No wonder we "on the inside" cannot adequately describe these somatoform disorders. Could it be, it must be asked, that on the contrary, these patients really are ill?
We are also asked to accept that healthism is a modern evil. The disgraceful fact, it would seem, is that the mob, distrustful of their doctors and a multiplicity of new and more lethal drugs, is actually out to improve its own health. This, of course, is the new curse of the age which should be stamped out by Prof. Weetman and his colleagues. The manifest absurdity of this view is beyond comment.
Perhaps it should be made clear why this flood of angry and disaffected patients seek out knowledge about their illness. Taking on board, for the sake of arguments, that a) they really are ill, b) they have through their researches learnt about their illness, and c) know the broad outlines of their treatment, if whatever they say is ignored, or put down to a functional somatoform disorder, then would not this response to their fate be entirely expected?
[According to Dr. Weetman] the mob, distrustful of their doctors and a multiplicity of new and more lethal drugs, is actually out to improve its own health. This, of course, is the new curse of the age which should be stamped out...-- Barry Durrant-PeatfieldBroda Barnes, whose pioneering and carefully researched work receives a passing mention in Prof. Weetman's article was of the opinion that perhaps 30% of folk by mid-life may have some level of thyroid dysfunction. The present writer who can lay claim to more than 40 years of practical experience with hypothyroidism and hypoadrenalism, sees no reason to disagree with this admittedly alarming statistic. Yet Prof. Weetman would have us believe that the majority of such sufferers are, basically, making the whole thing up. They cannot really be ill because the standard evidence gives them no support, and because they are told they are not. It is no help asking either, it would seem. They won't be listened to, and they won't be answered.
The new guidelines suggesting that patients should not be treated unless the TSH is over 10, is not only totally out of step with thinking elsewhere in the world - and especially the American Association of Clinical Endocrinologists - but is actually bizarre. There is a reference to the "risks" of a suppressed TSH, which are very much more imagined than real. What these new guidelines suggests, will condemn, certainly, thousands of patients to being refused treatment; and their consequent illness the result of their "functional somatoform disorder". Already, these guidelines have elicited a storm of protest, and it is to be deeply regretted that Prof. Weetman allies himself to this position. Quite what the agenda is that condemns so many patients to perhaps decades of ill-health, can only be wondered at. Worse, guidelines have a way of being set in stone, and then doctors who think outside the envelopes, will find themselves proceeded against, led perhaps by Prof. Weetman himself.
As we know, hypothyroidism may be manifest by a large number of symptoms and signs; and it may be instructive to pick out certain of them. We can include weight gain, depression and anxiety, arthralgia and rheumatic illness, and raised cholesterol. If the diagnosis of hypothyroidism is discounted - even forbidden - then the "functional somatoform disorders" must receive attention, and the caring practitioner, anxious to help, may find himself prescribing antidepressants, non-steroidal anti-inflammatories, statins, and weight loss agents. The disadvantages of this approach lie in the cumulative expense and multiplicity of side effects, apart from the fact that it is symptoms being dealt with and not cause.
Should the practitioner be able to overcome the hurdle of the diagnosis, then all the symptoms and signs could be treated using thyroxine, for a few pounds a month and usually with great success.
