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Professional Accreditation, Credentials and Licensure

by T. Colin Campbell, PhD

For almost 50 years, I have designed and directed large research projects in the areas of nutrition and health.  As a result of this experience, I have come to realize that most nutrition and health information is very misleading. It is no coincidence that we now have a health care crisis which is very expensive and which compromises the quality of life for millions of Americans and others living on a Western-style diet.  

The reason for this nutrition misinformation is largely due to who controls its development and dissemination. During the last several years—a time when our book The China Study (co-authored with my son, Tom) was published—I have spent much of my time trying to understand why diet and health information is so misleading and confusing. I especially have wanted to understand how the line that divides government's responsibility to promote health and industry's responsibility to make a profit have been blurred.

One of my most rewarding experiences has been to meet practitioners who are using the information described in our book (and related books) to help patients to regain their health, in spite of the fact that they have little or no training in nutrition.  I have learned of hundreds of cases in which the progression of serious conditions like cardiovascular disease and type 2 diabetes has been stopped, and in some cases completely reversed, as a result of using this information.

However, my contact with these health care professionals has brought to light another serious problem, namely that Americans are relying on medical information that, like nutrition information, also is terribly misguided. The reasons in both cases primarily involve the aggressive influence of private industry and special interest groups in the training of those medical practitioners who are then licensed to offer advice about health and healing to an unsuspecting public.  

Many health care consumers have become disillusioned with traditional health care. Similarly, individuals entering the health care field as professionals have become equally disillusioned with traditional health education strategies. I also have known would-be professionals interested in nutrition who do not want to pursue traditional dietetics programs because they strongly disagree with the American Dietetic Association who shamelessly promotes an industry-friendly but unhealthy dietary message.  Even some people with a sincere interest in medical practice, do not do so because they disagree with the reductionist approach to health care taught in traditional medical schools (using out-of-context drugs and supplements to treat symptoms, rather than a wholistic approach of diet and lifestyle to address the cause of the condition). Because of this troubling environment, an increasing number of people are seeking education programs outside of traditional medical and nutrition education. They are becoming nutritionists instead of traditional dietitians, and naturopaths, chiropractors and osteopaths instead of medical doctors, for example.

I have known about the main health care occupations that are licensed and recognized (nurses, doctors and dietitians, for example) but relatively recently learned of still more.  Coming down from my ivory tower, I have been more than pleasantly surprised at the exceptional knowledge and competence of many of these people.

On the history of health care regulation in the U.S., an interesting pattern has emerged to show that health care practice groups seek licensure not only to regulate and promote high quality practice, but also to keep others from engaging in their practice as competitors, an age-old human foible.  Medical doctors achieved licensure, and as a group, then spent enormous amounts of time and money to discredit osteopaths.  Once osteopaths gained licensure status, they joined with the MD's to discredit chiropractors.  Chiropractors eventually gained licensure, and have joined with the MD's and DO's to discredit naturopaths and other health care occupations that are still not licensed or regulated in most states.  As history has shown (osteopaths and chiropractors were never a threat to public health), the attempt to discredit those who have different medical philosophies and training is simply to protect turf and titles.

During my lengthy career, I have been faced with many difficult decisions concerning scientific evidence that too often is confounded by this question of who is professionally entitled to say what to whom. Often it has come down to my questioning of the widely accepted polices and standards that determine professional credentials and institutional accreditation, although I fully acknowledge the need to establish these standards. Indeed, I want to make abundantly clear that I endorse the need for standards that make clear who is legitimized to professionally participate in the health professions. But I am also increasingly concerned that too often we are relying on people because of their professional credentials than on their knowledge and competence. There are others, like myself, who also have similar concerns. If not acknowledged and seriously discussed, I fear that the standards that give professional structure to our system will begin to erode the system itself.

I know well people with highly credentialed degrees that entitle them to positions of power and public responsibility but who make contrary decisions against the public's interests in favor of their own interests. In contrast, I also know people who are making outstanding health contributions in the best interest of the public but who do not meet the guidelines and standards of professional credentials and accreditation. These contrary examples represent a serious miscarriage of professional justice and responsibility.

Nowhere is this problem more acute than it is when speaking about nutrition Medical schools who train the individuals with the most widely recognized medical and health credentials (MDs) offer no teaching or training in nutrition and treat the topic, at best, as 'alternative'. Fundamentally, the science of nutrition, at its most fundamental level, is the antithesis of the science and practice of medicine. Further, professionally accredited nutrition schools who award graduate degrees (MS, PhD) teach nutrition and do research that heavily favors a reductionist approach to biology—rather similar to a pharmacological approach—that has little no relevance to public health and, for that matter, even little relevance to nutrition. Even the nutrition curriculum established for the training of registered dietitians (RDs) at accredited institutions who offer this degree is controlled by the American Dietetic Association which is nothing more than a mouthpiece for the food and drug industries.

This presents a serious dilemma for the public as well as for my colleagues and me, as we develop this website. If we wish to use within our website the most talented and productive practitioners in nutrition, must we limit ourselves only to those individuals with credentialed degrees (MD, PhD, RD) obtained from institutions and programs that ignore and even eschew nutrition as a serious science? Or do we go beyond this imperial castle to seek the services of those who have gained knowledge of the subject and who have obtained superior clinical results? This is a painful dilemma, for why should we feel constrained, either legally or through public perception, to maintain our reputation by working only with state-sanctioned professionals when their training is either non-existent or is professionally biased in favor of the for-profit industry?

Insofar as nutrition is concerned, the contemporary standards used to establish professional credentials and institutional accreditation are indeed very blurred and have come close to being a mockery of public health. We can do better. My views of professional nutrition legitimacy in no way can be decided solely by the present professional standards. The only criterion that we will use to seek professional participation in this website will be on the basis of an individual's demonstrated performance in providing reliable nutrition information and service to the public. We will, of course, honor professional credentials but will do so in a transparent manner. Although we will appropriately take advantage of professional credentials and accredited institutions, we will not be held hostage to them.

Standards of education and training in the health sciences are important in preparing an individual for professional service. However, I believe that we have too often abused the use of these standards for determining important issues like curricula, licensure and agency directorships (for example, and with one exception, why must directors of NIH and FDA be limited only to those who have an MD?). In this instance, the public needs to know that nutrition (based on whole plant-based foods) is the chief contributing factor to good health and good medical practice (both physical and mental) but, regrettably and notably, it is almost completely ignored as a legitimate biomedical science by those perceived to have the 'highest' medical credentials but who have no training in this subject. For the credentialed and accredited institutions of medical practice and biomedical research to label nutrition using pejorative language is worse than unconscionable. It is immoral.

In summary, I challenge the way we too often use credentials and accreditations to determine professional legitimacy and participation in the health sciences. I do not mean to scrap the present system but simply to improve on it. And in this effort, we would do well to begin thinking about the fundamental bases upon which our medical disciplines are constructed. In doing so, we could better evaluate the use and misuse of our standards.