Is the ADA Blocking Alternative Nutrition Providers Intentionally ?-Part I



Three months ago, I wrote an article for Forbes entitled “Is the American Dietetic Association Attempting to Limit Market Competition in Nutrition Counseling?” Notice the question mark at the end of the title.

At that time, I had access to only one already-available internal ADA document, which rabidly attacked market competitors, and seemed to imply that the ADA should take legistlative action to restrict this market competition.

(“We must be aware that existing legal and regulatory constraints on practice are unlikely to prevent robust, broad competition in these growth areas,” writes Pepin Tuma in that document; Tuma is now Director of Regulatory Affairs at the ADA.)

Despite the obvious implications of that document, at that time I did not have any direct “smoking gun” linking the ADA’s explicit intention to limit marketplace competition (expressed in that document), with its aggressive action in the legislative sphere to create the very kinds of dietetics practice acts, and state boards of dietetics, under which Cooksey was threatened.

All that has changed now.
In the wake of that original article, I received an email from Judy Stone, Executive Director of the Michigan Nutrition Association, a coalition of Michigan nutrition consumers and practitioners. The subject line of her email to me was “ADA Smoking Gun Document. Naturally, I was intrigued.

Stone showed me a new internal document which had just been leaked to her from someone from within the ADA. This new document was far more detailed than the one I had access to when I wrote the last article. In the new document Stone showed me, the ADA openly strategizes on how to create NC-like licensure laws and dietetics boards across all 50 states, for the express purpose of limiting competition.

With this new document, there is now direct evidence linking the ADA’s stated desire to limit competition, to their legislative action (about which the ADA lies to the public, by saying the laws they are creating and lobbying for are designed to protect public safety, not limit competition.)

This document—among many others—had recently been leaked to Stone and the Michigan Nutrition Association, by members within the ADA disgusted by the organization’s monopoly-seeking behavior in state legislatures.

(Stone told me: “The ADA has not just angered non-dietetics nutrition professionals, but its own members as well, many of whom simply don’t want to be associated with this kind of power-grabbing under the guise of protecting the public. Willingness to share incriminating internal documents is one of the only ways for those members to effect change in their trade organization run amuck,” alluding to additional documents she has ready to share.)

She also gave this internal ADA document to the Alliance For Natural Health, a longtime critic of the ADA. The Alliance has now published the document on the Web.

The document opens boldly: the purpose of the document is to help allow “the profession of dietetics to be identified as the preferred and qualified provider of nutrition services.”

The document focuses on what it calls a “Mega Issue,” which is this: “What is needed to create greater understanding among RDs/DTRs of the value of licensure and the importance of active engagement to the long term future of the profession?”

In other words, the “Mega Issue,” as the document puts it, has nothing to do with protecting public health or safety, as the ADA claims frequently when it talks about its licensure efforts in public and with legislative representatives. Rather, the Mega Issue focuses around protecting the health, safety (and presumably profit margin) of… the profession itself.

The internal document then goes into what can only be described as a tirade against competitors:

There is a proliferation of nutrition-related titles and credentials available to individuals seeking a foothold in the field. . . . Many aggressively challenge the notion that dietitians should have practice exclusivity outside of the clinical setting, and they continue pushing legislative initiatives that allow use of the “nutritionist” title and permit them to perform holistic and other nutritional counseling.

The ADA further bemoans that. . .

As government funding for preventative care and wellness increases and private insurers continue expanding clinical coverage to include visits to nutrition professionals, there will likely be a concomitant growth in the number of competitor health care professionals willing to provide some form of nutritional counseling. . . . Registered Dietitians and Dietetic Technicians, Registered (DTRs) face a significant competitive threat in the provision of various dietetic and nutrition services.

All of this is particularly bad, the professional association says internally, because:

State affiliates [chapters of the ADA] have experienced organized opposition to licensure in all states in which current laws have been proposed. Grassroot opposition has been focused on the American Dietetic Association and has included arguments that dietitians lack preparation to delivery wellness and nutrition care outside of the hospital setting, that licensure creates a monopoly and restricts freedom of choice of provider by the public, creates job loss for non-RDs providers. . . and that licensure requires those who practice to be members of ADA (Appendix A). Rather than respond individually to these media campaigns, ADA can achieve a position of strength by developing and executing an initiative that supports licensure and the dietetics profession while adding member value. [Emphasis added]

Notice the focus on “adding member value.” NOT “protecting the public” or “ensuring public safety” but “adding member value.” Again, spoken like a true professional association.

For the benefit of ADA lobbyists, the document goes on to provide a state-by-state chart (p. 7 of the document) of which states have enacting the restrictive licensing laws the ADA has been lobbying and pushing for over decades—the kind of laws that “add member value” by allowing the censorship of competitors such as Cooksey.

The chart contains a handy color coding. States that have full “Licensure” regulations on the books—the type of regulation under which Cooksey ran afoul, and which the ADA is actively trying to create in all 50 states—are highlighted in yellow. (North Carolina, of course, is in yellow. ADA, 1; Steve Cooksey’s free speech, 0)

States that have less-restrictive “Certification” regulations are highlighted in green. States that have even less-restrictive “Title Protection” statutes are highlighted in red. And states with “No statutes” are highlighted in gray.

The open intention of the ADA, as expressed in this internal document, is to make every state on that chart yellow—i.e., to create NC-like censorship laws in every state in the union—for the clear purpose of limiting market competition.

The document discusses in detail how a secretive unit within the ADA, the “Work Group on Licensure, Scope of Practice and Competition” (WGLSC) created a “Model Practice Act” in 2010 (Appendix B in the leaked document), designed to spread restrictive NC-like dietitian licensure laws across the nation.

The document states:

Key components of the dietetics licensure statutes include: title protection, scope of practice, practice exclusivity clause [the clause that got Cooksey], operations of licensure board [the board that got Cooksey]. . . .

The Model Practice Act will provide a foundation for affiliates [state ADA chapters as in NC] as they seek to lobby for their licensure bills. . . ADA can achieve a position of strength by developing and executing an initiative that supports licensure and the dietetics profession while adding member value.

ADA staff provides a licensure toolkit to all states seeking licensure and sometimes travels to states seeking licensure to assist with development of bill language, provide guidance on lobbying strategies and develop appropriate messaging. ADA often assists with selection of the lobbyist and provides guidance on how to effectively work with the affiliate lobbyist for licensure success. . . .

It is important that dietetics licensure acts maximize the registered dietitian’s unique skills and expertise in the scope of practice. All registered dietitians and dietetic technicians, registered need to be mindful in these competitive times that other practitioners are seeking expansion of their services, creating “scope creep”.

Finally, as if shocked—shocked!—that someone might consider all this anti-competitive and protectionist behavior to be monopolistic, the document includes, as Appendix A, a reproduction of a critical article entitled, “The American Dietetic Association’s Monopoly Continues to Grow—But You Can Stop it Cold!”

For some reason, the document blocks out the website and author of the article, but a quick Google search of the title reveals it to be a reproduction of this article from the Alliance for Natural Health.

In introducing it in the Appendix, the document states, ”The following is an excerpt from a website complaining that the ADA is a ‘monopoly.’ The website continues to provide information about multiple states negatively portraying ADA and our members.”

The critical ANH article excerpted in the document’s appendix contains the following choice statements:

New bills have been introduced in a number of states that will give the ADA a monopoly over the practice of nutrition therapy—these are the people in charge of wonderful hospital food. Please take action in your state to stop this power grab and ensure consumer choice! . . . .

This is the organization that lists among its corporate sponsors soft drink giants Coca-Cola and PepsiCo, cereal manufacturers General Mills and Kellog’s, candy maker Mars [… and Hershey’s], and Unilever, the multinational corporation that owns many of the world’s consumer products brands in foods and beverages.



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