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Charity Registration Number 1138608
Thyroid Patient Advocacy challenges the Royal College of Physicians to end, once
and for all, the long standing controversy between Endocrinology and the quarter
of a million patients who continue to suffer the symptoms of hypothyroidism,
even after the recommended treatment.
Royal College of Physicians Mission: “We will be relentless in our pursuit of
improvements in healthcare and the health of the population. We will achieve this by
enhancing and harnessing the skills, knowledge and leadership of physicians in setting
challenging standards and encouraging positive change based on sound evidence”…
“Our historical mission of ensuring that medicine is practised to the highest standards
remains almost entirely unchanged… Our strategic framework will ensure that we
remain central to providing the best health services in the modern world”
The RCP’s Curriculum Fails Doctors
TPA believes that education on the subject of thyroid problems is flawed because
of the failure of the RCP’s curriculum1 which goes against the requirements by the
General Medical Council.2
There is no mention in the RCP curriculum of ANY training relating to peripheral
metabolism and peripheral hormone reception physiology (Euthyroid
hypometabolism)
There is no guidance in ‘The Map of Medicine’ 3 (accredited by the RCP) regarding
recommended diagnostics and treatment of Euthyroid hypometabolism. The need
for ‘other thyroid hormones’ is established by medical science,4-6 with
incontrovertible potential for deficiencies in somatic functions,7-13 for example]
and patient counterexamples.14
Euthyroid hypometabolism (EH) has been known to medical science for over 60
years, after medical practice had been warned of inadequate therapy with T4
monotherapy. This science has been ignored.
Yet, this practice not only persists, it has now been institutionalised by the RCP.15
Although it is alleged that the RCP policy statement refers only to
primary hypothyroidism, it does make restric tions that go beyond
primary hypothyroidism.
The majority of patients with the symptoms of hypothyroidism are
diagnosed and treated reasonably however, many are not satisfied with
their therapy. 1 6
The universally accepted Differential Diagnostic Protocol17 requires the
examination of ALL the physical issues, and recommends that ALL potential
causes for the patient's symptoms should be listed and scientifically tested,18-21
before bogus, patient-blaming excuses are postulated, such as “functional
somatoform disorder”, as cruelly propounded by Professor A P Weetman in his
paper “Whose Thyroid Hormone is it Anyway?” 22
The fact that mental issues cannot be tested objectively requires that they be
regarded as a diagnosis of last resort. Sharpe, et al.,23 indicated that “symptoms
are defined as ‘unexplained’ after disease has been excluded. Historically, which
diseases have been considered necessary to exclude (and the means of detecting
them) has depended on the state of medical science” as well as what medical
practice is willing to accept. The available medical science demonstrates that
there are more possibilities,24-26 but medical practice ignores or dismisses them.
27-29
However, this ignoring is not proper because there are patientcounterexamples.3032
The RCP Curriculum does not refer to any possibility of ddeficiencies of iron,
ferritin,33-36 B12,37 vitamin D3,38 folate,39,40 magnesium,41 copper, 42,43
Zinc,44,45 as common causes of patients with residual symptoms, or that sleep
apnoea,46 depression,47 adrenal insufficiency,48 relative adrenal insufficiency,49
Candida albicans,50 pre-diabetes (or diabetes),51 or undiagnosed coeliac disease
should be investigated.52 Neither does it mention other possible causes such as
failure of the mitochondria, 53 or Euthyroid hypometabolism.4,5
Ideally, when such tests are undertaken, there is only one cause left, and that
cause is treated. If there are none, the list of potential causes should be checked
for completeness. Failure to address these issues is a failure to meet the
diagnostics standard of care, yet over a quarter of a million sufferers in the UK
remain dissatisfied with the way they feel. They are told their blood tests (often
only TSH is measured) are ‘normal’, and that their symptoms are ‘not specific’, or
due to depression, over-eating, or they have some other patient-blaming
condition.
Because of the curriculum failure and endocrinology’s acceptance of ‘non-specific’
symptoms, patients are prescribed Prozac for depression; Amitriptyline for
fibromyalgia; anti-inflammatories for musculoskeletal pain; oral contraceptives
for irregular menses; low levels of antibiotics for acne; Viagra for loss of libido;
Ritalin for ADD; Allopurinol for gout; and/or Lipitor for high cholesterol and
others, too numerous to mention here. These prescriptions are costing the DoH
millions of pounds and places a heavy burden of responsibility on the NHS.
The RCP admits that “Patients with continuing symptoms after appropriate
thyroxine treatment should be further investigated to diagnose and treat the
cause,15 but the curriculum FAILS to indicate what tests should be done to carry
out these further investigations.
The RCP have made no attempt to evaluate the available scientific evidence
regarding diagnostics and therapy, the use of T3 or natural thyroid extract for
those patients who do not do well on T4 monotherapy. This wholesale dismissal of
the available scientific evidence, amounts to medical negligence.54-149
Our opinion is that the RCP’s and the Endocrinology Establishment’s view of the
greater thyroid system, is too narrow. TPA has produced, in association with a US
Researcher, a Table (see Appendix ‘A’). This begins with the familiar
hypothalamus-pituitary-thyroid gland axis and extends through peripheral
conversion sites, peripheral cellular hormone receptors, and the peripheral cells,
with support from the adrenals and the elimination of waste. Whilst it is not the
whole answer to the problem of education, we believe it is a starting point and
would welcome the RCP incorporating this in to its curriculum.
This problem is further exacerbated by the ‘Thyroid Function Testing Guidelines
(July 2006)’, BTA, Assn of Clinical Biochemists’ (ACB) and British Thyroid
Foundation (BTF),150 which also ignores a basic protocol of medicine - differential
diagnosis. The Guidelines appear to assume that peripheral metabolism and
peripheral hormone reception functions never fail, thereby ignoring all other
potential causes of the symptoms. TPA believes that this may, in part, be due to
the imprecise language currently used in describing ‘hypothyroidism’ (see heading
Imprecise Language).
The RCP is offering little in the way of credible evaluation of the available
scientific evidence, or the use of Liothyronine (T3) and/or Natural Thyroid
hormone for those patients failing on T4 monotherapy.
Endocrinology Fails Patients with Symptoms of
Hypothyroidism
There are no official Guidelines in the UK relating to the diagnosis and treatment
of sufferers from symptoms of hypothyroidism. Instead, doctors are forced to rely
on consensus statements drawn up by an independent panel of experts. All
grading systems, including the World Health Organisation (WHO), place
consensus statements and expert opinion by respected authorities, as the poorest
level of evidence, because they have failed to recognise new concepts and
treatments, based on up to date research as published in the medical literature.
150-156
A recent example of this was when the British Thyroid Foundation (BTF) teamed
up with ‘NHS Choices’ to present an Online Clinic on Thyroid Disorders, (January
2012),157 which turned out to be a fiasco. The panel of experts (drawn from
members of the British Thyroid Association (BTA)) became overwhelmed by the
sheer volume of questions, and were unable to enter into any debate with
questioners - as befits a forum. The online clinic served only to confirm the
opinion held by this charity, that inadequate training is resulting in poor, or no
diagnosis or correct treatment for over a quarter of a million patients in the UK.
This view was corroborated by Dr Kerbel (GP representative for the British
Thyroid Foundation),157 who apologised for “the poor deal patients are getting
and admitted “there is still a lot of substandard practice around because of a
problem with training & education, and that it is not only knowledge that’s lacking
– it’s experience, training and learning how to manage what is a complex,
difficult, and challenging condition”.
It is TPA’s belief that the problem of lack of knowledge and training, but perhaps
not the extent of it, has been known about for some considerable time. However,
the Royal College of Physicians (RCP), the General Medical Council (GMC), the
BTA and the Endocrinology speciality as a whole, have failed to address this,
thereby causing unnecessary suffering and real harm to patients, failed by
inadequate diagnostics and the correct thyroid hormone therapy.
Imprecise Language
‘The Linguistic Etiologies of Thyroxine-resistant Hypothyroidism’,158 by E.
Pritchard, published by Thyroid Science, addresses a very grave mistake that
doctors and researchers make in developing the concepts of hypothyroidism and
thyroid hormone therapy.
A logical examination of a continuing medical education course,159 and the
Medical Practice Guidelines for Hypothyroidism,160-167 finds that they are not clear.
158
There is a total lack of appreciation of the two physiologically different definitions
of ‘hypothyroidism’, believed to be equivalent prior to 1967. The RCP and the BTA
definitions are not equivalent
The RCP (London) defines hypothyroidism as: "The clinical consequences of
insufficient secretion by the thyroid gland"
This is the correct and narrow definition, which can, hopefully, be treated with
T4-only medication.
The BTA defines hypothyroidism as "The clinical consequences of insufficient
levels of thyroid hormones in the body"
In our opinion, the broad symptom-oriented BTA definition should therefore not
be called Hypothyroidism. Taber’s Cyclopedic Medical Dictionary suggests that
deficiencies in the hypothalamus-pituitary-thyroid axis, plus the potential
deficiencies in the peripheral metabolism and peripheral hormone reception,
which are recognised by science, and named “Euthyroid Hypometabolism”(EH).
The BTA broad definition fails to provide any diagnostic tools or therapy
recommendations for those with impaired cellular response to thyroid hormone.
The T4-only therapy is decidedly NOT applicable to EH, and may even be
questionable treatment for those with symptoms of hypothyroidism.4 ,5
In 1997, endocrinologists attempted to correlate the classical symptoms and
physical findings associated with hypothyroidism with modern thyroid blood tests.
This was the first study in almost 30 years in which doctors attempted to
demonstrate the clinical efficacy of thyroid function tests. Results were published
in the Journal of Clinical Endocrinology:
“It is of special interest that some patients with severe biochemical
hypothyroidism had only mild clinical signs, whereas other patients with
minor biochemical changes had quite severe clinical manifestations. Thus,
we assume that tissue hypothyroidism at the peripheral target organs
must be different in an individual patient. Therefore, the clinical score can
give a valuable estimate of the individual severity of metabolic
hypothyroidism”.168
This is an excellent illustration of EH, without the authors even being aware of it.
There is no doubt of the existence of peripheral hormone and peripheral
metabolism of T4 to T3. There are many readily available references. EH seems
relatively common, yet Endocrinology appear to be unaware of its existence.
Note that Thyroid Hormone Resistance (THR) is a rare condition 169 and is
physiologically different to EH and the two must not be confused.4,5
The RCP must either disclaim peripheral thyroid hormone deficiencies, or explain
their diagnostics and their proper therapy.
The reality of medical science and the need for linguistic care has yet to penetrate
the hypothyroidism guideline/statement authorship committees. The RCP web site
sets out their Clinical Guideline Standards.170
There is an urgent need for the RCP to indicate which Guideline Standard was
used for the statement on the Diagnosis and Management of Primary
Hypothyroidism.170
If the language used to describe these conditions was precise, this problem would
disappear. If Endocrinology continues with its ambiguity, those patients with
continuing symptoms will be doomed to continue with their suffering.
Liability under the Law of Torts
The Law of Torts requires inter alia that individuals, or organisations, in this case
- the RCP, should “know or should have known”171 of the available evidence and
current scientific knowledge in order to issue guidance which would not lead to
tortfeasance, resulting in harm to patients. By ignoring all of the following, the
RCP policy statement demonstrates numerous tort liabilities.
It is the opinion of TPA that those quarter of a million patients being left to
endure the symptoms of hypothyroidism, and who are not being afforded
appropriate treatment, can be described as having suffered through the tortious
acts of the RCP, BTA et. al., and should be liable for compensation through the
courts.
The RCP and BTA have:
1. Ignored warnings in medical science of the failure of T4 monotherapy.
(Kirk & Kvorning, 1947),172 (Means, 1954);173 (Baisier et al., 2001).174
2. Ignored the greater activity of T3 over T4. (Gross & Pitt-Rivers, 1953).175
3. Ignored the potential for euthyroid hypometabolism (Goldberg, 1960).4,5
4. Ignored the physiology discovered by (Refetoff, 1957176 and Braverman
1970)177 that connects the thyroid gland to the peripheral, symptomproducing cells.
5. Ignored the 14% of those treated with T4 monotherapy who are
dissatisfied with their treatment (Saravanan, 2002).178
6. Ignored the long term study showing the failures of endocrinology to
mitigate the symptoms of hypothyroidism (Baisier, Hertoghe, and
Eeckhaut, Circa 2001)174 that showed better clinical and laboratory
diagnostics treating patients with T3.
7. Ignored the existence of numerous subsequent studies on the
characteristics of peripheral conversion or metabolism of T4 to T3, and
peripheral cellular hormone reception functions.54-149
8. Ignored patient counterexamples to T4-only therapy where successful
treatment with T3 has been achieved.179
9. Ignored findings showing that intracellular chemistry depends upon T3,
not T4.4,5
10. Ignored demands of differential diagnostic protocol.17
11. Ignored linguistic and logical standards of care.158
12. Ignored the very common syndrome of thyroid and adrenal deficiency.48-49
using observation and medicine practised as an art.180 as the primary
diagnostic method, with the laboratory playing a secondary role.
13. Ignored the science showing the above syndrome has global effects
14. 181 with imbalance of other hormones, the likely presence of systemic
candida and dysbiosis, malabsorption and food allergy, all playing a
probable role.
15. Ignored their Duty of Care.182
Proof exists that the BTA and RCP have:
1. Established the fiction that T3 is universally ineffective. (Various anti-T3
studies and meta-analyses, circa 2000-2006)
2. Effectively banned all T3 therapies from consideration for treatment for
those who need it.
And by the above, plus maintenance of the above negligence, in spite of “knowing
or should have known”, Endocrinology continues to condemn a quarter of a
million patients to a miserable existence.
RCP and BTA Adherence to False Statements
The RCP stance is that they do not support the use of natural thyroid extract or
Liothyronine (T3) without further validated published research. TPA is puzzled by
this stance as there is no validated research published to show that T4
replacement is safe and effective for all patients. Studies show that for many
people, T4 is harmful by virtue of its ineffectiveness, therefore, the proposition
that T4 is safe and effective for all patients is false.183-192
The RCP and the BTA have long claimed that T4 monotherapy is effective for
most hypothyroid patients. Of four T4 versus T4/T3 studies published in 2003, T4
replacement was found to be ineffective for many hypothyroid patients.193,p.14
At that time, at least six other studies had shown this to be true.194-200
Absent a clear duty of candour, the linguistic abuse will continue to sour relations
between doctors and patients; misrepresentation of T3 as an inactive hormone,
whilst maintaining that T4 is active is a nonsense.
The ‘AGREE’ Collaboration Appraisal of Guidelines and Evaluation Instrument 201
provides a validated, internationally agreed framework for assessing the quality
of clinical practice guidelines. All recommendations should be linked to a list of
references on which it is based. The RCP policy statement fails to supply these
references, rendering it invalid.
Three years ago, a ‘new’ RCP report - ‘Innovating for Health’,202 found that
patients:
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



“Are worried about obtaining access to the most effective medicines to
treat their particular needs.
Want doctors to be free to prescribe the most effective drug based only on
clinical need.
Would like more choice, including choice between generic and branded
alternatives in the same drug class.
Are concerned that cost may be more important than efficacy in
prescribing or access to medicines decisions.
Wished that national decisions to make drugs available were uniformly
honoured at local level.
A UK-wide medicines strategy would be able to address these issues, with the
creation of a new Medicines Technical Advisory Group (MTAG), involving the
medical profession, the pharmaceutical industry, regulators and patient
organisations. The joint working strategy would pool untapped expertise across
many organisations. It could defuse conflict, provide a forum for constructive
discussion, enhance transparency and build trust.”
TPA would greatly welcome such a strategy.
Statements on BTA’s web site,203 which the RCP endorses, that synthetic T3/T4
and Armour Thyroid (and by extension, Erfa ‘Thyroid’, Nature Throid and
Westhroid) work no better than T4 monotherapy, are also presented as fact, but
are not substantiated.
These statements have contributed to the belief, endemic within Endocrinology,
that T3 is of no use and this alone has probably caused more suffering and
dysfunction than any other blunder in the history of medicine. Scientific facts
patently show the falsity of those statements.204
Failure of the RCP to take account of research constitutes a fraud.
Dr John Lowe repeatedly asked the BTA Executive Committee to respond to
specific points in a rebuttal he wrote to those statements, but received only an
acknowledgment from Dr Allhabadia, promising further consideration of the
matter after consultation with the RCP.205
This consultation has not yet happened and should be arranged as a matter of
urgency, with a view to either amending the BTA’s statements, or removing
them.
The Department of Health and doctors are, without question, accepting that the
RCP’s and BTA’s statements are scientifically accurate, leading them into making
decisions on behalf of patients that adversely affect their health and well-being.
The BTA mentions clinical trials in their statement that directly bear on its
conclusions, but fail to cite any of these. The medical literature contains at least
twenty two reports of studies in which researchers compared the effectiveness
and safety of different thyroid hormone therapies.206-218
Among the therapies compared in the studies were T4 monotherapy, desiccated
thyroid, and combined synthetic T4/T3. Instead of referencing these studies,
however, the Committee cited only two papers in which authors reviewed the
most recent studies that compared T4 monotherapy to synthetic T4/T3. One of
those papers is a review of the studies by Escobar- Morreale et al.,185
and the other is a report of a meta-analysis by Grozinsky-Glasberg et al.195 (see
Appendix ‘B’).
These two publications deal with synthetic T4/T3 therapies only and should NOT
have been included in the BTA statement on Armour versus T4-only therapy.
Both contain factual errors and unbalanced presentations of data, excluding, or
limiting data, favourable to T4/T3 therapies. Specific examples of these errors are
included in Dr Lowe’s rebuttal.196
Maintaining the T4 monotherapy, even for patients with continuing symptoms, as
Grozinsky-Glasberg, et al. 195 recommend, has the effect of weakening patients
with continuing symptoms, since they do reflect the reduction in the patient’s
natural ability to fight disease, particularly life’s great killers, diabetes and heart
disease.
The RCP, the Executive Committee of the BTA, Escobar-Morreale et al., and
Grozinsky-Glasberg et al. should correct their false statements of fact as well as
their unbalanced presentations of data relevant to their conclusions.
Patients have the right to benefit from medical practice guidelines/policy
statements that are scientifically correct, linguistically precise, logically
consistent, with no loose ends, and no overstatements.
Defective T4/T3 Studies
The RCP claim that the only evidence in all of the related medical science is 11
randomised clinical trials that compare a T4 monotherapy with a combination
T4/T3. This is so ludicrous that such a statement cannot be taken seriously.
In the T3 -T4 meta-analysis, the authors found 501 papers and rejected 490,
claiming they were not based upon randomised controlled trials. So effectively,
they ignored 98% of the available and relevant medical science on this pseudo
scientific basis.
There is also disparity in the meta-analysis between the context
219
(“In some patients symptoms of hypothyroidism persist despite therapy
with T4”)
and the conclusion
219
(“T4 monotherapy should remain the treatment of choice for clinical
hypothyroidism”). Meaning those with continuing symptoms on T4
monotherapy must continue to suffer.
Fewer than 1000 patients were studied, out of potentially millions world-wide.
Therefore, these studies, by inductive logic, are subject to counterexamples. TPA
has just under 2000 counterexamples to T4 monotherapy.14
An important factor in the design of the studies is the choice of subjects. The
subjects had identified thyroid gland issues and were substantially already
satisfied with their therapy. This substantially precluded those afflicted with
impaired cellular response to thyroid hormone.
The subject selection of the anti-T3 studies were largely those with:
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


Thyroid gland destruction or removal as compared with the recent pro -T3
study which had no such subjects.
They were doing well on T4 monotherapy.
The therapeutic value of the substituted T3 for the reduction in T4 was
less per a National Institute of Health (NIH) study.
The statistical method ignored low rate occurrences.
So the studies are defective and not representative of the reality of those with
deficient peripheral metabolisms or increased peripheral hormone receptor
resistance. The flaws in those study are; the choice of subjects; the choice of
therapies; the statistics; and the over-conclusions. Given the low occurrence
rates, they should have been looking for exceptions and not averages.
The second issue is the comparison. The focus on the thyroid gland suggests in
the literature, a 14 to 1 exchange because that is the ratio of T4 to T3 in the
thyroid gland. Some studies used other ratios, like 10:1 or 5:1. However,
according to Celi,220 the relative therapeutic value is 3:1. So the subjects were
under treated when on the T4/T3 combination. Also, the T3 dosage levels were
quite low, generally below the starting dose for adults (not children or seniors).
And then the statistical averaging makes any improvement appear negligible.
Using subjects with primary hypothyroidism is not representative of subject’s
deficient peripheral metabolism or increased peripheral hormone receptor
resistance. They are physiologically different.
It is long past the time when these defective studies must be investigated.
Confirming Studies
Almost ten years ago, laboratory experts, and a committee of the nation's top
endocrinologists issued recommendations to narrow the TSH reference interval so
that the high is 2.5 to 3.0, versus 5.0 to 5.5. Since then, there has been study
after study linking subclinical/mild/borderline hypothyroidism to a host of health
risks, including infertility, diabetes, high cholesterol, and heart disease. A recent
meta analysis for over 55,000 subjects, from 11 studies showed that Subclinical
hypothyroidism is associated with an increased risk of cardiovascular events and
mortality - particularly if TSH is 10mIU/L or over.221
So, why are the RCP and BTA failing to produce the scientific evidence to show
that the nation’s top endocrinologists are wrong, and that the RCP recommended
TSH reference interval of 0.5 to 10.0 is correct? No such evidence exists! The RCP
and BTA recommended TSH ref. interval is unmatched anywhere else in the
world.
In another follow up study of 15,106 subjects,222 it was found that TSH within the
reference range is positively and strongly associated with the risk of future
hypothyroidism. TSH at the lower limit of the reference range may be associated
with an increased risk of hyperthyroidism.
The recommended treatment of T4 monotherapy, more often than not, fails to
recognise that not everybody is able to convert sufficiently to the active T3
Joffe et al, (1985);223 Cooke et al, (1992);224 Gelenberg, (1992);225
Dommisse, (1993);226 Whybrow, (1994);227 nor in laboratory rats, EscobarMorreale et al, (1996).68 Routine measurement of free T3, whenever screening
for, or monitoring treatment of those patients with symptoms of hypothyroidism,
will quickly confirm this. But, the RCP and the BTA continue with their denial! This
makes a mockery of their standards.
There are also signs of dissatisfaction amongst medical practitioners concerning
T4 monotherapy, as reflected in the papers by Chopra (1997),228 DeGroot
(1999),229 Ridgway, Canaris, et al. (2000)230 and O’Reilly (2000).231
Still further evidence of the shift toward including T3 is provided by another
paper: The multi-centre Italian 'Evaluation of the adequacy of levothyroxine
replacement therapy in patients with central hypothyroidism' reported that "both
fT4 and fT3 serum levels ... are necessary for a more accurate disclosure of overor under-treated patients." (Ferretti et al, 1999).232 The RCP have disregarded
these studies – which again, makes a mockery of their standards.
The RCP and DoH has also disregarded the results of a survey of hypothyroid
patients undertaken by TPA in 2005-2006. This survey highlights the
dissatisfaction of many patients. This survey has very good credentials in that it
points to inconsistencies within the data presented by the RCP and the BTA as
being 'definitive'. This hypothyroid patient survey should be held up as valid,
contradictory evidence to the RCP policy statement. This makes a mockery of
their standards!
Of 1500 respondents to this survey, when asked of those undergoing L-thyroxine
-only therapy, “Do you feel that you have fully regained your optimal state of
health?” 1176 (78.4%) answered “NO”. 233
Counterexamples to T4-only Therapy
A responsible scientist, finding a counterexample to his idea must limit or
abandon his idea as unreliable.
TPA is in the process of collating a ‘Register of Counterexamples to T4
Monotherapy’.234 A component of the register is the patients’ willingness to
testify. This survey is applicable to those who continued to suffer symptoms on
T4 monotherapy and who found those symptoms were mitigated or disappeared
when they began T3 hormone therapy.
With the registering of just under 2000 counterexamples to T4 monotherapy
(March 2012) and with the philosophy of science, described by Sir Karl Popper,
TPA have irrefutable proof that Endocrinology’s stance is dangerously wrong and
that it’s continuance of practising in line with the T4 monotherapy diktat for all
sufferers of the symptoms of hypothyroidism is pernicious.
TPA is currently investigating the existence of triple counterexamples hidden in
the Register because they have the experience that comport with the test
protocol Challenge, De-challenge, Re-challenge (CDR).235
Further, triple counterexamples provide causation proof for the value of T3.
As currently delineated, which is not good even by medicine's standards, the
medical evidence for the support of the universal virtual ban on all T3containing hormone replacements is illogical, unethical and nonsensical, and
would not be admitted as evidence, because counterexamples demonstrate its
lack of reliability.
Autonomy of Medical Professionals
The RCP has taken away the right for medical practitioners to exercise their
professional clinical judgement.236
According to the ‘Medicines and Healthcare Regulatory Agency (MHRA) Review of
Unlicensed Medicines’, they make the point that: “Clinicians should have the
ability in appropriate circumstances to exercise their professional judgement to
commission the supply of an unlicensed medicine to meet the special needs of an
individual patient”.237
Taking away a doctor’s autonomy makes the RCP policy statement mandatory.
The law is not fond of unresolved issues and will follow the generally accepted
interpretation. The present case is the boycotting of all alternatives to
levothyroxine sodium. The doctor who dares defy the medical guidelines for the
benefit of the patient can find him/herself in substantial and costly disciplinary
difficulties with the GMC, even if the doctor is treating his patient ethically and
scientifically.
So doctors are fearful of the RCP’s influence upon the GMC. They fear losing their
career and livelihood should they dare to diagnose or treat outside of this policy
statement, which goes beyond the bounds of primary hypothyroidism. Fear of
prosecution enforces compliance. Compliance stops them diagnosing and treating
their patients properly. The RCP policy statement, because it goes beyond the
bounds of primary hypothyroidism, is harming patients and doctors.
A quote from a patient’s response to the International Hypothyroid
Patient Petition238
“The ignorance, arrogance and incomprehension of the medical doctors I have been
subjected to in my search for diagnosis and treatment leaves me incandescent with
rage. Even as a qualified health professional working for a major DGH I remain
powerless to prevent the cumulative long term health risks associated with lack of
treatment; I am voiceless, neutered, patronised, and crawling day-to-day through what
used to be my vital and colourful life. I would give everything I have for an open
minded and creative diagnostician, and more for a little compassion, but this seems to
be entirely beyond the capability of the modern medic. God help us all.”
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