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Post-publication Peer Reviews to:
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![[Read P3R]](/icons/misc/sectionDOWN.gif){kind=icon}
Credentials of Dietitian
Prevention of future tragedies of this kind
Untitled
Request for Additional Information From Authors
Authors' response
Illinois licensure of dietitians and nutritionists
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Mark Rosenblum, Nutritionist / Dietitian Univesity of Miami
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mrosenbl{at}mednet.med.miami.edu Mark Rosenblum
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I am curious if the "dietitian" who recommended the megavit/minerals in this case had a license to practice (some states require licensure for practice) and / or was a registered dietitian. Was there any actions to take away this persons credentials after this incident? Some people claim they are nutritionists/dietitians and have no credentials or training/degrees from accredited schools. |
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Ellen O'Leary, clinical nutritionist (registered dietitian) Children's Healthcare of Atlanta
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ellen.oleary{at}choa.org Ellen O'Leary
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This is a terribly sad story; I would hope that steps have been taken to see that the nutrition practitioner does no more harm. If the practitioner is licensed by the state to practice nutrition, or is registered by the American Dietetic Association, then at the very least, censure with suspension of privileges should occur. An unlicensed practitioner is more difficult to stop. Unfortunately since "dietitian" and "nutritionist" are not protected terms, anyone can use them. This makes it more difficult to put a stop to such inappropriate nutrition practices. Your recommendation for pediatricians to elicit information on alternative medicine use in a supportive (ie non-confrontational, nonjudgemental) environment from parents is the best hope for preventing future tragedies of this kind. |
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Cory Mermer, Researcher/Writer Independent
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cmermer{at}aol.com Cory Mermer
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McGuire et al make several important points in their report, but I would like to add a few comments. Pediatricians should be aware of and monitor the use of alternative therapies, but only on the condition that they have sufficient knowledge in this area. My personal experience and those of many others is that they simply do not have this knowledge, nor do they care to learn. As far as monitoring goes, this is truly where the pediatrician can make significant impact. That is, of course, if there is real monitoring of alternative therapies with appropriate lab work. For example, in this case, the proper blood work would have revealed the excessive magnesium levels and averted this tragedy. However, I suspect that a vast majority of pediatricians would not have gone as far as performing the proper testing. McGuire et al are also correct in pointing out that this is a rare occurrence and should not serve to deter everyone from using overwhelmingly safe treatments responsibly, especially when used for treatment of conditions that conventional medicine has no answers for, as in this case. Lastly, I wonder if there is any connection with the child's mental retardation condition and the hypermagnesemia. For example, could there be an underlying metabolic disorder in this child which caused the inability to properly process the mineral, and which may have also played a role in the development of the retardation. |
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Kim Robien, Clinical Dietitian Fred Hutchinson Cancer Research Center
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krobien{at}fhcrc.org Kim Robien
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I also have to question whether the "dietician" [sic] in question is actually a registered dietitian. Granted, there can be wide variation in practice among health care professionals, but it is difficult to believe that someone with the training and experience necessary to become a registered dietitian would feel comfortable recommending a large dose of any nutrient without access to the patient/client's lab work. Without knowing much of the patient's past medical history, it appears from the laboratory values reported that this patient was pre-renal, indicating that he would be experiencing decreased renal clearance of excess magnesium. Whether this is a result of the magnesium therapy or a confounding issue is unclear. I would like to ask the authors to clarify these points. I would also like to point out that the mother appears to have had difficulty with many other issues that may have contributed to the unfortunate outcome of this case (not acting on symptoms for several days, disconnecting patient from the ventilator rather than calling 911), and that perhaps the true issue here is that increased home care intervention would have been the key to preventing this tragedy. |
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John K McGuire, Instructor of Pediatrics St. Louis Children's Hospital/Washington University School of Medicine
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mcguire_j{at}kids.wustl.edu John K McGuire
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We appreciate the comments regarding the case report presented. The majority of questions that we have received concern the credentials of the nutritional consultant and inquiries into whether she was a "registered dietician". The full qualifications and training possessed by the consultant in this case are not known to us, however she was a licensed nutritional consultant practicing under the Illinois Dietetic and Nutrition Services Practice Act. To our knowledge, she was not an "RD" as certified by the American Dietetics Association. The use of the word dietician was taken from the practioners own description of her work. The second category of questions concerns whether action was taken against the nutrional consultant. Neither we, nor the child's mother pursued legal action against this individual. As far as we could ascertain, she did not break any laws or violate the terms of the contract she had with this child's mother. We feel that this reinforces our point that physicians should be involved in the process of monitoring care given to their patients, whether it comes from conventional or non-conventional sources. Mr. Mermer's comments regarding the abilities and interests of practitioners in monitoring alternative care are valid. We hope that this report serves to alert physicians that this is a role that should be part of our responsibility to the patient. Physicians need to recognize that alternative therapies will be utilized by our patients, and that the skills necessary to monitor that care need to be obtained. As we stated in the discussion, physicians need not become familiar with all of the therapies out there, but should support open dialogue with patients and their families. We thank the respondents for their interest in this case and are appreciative of |
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Marla Heller, Adjunct Clinical Instructor University of Illinois at Chicago
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MarlaHRD{at}uic.edu Marla Heller
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The authors note that the practitioner was a Licensed Nutrition Counselor under the Illinois Dietetic and Nutrition Services Practice Act. The politics of getting this bill passed by the Illinois legislature and signed by the Governor involved many compromises to protect the ability of "nutritionists" to be able to work with medically compromised patients. The state legislature and the governor were concerned with avoiding a "turf war" between self-appointed nutritionists and Registered Dietitians, rather than giving first priority to protecting the public. The bill was watered down several times from its original version which would have mandated that only Dietitians would have been able to work with patients who needed to follow a modified diet as directed by a physician. The physicians along with a Registered Dietitian would have been the appropriate team to prevent this tragedy. |
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