The problem is that, because many physicians are biased by the financial and advertising influence of Synthroid -- the profitable, top-selling thyroid drug, and one of the most prescribed drugs in America -- many patients never learn that there is any other option besides Synthroid. I find it highly unethical for doctors to fail to make patients aware of the options, even more so if the practitioners have a financial incentive to promote one drug over another.
It's worth noting that when attempting to educate regarding medical ethics, Rosenthal owes it to readers to disclose her family connections to drug companies. For example, her husband Kenneth Ain has personally been beneficiary of financial support from Abbott Laboratories, manufacturer of Synthroid, a levothyroxine drug.(7) Both Rosenthal and Ain also participate in a number of professional groups that similarly receive major drug company funding, including from Abbott. Readers deserve to know about such an intimate personal connection with the top-selling thyroid drug in America.
Thyroid Facts and Fiction
By criticizing patient advocacy books as offering misinformation, Rosenthal is implying that there is somehow agreement and consensus among experts about what even is considered misinformation. The fact is, there is no consensus . Instead, there is controversy amongst practitioners over the most basic facts regarding thyroid diagnosis and treatment.Certainly, Rosenthal is entitled to her opinion about others' work, but any scholarly critique of advocacy publications -- especially when her own works are noticeably absent -- should at least reflect a thorough knowledge and understanding of the source material she is criticizing.
For example, as mentioned earlier, endocrinologists do not even agree as to how to use the TSH test to detect hypothyroidism, or what levels constitute "normal." This alone means that the foundation upon which all conventional hypothyroidism diagnosis and treatment rests on is shaky at best.
Varying studies have been published presenting opposing perspectives on the usefulness of T3 treatment for hypothyroidism. Some studies have found that normal TSH, with elevated antibodies, is evidence of disease that warrants treatment, and may even prevent overt hypothyroidism.
These are just a few points that refute Rosenthal's charges of "misinformation." For a charge of misinformation to be more than just an opinion, there must be agreement. And since we fail to see agreement on many basic issues, it's clear that thyroid disease diagnosis and treatment is not black and white. Like much of medicine, the study of the thyroid is an evolving body of knowledge, filled with controversies and explorations.
The Bioethical Implications of Thyroid Treatment
Bioethical princples say that practitioners should have as their goals to avoid harming a patient, and to proactively provide help to a patient -- in essence, they should not pass up an opportunity to help a patient if such an opportunity is presented.In the case of RAI, is it ethical for a practitioner to fail to discuss options such as antithyroid drugs that might prevent a permanent, lifelong chronic disease -- hypothyroidism -- or to inordinately push patients toward a permanent, more invasive option in the absence of overwhelmingly compelling medical reasons?
Respect for the autonomy of patients is another fundamental bioethical principle. And fundamentally, I believe that patients deserve to know their options -- levothyroxine, liotrix, desiccated thyroid, supplemental liothyronine, and/or compounded thyroid drugs -- and deserve a practitioner willing to work with them to find the treatment approach that safely works best for them.
Respect for the autonomy of thyroid patients is crucial. In the end, Rosenthal's article raises a key question for me: How does denigrating patient advocacy web sites, listserves and books -- or suggesting that patients are so muddled or anxious that they can't even make their own decisions -- ethically contribute to the welfare or autonomy of thyroid patients?
Note: You can share your thoughts about her article with Sara Rosenthal directly by email.
Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," "Living Well With Chronic Fatigue Syndrome and Fibromyalgia," and the "Thyroid Guide to Fertility, Pregnancy and Breastfeeding Success." Click here for more information on Mary Shomon.
