This year's effort, sponsored by the maker of top-selling thyroid drug Synthroid, is themed "Target Your Numbers." The "numbers" message emphasizes the importance of the Thyroid Stimulating Hormone (TSH) test results.
Somehow each year, AACE manages to choose as its theme something that isn't particularly relevant to thyroid patients, while overlooking the essential issues. This year, in 2006, is unfortunately no exception. AACE and its endocrinologist members have again proven that they are, as I've referred to them in the past, "the accountants of medicine" -- more interested in the numbers than in actual human patients and how we feel.
In response to the "Target Your Numbers" campaign, I have one response:
We are patients... we are NOT numbers, and we are NOT lab test values.In my decade working as a thyroid patient advocate, I have always felt it was crucial that patients understand that tests are only one component of a skillful thyroid diagnosis. Every successful, patient-oriented thyroid expert I know views test results as just one part of a comprehensive diagnostic process that includes a thorough clinical examination, detailed patient history, and careful evaluation of symptoms.
The AACE's "Target Your Numbers" theme, however, shows how little the endocrinology specialty values the art of medicine. Endocrinologists, for the most part, prefer to rely on blood tests instead of their own observations, common sense, and the experiences of their patients. It's inexplicable.
They are also "campaigning" themselves out of a job. Because, if diagnosing and treating thyroid disease is as simple as "targeting the numbers," as AACE says, then why would a thyroid patient ever need to see an endocrinologist? Any family doctor, GP or physician's assistant -- or even a computer program, for that matter -- can spit out a diagnosis and prescription slip based solely on numbers on a lab report.
What is perhaps most disturbing about the campaign is that the endocrinologists -- led by the AACE -- do not even agree on the "numbers" they are so eager for you to target!
According to the January 2006 AACE press release,"The optimal goal TSH level for patients on treatment ranges between 0.3 to 3.0 mIU/L."
What AACE doesn't tell you, however, is that if you have your blood tested at most laboratories in the United States, the normal range for the TSH test is typically 0.5 to 5.0. The laboratories have not adopted the "new" range as of early 2006. So if you test between 3.0 and 5.0, for example, your lab results will be marked as "normal."
The AACE is conveniently breezing right past this ongoing, nearly four-year battle between two opposing camps in their own community. (For background, read The TSH Reference Range Wars).
On one side are the endocrinologists who continue to follow the old range, diagnosing and treating according to the TSH normal range of 0.5 to 5.0. The laboratories also continue to use this older range for testing and lab reports.
On the other side are the endocrinologists who believe that doctors should follow this newer, narrower normal TSH range of 0.3 to 3.0, as recommended by AACE and the National Academy of Clinical Biochemistry.
And in addition to these opposing camps, there are also doctors who simply haven't heard of the new range, and since labs aren't flagging results as abnormal, these doctors just don't know any better.
The implications are staggering.
One 2005 study found that if the upper portion of the normal range was lowered to 3.0, approximately 20% of the population are hypothyroid. That means 59 million people in the U.S. are hypothyroid, and the vast majority of them undiagnosed.
So, if we're going to take this 2006 campaign to heart and "target our numbers," AACE needs to answer some questions -- something they're not very good at, in my experience. (Read Dear AACE: You Still Haven't Answered Our Questions!)
If AACE wants to target anything, I'd suggest they choose as their target figuring out responses to the following four questions, whose answers will have a critical impact on the health of millions of Americans!!!:
What are the four questions?
