Power, Drugs, and Living Well

The following article was written in 2002. The doctor in the article has since retired.

Saturday afternoon and I have work and deadlines, but my energy and focus have fizzled like a limp balloon. Over the span of a few hours, this hard-working person who was just the other day described as indefatigable becomes a blob in front of the boob tube.

Later in the kitchen, I notice the bottle on the counter. I'd forgotten to take my usual afternoon drug. I take my afternoon amount at dinner time, and within minutes, I have energy and can focus again.

If the College of Physicians & Surgeons of British Columbia had their way, I wouldn't be able to take that drug. They've been trying to put a doctor who treats patients like me out of business for over a year. On September 27, they upheld the suspension of his medical licence.

Speed? Cocaine? No — I'm on thyroid medication.

So are a lot of people. Depending on the estimate, hypothyroidism, or an underfunctioning thyroid gland, affects from five to up to 40 percent of the adult population in Canada and the United States. But just how are those estimates made? By how many people are taking thyroid replacement hormone?

The thyroid gland sits above the Adam's apple and produces hormones used in every cell in the body. When the body doesn't get enough of these hormones, the list of possible symptoms includes fatigue, feeling cold when others don't, weight gain without a change in eating habits, depression, dry skin, hair loss, constipation, high cholesterol, menstrual problems, impaired memory, and the inability to think clearly. Think about what happens to a car if you drive it when it's low on oil, and you get the picture.

Until about 1975, doctors diagnosed and treated hypothyroidism by observing and listening to patients' symptoms. If the patient looks hypo, sounds hypo, and walks hypo, the patient probably is hypo. Give the patient some thyroid medication, and watch what changes. Keep raising or lowering the dose until you find the amount that the patient needs. Not exactly rocket science, but it wasn't scientific enough for those who prefer to make their diagnoses from a piece of paper, so the medical profession came up with a sure-fire test called the TSH test.

TSH stands for Thyroid Stimulating Hormone. This hormone is supposed to tell the thyroid gland when it needs to pump out more thyroid hormone, so a high TSH level should mean that the thyroid gland is underproducing, and vice-versa. Perfect. Never mind that the medical profession had already been through several other tests that were also supposed to have been unfailing methods of diagnosing hypothyroidism, or that this one hadn't undergone any testing to prove whether or not it actually correlated with how patients felt. It was idiot-proof.

To make a test useful, you need to establish a range of "normal." But if up to 40 percent of adults have thyroid problems, is there any chance that only people with optimally-functioning thyroid glands are included in the sample groups used to establish lab ranges?

The medical world still doesn't have a consensus on the acceptable range for the TSH test. The usual high end of the range is about 5.5 mU/L, some labs have their high number somewhere around 4.5, and a few labs go as high as 6. This means that a person could be diagnosed with hypothyroidism based on a blood sample at one lab but not with the same sample at another lab. It's also inconvenient that the American Association of Clinical Endocrinologists came out and said in 2001 that a TSH level over 3 should be considered suspect, and that back in 1997, the prestigious British Medical Journal questioned a TSH level over 2. Never mind, though; a number is a diagnosis, and that's what the medical profession wants.

Numerous thyroid patients don't feel well until their TSH level is under 2, often well under 2. Most labs haven't changed their TSH ranges, however, and with most doctors, a patient who has symptoms of hypothyroidism but a TSH level within the lab's "normal" range is not given treatment for hypothyroidism.

And for a lot of patients who are treated for hypothyroidism, the treatment itself is not adequate.

Imagine you work for a pharmaceutical company. Your company makes drugs to treat depression, weight gain, muscle aches and pain, constipation, hair loss, infertility, menstrual irregularities, high cholesterol, and many more common conditions. Your products meet the needs of the market. Now, it turns out that for up to 40 percent of the people who suffer from these problems, a single cheap pill could solve all of them. Which would you push at the doctors — the cheap pills, or the range of pills that help pay your mortgage?

Pushing pills is big business. The pharmaceutical industry spends more money on marketing than it does on research and development, with thousands of dollars budgeted per physician for direct-selling marketing efforts.

To be fair to doctors, most want to help their patients, but those who attended medical school after 1974 were taught that the TSH test is the gold standard for diagnosing and treating hypothyroidism. They don't know what else to do except to treat each of the symptoms individually, like trying to tape over all the holes in a hose that's sprung leaks along its entire length.

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