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Whose Health is It Anyway, Tony?

A Response to AP Weetman's 3/06 Anti-Patient Editorial in Clinical Endocrinology

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Updated December 30, 2012

Whose Health is It Anyway, Tony?

"Nothing seems more straightforward than treatment of hypothyroidism..." -- Tony Weetman

In a stunning display of medical condescension, endocrinologist AP "Tony" Weetman, Dean of the Medical School at the University of Sheffield in the UK, has written a derogatory, anti-patient editorial on thyroid disease, titled "Whose Thyroid Hormone Replacement is it Anyway?" It's a frightening view into the mind of many of today's endocrinologists, and the tired dogma that guides how they practice, but it's a must-read for any informed patient. It's available online at Medscape (free login required), and published in the March 2006 issue of the journal Clinical Endocrinology.

It's All In Your Head

In his editorial, Weetman states that patients who have "normal thyroid function tests" but insist they should be treated for multiple thyroid symptoms actually have "somatoform disorders." Sounds very medical and official, right? But make no mistake..."somatoform disorders" is medicalspeak for hypochondria. That's right. Weetman is saying is that if your tests are normal -- and apparently, even if you have a host of thyroid symptoms, a family history, and a goiter the size of a melon -- the diagnosis is simple and straightforward: you have a psychiatric condition. Yes, it's all in your head.

Why is it so easy to write you off as a mental health problem? Because "nothing seems more straightforward than treatment of hypothyroidism," says Weetman. According to Weetman, "we have robust assays to diagnose the condition and an effective replacement in the form of synthetic thyroxine."

Weetman doesn't explain, however, how it's all so straightforward. For example, consider the Colorado Thyroid Prevalence Survey, which found in 2000 that an estimated 13 million Americans may actually have an undiagnosed thyroid condition. And in 2003, the American Association of Clinical Endocrinologist's recommended narrowing of the TSH normal range to .3 to 3.0 means that as many as 59 million Americans have thyroid disease -- the vast majority of them undiagnosed.

And if synthetic thyroxine is such an effective replacement for the real thing, why, in the Colorado study, did they find that among patients taking it, only 60% were within the normal range of TSH? (And this was according to the old .5 to 5.0 standard.) And why did the Thyroid Foundation of America find in a study that more than half of all Graves' disease patients suffered what were obvious thyroid-related symptoms, after having radioactive iodine and being stabilized on levothyroxine therapy?

The reality: It's not as straightforward as Weetman seems to believe.

What IS Normal?

Despite dismissing patients with normal thyroid levels and symptoms as having mental health problems, Weetman never actually defines or identifies what "normal" is. This exposes one of the biggest flaws in his argument. Because he cannot declare that symptomatic patients have mental health problems if they have "normal thyroid function" if he hasn't even established scientifically what normal is.

The fact is, endocrinologists cannot even agree on what the so-called normal range is for the popular "TSH" test. The TSH Reference Range Wars have been raging for several years now, and show no signs of a cease fire.

Even today, you can ask two equally qualified endocrinologists to interpret the results of a patient with a TSH test score of 4.0. One doctor would say that patient was hypothyroid, and the other would have to, according to Weetman's logic, declare that the patient does not have a thyroid problem, but rather, has "somatoform disorders" and requires mental health treatment.

So, following objective fact -- a process Weetman holds up as the scientific ideal -- yields two opposite, yet supposedly equally valid diagnoses and courses of treatment.

Is it any surprise then, that patients are, as Weetman says, "dissatisfied with and mistrustful of standard medical advice." Because, depending on which doctor you talk to, for patients with a TSH of 3.1 to 5.0, they are being diagnosed and treated according to two totally opposing objective standards. This is science? I'm afraid not. It's actually plain ivory tower arrogance, with a little insecurity thrown in.

The problem is that endocrinologists like Weetman have found themselves incapable of properly diagnosing and treating their patients, or effectively resolving their symptoms. Rather than seeking to research and understand the problem, they fall back on the oldest trick in the book -- blame the victim. "We can't explain it, so it must be in their heads."

Some Doctors Are Dissatisfied Too

Some doctors are clearly dissatisfied with Weetman's standard medical advice too. These practitioners are not basing a thyroid diagnosis solely on the results of one test. These are doctors who actually know how to apply the art of medicine, who use a combination of judgment, and experience, and medical skills -- and not, like Weetman, just a chart with numbers -- to practice medicine.

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