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HPCSA vs. Professor Noakes A bird’s eye view Breckenridge February 2017 Dr. Zoë Harcombe, Ph.D
HPCSAvs.ProfessorNoakesAbird’seyeview
BreckenridgeFebruary2017
Dr.ZoëHarcombe,Ph.D
Agenda
• Theplayers&thekick-off• Thecomplaint&thecharge• The8meline• Thedoctor/pa8entrela8onship• Wasthe‘advice’unconven8onal?• What’sevidencegottodowithit?• Aninteres8ngaside• Whathappensnext?
HPCSAvsTheProf.
2©Dr.ZoëHarcombe,Ph.D.
Theplayers
Respondent,complainant&pro-formacomplainant
3©Dr.ZoëHarcombe,Ph.D.
Theplayers
Respondent,complainant&pro-formacomplainant
4©Dr.ZoëHarcombe,Ph.D.
Theplayers
TheProf’slegalteam
5©Dr.ZoëHarcombe,Ph.D.
DrCarynZinn&AdvocateDrRavin“Rocky”Ramdass
AdvocateMikeVanderNest
AdamPike
Thekick-off
• 3Feb2014@pippaleenstratweeted:“@ProfTimNoakes@SalCreedisLCHFea6ngOKforbreas<eedingmums?Worriedaboutallthedairy+cauliflower=windforbabies??”
• 5Feb2014@pro]imnoakestweeted:“@pippaleenstra@SalCreedBabydoesn’teatthedairyandcauliflower.Justveryhealthyhighfatbreastmilk.KeyistoweenbabyontoLCHF”
• 6Feb2014(6.27am)@Die88anClairetweeted:“@ProfTimNoakes@PippaLeenstraPippapleasecontactmeon0110238051orClaire@nutri6onalsolu6ons.co.zaforevidencebasedadvice”
Itstartedwithatweet...
6©Dr.ZoëHarcombe,Ph.D.
Thecomplaint(8.47am6Feb)“Towhomitmayconcern.IwouldliketofileareportagainstProfTimNoakes.Heisgivingincorrectmedical(medicalnutri6ontherapy)onTwiZerthatisnotevidence
based.IhaveaZachedtheTweetwhereProf.Noakesadvices(sic)abreas<eedingmothertoweanherbabyontoalow
carbohydratehighfatdiet.“IurgetheHPCSAtopleasetakeurgentac6onagainstthistypeofmisconductasProfNoakesisa“celebrity”inSouthAfricaandthepublicdoesnothavetheknowledgetounderstandthattheinforma6onheisadvoca6ngisnotevidencebased–it(sic)especiallydangeroustogivethisadviceforinfantsandcanpoten6allybelife-threatening.Iawaityourresponse.Kind
regards.ClaireJulsingStrydom."
7©Dr.ZoëHarcombe,Ph.D.
Thecharge
“THATyouareguiltyofunprofessionalconduct,orconductwhich,whichwhenregardishadtoyour
professionisunprofessional,inthatduringFebruary2014,youactedinamannerthatisnotin
accordancewiththenormsandstandardsofyourprofessioninthatyouprovidedunconven6onal
adviceonbreas<eedingbabiesonsocialnetworks(tweet).”
8©Dr.ZoëHarcombe,Ph.D.
Thecharge
• Thereisadoctor/pa8entrela8onship• Unconven8onaladvicehasbeenprovided- Paediatricadvice- All-popula8ondietaryguidelines
Whattheprosecu8onneedstoshow
9©Dr.ZoëHarcombe,Ph.D.
The8meline
• 3Feb2014thetweet;5Feb2014thereply• 6Feb2014(8.47am)thecomplaint• 20Feb2014TheProfinformedaboutthecomplaint• 2May2014TheProfreplied• July2014Naudeetalstudypublished• Sept2014HPCSAmadedecisiontochargeTheProf• 28Jan2015Theprofreceivedno8ceofthecharge
3yearshavepassed...
Fromtweettocharge
10©Dr.ZoëHarcombe,Ph.D.
The8meline
• Hearing1:4–5June2015• Hearing2:23Nov–2Dec2015• Hearing3:8–17February2016• Hearing4:17–26October2016
TheHearings
11©Dr.ZoëHarcombe,Ph.D.
The8meline
• AtleasttwoofthepanelmembersshouldberegisteredundertheprofessionalboardfortheMedicalandDentalProfession.
• AtleastoneofthosetwomustberegisteredinthesamedisciplineasTheProf(GeneralPrac88oner).
• OnepanelmemberwasnotregisteredundertheMedicalandDentalprofession(ProfessorBlaauw)andtheotherwasnotofthesamediscipline.
• ProfessorBlaauw,wasamemberoftheADSA–thecomplainant’sorganisa8on.
Hearing1:(4–5June2015)
12©Dr.ZoëHarcombe,Ph.D.
The8meline
• 23NovTheProfpleadednotguilty• Witnessesfortheprosecu8on:- Thecomplainant- ProfessorVorster–Publichealthnutri8onist(SADietaryGuidelines2013)
- ProfessorKruger–Publichealthnutri8onist- ProfessorDhansay–Childnutri8on(Stellenbosch)- MrMadube–LegalservicestoHPCSA
Hearing2:23Nov–2Dec2015
13©Dr.ZoëHarcombe,Ph.D.
The8meline
• ProfessorPienaar–ethics• TheSciencearrives:- Theevolu8onofthehumandiet- Theevolu8onofthediethearthypothesis- Insulinresistance&highcarbohydratediets- Obesogenicenvironment- Infantfeeding- BradfordHill&thescienceofcausa8on
Hearing3:8–17Feb2016
14©Dr.ZoëHarcombe,Ph.D.
The8meline
• Thesciencecon8nues(evidence&cross-examine)
Hearing4:17–26Oct2016
15©Dr.ZoëHarcombe,Ph.D.
The8meline
• Thesciencecon8nues(evidence&cross-examine)
Hearing4:17–26Oct2016
16©Dr.ZoëHarcombe,Ph.D.
Thedoctor/pa8entrela8onship
• TheHPCSAdefinesapa8entas“Therela6onshipbetweenthepa6entandtheHealthcareprac66onerisestablishedwhentheprac66oneragreestotreatthepa6entandthepa6entagreestobetreated.”
• Thecomplainantcross-examina8on:- Twiperthread–LeenstrawasnomoreTheProf’spa8ent
thananyotherresponder;- IfLeenstrawereTheProf’spa8entthenthecomplainant
superceded(stole!)apa8ent;- Thecomplainantheldaconsulta8onwithLeenstra,ifTheProf
wereadoctor,thecomplainantevenmoreso.
Goodluckwiththatone!
17©Dr.ZoëHarcombe,Ph.D.
Thedoctor/pa8entrela8onship
• Failuretoestablishadoctor/pa8entrela8onshipeffec8velydismissesthecharge–ethicalrulesofconductnolongerapply.
Theendofthecase
18©Dr.ZoëHarcombe,Ph.D.
Wastheadviceunconven8onal?
• ...itwasn’tunconven8onalanyway• Paediatricguidelines(SA2013DietaryGuidelines):“From6monthsofagegiveyourbabymeat,chicken,fish,oreggeverydayasoaenaspossible.Giveyour
babydarkgreenleafyvegetablesandorangecolouredvegetablesandfruiteveryday.”
Itwasn’tadvice,but...
19©Dr.ZoëHarcombe,Ph.D.
Thecharge
• Thetweetwasmedicaladvice.• Youarenotqualifiedtogivepaediatricadvice.• Youshouldhavedoneafullconsulta8on.• Twiperisnottherightforumformedicaladvice.• Youweregivingdangerousmedicaladvicetoaninfant.
• “KeyistoweanbabyontoLCHF”• Pinnedtweet...
Crossexamina8on
20©Dr.ZoëHarcombe,Ph.D.
21©Dr.ZoëHarcombe,Ph.D.
What’sevidencegottodowithit?
• TheNaudeetalreview“wewereallwai8ngforit”• Thedebateaboutunconven8onaladvice,hasbecomeadebateaboutevidence-basedadvicei.e.ifadviceisdifferenttothatgivenbypublicbodies,butitisevidence-based,isitunconven8onal?
• Conversely,ifadvicegivenbypublicbodiesisnotevidence-based,shoulditbeseenasunconven8onal?
Thedebatehasbecome...
22©Dr.ZoëHarcombe,Ph.D.
Ref:Harcombe&Noakes.Dec2016.SAMJ.Theuniversi8esofStellenbosch/CapeTownlow-carbohydratedietreview:Mistakeormischief?
What’sevidencegottodowithit?
• Allpopula8ondietaryguidelines.• TheProf&TheAngels
“Thedietaryguidelinesarewithoutevidencebase.Epidemicsofobesityanddiabetescoincidedwiththe
introduc8onofthosedietaryguidelines.”“Wasthiscoincidence?”
Evidencevs.conven8on
23©Dr.ZoëHarcombe,Ph.D.
Aninteres8ngaside
• @Die88anClaire“IAMHORRIFIED!!HOWCANYOUGIVEADVICELIKETHIS????”
• HPCSArule:“aprac66onershallnotcastreflec6onsontheprofessionalreputa6onorskillofanotherpersonregisteredundertheact.”
• Complainant:“maybeIoverreacted.”• ProfessorPienaar(ethics)seemedtoacceptthatthecomplainanthadbreachedthiscode.
• ProfessorKrugerwasaskedwhyshedidn’tfindagainstthecomplainantforthis.
Complainantbreachedcode?
24©Dr.ZoëHarcombe,Ph.D.
Whathappensnext?
• Closingarguments:4&5April2017• Paneldeliberate:6&7April2017• Verdictisdelivered:21April2017• Verdictwasdelivered28October2016!
25©Dr.ZoëHarcombe,Ph.D.
Whathappensnext?
26©Dr.ZoëHarcombe,Ph.D.
Andfinally...
“IlookforwardtothedaywhentheHPCSAwillcallforaninves6ga6onoftheveracityofthe
‘evidencebase’onwhichSouthAfricandie6ciansarecurrentlybeingtrainedanditseffectontheobesityanddiabetesepidemicthatiscripplingthehealthofthisna6on.”
ProfessorTimNoakes(responsetocomplaint2May2014)
27©Dr.ZoëHarcombe,Ph.D.
TheEnd!
MaytheLCHFForcebewithyou!
Thankyouforlistening☺
