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Credentials of Dietitian |
1 February 2000 |
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Mark Rosenblum,
Nutritionist / Dietitian
Univesity of Miami
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Re: Credentials of Dietitian
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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Prevention of future tragedies of this kind |
2 February 2000 |
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Ellen O'Leary,
clinical nutritionist (registered dietitian)
Children's Healthcare of Atlanta
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Re: Prevention of future tragedies of this kind
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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Untitled |
26 February 2000 |
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Cory Mermer,
Researcher/Writer
Independent
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Re: this article
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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Request for Additional Information From Authors |
8 March 2000 |
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Kim Robien,
Clinical Dietitian
Fred Hutchinson Cancer Research Center
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Re: Request for Additional Information From Authors
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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Authors' response |
8 March 2000 |
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John K McGuire,
Instructor of Pediatrics
St. Louis Children's Hospital/Washington University School of Medicine
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Re: Authors' response
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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Illinois licensure of dietitians and nutritionists |
10 March 2000 |
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Marla Heller,
Adjunct Clinical Instructor
University of Illinois at Chicago
Send letter to journal:
Re: Illinois licensure of dietitians and nutritionists
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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