2009 Another Troubled Year for Endocrinologists


Doctors who treat diabetes and thyroid disease (endocrinologists) are no strangers to unpredictable and unpleasant developments in their field of medicine. In a recent blog I pointed out a number of set-backs encountered in Endocrinology in 2008 http://www.metabolism.com/2008/02/29/a-year-of-stumbles-for-diabetes-care-in-the-us-part-1/ . In today’s blog I begin with part one of three on the latest stumbles in 2009 in this branch of medicine.

1. National Organization of Endocrinologists Attacks Use of Armour Thyroid. The national organization representing endocrinologists (American Academy of Clinical Endocrinologists) officially declared that the use of Armour Thyroid (dessicated thyroid tissue, “natural” thyroid replacement) was not recommended for treating hypothyroidism. The AACE based their decision on claims that preparation Armour thyroid was not well standardized and that the “t3” content of Armour might make it dangerous.

My own opinion is that for decades the makers of synthetic “t4” have financed the careers of endocrine leaders in the field of thyroid research. Eventually all teaching in the endocrine community in the U.S. has been homogenized into one mindset that only synthetic “t4” is a valid treatment for thyroid hormone replacement. Recent events have caused the makers of brand t4 to become more defensive. This is a result of insurance companies forcing an acceleration of the use of generic “t4” preparations by their members. To reinforce their position, the brand leaders of synthetic t4 chose this year to essentially wipe out any competition from the Armour thyroid advocates. To underscore the seriousness of the denunciation of Armour thyroid by the AACE, Medicare announced that Armour Thyroid was no longer to be a medication covered by the federal program.

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  • Hi Dr. P,

    Thanks for this post-interesting stuff. As a dietitian, I can relate to the fact that evidence-based treatments can oftentimes be overpowered by dollars and cents.

    Pfizer has funded hundreds of studies on Lipitor as a treatment for CVD while stacks of research supporting diet get ignored.

  • gina

    Dr. Pepper, I am confused. Here and elsewhere, you decry the dogma of t4-only treatment for hypothyroidism, and seem to be a proponent of Armour. However, when I googled your office location for a friend who will be in your area (after failing to find an address or phone number here), I found that your clinic’s website offers up the same old tired “wisdom”. The “Hypothyroidism FAQ” is lifted directly from the ultra-orthodox American Thyroid Association, and includes this gem : “Desiccated animal thyroid is rarely prescribed today, and there is no evidence that desiccated thyroid has any advantage over synthetic T4. ”

    http://www.palmbeachdiabetes.com/hypothyroidism.htm

    Please help me to understand this apparent inconsistency.

  • Dr. G. Pepper

    Gina

    I am a member of a 7 endocrinologist group, Palm Beach Diabetes and Endocrine Specialists. The website for our practice that you visited is maintained by our administrator who must use “the majority rule” method. That website’s primary role is to provide addresses and phone numbers for the various office locations. I do not participate in that website to provide opinions to the public and that is one reason I run my own, Metabolism.com. The info on the practice website is prepackaged by the American Thyroid Association as you can see by the statement at the bottom of the information pages.

    Thanks for the heads up, though. I will take this issue up with our administrator and see if I can get something more useful on these pages.

  • gina

    Dr. Pepper, thank you for your quick response – especially on a holiday weekend. I do
    understand that you are going against the mainstream, apparently even in your own group practice. Good luck with your group’s website administrator; I look forward to seeing improved, non-canned content!

  • Darla

    Dr Pepper,

    I had been kept very sick on Synthroid for 20 years. I was told that there was no other treatment for hypothryoidism. Criminal in my mind. The very day I started Armour I felt better. But it didn’t stop there. I raised my Armour till all hypo symptoms had gone away. That was 2 years ago. Today I am very functional and do things I would not have dreamed of before Armour.

    Through all this I found that the TSH test did not correspond with my symptoms. Free T3 and Free T4 were the tests I needed my doctor to go by. Do you find this as well.? Does a suppressed TSH send you into a tizzy like it did my previous doctors? Do you listen to symptoms and test Free’s?

    I found my cortisol was low as well. Once treated I was able to raise Armour and find my optimal dose. How do you feel about the role of cortisol in treating hypothyroidism?

  • Dr. G. Pepper

    Darla

    Our immune system usually protects us from viruses, bacteria and cancer. Hypothyroidism (under active thyroid) is frequently the result of the immune system’s misdirected attack on the thyroid gland. The reason a person’s immune system attacks their own thyroid is unknown but occurs much more commonly in women than men. This type of condition is known as an autoimmune disorder and when it causes hypothyroidism is called Hashimoto’s thyroiditis.

    A similar autoimmune disorder, but much more rare is when the adrenal gland is the target of the immune disease. The condition is referred to as Addison’s Disease when it causes adrenal insufficiency. The most famous person with Addison’s was President Kennedy. Although rare, Addison’s is much more common in people with Hashimoto’s hypothyroidism. You stated your cortisol (adrenal hormone) was low. Perhaps you have both Hashimoto’s and Addison’s. In that situation, it was appropriate for you to also receive replacement medication to restore normal cortisol levels.

    In most cases of Hashimoto’s where the adrenal gland is normal, using cortisol treatment is unnecessary.

    Hope that clarifies the situation for you.

  • Darla

    Dear Dr Pepper,

    Thank you for your reply.

    I do have Hashimoto’s. With enough Armour to stop all hypo symptoms, *which ended up being 5 grains) a low dose of Cortef, and a few key supplements I have my Hashi’s under control. It is a delicate balance.

    My cortisol tests, both saliva and serum, were very low, but were just barely in range. I could be wrong but do not believe this is an Addisons diagnosis, but in fact adrenal fatigue. I do find a low dose (20 – 30mg) of Cortef or Hydrocortisone helps in assisting Armour to get into the cells so it can do its job.

    Even the Armour insert tells us to make sure adrenal function is adequate before even starting Armour. Do you agree?

    • Dr. G. Pepper

      Darla

      Adrenal insufficiency, though exceedingly rare, occurs more often in the setting of hypothroidism due to Hashimoto’s. If someone with hypothyroidism plus adrenal insufficiency receives only thyroid hormone, the adrenal insufficiency can become more severe. This is a basic principle of endocrinology, but since this combination of events is so rare, internists (and even endocrinologists) may never have seen a case. The insert with the Armour prescription to check adrenal function is correct, as you point out, however.

      You are a rare bird and are fortunate to have found your way toward a healthy outcome. The fact that you need 5 gr of Armour also suggests your thyroid requirements are in a range most doctors never see.

      Thanks for sharing your experience with metabolism.com

  • Sue

    There are thousands of women who agree with Darla, who have Hashimotos and can only function on Armour with adrenal support. Our health, lives, and families are being put at risk without the necessary back up from endocrinologists.

  • Ronald Cobbs MD

    I must agree with Dr Pepper about Darla’s case. When a patient suffers from both hypothyroidism and adrenal insufficiency, it is vital to treat both. Checking adrenal function is something many physicians fail to do when hypothyroidism is diagnosed. But as Dr Pepper correctly points out, she is indeed fortunate that both were found and treated. Failure to treat adrenal insufficiency and treating hypothyroidism alone is potentially disasterous. I am glad that everything worked out well for her. I hope more physicians will at least consider the possibility of coexisting adrenal insufficiency prior to treating hypothyroidism.

  • Darla

    I am indeed fortunate to of found out about adrenal insufficiency and treat it. Sorry to say that not one endo would help me. I went through many and a few actually laughed at me. Endo’s ended up costing me a fortune, that I did not have, wasting my time and making me sicker. I wish they knew more about the their own supposed specialty.

    Dr Cobbs, may I ask your location?

  • Ronald Cobbs MD

    I see patients in my private office in Manhattan, New York. I also see patients in a private teaching hospital clinic.

  • gina

    Darla, if you were thinking either of going to Dr. Cobbs yourself, or referring a friend to him, you should be aware that he shares the same unenlightened mainstream view of Armour that AACE, etc. hold. Apparently, he will prescribe some cytomel to “a small minority” of patients, but he won’t “retreat to the non-precise dessicated thyroid preparations of the past”.
    http://www.metabolism.com/2009/03/22/ron-cobbs-noted-endocrinologist-speaks/

  • Ronald Cobbs MD

    It is true I do not use armour thyroid and share the “enlightened” view of AACE, the Endocrine Society and The Thyroid Association instead. However I do regognize the importance of treating both hypothyroidism and adrenal insufficiency when they coexist. I also add cytomel (T3) to any patient who does not feel back to normal after being fully treated with levothyroxine for documented hypothyroidism. Since the vast majority of those that I treat feel normal on levothyroxine alone, I do not add cytomel. However, every patient being treated who does not feel well on levothyroxine alone despite normal thyroid function tests is offered cytomel therapy in addition. This position is supported by medical literature and is the position that I continue to support myself. The key is to listen to the patient’s complaints and address the issues as they arise. Patients then have a choice to decide which physician to visit. But even though physicians like Dr Pepper and myself may not agree on a specific course of therapy, we all do want the very best for our patients. And we can and do respect each other as caring professionals.

    • Dr. G. Pepper

      Ron

      Thanks for your comments and guidance to our members. Each doctor strives to find therapies they believe work the best for their patients. I also use the combination of t4 and t3 (cytomel) when I think that is the best approach for a particular person. I appreciate that you recognize that other physicians may differ from the AACE recommendations when it comes to Armour use. What worries me is that the official AACE statements take a critical tone with those who differ with their opinion, undermining public confidence in practitioners who choose this treatment option.

  • gina

    Precisely, Dr. Pepper. AACE’s guidelines state that “In general,desiccated thyroid hormone, combinations of thyroid hormones, or triiodothyronine should not be used as replacement therapy” and that “The serum TSH level is most important” in determining the appropriate dosage level for treatment. (Most of us who have been on either cytomel or desiccated thyroid therapy know that TSH often goes below reference range before full therapeutic effect has been achieved, because of the TSH-suppressing effect of t3. Doctors who are concerned about iatrogenic hyperthyroidism can put their minds at ease by testing the actual active thyroid hormones free t3 and free t4, rather than relying on the indirect indications of the pituitary hormone TSH.)

    The unfortunate effect of AACE’s insistence on TSH-determined diagnosis and t4-only treatment is felt daily by patients (or would-be patients, whose diagnoses are missed as my hashimoto’s was, because of their in-range TSH). Just yesterday, a member of the thyroid forum I belong to reported that her board-certified endocrinologist told her that he didn’t care to hear any more about her continuing hypothyroid symptoms, because in his words “I don’t treat symptoms, I treat labs” (by which he meant TSH). While this physican’s candor was rare, his attitude towards his patient is not. Thanks to AACE’s guidelines, no doubt he felt that he had fulfilled his professional obligations to his patient.

    Additionally, I must point out that Dr. Cobbs’ statement that he would not “RETREAT to the non-precise dessicated thyroid preparations OF THE PAST” does not resonate with the “respect [for] each other as caring professionals” that he claims to have. It appears that his “recogni[tion] that other physicians may differ from the AACE recommendations when it comes to Armour use” is limited to saying that such a practice is obsolete, ie wrong. That hardly seems collegial.

  • Darla

    Thank you Gina for pointing out that Dr Cobbs does not use dessicated thyroid. I am impressed that he acknowledges adrenal insufficiency and hope that he treats his patients with it properly. But I can not, nor will I ever, take synthetic thryoid meds. They did not work for me, and quite a few others I know. I became very ill on them. If Dr Cobbs is closed minded toward Armour or other dessicated thyroid meds then he would not be the doctor for me or my acquaintances.

    The AACE’s view on Armour is wrong and it should be taken into consideration that there are a lot of folks out there that are not doing well on T4 only drugs and doctors are blaming it on other disorders. Depression from lack of T3, for instance, can not be effectively treated with anti-depressants.

  • Amy

    Yes, I am curious as to how many of Dr Cobb’s patients are also being treated for other disorders like depression, constipation, fatigue, etc and their symptoms are not being attributed to the simple fact that their synthetic hormone replacement is not doing the job. I also am curious to find out if Dr Cobb’s receives any funding from any pharaceutical companies or any other “benefits” in exchange for his brand-name-only promotion of their products.

  • Ronald Cobbs MD

    Thanks for asking Amy.

    As to the first question, I routinely ask my hypothyroid patients but only a few have complained of symptoms that might demonstrate inadequate hormonal replacement. For the few that have complained, I have routinely offered combination therapy as I previously described.

    As to the second question, I do not speak for or receive benefits from pharamaceutical companies other than free patient oriented diet sheets and logbooks for my diabetic patients. The law is very specific about what can be accepted to give to patients. And absolutely nothing comes from thyroid hormone producing companies.

    My views simply echo the official statements of concern from the Americal Association of Clinical Endocrinologists, The Endocrine Society and The American Thyroid Association as well as the published literature. These groups represent the official opinions of the majority of endocrine experts in the country. However, as you are aware, some do not share their opinions.

  • Ronald Cobbs MD

    Dr Pepper,

    My apologies! I did not see your reply from June 4th 2009 until just now. While AACE issues guidelines and recommendations, each physician and clinician is free to prescribe as they see fit so long as the medication is legal.

    While we disagree on Armour, I will agree that clinicians have the right to precribe it without fear of legal ramifications.

    On a personal note, I must say that I am still extremely grateful for all of the endocrinology that you taught me while I was an endocrine fellow. I still use your techniques for fine needle aspiration of thyroid nodules. And I still teach much of the endocrinology that you taught to me. I am forever in your debt! Thanks!

  • Amy

    Thank you Dr Cobbs for your reply. I am very sorry you are not open to desiccated thyroid as a treatment option for your patients. Other than this unfortunate oversight on your part you seem to be a well informed and caring doctor.
    Unfortunately the AACE and the ATA are VERY heavily funded by Abbott Labs and other makers of synthetic thyroid hormones. It is glaringly obvious to all of us who are natural thyroid proponents that Big Pharma has indeed hijacked the entire thyroid replacement education and treatment arena and essentially done all they can to wipe desiccated thyroid off the table as a treatment option. They have spent millions on this and to say otherwise is naive to say the least. Even their “published literature” is heavily flawed and slanted towards results that favor their products (see Dr Pepper’s examples in this newsletter). And we also know that the “No free lunch” rules have only recently been enacted to prevent the blatant marketing to physicians with freebies to influence their medication choices for their patients.
    I sincerely hope you will set your prejudices aside for a moment and read Janie Bowthorpe’s book Stop the Thyroid Madness. It is about how thousands of us have been under diagnosed with the TSH and poorly treated with T4 and synthetic hormones and how we are doing splendidly on natural thyroid hormones. It’s a very well thought out and reasoned argument as to why replacing our missing thyroid hormones with a product that closely resembles what our own thyroids produce, including the trace hormones T1, T2, and calcitonin is important for our overall health. It also addressed the extremely important connection of thyroid and adrenal fatigue, which is so often overlooked (or outright denied) by endocrinologists and mainstream doctors. I would also hope you would spend some time reading Mary Shomon’s extensive writings about how poorly thyroid disease is diagnosed and treated on About.com.
    I, and many others believe that to not at least offer desiccated thyroid as a treatment option is doing your patients a disservice. I am curious how many of them go to other physicians for treatments of various ailments like depression, high cholesterol, menstrual difficulties, joint pains, etc. Most don’t connect these problems with their thyroid treatment and won’t necessarily discuss them with their endo specialist.
    I hope you will at least explore the possibility that you have been very much influenced by large pharmaceutical companies in your patient care decisions. You could be in store for some very pleasant surprises if you open your mind to the option that desiccated thyroid works so well for so many.
    PS. I was just at my local pharmacy filling my script for Naturethroid and was behind a woman in line who was trying to get her newly prescribed Synthroid filled, only to be told that her insurance would not cover the cost for a non-generic. She was stymied as to what to do because her doctor had insisted on a branded medication. I hope you take this into consideration when you stipulate these branded meds, which for many are simply not affordable.

  • Darla

    Amy, will you be my doctor? 🙂

  • Amy

    Oh dear, I hope I’m not giving the impression I’m a doctor! Heaven forbid!
    I’m only a long-undiagnosed thyroid sufferer who has a somewhat passionate interest in trying to keep others from going through what I’ve been through.
    Darla, I hope you have found a great doctor, like Dr Pepper here, who actually listens to you and who will help you make an informed decision about your treatment. I am extremely fortunate to have found one in my own locale.

  • Darla

    Oh Amy, I was just kidding. I am not a doctor either, but you do have the same views I do. I read Janie’s and Broda Barnes book plus a few others. Their protocol with Nature-throid, and Hyrdrocortisone healed me after 20 years of that horrid Synthroid. I had to give up my business because I was so sick. I am reopening soon if the economy will cooperate. 🙂

    I have found a pretty good doctor. Finally.

  • Amy

    Thanks Darla, so good to find a kindred spirit! I just hope this groundswell of patients who are sick of being held hostage to Big Parma’s death grip on our treatment options will continue to grow.
    Dr Cobbs says above,
    “While AACE issues guidelines and recommendations, each physician and clinician is free to prescribe as they see fit so long as the medication is legal.
    While we disagree on Armour, I will agree that clinicians have the right to precribe it without fear of legal ramifications”
    To me there are ominous overtones to this statement (though I certainly don’t think Dr Cobbs is aware of them). Just how far will Big Pharma go to discredit desiccated thyroid, or even try to influence the FDA to outlaw it? Today, no Medicare coverage. Tomorrow, we’re forced to go down to the street corners to get natural thyroid from scary suppliers? Quite frankly, I would not put it past them.

  • Darla

    I’m with you Amy. You would think that docs could see how important and how well Armour and Nature-throid works if we would go to such lengths. Just look at the work it takes to find the right doctor.

    The FDA has way too much power and I fear the worst quite frankly.

  • gina

    Amy, I see that you have read Janie Bowthorpe’s Stop the Thyroid Madness book and are familiar with her website of the same name. Do you know about the very active support group she started? You might like the virtual company of others who are on the same path to health! http://www.stopthethyroidmadness.com/talk-to-others/

  • Amy

    Yes, I’ve been very active on realthyroidhelp and other forums for a while now. I’m also a shameless promoter of natural thyroid and Janie’s book on the health boards thyroid disorders forum, where both methods of treatment are talked about. I think it’s important to get the word out and show there are alternatives to synthetic-only thyroid hormones.

  • gina

    That’s great, Amy! It sounds like you do a lot of outreach: a lot of people on the healthboards forum are either recently diagnosed or have been miserable for years on TSH-determined doses of t4 meds. Both groups are often unaware of the alternative of symptom-centered treatment with natural thyroid meds. Just to clarify, realthyroidhelp is not Janie’s group, although they do follow STTM concepts. Janie’s forum “NTH” is a yahoo group; if you ever want to be in a group where everybody already “gets” it, that’s the one to join!

  • Ronald Cobbs MD

    Dear Amy. Please understand that I have no set agenda. As an academic teaching physician am obligated to report and follow the published literature. This is called evidenced based medicine. No prejudice is involved in this whatsoever. As I explained earlier, physicians are free to prescribe as they see fit. In evidenced based medicine, if say 30 articles are published on a topic 5 pro and 25 con the the weight of evidence favors the con. From these sorts of studies guidelines are drawn and published by the leading agencies. While these are not binding there are recommendations based on published studies. While I realize this is not the popular opinion on this webpage thread, it is how academic medicine is currently practiced in our great country. For those physicians and scientisits who feel that otherwise they are free to write paper in peer reviewed journals to add to the wealth of medical knowledge. We can not rely just on anicdotal reports since this introduces error. If enough evidence to the contrary is published, guidelines change. There have nothing to do with sponsorships etc. BTW: often the difference in actual cost between generics and brands are only a few dollars. In some cases like levoxyl, the cost in NY was the same as the generic. So if cost is an issue, the physician can just go to epocrates or drugstore.com to check the prices and prescribe the cheapest one. I do this myself.

  • Amy

    Thank you Dr Cobb for this interesting debate! My husband teaches EBM and pharmacology at a nearby Allied Health University so I am well aware of how important it is to use randomized double blinded placebo control trials in medicine.

    After reading your letter I was thinking about formulating my response, so I thought I’d do a search as to just how many trials have been conducted comparing Levothyroxine and desiccated porcine thyroid. You can imagine my surprise when I came up with a big fat zero. I did find this illuminating remark in “Trends in thyroid hormone prescribing and consumption in the UK” by Anna L Mitchell et. al. published 11 May 2009:

    “As there has never been a randomised trial of levothyroxine versus porcine thyroid extract, any possible health benefit remains uncharacterised”,

    In fact the only trials I could find published about natural thyroid effects on humans at all mostly date back to the 1930s and 1940s. So I find it interesting that you only prescribe one medication over another even when no studies (not even bad ones!) have been done to compare the two.

    So, based on these facts, I find your statement, “We can not rely just on anicdotal reports since this introduces error. If enough evidence to the contrary is published, guidelines change. There have nothing to do with sponsorships etc” to be a disservice to your patients. In the first place, if there are no studies done but there are thousands of patients who are benefiting from a treatment that has essentially been successfully in use for over 100 years, maybe doctors DO need to listen to their patients, no matter how anecdotal their statements may be.

    And secondly, in this “great country” of ours the sad fact remains that medicine and pharmacology are very much profit driven and if pharmaceutical companies have a profit motive to promote and fund one kind of treatment over all others they will do so, to the tune of billions of dollars. There is no money out there to fund good studies comparing desiccated thyroid and synthetics, especially over the long term, which is where natural thyroid tends to outshine levothyroxine. I’m willing to bet that the reason for this is because Abbott and their ilk are not comfortable with the probable outcome of a really well done study of this nature.

    But still the vast majority of doctors tend to prescribe synthetics. There can only be one reason for this and that is the undue influence Big Pharma has on our entire medical system. We’ve seen this over and over again with many unsafe and poorly researched medications that Pharma has pushed through the FDA and heavily influenced doctors to prescribe to bad or even devastating effect. Anyone who has even a passing knowledge of the news knows that the scandals abound.

    Thanks for this interesting conversation Dr Cobb. I do hope you will see that, in this case, we do not have all the proper studies necessary to base a rigid adherence to synthetic-only treatment. What we do have are literally thousands of patients who can give very heartfelt accounts of how poorly they did on synthetics and how natural thyroid has given them their lives back. I think it’s time to listen.

  • Ronald Cobbs MD

    Dear Amy. As you discovered, there are precious few articles comparing the two forms of treatment. Also as you discoveredthe only trails published on natural thyroid hormones were published a long time ago. It would be impossible to debate this in detail as it would require a detailed understanding of how guidelines are established. However as I stated, the leading endocrinology organizations have all advocated the use of levothyroxine over dessicated thyroid preparations. As you discovered, there are simple no studies proviing all the the claims of the superiority of dessicated hormone over current preparations,. There are however a wealth of studies on the safety of the levothyroxine preparations. That fact has been clearly established in the peer reviewed literature. While it is true physicians are able to prescribe any legal drug for any purpose, if an unwanted side effect occurs and a physcian is sued, that physician is judged on the standard of care as advocated by the set guidelines as well as the standard of care in the community. Therefore if there are no recent studies documenting the safety of Amour, that physician is now at a disadvatage in his or her defense. So many people on this thread have advocated the use of Amour however most were unaware of the lack of published data to support it’s use. So if you really feel physicians should prescribe more of it, it now falls on you to encourage more of them to write papers. Perform the studies. Do what is necessary to prove the safety of the product that you desire. Only then may guidelines change. Until that time, the wealth of the published literature as well as all of the issued guidelines encourage physicians to use levothyroxine. Again, anicdotal claim have no weight in medical literature. They have lead to errors in management for years. You say you want a change, them get the proponents of dessicated thyroid to publish. That would be the way to get what you want. Without new data, physicians are otherwise best to follow the advise of the published clinical practice guidelines in order to insure the best care for the patients. As the literature changes, our practices must change to keep up with the literature. That is how academic medicine must function. There is simply no other answer. One last thought that might help. You might want to consult with AACE, the ATA and the Endocrine Society. Despite all the comments writen above, they generate their guidelines based on studies and published literature not drug company dollars. Ask them for the literature that they used in order to develop their guidelines. You will be surprised about all the literature in their favor that you make have never seen. Seems to me that your issue is really why guidelines are issued and what evidence was used to support those guidelines. It should not be to confront a physician who follows the commonly accepted peer reviewed guidelines issued by the national experts in the disease process.

  • Amy

    Dr Cobbs, I completely agree that confronting a physician who follows commonly accepted guidelines and who has no interest in looking at alternatives is probably a complete waste of time on my part. But you are here and engaged so I jumped at the chance to express my own point of view.

    Of course I was hoping that you might see that the drug companies that manufacture synthetics have the huge resources available to test their products (and have had to do so to get them their belated FDA approval), while natural desiccated thyroid, which has been in established use for decades with no discernable ill effects, no patents, and no large corporations behind them with a financial incentive to fund similar studies, are being eliminated, not based on their lack of merit or safety but simply because nobody has done the studies.

    This has let me to think that maybe your natural curiosity might be piqued to look at this as a good research project for yourself, as an academic teaching physician. There is a vacuum here and synthetics are rushing in to fill the space to the exclusion of other long-established therapies that could be just as good or even better. You obviously have an interest in this, hence your presence here and I would hope you’d agree that this is a great study crying out to be done. I would even venture you are a perfect person to conduct this since you are not clouded with a wish to see that desiccated thyroid does better and your claim that you have not been influenced by Big Pharma.

    In fact, I would think that you and Dr Pepper would be a great team, coming from two sides of the same coin and your long and positive relationship. I am very impressed with Dr Pepper’s take on other poorly done studies about T3 and T4 therapy and feel he is a great choice to help formulate a well thought-out study.

    So if, as you claim, there really isn’t a profit motive in good medical research, then here is an excellent opportunity to provide the medical community as well as the endocrine societies with solid information that allows them to base their guidelines on solid facts instead of the currently unbalanced assumptions.

    Again, thank you for your engagement and interest in this. I sense that you are getting a tad impatient with me and hope that you realize that I, as a hypothyroidism sufferer, have a very real interest in my own health and well being. I also tend to be a very vocal advocate for others in my situation. Please understand that many, many of us have been misdiagnosed and mistreated for years, if not decades, and that this is forming a groundswell of dissatisfaction, if not downright anger, towards the practice of endocrinology as a whole (hence the title of this thread, 2009 Another Troubled Year for Endocrinologists). I find this to be a real shame and feel that it’s only by becoming more vocal and confronting the practitioners themselves with the discrepancies in their practice as we see them, will we obtain better diagnostics and treatment.

  • Randy Thompson

    Gina and Amy,

    Wow….. thanks so much for your comments. I have been educating myself for months now, and I am so angry now that I see the arrogance of the mainstream medical community. I am 55 years of age, and suffered since age 16 with symptoms that I now know are a result of hypothyroidism.
    I made so many attempts through different doctors all through the years to get some help. It wasn’t till the internet opened up the chance for us to do some research and find “kindred spirits” that I began to get answers. I have found a doctor that is treating me with Armour and HC. I am on a path now to get my health back. Thanks so much for this forum.

    Dr Pepper, thanks very much.

    Randy

  • Ronald Cobbs MD

    Amy, thank you so much for understanding. I have recently been in contact with Dr Pepper about some of this. I am not sure if my current schedule (both academic teaching physician and private endocrinologist) would allow much time for a study with the numbers necessary to meet statistical standards required for publication. However I can still discuss it with Dr Pepper. Thanks for your comments. I do promise that I will listen intently to my patients concerns and I hope that my fellow physician will do likewise.