An Australian doctor has become yet another collateral victim of a medical board extremely zealous in enforcing regulations for ignoring official nutrition guidelines.
Dr Gary Fettke has recommended low carb living for at least two years in his practice before the Australian Health Practitioner Regulation Agency (AHPRA) decided to silence him.
Fettke, who is trained as an orthopedic surgeon, discovered about low carb by doing his own research and has been lecturing at length about the science behind low carbohydrate, high fat (LCHF).
He and his wife founded a dietetic organisation called Nutrition for Life in 2014 to share and apply this knowledge to diabetes management.
But, Fettke was anonymously reported to the AHPRA health board who requested that he be banned from communicating nutrition advice in any way as a doctor.
Did AHPRA make an example of Dr Fettke?
Prior to AHPRA’s ruling, a 2013 Senate Inquiry highlighted the failings of AHPRA’s complaints-handling in order to guarantee public safety.
As a result of this investigation, there was a call for a more strict handling of complaints against practitioners by AHPRA.
This could have motivated relentless pursuing of legal action against Dr Fettke for giving out unsolicited nutrition advice in favour of low carb.
Gary Fettke: punished for speaking the truth
The dietary evidence points to a low carb diet as the only non drug-mediated way that people with diabetes can truly control insulin and stabilise their blood sugar levels.
For the majority of scientists interested in nutrition, if a new evidence-based approach provides better outcomes, then this evidence should be more explicitly reflected in patient care.
Sadly, with low carb, this is often not the case, for many regulatory bodies think that it is not within a doctor’s remit to advise patients about this diet.
Yet, Fettke’s patients have greatly benefited from his advice, and the diet reportedly caused no harm to any of them.
But, AHPRA considers that Gary is not an expert in the field of nutrition or diabetes, and therefore has no authority to give such advice.
The AHPRA has completely overlooked the fact that a great deal of Fettke’s patients suffered from weight-related joint issues and/or diabetes.
Fettke was therefore immersed in the scientific literature about diabetes and nutrition research for years.
Promoting high fat, low carb comes at a cost
The mere act of informing patients about low carb and recommending it to them on a voluntary basis can trigger serious consequences for doctors these days.
Meanwhile, patients are being given the wrong information and led to believe that there is nothing they can do besides treatment to help reverse their type 2 diabetes.
The current recommendation, of eating less and moving more, that patients receive has not been proven as effective as reducing carbohydrate intake in a growing number of studies.
In the UK, GPs tend not to give weight loss advice, because they know that standard recommendations don’t work, and, that if they push something like low carbing instead, they will be condemned for rebutting the official eat-well guidelines in use.
Doctors have to follow national guidelines, or they run the risk of receiving complaints for not maintaining standard of care.
As a result of these forces lined up against them, few actively promote low carb in their everyday practice, fearful of suffering the same fate as Tim Noakes in South Africa.
What are Fettke’s recourses?
Historically, decisions following investigations into suspected misconducts are usually final. There was, however, an exception in the case of a GP by the name of Dr Annika Dahlqvist, who had similar significant issues in 2005 in Sweden.
Dr Dahlqvist got exonerated after a panel of PhDs and MDs set up by the government spent two years reviewing 16,000 studies about low carb.
This finally came out with guidance that for people with diabetes who are overweight, low carb is a preferred diet from the science.
Dr Fettke did not get such a fair trial, as AHPRA’s investigation lasted only 137 days and resulted in no discussion of the science or chance of appeal.
For the remainder of his medical career, Dr Fettke can’t talk about nutrition on any platform, nor can he speak with his patients or the public about nutrition and the role he believes that LCHF can play in the management of diabetes.
The same restrictions also precludes him from participating in nutrition research projects with the aim of improving the health outcomes of his patients, and getting a degree in nutrition, as long as he remains a doctor under AHPRA’s umbrella.
The fact that many doctors promoting the low carb, high fat lifestyle are being ruthlessly attacked for doing so is a cause for concern.
But, it is about the message, not the messenger. The evidence is out there and nobody can stop this important message from being spread.
Keeping the LCHF message going
Shortly after the AHPRA’s ruling, Fettke sent out the following email to all his followers and low carb advocates:
It is with frustration that I write to inform you that I have been ‘silenced’, forever, by the Australian Medical Board, known as AHPRA.
We have a draconian system here in Australia where anonymous notifications can go in and they are investigated for public safety. The accused can only submit material but never have right of reply. It is a star chamber.
I recently got to present that ‘opinion’ of the process and the fabricated evidence at a Senate Inquiry. My evidence on the failings of AHPRA was granted parliamentary privilege which allowed a tell all opportunity.
Within a few hours I received an email final determination of the 2 ½ year investigation. Coincidence or just another kick in the guts?
My first notification in 2014 was from an anonymous dietitian for me advocating cutting back sugar intake to what is now the WHO recommendations.
Behind closed doors, with no right of reply or appeal, the goal posts shifted and I was investigated for the whole LCHF concept, for being disrespectful to health professionals (the Dietitians Association of Australia and the Heart Foundation, but never an individual) on social media and for failing to disclose a conflict of interest (COI) in our Nutrition for Life Centre, whilst on social media.
The good news is that AHPRA have decided NOT to argue the LCHF concept. I submitted enough material for a thesis and they have accepted that LCHF may be that the benefits of the LCHF lifestyle become the accepted best medical practice.
The central issue for my silencing has been that my primary medical degree and my further qualifications as an Orthopaedic Surgeon are not satisfactory to give nutritional advice. “The fundamental fact ‘is’ that you are not suitably trained or educated as a medical practitioner to be providing advice or recommendations on this topic as a medical practitioner.”
If it wasn’t so serious it would be farcical. This decision is non-appealable under National Law. The determination is life long and by its wording, does not allow me to even do research in the area or gain further qualification because that would involve me communicating in the area of nutrition. The only thing I have not clarified is if it affects international boundaries.
The other parts of the AHPRA decision I can live with:
I will not force anyone to eat LCHF, not that I ever did or ever could.
I will show respect to the medical profession (doesn’t stop me from thinking otherwise).
The COI allegation is unproven as I do declare my vested interest for all patients that I send to Nutrition for Life. I admit guilt for not doing that in social media but the doctor/patient relationship is not defined in that context. I pointed out to AHPRA that they shouldn’t be applying jurisdiction in an area that is undefined. That went down like a lead balloon.
I also pointed out that AHPRA don’t govern nutritional advice in Australia. Another lead balloon.
I had a recent notification, again from an anonymous dietitian, and have been investigated for ‘inappropriate’ reversal of someone’s Type 2 Diabetes and was also reported for what I was ‘about to say’ at a hospital food national conference. AHPRA actually asked me for a copy of my speech BEFORE I gave the talk. I refused as it was an infringement of the right of free speech.
AHPRA have just this week decided to close that investigation but have warned me that they will be observing me to see if a ‘pattern of behaviour’ continues, presumably in relation to reversing more patients’ diabetes.
I hear rumours that I have ‘attacked’ health professionals at a personal level – that is simply unfounded and I think started by some naysayers.
If this sounds like a horror story, it is. I honestly thought that this would just fade away but strange things do happen when you upset the ‘industry’. Just see what’s happening with Tim Noakes.
The only thing in Tim’s favour is that it has gone to court. Mine is a closed process with no right of appeal, unless I can continue to have politicians assist.
My next step is to challenge the process via more closed groups and that will be years of tying me up. I am going the public awareness path as the finding lacks the common-sense conclusion. We are liaising with some media channels and politicians. It’s all we can do”.
A petitition is currently circulating online to stop the gag order against Dr Fettke and defend the right of physicians to offer evidence-based dietary advice.