Dear Dr. Guttler: Yes, patients deserve and should demand relief...

"[Mary Shomon] wants anyone with thyroid failure, that is still complaining of non-specific symptoms when all thyroid tests are normal, to demand continued search for a relief..." -- Richard Guttler, M.D.

So writes Richard Guttler, believing this to be a negative statement about me, in his latest web page update. Dr. Guttler has been receiving mail from outraged thyroid patients who responded to his recent comments about thyroid disease, patient advocacy, and my website. He has chosen to respond online, and so I have written an open letter to clarify some of the errors in his online response.

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Dr. Guttler:

I feel it's important to clarify some of the errors in your latest issue.

First, I have no relationship to ad sales at the About.com website. Just as it would be irrational to suggest that a columnist or writer at a newspaper has a relationship to the advertisers and ads that run in the paper, it's utterly irrational to suggest that I have any similar relationship. (Also note, I am a writer, I work as an off-site independent contractor, I am not a salaried employee of About, nor is About.com my "job.")

Second, suggesting in my article that readers "Drop him a line at Dr.Guttler@thyroid.com and let him know what you think of his website and newsletter" is a legitimate call for patients to voice opinions. It is not rational to depict that as a "call for an email attack on you."

Third, you say, "...unlike Mary's site we have no Ads, and receive no outside funds." I have no financial relationship with any thyroid drug makers, including Abbott (Synthroid), Jones, (Levoxyl, Cytomel, Levothroid), Forest (Thyrolar, Armour) or any other thyroid drug companies such as Genzyme (Thyogen). None. And companies that choose to advertise do so either with About's ad sales department, with which I have no input, control or contact, or with Google's advertising program, which runs ads on sites throughout the web, and again, I have no input, control or relationship with them. Again, keep in mind that columnist/reporter parallel, and you'll perhaps understand the connection, including the lack of any financial relationship. It's true that reporters for newspapers or magazines that have advertising are likely to keep working, versus newspapers or magazines who have no advertisers. Beyond that, there is no relationship between "editorial" and "advertising."

To state that you receive no outside funds is disingenuous. Your page states that the "Thyroid Home Page does not receive any outside funding..." and you go on to list most of the thyroid drug companies. (You do not, however, list in your disclaimer a drug you quite regularly mention at your site, Thyrogen, or its manufacturer Genzyme. Is that an oversight, or accurate representation?) At the same time, you readily shared, in announcing your decision to start charging every person a fee to answer their emails, that "Several years ago with an educational grant from a large drug company, I answered email questions from thyroid patients..." So, while they weren't funding the site per se, the pharmaceutical company was paying you.

And that is just one instance beyond the quite literal and semantic interpretation of "funding for the Thyroid Home Page." How many more are there? Because as you phrase it, you may be receiving various funding, having consulting relationships, or accept funding for your Santa Monica Thyroid Diagnostic Center -- funding that is not earmarked specifically for the Thyroid Home Page.

To that end, I would ask how often in your career -- since starting medical school -- have you personally, via the Santa Monica Thyroid Diagnostic Center -- the corporation of which you are sole owner -- or via anyone in the employ of you or the Santa Monica Thyroid Diagnostic Center:

1. accepted free drug samples that came from a pharmaceutical company?

2. accepted any gifts -- including food, meals, cookies, gift items, logo items such as prescription pads, pens, patient literature, office accessories, etc. -- from a pharmaceutical company?

3. received funding for any research projects, research papers, domestic or international travel, web projects, presentations, speeches, symposia, panel participation, etc. that came either directly from a pharmaceutical company, or 2nd generation -- meaning it was given by a pharmaceutical company to an organization that accepts pharmaceutical sponsorship or research money for use in funding said research, travel, projects, honoraria, etc.

4. attended a professional meeting where meals, hotel, incidentals, symposia, cocktail receptions, rounds of golf, or other events were paid for all or in part, or sponsored by, a thyroid drug company?

5. received honorarium, funding, in-kind items, equipment, or financial support from pharmaceutical, research, equipment, or other medical companies?

It's also pertinent to note at minimum that Dr. Carole Spencer, the "Lab Director" in your employ, is head of the American Thyroid Association, which receives extensive funding from pharmaceutical companies, including Abbott (Synthroid.) She also lists in her online CV that she has served as a consultant to Abbott Diagnostics (maker of thyroid tests), Genzyme Corporation (maker of Thyrogen) and Knoll Pharmaceuticals (former maker of Synthroid.) Typically, consulting implies a financial relationship.

We are coming from polar opposite perspectives. It's clear to me how opposite we really are when I read your statements such as these, and I quote you exactly:

"Other similar symptoms, such as fatigue, and weight gain are not thyroid related if the testing is stable and normal."

"T4 always converts to T3 when given to hypothyroid ambulatory patients. One hormone, T4, given causes the body to make the T3 in every cell of the body."

"Thyroid hair loss does not occur if you have normal thyroid testing, T4, T3, and TSH."

and my favorite...

"We have the most accurate thyroid testing, and if you test normal, and have symptoms most likely your symptoms are not due to abnormal thyroid balance"

I know you truly believe your opinions are true, as you have been consistent about them over the years. But we most definitely differ on these issues, as well as many of the most basic aspects of what constitutes quality care for thyroid patients.

In my case, since 1997, my motto has been, and will continue to be, "We're Patients...NOT Lab Values," and I believe patients deserve practitioners who share that fundamental core belief and attitude.

My position has always been, and will continue to be, that the best thyroid medicine for every patient is the one that works best and safely for each of us, and yes, that can include Armour and Thyrolar -- among many other options, including Synthroid, Unithroid, Levoxyl, Levothroid, Cytomel, and compounded T3 -- and potential new options on the horizons.

I have allegiance only to my fellow thyroid patients and their welfare, and am not beholden financially or otherwise to powerful pharmaceutical interests.

And finally, I maintain that patients who continue to have symptoms -- and I do consider fatigue, hair loss, weight gain, depression, low libido, miscarriage, infertility, etc. to be related to hypothyroidism -- are not condemned to a life of ill health. People who do not feel well on one therapy -- despite "normal lab values" -- should seek other doctors and/or safe and effective conventional or alternative treatments in order to feel as well as possible. And my independence allows me to say so.

I believe thyroid patients don't deserve any less.

Live well,

Mary Shomon