Who Should Control Nutrition and Diet Advice?

Should RD’s be federally annointed gate-keepers of diet advice?

That’s the question asked by Andy Bellatti.

In my opinion, no. 

He breaks the issue into two components:

1). Corporate lobbying by big companies on the ADA that propogates bad advice

2). The usefulness of licensure itself to validate professionals and protect the public.

If I understand him correctly, he’s skeptical of the ADA (American Dietetic Association) about number one, but more understanding about the latter point, while still harboring doubts. 

As with everything he writes, it’s thoughtful and worth the read. So go read it.

I’ll add my two cents. Keep in mind I’m not an RD, and am one of those people spouting off about nutrition without licensure. So maybe I’m biased. You be the judge.

Concerning the first point, it’s important to realize that anytime you create a monolithic organization that singlehandedly controls access to something, you’re creating a locus of control that’ll eventually be exploited by well connected insiders. It’s the nature of the beast. You can lobby to make the pertinent members in the system more virtuous, but that misses the key point: any system that requires virtue among a small group of people to function is a lousy system! In engineering “fault tolerance” is the principle that the best system is the one that can withstand damage to the greatest number of individual components and not break. Businessmen and engineers internalize the concept in a lot of what they do. Monolithic gatekeeping and fault tolerance are anti-thetical to one another.

The issues surrounding point two are more subtle. 

In a sense, the licensure issue is a bit like the open source vs. closed source debate. 

The problem boils down to the best filtering mechanism. Is it a professional exam and schooling (licensure) or the collective wisdom of the crowds? (Open source).

Proponents of licensure would contest that you need the “rigor” imposed by schooling to ensure good quality, but I think that point misses the dynamics at work in open source. If you’re working open source you’re most likely doing it because you love it, which is why you’re doing it for free. So while it’s true that any ol’ dude with a laptop can start a blog and spout off diet advice, the darwinian mechanism tends to turn it into a choice of the best amateurs doing it for free vs professionals that are doing it because they get paid. (I understand that lots of dieticians probably love their job and are good at it, so don’t bite!)

Proponents of the ADA are also over-looking a damning point: How much is the RD used as a means to communicate diet advice anyway? I’d argue not as much as many RD’s would like to admit. I’m sure most RD’s spend a good portion of their days helping people with nutritional advice and spreading wisdom, but the vast majority of people have been consuming their nutrition news through magazines, websites, and gossip for a long time….not through RD’s.

And lastly, the issue is an empirical one at heart. A simple way to answer the question would be to look at studies that measure the impact occupational licensure has on professional quality. This has been done many times already.

I’ll do the heavy lifting for you and provide you with some results.

If you’re curious, Adam Smith was the first to discuss the issue of occupational licensure in The Wealth of Nations in 1776. It’s an old issue. 

Simon Kuznets and Milton Friedman (two nobel laureates) discussed the issue of licensure repeatedly in the 1940’s arguing that it worked more like a medieval guild than a public service.

Here’s a paragraph from a summary paper written about the benefits of occupational licensing (emphasis added by me):

One of the major justifications for occupational licensing is that it increases service quality. Yet the available studies offer little evidence that licensing individuals has an impact on the quality of service received by consumers. For example, my examination of data from Wisconsin and Minnesota finds no evidence of differences in consumer complaints between Wisconsin, which licensed certain health care occupations, such as physical therapists, respiratory care providers, and physician assistants, and complaints to state boards in Minnesota, which certified the same occupations.

The idea that appointing a single group as the sole gatekeepers of anything, be it diet advice, medical services, or mortgage brokering, is an old chestnut that, in my opinion, needs to die. Gatekeepers benefit a few, but those are usually the well connected, which in turn hurts the many.

The biggest price in annointing gatekeepers is the dog that never barks. Centralizing advice has all the downfalls of committee based decision making, and squelches the ability of passionate amateurs with different viewpoints to contribute their part.