1. Sheila Turner and Eric Pritchard Sheila Turner and Eric Pritchard United Kingdom says:

    Vision, Purpose, and Objective of the Royal College of Physicians http://www.rcplondon.ac.uk/Pages/index.aspx


    RCP Statement: "Educated to the Highest Medical Standards":


    FACT:  The medical science of the post thyroid aetiologies of the symptoms of hypothyroidism, circa 1970, is systematically ignored and dismissed - has been proven once again. [2-4]


    RCP Statement: "Leading Role in Delivering High Quality Patient Care":


    FACT: Patients are ignored in favour of laboratory assays. When the "subjective" patient presentation conflicts with the "objective" blood test, the test results take precedence - the source of the conflict is not investigated - it could be that the test is improper or improperly interpreted as thyroid function tests are for post thyroid deficiencies. The medical care of the post thyroid deficient patient is essentially no care. The prescription by the Royal College of Physician for these victims is chronic suffering and increased susceptibility to disease, especially life's great killers, diabetes and heart disease. [5-16]


    The RCP is not leading the way towards high quality patient care but following the improper, unethical care of peripheral thyroid hormone deficient (post thyroid) patients required by other medical associations, British [17-19] and American [20-25]


    The RCP guidance on the diagnosis and management of primary hypothyroidism is not logically consistent. It also does not adhere to linguistic standards of care set in the 17th Century and does not adhere to protocols for authoring medical practice guidelines set forth by the American Association of Clinical Endocrinologists [26] and others.


    If this statement on the diagnosis and maintenance of primary hypothyroidism were examined as studies on medical practice guidelines [27-29] would do, it would be judged a failure, probably an abject failure.


    RCP Statement: "Championing the Values of the Medical Profession":


    FACT: The medical care prescribed by the RCP for the post thyroid deficient patient violate numerous standards of medical ethics. Briefly they are the following:



        
    • Provide a Good Standard of Practice and Care. Keep Your Professional Knowledge and Skills up to Date. The UK General Medical Council (2006)

    •   
    • Make the Care of Your Patient Your First Concern The UK General Medical Council (2006)

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    • Be Honest and Open and Act With Integrity. The UK General Medical Council (2006)

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    • In the treatment of a patient, where proven prophylactic, diagnostic and therapeutic methods do not exist or have been ineffective, the physician, with informed consent from the patient, must be free to use unproven or new prophylactic, diagnostic and therapeutic measures, if in the physician's judgement it offers hope of saving life, re-establishing health or alleviating suffering. Where possible, these measures should be made the object of research, designed to evaluate their safety and efficacy. In all cases, new information should be recorded and, where appropriate, published. The other relevant guidelines of this Declaration should be followed. (World Medical Association - Helsinki, 1964)


    RCP Statement:"Improving Standards of Clinical Practice":


    FACT: The clinical practice prescribed by the RCP for the post thyroid deficient patient IGNORES medical science, the differential diagnostic protocol, and evidence based medicine.


    Medical science has acknowledged the existence of the post thyroid operations upon thyroid hormones - the conversion of the relatively inactive pro-hormone, thyroxine (T4), to the active hormone, triiodothyronine (T3) and the reception of T3 by the peripheral cells for the use in their nuclei. But these are not included in any differential diagnostic expressed or implied. The evidence proffered by this medical science must be considered as part of clinical practice. However, the routine thyroid laboratory assays do not examine post thyroid behaviour. And the RCP has effectively banned all other potential tests. This is contrary to the wisdom of system testing, which demands testing before and after every major function. Even more basically, the RCP is effectively covering up the shortfalls of medicine for the post thyroid deficient patient in the fog of imprecise language which confuses these issues by describing physiologically different issues by the same names and terms. [30].


    The care of post thyroid deficient patients is distinctly not centred on the patient. It is, however, centred upon one or more quite unprofessional human frailties, such as ignorance or improper dismissal of relative medical science.


    The improper diagnosis of "functional somatoform disorders" unfairly blames the patients' imaginations for their treatable physical deficiencies. [31] The improper blaming of inadequate medicine with "nonspecific symptoms" also unfairly condemns the patient to life-long chronic suffering. [4]


    If the RCP statement were truly patient centred it would not proscribe the therapies that have been proven necessary in so many patients and are necessary in so many more. A study discovered of those treated for hypothyroidism, 13% were dissatisfied with their medical treatment and care [32] and worse. [33] These high dissatisfaction rates are neither caring nor professional.


    RCP Statement:
      "Supporting Physicians in their Practice of Medicine":


    FACT: The RCP, by issuing the subject statement, has joined other professional societies in forcing a professional dilemma upon medical practitioners: Treat post thyroid deficient patients ethically and scientifically and face the wrath of the General Medical Council - or not treating the patient properly or ethically. Either way, this is hardly being supportive of the practice of medicine in the niche of post thyroid deficiencies. [30] The RCP is setting a standard of care in the post thyroid deficiency niche which is unreasonably below the potential demonstrated by medical science.


    RCP Statement:  "Provide Leadership on Health and Healthcare Issues":


    FACT:  The RCP, in support of various endocrinology associations relative to the knowledge, diagnostics, and healthcare for the post thyroid deficient patient, has not lead - but retreated from modern medical science, embraced the imprecise language of this niche of medical practice, and created the basis for enforcement for virtually torturing of all post thyroid deficient patients. This is distinctly not healthcare leadership.



        
    1. The Royal College of Physicians, The Diagnosis and Management of Primary Hypothyroidism, November 2008, Endorsed by the Royal College of General Practitioners made on behalf of numerous endocrinology associations

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    3. Gossel, TA, Endocrinology Continuing Education accredited by the Accreditation Council for Continuing Medical Education (ACCME), 2005

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    5. Garber JR, Hypothyroidism-Talking Points 2006, AACE

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    7. "Wilson's Syndrome," American Thyroid Association, Nov 1999 updated May 2005

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    9. Starr, Mark MD, Hypothyroidism Type 2, Mark Starr Trust, Columbia, MO, 2005

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    11. Lowe JC, The Metabolic Treatment of Fibromyalgia, McDowell Publishing Company, 2000

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    13. Barnes, B MD, Hypothyroidism: The Unsuspected Illness, Harper & Row, 1976, pgs 142-144, 178-181

    14.   
    15. American Thyroid Association, Hypothyroidism, ©2005, a patient brochure available at the ATA website: http://www.thyroid.org

    16.   
    17. Hypothyroidism, a publication by the American Association of Clinical Endocrinologists and supported by Abbott Laboratories. 2006 & 2008. http://www.thyroidawareness.com

    18.   
    19. Nikoo MH, Cardiovascular Manifestations of Hypothyroidism, Shiraz E-Medical J, 2(1) www.sums.ac.ir/.../hypothy&heart.htm

    20.   
    21. Hak AE, Pols HAP, Visser, TJ, et al., Low Thyroid Function Without Symptoms as a Risk Indicator for Heart Disease in Older Women, Ann of Intern Med, 15 Feb 2000, 132(4):270-278

    22.   
    23. Camacho PM, Dwarkanathan AA, Sick Euthyroid Syndrome, Postgraduate Medicine , April 1999, 105(4)

    24.   
    25. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC, The Colorado Thyroid Disease Prevalence Study, Arch Intern Med, Feb 28, 2000, 160(4)

    26.   
    27. Thyroid Problems Increase Risk of Heart Disease and Death, American Thyroid Association, Oct 1, 2004

    28.   
    29. Kvetny J, Heldgaard PE, Bladbjerg EM, and Gram J, Subclinical Hypothyroidism is Associated with a Low-Grade Inflammation, Increased Triglyceride Levels, and Predicts Cardiovascular Disease in Males Below 50 Years, Clin Endocrinol, August 2004, 61(2):232

    30.   
    31. Iervasi G, Pingitore A, Landi P., et al., Low-T3 Syndrome - A Strong Prognostic Predictor of Death in Patients With Heart Disease, Clin Physiol Inst, American Heart Association ©2003

    32.   
    33. Hypothyroidism - Clinical Features and Treatment, a publication of the British Thyroid Association, www.british-thyroid-association.org/guidelines.htm

    34.   
    35. Vanderpump MPJ, Ahlquist JAO, Franklyn JA, et al., Consensus Statement for Good Practice and Audit Measures in the Management of Hypothyroidism and Hyperthyroidism, BMJ, August 1996

    36.   
    37. UK Guidelines for the Use of Thyroid Function Tests, The Association for Clinical Biochemistry, British Thyroid Association, British Thyroid Foundation, (2006), www.british-thyroid-association.org/guidelines.htm

    38.   
    39. Baskin HJ, MD, Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism, Am Assoc Clin Endocrinol, 2002, Rev 2006

    40.   
    41. Levy EG, Ridgway EC, Wartofsky L, Algorithms for Diagnosis and Management of Thyroid Disorders, http://www.thyroidtoday.com

    42.   
    43. The American Thyroid Association provides links to several hypothyroidism related guidelines: "Use of Laboratory Tests in Thyroid Disorders," "Treatment Guidelines for Patients with Hyperthyroidism and Hypothyroidism," and "Guidelines for Detection of Thyroid Dysfunction."

    44.   
    45. Levy EG, Hypothyroidism Treatment Failure: Differential Diagnosis, http://www.thyroidtoday.com,

    46.   
    47. Garber JR, Hennessey JV, Lieberman JA, Morris CM, Talbert RI, Managing the Challenges of Hypothyroidism, Supplement to J of Fam Pract, 2006, http://www.jponline.com

    48.   
    49. Kaplan MM, Clinical Perspectives in the Diagnosis of Thyroid Disease, Clin Chem, 1999, 45:8(B) 1377-1383

    50.   
    51. Mechanic JI, Berman DA, Braithwaite SS, Palumbo PJ, American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Practice Guidelines, Endocr Pract, 2004, 10(4), Particularly Table 4

    52.   
    53. Shaneyfelt TM, Mayo-Smith MF, Rothwangl, J, Are Guidelines Following Guidelines?, JAMA, May 26, 1999., 281(20)

    54.   
    55. Grilli R, Magrini N, Penna A, Mura G, Liberati A, Practice Guidelines Developed by Specialty Societies: The Need For a Critical Appraisal, Lancet, Jan 8, 2000.

    56.   
    57. Burgers JS, Fervers B, Haugh M, Brouwers M, Browman G, Cluzeau PFA, Internatinal Assessment of the Quality of Clinical Practice Guidelines in Oncology Using the Appraisal of Guidelines and Research and Evaluation Instrument, J Clin Oncol, May 15, 2004, 22(10)

    58.   
    59. Pritchard EK, "The Linguistic Etiologies of Thyroxine-Resistant Hypothyroidism," Thyroid Science http://www.thyroidscience.com - click on "debate."

    60.   
    61. Weetman AP, Whose Thyroid Hormone Replacement is it Anyway? Clin Endocrinol, 2006;64(3):231-233

    62.   
    63. Saravanan P, Chau F, Roberts N, Vedhara K, Greenwood R, Dayan CM, 2002, Psychological Well-Being in Patients on "Adequate" Doses of L-Thyroxine Results of a Large, Controlled Community-Based Questionnaire Study, Clinical Endocrinology, 2002, 57: 577-585

    64.   
    65. Turner S, Hypothyroidism Patient Survey Results, Thyroid Patient Advocacy-UK, http://www.tpa-uk.org/tpauk_survey.pdf  

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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