Category Archives: Mainstream Medicine

Who shall guard the guardians? Dr Malcolm Kendrick

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A quick skim through this entry taken, with permission, from the blog of Dr Malcolm Kendrick, gives frightening insight into the bias and financial conflicts of interest often at play when various committees draw up the various “guidelines” we are all supposed to stick to in our health programmes. Yet if doctors do not stick rigidly to these guidelines, even though they feel that doing so is not in the best interest of their patient, they are in danger of having their practice licences revoked as has happened here in Singapore. The double standards working here are such a travesty of justice!

http://drmalcolmkendrick.org/2013/08/02/who-shall-guard-the-guardians/

Who shall guard the guardians?

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(Quis custodiet ipsos custodes?)

Mainstream medicine increasingly relies on Guidelines. Well, they are called guidelines, but increasingly they carry the force of law. In many countries if you try to practice outside the wise and infallible guidelines you may lose your license to practice medicine. In the US, you may well be dragged into court, and if you have not been following the guidelines, you will be sued. You can even be gaoled (or jailed, as we say in the UK).

In short, guidelines are very serious and important things indeed, and they now rule medicine with a rod of steel. In the UK up to 50% of general practice time is spend ensuring that all patients are constantly monitored to ensure that various guidelines are rigorously followed. Is the BP low enough, the cholesterol low enough, have you checked blood sugar levels etc.

But where do guidelines come from – exactly? Who gives people the right to sit on guideline committees? What are the entrance requirements? Who shall guard the guideliners?

The answer is, perhaps shockingly, that there are almost no rules to this. If a group, such as the National Institutes for Health in the US, decides to set up a committee to decide on, for example, what is the healthy level for cholesterol lowering, what happens? They ask a number of Key Opinion Leaders to join the committee. In this case the NCEP (National Cholesterol Education Programme – which is a committee, not a programme).

In 2004 this committee decided that cholesterol levels should be lowered far more aggressively than in the past. Based on, as far as I could see, very flimsy evidence.  Could it be that that committee was, in some way, biased in favour of cholesterol lowering companies?  A number of people, including me, demanded to see if any of the eight invited members of this hugely important committee had financial conflicts.

With much reluctance, the conflicts were revealed (I have highlighted, in bold, the companies who marketed cholesterol lowering agents at the time.) See below

ATP III Update 2004:  Financial Disclosure of NCEP members

Dr. Cleeman: (Chairman) has no financial relationships to disclose.

Dr. Grundy: has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline.

Dr. Bairey Merz: has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.

Dr. Brewer: has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis.

Dr. Clark: has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer.

Dr. Hunninghake: has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer.

Dr. Pasternak: has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS-Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca.

Dr. Smith: has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson.

Dr. Stone: has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant.

http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04_disclose.htm

Of course, as people have stated to me, the mere fact that there were seventy two financial conflicts of interest does not mean that the guidelines themselves were biased. But you know what, I don’t believe it. Imagine if eight Supreme Court judges, ruling on any issue, had seventy two direct financial conflicts of interest to do with that issue…..Well, the outcry would never end.

Yet doctors, it seems, are beyond any suspicion – of any sort. There is not the slightest possibility that any doctor would ever do anything wrong….We are, after all, superior beings. ‘But, what’s that you say skippy…. hold on.’

‘Despite a 2-year-old scandal discrediting key evidence, current guidelines relying on this evidence have not been revised. As a result of physicians following these guidelines, some researchers say, it is possible that thousands of patients may have died each year in the UK alone. It is unlikely that a true understanding of the damage will ever be known…..

The guidelines, which were published in 2009, were based on analyses of the available trials. The strongest evidence came from the DECREASE family of trials, which appeared to strongly support perioperative beta-blockade, and one other large trial, POISE, which raised concerns that beta-blockers might lead to an increase in deaths

In 2011, however, faith in the reliability of the DECREASE trials was shattered as a result of a scientific misconduct scandal centering on the principal investigator of the studies, the now disgraced Dutch researcher Don Poldermans. The issue was further complicated because, in addition to his key role in the trials, Poldermans was the chairman of the committee that drafted the guidelines.’ http://cardiobrief.org/2013/07/31/european-heart-guidelines-based-on-disgraced-research-may-have-caused-thousands-of-deaths/

Oh well, maybe not.

The fact is that, wherever you look, guidelines are being developed by doctors who have widespread conflicts of interest. And if you go a step further back to review the studies that the guidelines are based on, they are run by, and written up by, doctors who have enormous conflicts of interest. Although sometimes, these conflicts are just…well, forgotten about.

For example, a few opinion leader were ‘named and shamed’ by the Journal of the American Medical Association, when someone pointed out that a number of the authors of the original paper they wrote might just have slipped up in declaring their conflicts:

Unreported Financial Disclosures in: ‘Association of LDL Cholesterol, Non–HDL Cholesterol, and Apolipoprotein B Levels With Risk of Cardiovascular Events Among Patients Treated With Statins: A Meta-analysis.’

….the following disclosures should have been reported: “Dr Mora reports receipt of travel accommodations/meeting expenses from Pfizer; Dr Durrington reports provision of consulting services to Hoffman-La Roche, delivering lectures or serving on the speakers bureau for Pfizer, and receipt of royalties from Hodder Arnold Health Press; Dr Hitman reports receipt of lecture fees and travel expenses from Pfizer, provision of consulting services on advisory panels to GlaxoSmithKline, Merck Sharp & Dohme, Eli Lilly, and Novo Nordisk, receipt of a grant from Eli Lilly, and delivering lectures or serving on the speakers bureau for GlaxoSmithKline, Takeda, and Merck Sharp & Dohme; Dr Welch reports receipt of a grant, consulting fees, travel support, payment for writing or manuscript review, and provision of writing assistance, medicines, equipment, or administrative support from Pfizer, and provision of consultancy services to Edwards, MAP, and NuPathe; Dr Demicco reports having stock/stock options with Pfizer; Dr Clearfield reports provision of consulting services on advisory committees to Merck Sharp & Dohme and AstraZeneca; Dr Tonkin reports provision of consulting services to Pfizer, delivering lectures or serving on the speakers bureau for Novartis and Roche, and having stock/stock options with CSL and Sonic Health Care; and Dr Ridker reports board membership with Merck Sharp & Dohme and receipt of a grant or pending grant to his institution from Amgen. http://jama.ama-assn.org/content/307/16/1694.3.full?etoc

Not a bad little list. As you can see, Dr Ridker had board membership with Merck Sharp and Dohme…… a company that has made billions from selling statins. Now, here is he is authoring a paper on the benefit of statins (which will be used to develop guidelines on cholesterol lowering), and he simply forgot about this conflict of interest. As for the others, well, they’re also busy people; things must have just slipped their minds, such as thirty three separate financial conflicts.

For this terrible crime against the integrity of medical science, none of them can ever again do medical research, or author a medical paper, or sit on guideline committees. Cue, mad cackling laughter. As you may expect, absolutely nothing happened at all, apart from the publication of that statement you in the Journal in the American Medical Journal (JAMA).

I am sorry, but the system of developing guidelines is, frankly, bust. It has been for many years, but it is a very big and dangerous looking nettle to grasp, and no-one, currently has the will to do it.

Someone, somewhere, needs to ensure that guidelines, and the evidence they are based on, and the interpretation of that evidence, is of the highest quality – and free from potential bias, and financial conflicts of interest. We are about as far from this happy state of affairs as I am from being invited onto any guideline committee, ever, anywhere.

And that, my friend, is a very, very long way away indeed. You would need to Hubble telescope to see across distances as vast as that.

 

Note from HCS:

Dr Kendrick’s latest book, “Doctoring Data”, to be officially launched this year, is available at http://doctoringdata.co.uk/

After reading this book you will know what to believe and what to ignore. You’ll have a much better understanding of the world of medical research. A world in crisis.

 

Where does the evidence come from?

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The circulars which the Ministry Of Health (MOH) has sent to all clinics in Singapore call for all treatment to be “evidence based medicine”. Their definition of this concept has not been given.  One of the reference sources on the MOH website (Duke University, Introduction to Evidence-Based Medicine) gives us this definition from David Sackett, the founding father of the concept of evidence based medicine (bolding by HCS):

Evidence Based Practice (EBP) is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology.

(Sackett, D. (2002) Evidence-based Medicine: How to Practice and Teach EBM, 2nd edn. London: Churchill Livingstone.)

The Duke University website goes on (bolding by HCS):

The evidence, by itself, does not make the decision, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, and/or the etiology of disorders.

http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021

The analysis below is taken from Evidence Based Practice, McGraw-Hill Education (bolding by HCS):

Sackett acknowledges and values the different types of knowledge held by the clinician, for example, knowledge acquired through cultural and personal experiences, logical and critical knowledge gained through curriculum and the extra insight that can only be acquired through cumulative clinical expertise. He values the patient as an empowered decision maker and highlights that not all research is transferable into practice due to flaws in either design or reason.

https://www.mheducation.co.uk/openup/chapters/9780335244737.pdf

Note that Sackett states that the best evidence is usually found in what the MOH would call “relevant research”. However, when the evidence found in laboratory tests is responded to with finely adjusted bioidentical hormone replacement (including desiccated thyroid) there is ample evidence available provided by well-respected doctors worldwide (some of it on this site) that patients are receiving the care they need and, further, the care that addresses “the patient’s unique concerns, expectations, and values”.

Interestingly Sackett refined his position. Taken from Too Many Experts Spoil The Science, 8 May 2000 (Bolding by HCS):

http://www.abc.net.au/cgi-bin/common/printfriendly.pl?/science/news/health/HealthRepublish_124166.htm

According to the founder of Evidence Based Medicine experts are hindering the healthy advancement of science. Writing in this week’s British Medical Journal (BMJ), Canadian-based researcher, David Sackett, said that he would “never again lecture, write, or referee anything to do with evidence based clinical practice”. Sackett is not doing this because he has ceased to believe in evidence based clinical practice but, as the BMJ comments, because he is worried about the power of experts in stifling new ideas and wants the retirement of experts to be made compulsory.

Sackett claims that the prestige of experts (including himself) gives their opinions far greater persuasive power than they deserve on scientific grounds alone. “Whether through deference, fear, or respect, others tend not to challenge them, and progress towards the truth is impaired in the presence of an expert,” he writes.

He also argues that expert bias against new ideas operates during the review of grant applications and manuscripts. “Reviewers face the unavoidable temptation to accept or reject new evidence and ideas, not on the basis of scientific merit, but on the extent to which they agree or disagree with the public positions taken by experts on these matters.

(Sackett’s article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118019/)

In response to this, Dr Malcolm Kendrick comments on his blog You Are Killing Patients:

My rather cynical view is that experts can be compared to those men (usually men) who have grabbed hold of the microphone at the front of a mob during a protest march. With this simple act they have managed to gain status and authority. Shortly after they become spokesmen for the revolutionary movement, then leaders…then despots.

However, most newspapers, journalists, television producers never ask they question, how did an expert become an expert – what makes them so. Instead, they are completely in the thrall of the ‘experts’, and greatly fear their power. Which means that when an eminent professor loads and fires the ‘you’re killing patients’ gun, all hell breaks loose and panic stalks the land. Journalists, newspaper editors, TV producers and suchlike quiver in fear. They instantly retract everything they have ever published on the matter, and promise never to do it again.

http://drmalcolmkendrick.org/2014/06/04/you-are-killing-patients/

The topic of evidence based medicine is one that stirs controversy. Surely the patient themselves should provide some of the evidence – if it works, and it hasn’t killed anyone, don’t ban it. If it works and I feel good on it, I want to continue using it. Recently there has been much debate about the safety of supplements. However, every year more than 106,000 people die from reactions to prescription medicine. The last year we have data for, which was 2013, the number of people who died from taking a nutrient was zero. Surely that is “evidence” of their safety, if not of their efficacy?

 

Is medical research now beyond redemption? Dr Malcolm Kendrick

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The following entry is taken, with permission, from the blog of Dr Malcolm Kendrick, a GP in Macclesfield, UK, an original member of the Centre for Evidence Based Medicine in Oxford and of The International Network of Cholesterol Sceptics (THINCS). He describes his blog thus:

This blog is my best effort at providing some balance to the increasingly strident healthcare lobby that seems intent on scaring everyone about almost everything. Is there a foodstuff that is safe to eat anymore? Is there any activity that does not cause cancer or heart disease?

http://drmalcolmkendrick.org/about/

 

Is medical research now beyond redemption?

(Bolding by HCS)

51 Replies

Below, I have copied an entire article from the BMJ, written by Dr Des Spence, who is a fellow Scottish GP. We communicate from time to time, and share a general view that medicine is heading in a very unfortunate direction with overdiagnosis and over-treatment/polypharmacy becoming a massive problem.

This is driven, in the main part, by the pharmaceutical industry. An industry that would like to see the entire population of the world taking medication every day….. forever. To achieve this they have, effectively, grabbed hold of medical research and twisted it to their own ends.

Anyway, please read this article. It encapsulates much of what I feel, and I believe it needs a wider audience [I have added a few comments into the text to ensure that I am not breaching copyright]

Evidence based medicine (EBM) wrong footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fuelling overdiagnosis and overtreatment.

[This is now a major problem for GPs who are increasingly measured and monitored, and funded, according to how accurately we follow guidelines mk comment] [And in some cases in Singapore, barred from running their practices. HCS]

You see, without so called “evidence” there is no seat at the guideline table. This is the fundamental “commissioning bias,” the elephant in the room, because the drug industry controls and funds most research. So the drug industry and EBM have set about legitimising illegitimate diagnoses and then widening drug indications, and now doctors can prescribe a pill for every ill.

[As you can imagine, this makes it difficult not to prescribe statins mk comment]

The billion prescriptions a year in England in 2012, up 66% in one decade, do not reflect a true increased burden of illness nor an ageing population, just polypharmacy supposedly based on evidence. The drug industry’s corporate mission is to make us all sick however well we feel. [Absolutely true mk comment] As for EBM screening programmes, these are the combine harvester of wellbeing, producing bails of overdiagnosis and misery.

Corruption in clinical research is sponsored by billion dollar marketing razzmatazz and promotion passed off as postgraduate education. By contrast, the disorganised protesters have but placards and a couple of felt tip pens to promote their message, and no one wants to listen to tiresome naysayers anyway.

[Speaking as a tiresome naysayer, I could not agree more mk comment]

How many people care that the research pond is polluted, with fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes? Medical experts who should be providing oversight are on the take. Even the National Institute for Health and Care Excellence and the Cochrane Collaboration do not exclude authors with conflicts of interest, who therefore have predetermined agendas. The current incarnation of EBM is corrupted, let down by academics and regulators alike.

[If anyone has any suggestion how to improve regulation, please let me know mk comment]

What do we do? We must first recognise that we have a problem. Research should focus on what we don’t know. We should study the natural history of disease, research non-drug based interventions, question diagnostic criteria, tighten the definition of competing interests, and research the actual long term benefits of drugs while promoting intellectual scepticism. If we don’t tackle the flaws of EBM there will be a disaster, but I fear it will take a disaster before anyone will listen.

[There have already been many disasters, but nobody has yet listened mk comment]

Original article can be found here

Sorry about the intrusive comments, but I don’t want the BMJ jumping up and down on me – especially as they are the only major journal that seems keen to criticize the industry.

What Des Spence is saying, is what I have been saying for some time now. Evidence Based Medicine (EBM) could have been a great thing – so long as it was not enforced too rigidly. But the evidence has been manipulated and corrupted all the way along the line. EBM is now almost completely broken as a tool to help treat patients.

Some years ago I stated that I no longer believe in many research papers that I read. All I tend to do is look at the authors, look at the conflicts of interest, look at the companies who sponsored the study, and I know exactly what the research is going to say – before I have even read the paper.

I have also virtually given up on references. What is the point, when you can find a reference to support any point of view that you want to promote? Frankly, I do not know where the truth resides any more. I wish to use evidence, and the results of clinical studies, but I always fear that I am standing on quicksand when I do so.

We are at a crisis point. Medical research today (in areas where there is money to be made) is almost beyond redemption. If I had my way I would close down pubmed, burn all the journals, and start again, building up a solid database of facts that we can actually rely on – free from commercial bias. But this is never, ever, going to happen.

 

Note from HCS:

Dr Kendrick’s latest book, “Doctoring Data”, to be officially launched this year, is available at http://doctoringdata.co.uk/

After reading this book you will know what to believe and what to ignore. You’ll have a much better understanding of the world of medical research. A world in crisis.

 

Dr Oz – and alternative medicine – is under attack

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Excerpts from Dr Frank Shallenberger’s Second Opinion Newsletter Volume 12, Issue 50 April 27, 2015

As I and so many of my colleagues have experienced, these attacks are always based simply on the fact that we don’t buy into the party line of drugs, surgery, and poison. They think we’re a threat to their system. And we are.

Along with Dr. Oz, we regularly expose the issues with conventional medicine. For instance, besides having the guts to go up against the big money at Monsanto and other GMO producers, Dr. Oz has angered the medical community by saying he didn’t vaccinate his children. You have to understand that these two issues are complete heresy in the religion of conventional medicine. Doctors like Dr. Oz who buck these official doctrines must be burned at the stake.

.  .  .

This gang of attack dogs refers to themselves in the letter as “distinguished physicians.” Let’s look at what distinguishes them enough to be judge and jury of Dr. Oz. Dr. Miller is a specialist, not in medicine, but in “Scientific Philosophy & Public Policy” at Stanford University. He is definitely not a doctor you would want to see if you were really sick. But he is definitely one of those elite ivory tower docs who look down on anyone he might disagree with. To show you just how concerned about your health Dr. Miller is, you should know that he helped run disinformation campaigns and fake science front operations for Big Tobacco back in the 1990s. In fact, he founded the tobacco industry front group The Advancement of Sound Science Coalition. Obviously, Dr. Miller is interested in money – not your health.

Another member of the gang, Dr. Gilbert Ross, was the executive director of the American Council on Science and Health. This is another shady group that Dr. Miller started in 1978. Together, these two men built a powerful front group that actively solicits funds from corporations that have no interest in your health. One of their big positions is fighting GMO labeling. In fact, four of the “experts” who signed the letter to Columbia University receive money from GMO companies. Oh, and one more fact about Dr. Ross. He’s a convicted criminal. He conducted an extensive scheme to defraud Medicaid and was “convicted of racketeering, mail fraud and conspiracy” in 2005. He lost his medical license and was sentenced to 47 months in jail. He also had to pay $612,855 in restitution. These are the “distinguished physicians” who signed this letter.

.  .  .

Read in full at:

http://www.secondopinionnewsletter.com/health-alert-archive/view-archive/13438/dr-oz–and-alternative-medicine–is-under-attack.htm

Mother Jailed for Getting Her Sick Daughter Hormone Therapy, Later Cleared. Her Lawyer’s Statement. A Letter from Dr Thierry Hertoghe.

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If it was “their” daughter surely “they” would want the help this British mother got from world renowned Dr Thierry Hertoghe, a Belgian physician and expert in hormone therapy, President of the International Hormone Society, which has 3000 physician members worldwide.

 

Mother jailed

Mail Online, 1 November 2014, Poison my daughter? No, I was trying to CURE her: Mother jailed for child cruelty after rejecting NHS care to seek treatment at foreign clinic for teenager’s hormone therapy http://www.dailymail.co.uk/femail/article-2817084/Poison-daughter-No-trying-CURE-Mother-jailed-child-cruelty-rejecting-NHS-care-seek-treatment-foreign-clinic-teenager-s-hormone-therapy.html

Mail Online, 3 November 2014, A cure for thyroid problems the NHS ignores – or quack doctor’s poison? Mary gave her daughter hormones prescribed for crippling tiredness. Then police arrested her for child cruelty  http://www.dailymail.co.uk/health/article-2819347/A-cure-thyroid-problems-NHS-ignores-quack-doctor-s-poison-Mary-gave-daughter-hormones-prescribed-crippling-tiredness-police-arrested-child-cruelty.html

 

Mother cleared

Thankfully the mother was cleared. Dr Thierry Hertoghe gave evidence at her trial. He described the British National Health Service as 40 years behind in this area of treatment. He commented that the NHS only treats patients when they are 70% hormone deficient, where he and his colleagues treat when the patient is 25-30% deficient.

The Independent, 30 October 2014, Mother cleared of poisoning teenager daughter with hormones supplied by Belgian doctor says case should be landmark for parents’ rights http://www.independent.co.uk/news/uk/crime/mother-cleared-of-poisoning-teenager-daughter-with-hormones-supplied-by-belgian-doctor-9829226.htm

 

Mary Kidson’s lawyer comments

From the website of Ken Hind CBE, one of Mary Kidson’s Lawyers, November 9, 2014 (bolding by HCS): http://kenhindbarrister.co.uk/press/

Lancashire Counsel and Solicitors secure acquittal for mother charged with poisoning her daughter in land mark case

Lancashire Barrister Ken Hind and Blackburn Solicitors Simon Farnsworth, Deborah Morgan of  FMB  took on the case of Mary Kidson a local woman from Nelson, who had moved to live in Herefordshire and secured her acquittal in a landmark case that could have long term  impacts on suffers from thyroid and cortisol hormone deficiencies throughout the NHS .

Ken Hind commented “We were initially approached by Mary Kidson’s family to take this case and we undertook it as this was the kind of case which we came into this profession to deal with and protect the man and woman in the street where we see the state has got things wrong. FMB is a medium sized 3 partner firm of solicitors who instructed me as an independent member of the bar”.

Mary Kidson’s daughter suffered with a number of physical problems , primarily she was constantly fatigued, had low blood pressure , lack of energy, pain in muscles and joints plus other problems. She was seen by 5 endocrine paediatric consultants in the (National Health Service) NHS – 4 of whom discharged her saying there was nothing wrong with her as it was all in the mind . Mary did not believe this , she researched on the internet , read books on hormone deficiency and accessed the web sites of Thyroid UK and the Thyroid Patients Advocacy Forum . She was convinced her daughter had deficiencies in cortisol, thyroid and oestrogen.

Taking advantage of section 13 in the Medicines Act 1968 she ordered hormones from  accredited pharmacies on the internet . She consulted Dr Durrant Peatfield an unregistered physician who had been criticised by the (General Medical Council) GMC for his views expressed in his book on the Thyroid Gland (can be downloaded off Amazon) who approved her treatments . She was still concerned to have a registered physician directing her daughter’s treatment and was recommended to Dr Thierry Hertoghe , the President of the  International Hormone Society with 3000 physician members worldwide. Dr Hertoghe has written 7 books including the Hormone Manual , one of the leading text books for physicians practising abroad in this field.

Mary took her daughter to Brussels where Dr Hertoghe carried out tests on 40 hormones and minerals , far more than carried out by the NHS and diagnosed chronic fatigue syndrome caused by hormone deficiencies. He prescribed hormones and nutrients and treated her for  5 months .

On the 5th March 2013 without having spoken to Mary, social workers and police officers turned up at her home & arrested her, took her daughter into interim care where she was placed with foster carers whom she did not know her for 2 months. Doctors examined Mary’s daughter who they said had nothing wrong with her, made no contact with Dr Hertoghe to ask about diagnosis and treatments , despite the fact he wrote to the police , doctors in the case and social services 3 times. NHS doctors ended all the hormone treatments. Mary’s daughter was interviewed on videotape by the police and said she felt better as a consequence of the treatments.

9 months later in January 2014, the police charged Mary Kidson with poisoning her daughter unlawfully and maliciously causing grievous bodily harm or endangering her life. Mary was only able to see her daughter for 2 hours a fortnight and that was under the supervision of a social worker until April 2014 . In breach of her bail conditions  Mary was phoning and texting her daughter in response to requests  for help and reassurance. Mary was remanded in custody to prison  for 6 months for a breach of this  bail condition, her daughter was certified under the Mental Health Act and sent to a psychiatric hospital where she remains.

The case came to Worcester Crown Court for trial for 3 weeks. Deborah Morgan who prepared the case for trial commented ‘One of our first requirements was to speak to Mary’s 16 year old daughter as the prosecution declined to call her but Hereford Social Services blocked it at every turn. Eventually a psychiatrist appointed by the defence was allowed into the hospital to speak to her, he found she was fit to give evidence and wanted to do so on behalf of her mother as she was within 2 weeks of being discharged by her psychiatrist. I turned up at the hospital to see her and was told I could not do so because Herefordshire Social Services blocked it. Eventually I was allowed in after application to the trial Judge which Herefordshire Social Services fiercely resisted in court.

Ken Hind stated  “Mary Kidson’s defence was that as a loving  caring mother who had struggled for years with her daughter’s ill health  she only wanted to see her get well, develop normally and have a happy, fulfilled adult life.  After 11 days in court, evidence from 5 consultants, 2 social workers , a forensic scientist and police officers,  the Judge directed the jury to acquit Mary Kidson as there was no evidence of grievous bodily harm (accepted by the prosecution) and that the alleged victim’s life had not been endangered”.

At the centre of the case was the treatment of NHS doctors for thyroid hormone deficiency. Dr Hertoghe from Brussels who gave evidence described the NHS as 40 years behind in this area of treatment. He commented that the NHS only treats patients when they are 70% hormone deficient, where he and his colleagues treat when the patient is 25-30% deficient . A major point of argument was the use of natural dessicated thyroid or liothyronine  a drug prescribed by Dr Hertoghe. The Royal College of Physicians directive for treatment of thyroid deficiency is the prescribing of levythyroxine which is an artificial type of thyroid hormone T4. This is converted by the body into T3 the main active ingredient of thyroid production and very necessary to sustain quality life. Doctors are disciplined by the GMC for stepping outside the dictat. There are estimated to be 1.3 million NHS patients who are thryroid deficient. For about a million of these patients levythyroxine works. For the remaining 300,000 their problems are different as their bodies cannot convert T4 to T3 in sufficient quantities.

Sheila Turner the Chairman of the Thyroid Patient Advocacy Forum commented thus “I suffered symptoms similar to Mary’s daughter, I found a doctor who diagnosed my problem and prescribed T3. My life was revolutionised – I felt normal again. The Forum had 1.25 million hits on its web site in just the months April and May this year to give some idea of the extent of the problem. We have seen 10,500 people who have come to seek meaningful information and guidance”.

“The defence team , Deborah Morgan , Sue Hind (researcher) and me are actually all strong supporters of the NHS , believing health care should be available tax funded at the point of delivery. To quote Dr Fraser however, the leading paediatrician for the prosecution in the witness box , ‘The NHS does not always get it right’.

“Thyroid UK one of the 2 major organisations campaigning for change have called for the government to fund research on the use of T3 in the NHS. They have placed on the Parliamentary web site an e petition , currently signed by 7130 people. We ask you to sign this petition as if  100,000 sign  there will be a parliamentary debate on this very subject and some positive good will come out of the tragic case of Mary Kidson. If the politicians listen to the views of many doctors throughout the world the whole issue can be is resolved by properly funded research for the benefit of many NHS patients” .

“Meanwhile Mary Kidson will fight in the courts for the return of her daughter. During our conduct of the case we have discovered that this is not an isolated tragedy which are mainly dealt with in Family Courts where anxious parents have been threatened with removal of their children into care . This has also been true in the case of ME sufferers, a condition very similar in some respects to chronic fatigue syndrome”.

Fund research into T3 and/or natural desiccated thyroid treatment for hypothyroidism

Responsible department: Department of Health

Many patients with hypothyroidism continue to have symptoms on levothyroxine (T4) but find that their symptoms are often greatly reduced when they take liothyronine (T3) or natural desiccated thyroid.

Natural desiccated thyroid is only manufactured in the US and Canada but can be prescribed in the UK on a “named patient” basis. Many doctors will not prescribe it because there are no randomised controlled trials as it was manufactured before licensing of medicines came into being.

Research has shown that some patients have benefited from natural desiccated thyroid but there needs to be more research done to investigate whether this would be a better treatment for patients.

More research also needs to be done on the addition of T3 to T4 because previous research has been inconclusive.

Note:

1.  Herefordshire Social Services Department was reviewed by Ofsted and found to inadequate on all 4 of the main categories and given a 6 month timetable to improve services .During this 6 month period they took Mary Kidson’s daughter way from her without speaking either to her or her physician.

2.  On the first day of the trial the Wye Valley Health Trust, from which 3 of the paediatric consultants called for the prosecution came, was put into special measures by the Department of Health.

 

Letter from Dr Thierry Hertoghe     (Bolding by HCS)

From: “Dr Thierry Hertoghe” <dr.hertoghe@hertoghe.eu>

Date: November 6, 2014 at 9:53:07 PM GMT+8

To:

Subject: SUCESS : the mother of the hormone-treated child, is CLEARED OF ALL CHARGES AND FREE, OUT OF PRISON – HORMONE RIGHTS INTERNATIONAL

Reply-To: office@hertoghe.eu

Dear Dr,

Many thanks for your testimonies and petitions.

MARY KIDSON, the mother of the hormone-treated child, is CLEARED OF ALL CHARGES AND FREE, OUT OF PRISON. Your testimonies and petitions were included in my medical report and have contributed to the success.

Mary Kidson is the mother who was imprisoned because she brought her daughter with six years of severe chronic fatigue syndrome (making it impossible for her to go to school) to my consultation and applied the hormone and nutritional treatments, which substantially improved her daughter’s health.

After two and a half weeks of a court trial with extensive media coverage the prosecution claims collapsed before defense witnesses would even provide their evidence.  I did however give evidence as an expert witness during the trial.

None of the absurd claims of potentially or actually harming the child made by the prosecution and the NHS were shown to have any grounds in reality.  In fact, the prosecution, child protection and NHS doctors have themselves severely traumatized child and mother, the child being now in a psychiatric institute with heavy psychotropic medication.

Links to the BBC: http://www.bbc.com/news/uk-england-hereford-worcester-29829946

Links to the Daily Mail: Lynne Wallis For The Mail On Sunday or: http://www.dailymail.co.uk/home/search.html?S=&authornamef=Lynne+Wallis+For+The+Mail+On+Sunday; http://www.dailymail.co.uk/health/article-2819347/A-cure-thyroid-problems-NHS-ignores-quack-doctor-s-poison-Mary-gave-daughter-hormones-prescribed-crippling-tiredness-police-arrested-child-cruelty.html

Links to the Independent: http://www.independent.co.uk/news/uk/crime/mother-cleared-of-poisoning-teenager-daughter-with-hormones-supplied-by-belgian-doctor-9829226.html

 

HORMONE RIGHTS INTERNATIONAL: Let’s make that this will not happen again. Your personal testimonies have shown that this is an international problem, not only limited to the UK. We are building an internet organization similar to Amnesty International called “HORMONE RIGHTS INTERNATIONAL”, organization of patients, physicians and other health professionals, to defend people’s right throughout the world for them and their family members to receive hormone therapy if they have hormone deficiencies.

Any attack against this right will put HORMONE RIGHTS INTERNATIONAL in action, launching internet news, emails and (post)mails from HORMONE RIGHTS INTERNATIONAL members to the institution that intervenes wrongly.  Patients should be free to attend a doctor of their choice without suffering interference by other medics or institutions.

Hormone deficiencies are as frequent as eye problems. Many of us are born hormone-deficient to some degree, and we all become more hormone-deficient with advancing age. Correcting these deficiencies with safe hormone doses gives to people their life and health back.

Become a free member by signing the membership form here below and sending it back to ihs@intlhormonesociety.org

I (fill in what fits):

O      become member of HORMONE RIGHTS INTERNATIONAL and engage once or more per year to send a testimony or sign a petition by email or post mail to any institution who attacks patients, parents of patients or their physicians or other health professionals, and tries to limit their right to hormone therapy.

O      wish to additionally participate more actively in the organization as active member preparing papers and actions, finding journalists, etc.

O      accept that my testimony(ies) is (are) published on websites or in books

First Name: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I__

Family Name: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I

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n°: I_ __I___I___I       Zip code: I___I___I___I___I___I___I

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E-MAIL: I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I

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Office: I___I___I___I___I___I___I___I___I___I___I___I___I__I___I___I_

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Signature: __________________________________

 

Thanks for all your wonderful input,

Warm regards,

Dr Thierry Hertoghe

President of the World Society of Anti-Aging Medicine

President of the International Hormone Society

Discover www.lifespan-journal.com and enjoy the latest breakthroughs in Lifespan Medicine.

7 Avenue Van Bever

1180 Brussels – Belgium

Phone +32 2 379 34 43 fax +32 2 732 57 43 office@hertoghe.eu www.hertoghe.eu  

Living healthier with hormone and nutritional therapies. Training for physicians

The Slippery Slope: A Bittersweet Diabetes Economy

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While not directly related to bioidentical hormone replacement or natural desiccated thyroid therapy, this article is a depressing insight into the workings of the drug industry and the FDA and the money involved while concerns with the best treatment for patients seem to be side-lined.

The Slippery Slope: A Bittersweet Diabetes Economy

Special Reports: 21 December 2014

http://www.medpagetoday.com/Endocrinology/Diabetes/49227

Mainstream Medicine Still Struggles to Comprehend What Women Want

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We thought one of the benefits of compounded hormone therapy was that it overcame concerns of overdosing or underdosing because it can be adjusted according to hormone levels in individual blood tests. The Endocrine Society seems not to agree . . .

Pharmacist survey shows huge growth in compounded menopausal hormone therapy 

6 March 2015, The Endocrine Society

Among prescriptions filled for menopausal hormone therapy (HT) in the U.S., almost half now are custom-compounded “bioidentical” hormones, according to analysis of a recent survey of nearly 500 pharmacists. The study results will be presented Friday March 6th at the Endocrine Society’s 97th annual meeting in San Diego.

Custom-compounded prescriptions, which are mixed for an individual according to a doctor’s prescription, are not well-regulated or monitored by the U.S. Food and Drug Administration (FDA).

“Despite the increased quality risks and the lack of safety and efficacy data for non-FDA regulated custom-compounded bioidentical hormones, their use by menopausal women is higher than expected and appears to be continuing to grow,” said lead researcher JoAnn Pinkerton, MD, a professor of obstetrics and gynecology at the University of Virginia Health System, Charlottesville.

Pinkerton cited statistics from Symphony Health Solutions that there were 36 million FDA-approved prescriptions filled for HT in 2012. That number is down 61 percent from the 93 million HT prescriptions filled in 2002.

Some postmenopausal women have been seeking alternatives to traditional hormone therapy since the Women’s Health Initiative study in 2002 linked it to certain increased health risks. Since then, customized bioidentical hormones have often been marketed as natural, safer alternatives to FDA-approved HT, with purported fewer side effects. However, according to the Endocrine Society, there is no scientific evidence supporting the safety or effectiveness of compounded bioidentical hormones.

Pinkerton and her colleagues analyzed results of a survey conducted last October on behalf of the International Journal of Pharmaceutical Compounding and in Thought Research, and sent to 12,250 pharmacists who provide compounding services. From 904 pharmacists who reported working at independent community pharmacies or independent compounding pharmacies, the number of completed survey responses totaled 483 (365 responses from community pharmacies and 118 from compounding pharmacies).

Based on the pharmacists’ responses of how many custom-compounded HT prescriptions they fill and the average percentage of compounding reported by the National Community Pharmacists Association and industry market research firm IBISWorld, the researchers estimated that 26 to 36 million total prescriptions custom-compounded HT were filled last year.

Of the responding pharmacists, 69 percent reported that they expected their HT compounding business to grow over the next two years. A greater proportion of compounding pharmacists anticipated growth than did community pharmacists: 75 percent versus 52 percent, respectively. Most pharmacists projected 5 to 25 percent growth of HT compounding by 2016, Pinkerton said.

In November of 2013, Congress passed the Drug Quality and Security Act (DQSA),14,15 which clarifies the FDA’s authority to enforce provisions of the Federal Food, Drug, and Cosmetic Act (FFDCA) that apply to pharmacy compounding. However, health providers and their patients should understand the differences in and the risks associated with less-regulated treatments of compounded menopausal hormone therapy,” she stated.

Possible risks of compounded HT, according to Pinkerton, include the lack of safety and efficacy data along with possible presence of contaminants and concerns of overdosing or underdosing.

Taken from: www.sciencedaily.com/releases/2015/03/150306132714.htm

 

 

 

Previous Editor of the British Medical Journal Makes an Admission

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Richard Smith, the previous editor of the British Medical Journal, recently published an article in that journal entitled Are some diets ‘mass murder’? (British Medical Journal, 15 December 2014.) While the article was related to diet (he was explaining that, after reading Nina Teicholz’s book The Big Fat Surprise,  he now feels that the dietary advice given by western medicine about saturated fat for the last fifty years or so is complete nonsense), the sentiments expressed relate to many areas of general medical wisdom handed out to the public by the FDA and various health authorities.

He states that, ”…the forensic demolition of the hypothesis that saturated fat is the cause of cardiovascular disease is impressive. Indeed, the book is deeply disturbing in showing how overenthusiastic scientists, massive conflicts of interest, and politically driven policy makers can make deeply damaging mistakes. Over 40 years I’ve come to recognise which I might have known from the beginning – that science is a human activity with the error, self-deception, grandiosity, bias, self-interest, cruelty, fraud, and theft that is inherent in all human activities (together with some saintliness), but this book shook me.”

(Bolding by HCS)

History of Thyroid Testing – Dr John Midgley

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 Transcript of the talk by Dr John Midgley at the Thyroid UK 2014 Conference 18/10/2014

History of Thyroid Testing 

There have been long, sad and unsatisfactory developments in thyroid function testing, including up to the present day.

The first thyroid function test, in the form such tests are used today, appeared in 1960. This measured total thyroxine (T4). Before this, convenient measurement of thyroid hormones was not possible. However, breakthrough though this was, it was immediately realised that this was insufficient for accurate estimation of thyroid function.

Thyroid hormones (T4 and T3) leave the thyroid gland and in the bloodstream are bound onto transport proteins that convey the hormones to the tissues. There are three of these transport proteins: thyroxine-binding globulin (TBG), transthyretin and albumin. Of these TBG is the most important in the average person. It transports about 70% of T4 and 60% of T3.

As the transport proteins and their T4/T3 load pass by the tissues in the bloodstream, very small amounts of hormone are freed as required. These are the free T4 and free T3 fractions. As the tissues remove T4 and T3 for their own use, more is released by the transport proteins for the next tissues to use. The free T4 (FT4) and free T3 (FT3) fractions are a very small percentage of the total circulating hormones. In the case of FT4 in the average person it is about 2/100 of 1% of the total T4 and for FT3 2/10 of 1% of the total T3. Therefore, it is necessary to measure FT4 and FT3 rather than total T4 or total T3.

The problem is that we are all unique in the makeup and amounts of our transport proteins. In the vast majority of people, the TBG levels can be different by at least a factor of 2; and the same (independently) for the other two proteins. There are people with either no TBG at all, or 4 times the normal amount. Their reservoirs of T4 and T3 are therefore hugely different for the same FT4 and FT3. Also, the pregnant woman has twice the TBG and ¾ the amount of albumin she had when not pregnant. We also lose transthyretin and albumin when critically ill or with trauma like burns or septicaemia.

To try to get a measure of FT4, a test was developed in 1963-65 to try to convert the total T4 result to a FT4 result. This was the thyroid hormone uptake test. In conjunction with a total T4 result, the two tests could be amalgamated to produce what was claimed was an estimate of FT4. The test method is still used today; e.g. in certain American private labs and elsewhere. However, it is not based on sound principles and does not work properly, especially for people with extreme differences in TBG from the average. Even the pregnant woman’s results are compromised.

In the remainder of the 1960’s, commercial firms were set up to provide ready made tests for the clinical chemistry labs to use.

In about 1975, commercial TSH and T3 tests were developed and sold. The TSH test was first generation – that is, it could only measure and detect hypothyroidism (the depressed levels in hyperthyroidism were too low to be measured directly). Such was the growing demand for tests that the various companies competed with one another for business in the labs. Since the method of measurement (radioactivity) was the same in all tests, competition was such that no company would have a monopoly of business in the labs. This competition produced faster and slicker tests with shorter and shorter times – giving quicker turnover and more tests done in a given time.

In the late 1970’s the shortcomings of the thyroid hormone uptake test, arising from the variation in TBG levels in patients, were very apparent. The demand for properly formulated and soundly developed FT4 and FT3 tests was very great.

As a response, companies and individuals produced various forms of tests claiming to measure these fractions. Many of the offerings were not soundly based, and  slowly disappeared into obscurity and obsolescence. Two methods did however prevail and form the basis of FT4 and FT3 testing today.

The London researcher (now a distinguished professor – Nobel Laureate just failed), who had developed the pioneering total test 20 years earlier invented a validly based test for FT4. At the same time, I invented and my company developed and offered a method based on a different principle, but also soundly based.

My method as initially developed was not perfect – there were obscure areas of thyroidology where there were problems but we’d identified them and given advice to circumvent.

The professor’s method was sound but suffered from the fact that there were several steps to take before you got an answer, which took time and cost precision – the more handling, the more progressive errors creep in.

On the other hand, the test I had invented was, in the hands of the lab technician exactly the same in handling as the existing total T4 test – a big time/turnover/precision advantage for the busy lab.

The London professor and his group decided to try to destroy the validity and reputation of the rival test and those who had developed it. So began a long series of aggressive, long and detailed theoretical arguments as to why the test I had invented was, in its present form, unfit for purpose and could not and did not work.

In vain did we show that the practical working of our test bore no resemblance whatever to his theoretical predictions – this only invited more and more vituperative denunciation. This aggressive, acrimonious and almost libellous controversy (the worst in the history of any discipline in clinical chemistry) continued for almost 20 years before dying out in the futility with which it had started.

During this time, the average clinical chemistry worker in the average hospital was totally oblivious to all this rarefied argument and was happy that at last a reliable FT4/FT3 test was available. For example it brought into the diagnostic fold even the most TBG-extreme people mentioned earlier. For a while, there was a golden age in thyroid diagnosis where all tests (TSH, FT4, FT3 were used – especially in Germany and Japan).

In the mid-eighties, pressures on the clinical chemistry lab were beginning to be overwhelming. Such was the demand for tests that the disposal of radioactive waste was too great for licencing of disposal. Consequently non-radioactive detection methods had to be substituted. Two things happened around 1985.

First, second and third generation TSH tests were developed – now one could directly detect both hypo and hyperthyroidism. Secondly, the manufacturers produced several solutions to the nonradioactive detection methods, and integrated them into dedicated automatic analytical platforms. Now one had machines that took the place of the skilled hands-on technician – it was a case now of loading the machine, programming it and pressing the “start” button.

This led to lab monopoly – having chosen the machine, one was confined to the tests dedicated to that machine. However, the individual solutions of the manufacturers to the method of detection in tests led to problems with FT4 and FT3 test development (uniquely).

Unlike all other tests, FT4 and FT3 tests demand special and essential requirements. They must be run at blood temperature (37 degrees), they must sample only a tiny quantity of the available T4 and T3 so as not to sample the T4 and T3 bound to the transport proteins, they must use the same chemical surroundings (for example, salt content, phosphate content) as is present in blood, and they must work in the right acidity as present in blood.

The failure of the development scientists to understand these special requirements, and the compromises needed to make the detection methods work, led to great variation in the performance of the FT4 and especially the FT3 tests between manufacturers offerings. For FT4 this is at present up to 40% difference and for FT3 60%. I would expect no more than a 5% difference as a reasonable variation.

As a result, sensitive TSH tests began to have a paramount position in thyroid function testing. There exists a paradigm of thinking today which closely links FT4 and TSH as a constant relationship over the whole thyroid function spectrum. Therefore, if you do a TSH test, then why do an FT4 test because the TSH value implies an FT4 value – the FT4 test is controversial and inconsistent so why do it? The seeds of TSH only screening had started to sprout.

In 1988 I and my colleagues invented a new test for FT4 and FT3, based on the invention of 1980 but getting rid of the problems at the margins mentioned earlier. Shortly after, I left the field entirely for 10 years, only returning by accident in 1999.

On returning to the field I found it in chaos. In 1992, a group of American scientists had begun to analyse and dissect the commercial FT4 tests to understand why they were so inconsistent. They began a series of papers in the peer reviewed important leading journals which lasted until 2009.

Their findings were on the surface devastating – that is, they alleged that however it came about, all FT4 tests were influenced by the levels of transport proteins in blood – devastating because this meant that they were subject to the T4 and T3 bound by those transport proteins – and the whole point of doing FT4 and FT3 tests is to be independent of these effects.

As it turned out, the whole of this work was completely invalid and wrongly conceived from beginning to end – a completely meaningless study programme. I and a colleague pointed this out but, especially in America, their findings are accepted and further confuse today’s understanding of the FT4 and FT3 tests. Meanwhile, the cheap, easy to understand, rapid, and eminently automatable TSH test was gaining strength as a catch-all screen.

In 2005 a new group of US workers came on the scene with a specialised technique for measuring FT4 and FT3 which they alleged was superior to the commercial tests in that it more closely correlated FT4 and TSH.

In 2009 I looked into their work and found it had been done at the wrong temperature – this is important because T4/T3 binding to TBG is very temperature sensitive. On advising them of this, they merely obfuscated and blustered, and though henceforward using the right temperature, did not retract their earlier wrong work butactually included it in papers when they used the right temperature as if the wrong work somehow backed them up – scientific honesty?

Now we come to the present day. We have simultaneously in existence licensed, manufactured and used in diagnosis, tests based on the discredited thyroid hormone uptake test, tests based on sound methodology but including the earlier imperfect tests up to the modern improved ones, and tests offered that are to be run invalidly at room temperature.

This implies a complete failure to regulate by the international regulators whose job it is to ensure equivalence of results. The composite failure of the manufacturers to produce consistent FT4 and FT3 tests has already been mentioned. The failure of the medical thyroidology fraternity to ensure consistency of the tests they use is an additional factor in the diagnostic chaos that is now present. No wonder TSH only screening has gained credence in such an atmosphere.

There is a triple failure that has led to a diagnostic hiatus that urgently needs correcting. The paradigm of the TSH-FT4 relationship is wrong, especially in treatment. The whole conceptual thinking behind diagnosis thyroidology and the importance of personal diagnosis based on the patient rather than whether the numbers fall in or out of the normal range is fatally flawed. For the moment mechanical thinking has traduced medical diagnosis.