers
202-803-5123
[email protected]

Action Alerts!

While ANH-USA has been very successful defeating AND-proposed RD monopoly bills, we’re currently exploring multiple legal and regulatory options that would end the anti-competitive, restrictive trade and anti-free speech actions of state dietetics boards.

If you are a resident of Florida, Ohio, Georgia, or North Carolina, please contact your state legislators and ask them to repeal your state’s dietetics board. In NC, there’s even a bill, HB 676, which hopes to do just that. Please send your message to your state senators and representatives today!

Florida Ohio Georgia North Carolina

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New York, S.4999, would create a licensure scheme for nutritionists and dietitians (lumping them together as if there were no difference). It creates a board disproportionately made up of RDs, ensuring a board biased against non-dietitians.

This bill is very similar to one introduced last year by the same senator, Kenneth Lavalle (R-NY01). We hope the bill doesn’t have legs, since no companion House bill was introduced, and the similar bill did not go anywhere last year, but we’re not taking any chances. New York residents, please send your message immediately!

New York

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Michigan, HB. 4688, would repeal the 2006 the Dietetic/Nutrition Regulation Act, and eliminate the Dietetic/Nutrition Licensing Board.  Michigan residents, please send you message immediately!

Michigan

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26 Responses to “ANH-USA Uncovers Suspicious Activity by State Dietetic and Health Boards”

  1. Skylar Phoenix says:

    Everyone needs to find and watch the documentry “Genetic Roulette” and then hold AND accountable for how it is safe to allow GMO foods to be consumed by animals and humans.
    Demand they look at studies outside scientific bias of Monsanto.

       1 likes

  2. Dee Arthur says:

    I would like to point out that most doctors do not have adequate education nor training to be a qualified diet counselor or a nutritionist/dietician. Very few doctors recommend their patients/clients to see a dietitian, also. So do we slam fines and lawsuits against all doctors for their inadequate knowledge about nutrition and diet???

    Why dont they go after the corporations creating GMO’s in our food we eat?? Why are we hitting and blaming the middle or lower person in small businesses?? Why not fight the big corporations that are enhancing our foods with chemicals causing the “Obesity” problems?? These corporations are doing the most harm and making the most money.
    Let’s tackle the real problems and find the real solutions!

       5 likes

    • Adam says:

      Per the AND Education and Professional Requirements

      Required College Courses (Undergraduate Level)
      Anatomy
      Physiology
      Biochemistry
      Chemistry
      Microbiology
      Pharmacology

      All part of the core curriculum for all doctoral level health care providers. Graduate level courses which means higher level of detail and number of course hours than undergraduate.

      I don’t know what doctors you go to that provide dietary advice routinely but in the 6 or so minutes that any of my friends or relatives get to talk with their primary care providers, no advice is given. If you want to make a positive impact with respect to public health, join the American Public Health Association and start public education programs. Please don’t push for unnecessary restrictive legislation and bash health care providers that may not even know the education differences between a dietician and nutritionist let alone feel confident referring their patients to one. Meet them half way and try to introduce yourself to the providers in your area. Bring research papers that show what you recommend is backed by hard peer reviewed evidence.

      I’m in favor of raising standards whether educational standards or standards of care but not monopolizing for higher profit.

         0 likes

    • tk says:

      Tom Kelly hi AAEM fans,here’s some useful stuff,,from OPEN SECRETS DOT ORG,,donations to hse of reps,2012 from monsanto corp,dems 72,000 republicans 190,500 senate,,democrat,=37,500 republican 85,000 total 375,000 dollars that is, source was wikileaks,wonder why we hear our watchdog press quiet as sign language
      here might be the reason congress sits on butts on these health issues

         0 likes

  3. Maude says:

    I just visited the AND site (eatright.org), where in 5 minutes I found multiple examples of dangerous disinformation–that fibromyalgia is incurable, but maintaining a healthy weight might help is the tip of the day (not a word about thyroid function), calcium for bone health includes only a tiny mention of vitamin D at the bottom, with nothing about it’s being mandatory for calcium absorption, and the recommendations for soy as a wonderful protein source is all over the place, including dietary advice for small children. And (as you know) their funding comes from some of the worst offenders against good health. ( ConAgra, Coca-Cola, Hershey, SoyJoy! . . .). Why can’t we sue them for fraud and deception? Does endangering the public welfare conflict with their charter, or violate their 501 status? GRRRRR! I told myself I wasn’t gonna think about this insanity today. Oh, well. Maybe tomorrow.

       29 likes

    • Ahab Galbraith says:

      We can sue them, but their thousand dollar an hour lawyers would eat us for a snack.

         0 likes

    • jean says:

      what bothers me is when ag business profiteers seem to be making inroads on dieticians so that the dieticians seem to favor things like soda that is full of corn and other crap. the registered dieticians seem to be getting too much money from a lot of profiteesr that promote bad unhealthy food. the conference was loaded with pepsi colar and other soft drink promotion. that is not good nutrition. so why are the regular dieticians selling out?

         0 likes

  4. MachineGhost says:

    > While ANH-USA has been very successful defeating AND-proposed RD monopoly bills, we’re
    > currently exploring multiple legal and regulatory options that would end the anti-competitive,
    > restrictive trade and anti-free speech actions of state dietetics boards.

    You need to work with the Institute for Justice. They specialize in shooting down cases of economic protectionism.

       6 likes

    • Dr. Peterson says:

      I am a chiropractor who has studied nutrition and herbology for thirty years. Some cutting edge reserach has been done by RD’s to deliberatly give an impression that their education is credible and the instructors at their schools are NOT paid off by the food industry, which is a blatent hoax. My profession has experienced the political discrimination for over 100 years. Grassroots politics is our only hope for a free society. Educational pontifs trapped in a dogmatic paradigm BELIEVE that big business is here to help us all, but those profitting are the only one benefitiing.
      They read the soy studies from Japan and see there is a lesser degree of breast cancer for those women who eat soy in newborns and infants.This soy is fermented much of the time and certainly not GMO with the artificial hormones like genistien and other phytohemical abnormalities.The body doesn’t rcognize these Frankensteins and metabolites don’t get processed.Do these supposed nutritionists even know that nutrition found in nature is levorotatory and manmade chemicals are dextrorotatory. This is the fundamental difference between pharmaceutical supplements and whole food concentrates. It’s all about greed and power.
      These are the same morons who criticised Dr. Linus Pauling for making claims about vitamin C. Where’s all the Nobel Prizes for their profession. He had two did they have any? Why do we let the stupid people make rules for all of us? Apathy, complacency and misinformation.

         4 likes

  5. Celia R. Javadi says:

    A few years ago, my CNP/ND told me about a practicing ND friend of hers in Cincinnati, Ohio, who was arrested and jailed, her practice records confiscated, for “practicing nutrition without a license” (i.e., an RD) in the People’s Republic of Ohio. This state bills itself as “conservative” across its legal boards. Read that as unfairly restrictive in essentially all professional venues and weighted towards garnering all power in the hands of a few. As noted, the victim was professionally trained as a Doctor of Naturopathy.

    I am currently undergoing a distance learning program for an ND. While I have read many complaints against these programs, I have to say they were written by people who have no clue what the programs entail. One of the finest complaints was that we receive no hospital practice during our training, which complaint essentially compares oranges to watermelons.

    The information I am required to assimilate through study is massive. The exams I take cover minutia. First level courses target details. Higher level courses, where I currently am in the program, target critical thinking skills in conjunction with details. In states which support the ND program, research is required. In states like Ohio, research under this program is dicey, so there is an alternate tract for those of us whose states do not support naturopathic research and practice. I would have liked to have done some research, and have several ideas I would like to research.

       2 likes

  6. Michele says:

    The spirit behind movements by AND appears unconstitutional; only the Federal government can regulate trade in the USA I believe. Further the intentions of the AND appears un- Democratic based upon its reliance upon secrecy and attitude of beyond approach. AND is completely out of alignment with public health. It appears it uses an Obesity epidemic in the USA to propelled a private agenda. Penalties are perhaps its primary revenue stream besides insider lobby money. AND demonstrate no shame because its ideology trumps what it true, right and legal. AND mirrors RD activities to MD monopoly on western medicine. MDs wish to eradicate alternative medicine in the USA as does Pharma act to eradicate health supplements.

       5 likes

  7. Merle Janes, MD says:

    First Amendment should trump any effort by any “trade group” which is using the Power of the State to crush their economic competition. This is especially so when that trade group pursues a narrow path of What is Right and Correct and holds itself out as THE authority (which has a Direct Line to the Truth). The AMA did this starting from its earliest days, intending to crush all opposition and opposing (or just different) views on what constituted the practice of medicine.

       6 likes

  8. Don’t know what we’d do without ypo! Keep up the good work.

       1 likes

  9. mike says:

    Well, I remember a while back when the TV ads were telling us not to use coconut palm oil or butter, which supposedly weren’t good for us, and that corn oil was far better – it only took about 4 decades (40 years) for that wisdom to fade without any real penalties to the perpetrators, and considerable health hazards to the general public. I don’t need the government to decide for me what to eat – they still are pretending that GMO’s are just like real food, in spite of disturbing evidence to the contrary. The commercial biases of these quasi-governmental RD monopolies represent conflicts of interest regarding the liberties of ordinary people in this country.

       7 likes

  10. Peggy G. says:

    In Colorado a bill was just passed, SB 13-215, called the Natural Healthcare Consumer Protection Act. It is awaiting the governor’s signature. It is a right to practice act for unlicensed natural healthcare providers, offering protection from the laws of licensed healthcare groups and professionals, provided the NHP informs clients of educational background, that we are not licensed by the state, and we won’t perform a long list of “can’t do’s” (surgery ,venipuncture, medical treatments, etc.). It was nicely presented as a consumer protection bill while at the same time preserving the rights of both consumers and practitioners to maintain unlicensed healthcare options. There is an obnoxious amendment from the pediatricians that we can’t “treat” anyone under the age of 2, and must get a parent’s signature for ages 2-8, stripping parents’ rights to decide their children’s care. But we will take what we can get. Hopefully it will protect against the RDs when they will undoubtedly try yet again to push through a licensing bill.

       3 likes

  11. John Brown says:

    While hundreds of thousands die from prescription medicines These murders harass nutritionists. It is time the people rise up and prosecute these murders!!!

       4 likes

  12. Shannon Robinsob says:

    Not acceptable

       0 likes

  13. Shannon Robinsob says:

    Not acceptable!

       0 likes

  14. The New York State Department of Health (NYSDOH) prosecutes physicians and other health professionals without the use of due process rights, such as the right to have witnesses for one’s defense, and the right to unbiased judges, among others, thus flouting the Fifth and the Fourteenth amendment clauses on these fundamental rights.
    The NYS legislature introduced bills to correct these abusive practices. They were all vetoed by Governor George E. Pataki in 2004.

       0 likes

  15. Rodney Leedahl says:

    I think it is time to study how, and what it took, to get a case in front of the supreme court by Chiropractors against the AMA (American Medical Asscociation). The AND is behaveing just like the AMA. Chiropractors did win to get the AMA to quit defaming them, but the damage was already done. Chiropractors still have to convince people that they are not “quacks.”

       5 likes

  16. P Campbell says:

    Practicing nutrition without a license? Arrest all mothers immediately!

       9 likes

  17. Alan Lambert says:

    It is unfortunate, but (not only on this subject) constant surveillance of the inappropriate use of governmental power is essential. Left unchecked, interest groups have, and will continue to promote their own agendas without regard for anyone else’s well being.

       3 likes

  18. As a military veteran with over 20 years of service in the US Air Force, and sworn to “support, protect and defend the Constitution of the United States against all enemies, foreign and domestic,” I am enraged that the Academy of Nutrition and Dietetics engages in some of the very things we sought to overturn in the communist bloc during the Cold War. These are nothing less than secret police activities, which should be exposed and eliminated.
    As chair of the 50,000 member Texas Health Freedom Coalition, I am proud that our team has helped deter the AND and its Texas affiliate from even filing a licensing bill in Texas. It was Patrick Henry, I believe, who said “the price of liberty is eternal vigilance.” We must stand watch on the ramparts of freedom to preclude organizations like the AND from violating that very freedom. Many congratulations to ANH-US for this in depth report. Well done!

       6 likes

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