Are Registered Dieticians “Practicing Medicine” Without a License?

November 20, 2012
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Green apple with stethoscopeIf so, it would be ironic, since RD groups are using similar laws to attack and suppress other, often better qualified nutritionists.

The Georgia Board of Examiners of Licensed Dietitians met on February 17. According to the minutes, the meeting included six board members, the executive director for the Georgia Board of Nursing, and the assistant attorney general for the state of Georgia.

On page 3 of the minutes we see that a board member, in reference to one of the board’s Dietitian Investigative Cases, suggested the investigator should pose as suffering from celiac disease or IBS, request counseling for those issues, and retrieve a copy of a brochure and any educational materials provided by the respondent. She also suggested the investigator should “present as having GI discomfort to see if the respondent attempts to assess the investigator’s symptoms,” which would be a legal violation. The motion was carried unanimously.

This was nothing less than an undercover sting operation on a nutritionist, conducted with the full knowledge and cooperation of the Georgia attorney general’s office (AG). Said nutritionist was being investigated for practicing nutrition counseling without a license—because in Georgia, nutrition counseling is restricted to RDs, or Registered Dietitians, a trademarked term for members of the Academy of Nutrition and Dietetics, formerly the American Dietetic Association (AND/ADA). The board is clearly using entrapment methods to enforce its licensing statute, and to ensure that only RDs are allowed to give advice on nutrition-related diseases such as irritable bowel syndrome. They want a monopoly, and they will use state laws to make sure they have it.

However, such sneaky tactics could backfire on them. Under the Georgia Medical Practice Act’s definition of the “practice of medicine,” only physicians are allowed offer “suggestion, recommendation, or prescribing of any form of treatment for the intended palliation, relief, or cure of any physical, mental, or functional ailment or defect of any person with the intention of receiving therefore, either directly or indirectly, any fee, gift or compensation whatsoever” (section 43-34-21).

Although certain professions are exempted, such as nurses and midwives (section 43-34-22), there is no exemption for Registered Dietitians. Providing nutrition advice for “maintaining client health” is protected under the Georgia Dietetics Practice Act, but arguably this licensure law is in conflict with the medical practice act.

Providing nutrition therapy for IBS and celiac disease, while important, is also very profitable. An Australian dietitian, for example, created a diet to treat celiac disease that avoids grain proteins and foods containing certain sugars called FODMAPS, an acronym for potentially tough-to-absorb molecules. Her low-gut-irritant diet spurred an $8.3 billion market, encouraging the likes of Abbott Laboratories to introduce products devoted to food intolerance. The AND/ADA seems to want to tap into that market in the US—and keep it the exclusive domain of RDs.

Such a move could conflict, as it apparently does in Georgia, with state laws on the practice of medicine. State laws vary, of course, and while this would have to be analyzed on a state-by-state basis, the Federation of State Medical Boards (FSMB) is able to give us the big picture: their model law on the practice of medicine is used as standard language by many state boards, as we have reported previously. The FSMB’s definition of the practice of medicine includes “offering or undertaking to prevent or to diagnose, correct and/or treat in any manner…any disease, illness, pain, wound, fracture, infirmity, defect or abnormal physical or mental condition in any person” (section II).

There are exemptions for those “practicing…any other of the healing arts in accord with and as provided by the laws of the jurisdiction.” But it would depend on how the states interpret “healing arts” in their own statute, or whether they even include it in the first place. Otherwise, “correcting or treating” diseases like IBS and celiac disease would certainly be the province of physicians only, and not RDs!

This fierce battle for territory seems to occur among AND/ADA’s own members as well. For example, the Florida Dietetics and Nutrition Practice Council voted to deny licenses even to other Registered Dietitians simply because they were licensed in other states (specifically, New York and North Carolina).

State dietetics boards can use licensure to recommend that individuals practicing nutrition counseling without the proper organization’s blessing—even nutritionists with advanced degrees and certifications from organizations with higher and more exacting standards than those of the AND/ADA—be legally prosecuted, with penalties that include severe fines and even jail time. Everything you say can and will be used against you when you testify before these boards!

Nutrition practitioners and counselors may wish obtain our guide, What Every Practitioner Needs to Know: A Practitioner’s Guide to Protecting Your License and Your Practice from Medical Board and Other Government Action. It’s free when you join ANH-USA as an Integrative Community Member. To learn more, visit http://www.anh-usa.org/main-menu/take-action/join/.

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7 Responses to “Are Registered Dieticians “Practicing Medicine” Without a License?”

  1. Michele says:

    Debates like this over patient care is like a custody battle over a minor, but the debate is about a patient/client. Patient / client choice is at risk in the western medical model that appears to declare it has the sole legal right to human disease and can control the human experience of health. Human disease has no patent. Health is the responsibility of the patient/client. Even minors have a choice which parent they might prefer to live with. An attack on RD exposes advice and choice to prevent disease through diet as a threat to physicans who make a profit off disease management. Western medicine cares more about the health of its financial house than the health of a human being. I think counter attacks need to pursue against the western medicine model that does more harm than good for human life.

       2 likes

  2. While I am responding to these outrageous acts by the Georgia dietitians in my capacity as chair of the Texas Health Freedom Coalition (the nation’s largest state level natural health advocacy organization, with over 50,000 members), I am also doing so as a military veteran. When I accepted my commission as a second lieutenant upon graduation from the Air Force Academy in 1972, it was under oath to “support, protect and defend the Constitution of the United States…” That sacred document, of course, includes our Bill of Rights.
    During my 20 year Air Force career (I retired in the rank of lieutenant colonel), I spent over half my time as a B-52 bomber pilot standing nuclear alert. Before each week long alert tour, I and my fellow crew members received an intelligence update about the goings on in the then-Soviet Union. Frequently mentioned were the activities of the Soviet secret police, which included domestic spying on Soviet citizens.
    Ladies and gentlemen, you can wrap the actions of the Georgia dietitians in whatever legal niceties you wish, but when it comes down to it, spying is spying. It is even more appalling that the Georgia assistant attorney general would agree to such tactics.
    This is the United States of America, whose Constitution I am still sworn to uphold. I am outraged that the dietetics community would stoop to Third World/Communist totalitarian state tactics to advance their monopoly. You can be sure that, in the upcoming Texas legislative session, all of this reprehensible conduct will be prominently mentioned to the members of the legislature. Enough is enough. The gloves are coming off. Any dietitian who stands idly by and allows their national and state level professional organizations to continue such conduct is aiding and abettting it. We either stand for liberty, or for tyranny. The choice is clear.

       4 likes

  3. Lois Pratt says:

    Instead of this being a battle between health care providers, we should be pulling together to help the vast majority of people in our country who are highly effected by the industrial food system. There is no need for competitive attitudes when there is so much work to be done.

       1 likes

  4. Marc Authier says:

    Monopolies are never good. What is going on in USA when it comes to the monopoly of doctors on health issues, is one fine example. Doctors know almost nothing about nutrition and the importance on health. The People will have to break this corporatist monopoly.

       0 likes

  5. RossD says:

    I always read that Nutritionists were far more credible than Dietitians. Dietitians are the ones in cahoots with Pepsi Cola and things like corn syrup that they prefer to call “corn sugar” and they are also the ones that come up with those crappy hospital meals that I’m told are inedible. Dietitians have a credibility problem, schilling for these big corporations.

       1 likes

  6. Tracy says:

    There is a section of the Georgia Practice Act that appears to exempt those nutritionists with accredited higher degrees from the restrictions:

    “Persons with a master’s or doctorate degree from any regionally accredited college
    or university with a major course of study in human nutrition, food and nutrition,
    dietetics, food systems management, or nutrition education, or persons with a doctorate
    degree from a regionally accredited college or university with a major course of study in
    nutritional biochemistry, provided that such persons shall not use the title “dietitian.” ”

    There are also exemptions for “Persons licensed to practice the professions of dentistry, medicine, osteopathy, chiropractic, nursing, or pharmacy from engaging in the practice of dietetics when incidental to the practice of their profession, except that such persons may not use the title “dietitian”

    I have seen many chiropractors specifically advertise nutritional and weight loss services that are far from “incidental” to their practice. Doctors of Physical Therapy should be added to the above list, as we are also eligible to be diabetes educators. Why dentists, nurses, pharmacists and chiropractors and not PTs?

    These licensing laws are a sham, restrict the ability to earn a living, and are manipulated by groups seeking to protect what should be open to other qualified individuals.

    I am a DPT finishing up a masters degree in nutrition from an accredited university. I plan on being a practicing nutritionist in Ga next year. It’s a good thing I also have a law degree, which will probably come in handy,

       2 likes

  7. Jan says:

    If I lived in Georgia I would be on the case of every involved politician for wasting their time on this “entrapment”.

       0 likes

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