The team of nutritionists at D’avignon Digestive Health Centre on Danforth Avenue in Toronto are an impressive bunch — just consider their qualifications:
- Louise Comtois – CNP, RNCP, Colon Therapist
- Heidi Horowitz – CNP, RNCP, Live Cell Analyst
- Marnie Ryan – CNP, Colon Therapist
- Natasha Audette – RHN, Colon Therapist
- Jane Sloan – CNP, NNCP, RhA
CNP, RNCP, RHN, NNCP. I single out D’avignon only because they came up at the top of my Google search, but the story is consistent across the nutritionist community — there are an awful lot of letters next to the names of practitioners. So what exactly do they all mean?
Let’s start with the CNP, or Certified Nutritional Practitioner, since 4 of the 5 nutritionists above sport it. This designation is provided by the Certified Nutritional Practitioners Council of Canada (CNPCC) to graduates of select programs in Canada, such as the Applied Holistic Nutrition program offered by the Institute of Holistic Nutrition (IHN). Other programs that qualify under the CNPCC’s criteria include…
Hmm. It seems there aren’t any other programs: according to the IHN’s Certification page, “The designation CNP is earned exclusively by graduates of IHN.” Which seems odd for two reasons. First, the three Canadian trademarks for “CNP” are owned by other people (two of which, strangely enough, are also CAM-based). And second, because that would mean the CNPCC — this Canadian Council that actually confers the CNP designation — only exists to accredit the graduates of one school.
So is the IHN’s program the only one that meets the CNPCC’s exacting criteria, or is something strange going on here? Checking the CNPCC website doesn’t help much…because it doesn’t exist. In fact, the only hits I could find on Google for the CNPCC were on the sites of IHN graduates.
So I called the IHN, and indeed the CNPCC is really just the school itself. To be honest, given the pretense apparent online, I was expecting to encounter some level subterfuge on the topic, but both individuals I talked to (Head Administrator Sancha Fenster and recent graduate and trade show coordinator Jennifer Papaconstantinou) were refreshingly guileless. They informed me that upon graduation, students receive two pieces of paper — a Diploma in Holistic Nutrition and a CNP certificate — and some graduates go on to practice based on the strength of these alone. But for many, this is only the beginning of their certification odyssey.
The Tale of Two Ladies in Brantford
That’s because the CNP is not the only designation that the IHN’s program qualifies for — graduates are also eligible for the RNCP and ROHP designations from the International Organization of Nutritional Consultants (IONC). And unlike the CNPCC, the IONC is actually a third party organization that confers its designation on the graduates of multiple schools.
Yet those programs aren’t quite as international as the organization’s moniker makes out — there are eight, and all but one is in Canada (the other is in California). The organization’s headquarters, according to their website, is at 115 George St. in Oakville, Ontario — here’s a picture courtesy of Google Maps.
Now perhaps it’s not that unusual for an international organization to be run out of a PO box, but it did set my warning bells ringing, so I did a little more digging. Their site doesn’t list an executive, but two names came up on some of the advocacy letters they posted on their legislature page — Irene Yaychuk-Arabei (President) and C Carleton-Fitchett (GM). Given the uniqueness of Irene’s name, she wasn’t too hard to find — she’s a “holistic health educator” working at a small practice called Holistique in Brantford, Ontario, which appears to be a home office. Who else works and (according to Canada411) lives there? You guessed it, Catherine Carleton-Fitchett.
So what, you say? Well here’s the thing — the organization doesn’t appear to do all that much. They certainly can’t keep their trademarks in order — despite saying on their site that “The RNCP and ROHP certificate issued is the property of IONC,” a CIPO search finds nothing for ROHP and the mark for RNCP abandoned.
They do write a quarterly newsletter, send off the odd lobbying missive to the government, and provide discounted liability insurance rates. It was this last point that both contacts at IHN mentioned when I asked about the organization, though Papaconstantinou admitted that you can get discounted insurance from a lot of places. Beyond that, what they mainly appear to do is cash cheques from the 590 active members listed in their member directory. Their designations cost $350 apiece, bringing a cool $200,000 a year into the family business.
This isn’t just just my impression. In the numerous discussions I had with the various schools and other organizations in preparation for this article, it wasn’t too hard to read between the lines what they thought of the IONC. Typical were the words of Wendy Gibson, Executive Director of the (rival) Canadian Association of Natural Nutritional Practitioners:
It’s all a bit political. What happened was there was one professional association for 20 years – IONC – but not a lot really happening. People would graduate and join, and then fall away from it as the years went on. I didn’t really see a value – you’d pay them $400 to become a member, and wouldn’t get much out of it. But because they were the only association for so long, there was the impression that once you graduated, that’s what you had to do.
No one would say outright that they thought it was a con game — why would they tell an “outsider” like me? — but several laughed knowingly when I made a more delicately worded suggestion to that effect. Gibson was somewhat more forthright: “[They’re] supposed to be a not-for-profit, and they claim to have 700 members, and they charge them $400/year, so where’s the money going? There’s no accountability.” She was one of several who recommended I ask them directly what they spend their revenues on. So I did just that.
I spoke to Penny — one of the two part time office workers who put in 10-12 hours a week handling the paperwork. So there are at least some salaries going out the door, I thought as she introduced herself. Yes, Penny confirmed, Fitchett does draw a salary as GM — she didn’t know how much — but beyond that couldn’t provide any details of the association’s expenditures. She promised to find and send me a financial statement, but it never arrived.
One thing I did confirm though: they’re not spending their money on patient protection. When I asked about how they enforce their standard of practice and deal with patient complaints, I was told that they don’t get involved in that, and would refer them to the liability insurer instead. This, it turned out, was a common refrain among the certifying organizations I talked to.
So something certainly seems askew in Brantford, but the thing that struck me most was the role of the school here. Rather than protect their students from this sort of thing, the schools that participate actually advertise it as an advantage. The Alive Academy says they’re “proud to be affiliated” with the IONC. The Longevity Center says, “Our Level II advanced program is designed to meet the needs of the student who is pursuing the R.N.C. or R.N.C.P. designation.” Similar messages appear on the websites of the College of International Holistic Studies, the Edison Institute of Nutrition, Hawthorne University, the Natural Health Consultant’s Institute, and of course the IHN.
Why do they support it? I got no clear answer, but some clues emerged in my discussions. The first and most obvious is that — like the fictitious CNPCC that turned out to be the IHN itself — it’s a way for schools to communicate their “legitimacy” in an unregulated industry. Papaconstantinou was quick to point out that while many schools’ graduates will qualify for the (lower tier) RNCP, IHN’s graduates also automatically qualify for the (higher tier) ROHP because their program is more intensive. She then rattled off 5 courses that differentiate the school from its competitors, as if to drive home the point that IONC blessing is great marketing for the school. But beyond that, I have to wonder about one of the things Fenster said: that to keep up the IONC designations requires 25 hours a year of continuing education. If it wasn’t already clear how the incentives in this equation flow, she reminded me that the IHN offers CE courses to fulfill those credits.
More Legitimate Legitimacy?
There does seem to be one school willing to buck the trend, however — The Canadian School of Natural Nutrition (CSNN) fails entirely to promote their IONC-approved status. They used to, but not anymore. In fact, Penny said that the CSNN now refuses to provide their curriculum to the IONC for review, so CSNN graduates no longer automatically qualify for the IONC designations.
Touch of conscience perhaps? Don’t bet on it. The shift was co-incident with the recent rise of the Canadian Association of Holistic Nutritional Professionals (CAHNPro) — an organization the CSNN seems pretty close to, considering it operates out of their Toronto East campus and all 10 of CAHNPro’s board members are CSNN graduates.
So what does it do? Their stated objective is quite simple: to create sustainable employment in holistic nutrition, the most important component of which is getting them added to the list of paramedical services that insurance companies regularly pay for. At the macro/national level, they’re attempting to create legitimacy for the industry by encouraging the cross-school consistency required for government — and insurance company — recognition, and conducting holistic nutrition research to bolster the field. (Unfortunately, none of this seems to be available yet, but when I spoke with Eleanor Healy at CAHNPro, she referenced weight loss, diabetes, and perinatal studies ongoing). At the micro level, they provide career services, an apprenticeship program, continuing education, and “Board Certification” for graduates. Of course these aren’t free. The two year apprenticeship, which begins upon graduation from the approved program (CSNN, IHN, and Edison qualify), costs $995. Once completed, senior members pay $300/yr to keep their status. Continuing education courses are offered online through CAHNPro, at a cost ~$600 a year for the two courses required to meet the annual 25 hour CE requirement.
Start doing the math on their 220 members, and it’s already making at least as much as the IONC — and they’re only a year and a half old. Perhaps that’s justifiable given the difference between their service levels. Healy admitted that she used to be an IONC member, but was disappointed by the fact that she “didn’t really hear from them, except for the newsletter.” On a purely economic level, it does seem to offer much better value for the dollar, though there are still holes compared to what a typical regulated professional association would provide.
For example, I asked Healy the same question I asked the IONC about professional standards and the investigation of patient complaints. She told me that there wasn’t any need for such things because “basically we can’t do any harm. We’re a different designation than a Dietitian who works in a hospital and can do harm. Our protocols can’t cause harm.” Nope, no harm could could possibly be caused by bad diet advice.
And this points back to CAHNPro’s main purpose which, again, is to build a market through insurance company recognition — an activity that clearly benefits the participating schools by raising demand for their courses. Still, I can’t help but wonder if this isn’t also a direct response to the success of the IONC and the similar organizations I’ll discuss in Part 2 — an attempt by the schools, esp. CSNN, to repatriate the money being spent on third-party accreditation. Though I attempted to tease this out of the schools in my interviews, I wasn’t able to confirm such a motive — again, why would they tell me? — so it remains merely a plausible theory.
And There’s More
Terrifying as it may be, we haven’t yet gotten to the darkest regions of this strange world we’re exploring, so I’ll pick up where I left off in the second instalment tomorrow. Then, in Part 3, we’ll compare these various flavours of nutritionist with their science-based alternative: the Dietitian. [Read Part 2]
Photo courtesy of Inspired RD via Flickr under Creative Commons
*This blog post was originally published at Skeptic North » Erik Davis*