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A Critique of Dr. Richard Guttler's Beliefs About Hypothyroidism |
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Selected
Letters in Response to
Introduction |
Then I learned of T3. My quality of life on T4 alone was so lousy that I wanted to try adding T3 to the T4. But it took years and many doctors before I found one who would prescribe T3. Within three days of using a T3/T4 combination, my pain stopped. I still have some other symptoms, but these are decreasing with adjustments of my dosage. There is no doubt in my mind that my pain was relieved by adding T3. It is great to be without this pain for the first time in eight years! Thanks to you! From reading your books and following your recommendations, I’ve been given my life back. Thanks also for standing up to Dr. Guttler in such a public forum. Dr. Lowe: I appreciate you taking the time to write. As you know, millions of people are in your previous plight; they’re kept chronically ill by the T4-replacement that Dr. Guttler adamantly advocates—despite the overwhelming evidence against it. T4-replacement has done unspeakable harm the world over. Having examined the evidence of that harm, I can only consider the imposition of T4-replacement on hypothyroid patients as shockingly cruel and brutal. That imposition has ruined the lives of millions of people. Despite the well-documented harm, Dr. Guttler and his "real thyroid experts" will for now continue to dogmatically claim that T4-replacement as safe and effective for all hypothyroid patients. The specialty made up of those doctors isn’t deterred by scientific evidence or logical proofs showing the horrific results of their advocacy. Nor are they dissuaded by appeals to mercy. As long as huge financial incentives flow from corporations to that specialty, I’m convinced that the specialty will continue to doggedly advocate T4-replacement. The specialty’s obstinate advocacy has consigned millions of hypothyroid patients to feeling hopeless that they’ll ever recover their health. Letters such as yours, however, give many of them renewed hope. We publish such letters at drlowe.com to encourage patients who are presently suffering, as you did, on T4-replacement. Often, a patient tells us that she was emboldened by reading another patient’s description of her recovery; she then put her foot down, refused to allow her doctor to restrict her to T4-replacement, and, after switching to a T4/T3 product, fully regained her health. I know that your story, too, will give others courage, and for that, I sincerely appreciate you sharing it with us. October
10, 2004
Dear Dr. Lowe: I knew that you must be an expert in syllogism! I was a philosophy major myself and I love it when someone can really lay out a logical argument! I just now clicked on your C.V. and confirmed my belief that you know your 'squares of the opposition.' I detected this method of cogent analysis when I read your paper on 'Thyroid Replacement Therapies' from May 2004. It's too bad the medical community doesn't require pre-med students to take logic before they get out into the real world, to later write academic papers and journal articles. The conclusions many researchers make are illogical and confusing at best. Your latest defense of Mary Shomon is terrific! If not for Mary Shomon's website and the great people who contribute to it, I would still be suffering from depression, weight gain and thyroid disease—all from Dr. Guttler's (et al) T4-only (Synthroid) regimen. I switched my meds over to Naturethroid in June and feel terrific for the first time in 40 yrs. I never knew what it like was to have the cloud of low grade depression removed from my life. Do I credit the natural T3/T4 thyroid medication for this? You bet. Unequivocally. Problem is, I've become very cynical as to the reason why many doctors don't want to see T3/T4 treatments succeed. In one short sentence: their association with BIG PHARMA. Too many cozy relationships potentially disrupted, too many revenue streams lost. Both stand to lose if T3/T4 combo was the 'magic bullet.' Who would need statins? antidepressants? GERD meds? The list goes on . . . . I really look forward to reading your new book Tyranny of the TSH* when it's published. I am already on the mailing list to receive notification. Here's to success in busting the dominant paradigm! *To get on the list to be notified when Tyranny of the TSH is available, just send a blank email to the publisher. Dr. Lowe: Thank you for your email. Your comments in it are entirely correct about the issue of T4/T3 combination thyroid hormone products. The reason is clear why Dr. Guttler's "real thyroid experts" doggedly advocate T4-replacement despite its keeping millions of hypothyroid patients ill and susceptible to premature death—Big Pharma. The bottom line is that Big Pharma has bought the loyalty of high-profile opinion makers among thyroid researchers. As a quid pro quo for Big Pharma’s financial inducements, those researchers, as well as tenaciously advocating T4-replacement, maintain a system of intimidation to frighten doctors into acquiescing and cooperating with to the moneymaking scheme. The cost of the scheme in terms of chronic illness and shortened life spans is incalculable but horrifically high. Indeed, in terms of chronic human suffering and premature death, I consider the scheme a worldwide atrocity that by comparison dwarfs even that of Islamic terrorism. You wrote, "If not for Mary Shomon's website and the great people who contribute on the about.com thyroid forum, I would still be suffering from depression, weight gain and thyroid disease—all from Dr. Guttler's (et al) T4-only (Synthroid) regimen." I am happy that you've recovered your health with a T4/T3 product, as so many others have. Fortunately, Mary's efforts have now liberated legions of patients from the horrors inflicted on them by the false beliefs of Dr. Guttler and his "real thyroid experts." Mary has also inspired some recovered patients to become thyroid patient advocates. These new advocates are joining Mary in the movement to rescue more patients from T4-replacement. I hope you'll take part by broadcasting your personal experience. Many patients currently suffering from T4-replacement will find in your story the encouragement to press on until they, like you, have recovered. So I hope you'll be vocal. You also wrote, "It's too bad the medical community doesn't require pre-med students to take logic before they get out into the real world, to later write academic papers and journal articles. The conclusions many research findings make are illogical and confusing at best." I couldn't agree more. I personally have felt immense frustration from the illogical and confusing publications of physicians who do research. I was especially frustrated when studying the 6000 or so research papers I referenced in The Metabolic Treatment of Fibromyalgia (MTF). The authors of only a fraction of the papers wrote with precision and clarity, and many reached invalid conclusions. In MTF, I detailed how medical school is different from all other doctoral programs in a crucially important way. It is different in that medical students are not taught to question and challenge beliefs—a practice that's essential to the development of rationality. Instead, they're pressured into accepting without question most of the propositions presented to them. Hence, medical school is more like the military or the Church, where authority figures hurls down edicts, and subordinates accept them on faith. Some graduate physicians, of course, admirably escape the mind-closing influence of medical school. But many, perhaps most, physicians remain mired in it, and their authoritative, dogmatic attitudes (exemplified by Dr. Richard Guttler) are testimony to it. I once had a logic professor who years before had taught a brief logic course to medical students at Harvard. Someone asked him how they did in the course, and his reply was, "I wouldn't want them making decisions that my life depends on." It takes little study of the published medical research literature to see that there is an urgent need for remedial logic courses for physicians doing research. Because of this, I personally believe that every physician who conducts research or writes a research report should do so only under the strict supervision and guidance of a professional logician. Otherwise, medical research and publications are likely to remain what they currently largely are—a thinly-disguised marketing scheme of Big Pharma. Anyone who doubts this should read Shannon Brownlee's recent article "Why you can't trust medical journals anymore" and Anthony Barnett's article "How drug firms 'hoodwink' medical journals." Incidentally, when I'm working to solve a problem or formulating ideas for publication, I still do use syllogistic logic. But I most often use mathematical logic because it is so much more flexible. I don't believe, however, that medical researchers necessarily need to be skilled in mathematical logic; they would do far better even with training in elementary categorical logic. You may know that in the early-to-mid 1990s, I determined that inadequate thyroid hormone regulation is the main underlying mechanism of "fibromyalgia." It is interesting to me that to make that determination (which still eludes the less-logically-capable rheumatology fibromyalgia researchers), I mainly used John Stuart Mill's methods for inductive inference (although I staunchly believe all induction is actually deduction, and that we don't infer but in fact deduce). Mill's methods, of course, are extremely simple to understand and use, and I think if physicians would use nothing more than these, medical research would proceed in a far more productive direction. Of course, it's to Big Pharma's advantage that physicians doing research remain incompetent at elementary logic. If they were proficient at it, they would less often reach invalid conclusions that favor the financial interests of the corporations that lavish them with financial incentives. An excellent example of such invalid conclusions is in my critique of the thyroid hormone replacement studies that were published in 2003. Again, I'm grateful for your email and happy to hear of your recovery with a T4/T3 product. Very best wishes. August
22, 2004
I'm on my 4th internist and 2nd endocrinologist now. As you know, it's no easy task finding a doctor that will listen to you, and who won’t look at you like you’re crazy because the blood test was "in range" (I'm really sick and tired of that phrase!) even though you feel awful. It's the "in range" that was making me sick and tired. From being undertreated, I also ended up with celiac disease and then carpal tunnel syndrome. If the TSH test is so great, why do so many of us feel lousy with doses of T4 that keep our TSH "in range"? In other words, why doesn't this range speak for the symptoms that ruin our lives? I know 3 other women personally that say hypothyroidism has ruined their lives, as it nearly has mine. Your point about being "in range" and still having symptoms is dead center, and I wish others would listen to you. Your point about doctors lowering the T4 dosage to put you "in range" and bringing back the symptoms is not only dead center, but deadly. I experienced this firsthand from my 3rd internist who was compulsive about my TSH being "right in the middle" of the range. I don't understand why the medical profession at large won’t listen to us patients, and only prescribes other drugs to reduce our hypothyroid symptoms. Check out any thyroid chat session on the Internet and you’ll see that it's staggering how many people are plaqued with this. As I told my first endocrinologist--I'm not asking for hallucinogenic drugs, I just want to feel normal and be able to live my life. Is that too much to ask for? Something's really wrong with the thyroid treatment picture. But why? Dr. Lowe: I believe I know exactly why. To understand, consider something Dr. Richard Guttler wrote in his newsletter in response to my critique of his scientifically bankrupt beliefs about hypothyroidism: "The patients need to know," he wrote, "that real research into all aspects of thyroid disease are [sic] being published in ‘real’ medical journals everyday. Thyroid treatment is evolving as we learn more about the gland, [sic] and it's functions."[1] (Italics mine.) Guttler is right that research is going on. Journals publish such a profusion of study reports that it’s hard to keep up even with a small portion of them. But when he writes that "thyroid treatment is evolving," if he’s referring to the treatment of hypothyroidism by "real thyroid experts," he’s dead wrong. I’ve studied the textbooks written by his "real thyroid experts," and for the last thirty years or so, every edition of every book has promoted the same cookie-cutter approach to the treatment of hypothyroidism: T4-replacement—allowing patients to use only T4 and adjusting their dosages by thyroid function lab test results. T4-replacement virtually always succeeds at what the authors of those books and Dr. Guttler strive for—keeping the TSH within the current reference range. But as you and millions of other hypothyroid patients know, to succeed in that respect is often to fail at relieving patients’ hypothyroid symptoms. Studies by endocrinologists have proven this,[2][3][4][5] and at least one study suggests that patients on T4-replacement develop potentially-fatal diseases associated with under-treated hypothyroidism and must use more drugs.[6] The endocrinologists who conducted the studies proving that many patients on T4-replacement continue to suffer ignored what their own studies proved! Despite their studies showing that T4-replacement leaves many patients with hypothyroid symptoms, they advised that the therapy remain the treatment of choice for hypothyroidism. Dr. Guttler gives the impression that he’s read two of the studies. But despite those studies showing that T4-replacement doesn’t work for many patients, he goes on shamelessly singing its praises. "But why?" you and millions of other suffering hypothyroid patients ask. Indeed, why do most doctors ignore your pleas for effective treatment when T4-replacement has failed you? Mary Shomon eloquently explains: "The prevailing dogma says that all you need to know is that the TSH test is the gold standard for diagnosis, and the only treatment is T4-replacement/levothyroxine. Even then, the dogma usually stipulates that you use Synthroid, the top-selling levothyroxine drug, the most expensive of all the brands, the one that has legions of drug reps in its employ, and the one that not coincidentally spreads around millions in research money, grants, honoraria, freebies, samples, and support to doctors, endocrinologists, professional groups and patient organizations each year." [7]Clearly, scientific studies have now debunked the belief that T4-replacement is always safe and effective. But this fact hasn’t penetrated into the noggins of the "real thyroid experts." And in my opinion, it won’t penetrate—not while the eyes and ears of the endocrinology specialty are walled off by thick layers of money lavished on it by corporations that profit from T4-replacement. Those corporations are kept rich partly by the endocrinology specialty’s endorsing and enforcing T4-replacement—no matter what the science shows. And as long as the specialty continues with its end of the quid pro quo, the corporations will continue, as Mary wrote, to "spread around millions" to the specialty. And in turn, the specialty will continue to endorse and enforce T4-replacement. In my forthcoming book, Tyranny of the TSH, I call this relationship the "Endo/Corp Cartel," and I present evidence that it’s responsible for incalculable human misery. In my opinion, no appeal to humanitarian or scientific imperative will dissuade this Cartel from imposing T4-replacement on hypothyroid patients—even when the treatment fails to relieve their suffering. I believe the only action that will stop the suffering of millions of these patients (which in my assessment is a worldwide public health atrocity) is a class action lawsuit. The Bush administration, however, is working to make it harder for citizens to defend themselves against corporations with this powerful tool of the people. So, if a class action suit is to stop the atrocity, it had best do so soon. References
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