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Letters to the Editor Issue 84

by Letters(more info)

listed in letters to the editor, originally published in issue 84 - January 2003

Urgent Appeal for Integrated Cancer Care

Where do cancer patients turn in their fight for life when their cancer fails to respond to conventional treatment and there is no hope in the NHS for 'last hope' integrated cancer care? Despite a lack of NHS provision, in 1997 a terminally-ill breast cancer patient embarked upon the Bristol Cancer Help Centre model of holistic cancer care and Gerson Therapy in a bid to save her life.

This patient is now seeking Judicial Review of her health authority's decision not to assist with treatment finding on the grounds that there are no prospective or randomised controlled trials (RCTs) even though:

* There is more medical evidence in her case than if she had been in an RCT;
* There are similar case studies showing the benefits of this approach;
* An NHS consultant oncologist clinically supervises her treatment;
* Her treatment has been a safe and effective means of extending her life;
* Parliamentary support for 'last hope' integrated cancer care has been given.

The Bristol Cancer Help Centre opened a contingency fund to cover the legal costs of this case which the High Court Judge decided has 'merits'. However, leave for a judicial review was granted with the recommendation that the health authority's offer of an independent medical assessment be accepted as a means of resolution.

Subsequently, due to the uniqueness and complexity of this pioneering case, arduous and on-going negotiations to determine the terms of the independent medical assessment have taken place which are on the brink of being settled. But the resulting escalation in legal costs has caused a deficit in the contingency fund and further donations are urgently needed to enable this process to be successfully concluded.

If you would like to help and ensure that either the Independent Assessment or the full Judicial Review can go ahead please send a cheque payable to 'Bristol Cancer Help Centre' (Reg'd Charity 284881) stating that you support the 'Right to Life' action to:

Melissa Henry,
Right to Life,
c/o Bristol Cancer Help Centre,
Grove House, Cornwallis Grove, Bristol, BS8 4PG

Thomas Myers re Joël Carbonnel Comment

In the October 2002 Issue 81, p 49, Joël Carbonnel, in a discussion of muscle chains in Mind the Body, Embody the Mind, kindly mentions my book on the Anatomy Trains, before going on to dismiss any ideas of myofascial linkages that do not originate with Françoise Mézières.

I very much appreciate the work of Mézières, and appreciate the kind of cross-pollination that Joel's background and reading bring to the column. And while I agree with him and Mézières on some of the laws of muscle chains, I am loathe to let this dismissal stand.

The Anatomy Trains do not attempt to recreate the functional linkages of Mézières and Busquet, though there are similarities to both these lines and acupuncture meridians. The Anatomy Trains myofascial meridian lines describe lines of strain transmission, chains of 'fixation' muscles through the fascial fabric. As such, they do not need to overlap in the way Joël describes and Mézières requires – muscles joined end-to-end do communicate via the fascial fabric which joins them. Mézières and Joël are still apparently trapped in the 'single muscle concept', the familiar idea that muscles work solely between their proximal and distal attachments.

The truth is, there are no single muscles absent [from] a dissector's knife, and the near total dependence of modern physical therapy and performance therapies on this mechanistic concept leads them all down some fairly arcane and fruitless paths (of which Mézières, I hasten to add, is not one). The truth, in this case, is the unity of the fascial net, in which muscle tissue inhabits 600 of the 1000 or so pockets within the net. The implications of this 'New Age'-y but accurate picture are just beginning to be explored, and the Anatomy Trains book is one sally down this road.

More information on fascial tensegrity is available on www.anatomytrains.co.uk/    www.anatomytrains.com/

Thomas Myers, author Anatomy Trains
kinesis@prexar.com

Joël Carbonnel Replies

It was not my intention to dismiss, as Tom infers, any ideas of myofascial linkages, but to express my opinion that, since a tug in the fascial net is communicated across the entire fascial net, it is difficult to see how there can be specific myofascial meridians that conduct strains, tension, movements, etc. I believe that muscles are the important component in the distribution of these movements and restrictions. Similarly, I was not suggesting that Tom was attempting to recreate the functional linkages of Mézières and Busquet, but, as Tom mentions them in his book, I thought it was fitting to bring a little historical perspective and to clarify that Busquet's muscular chains have very little in common with Mézières.

One of the most important discovery made by Mézières was that some muscles are linked into chains and that they never 'behave' like isolated muscles. Hence I disagree with his statement that "Mézières and Joël are still apparently trapped in the 'single muscle concept', the familiar idea that muscles work solely between their proximal and distal attachments." I invite him to re-read my column The Weakest Chains in Positive Health Issue 81, October 2002, a modest contribution to this complex subject.

Regarding the connective tissue per se, it goes without saying that we cannot isolate muscle from fascia but perhaps I should have done just that to avoid any misunderstanding. I see connective tissue as a substance which over the years tends to set like a jelly due to collagen, its main protein, increasing its rigidity and reducing its solubility. This general stiffening of connective tissue causes hardening or sclerosis of the tissues and organs, crippling their efficiency – the process of ageing. Dr Rabagliati called connective tissue "the great dumping ground of the blood". Regarding the connective tissue associated with muscle tissue, it is interesting to note that when muscles remain for a prolonged time in a shortened state, their connective tissue increases while there is a loss of sarcomeres (the contractile element of the muscle). So it is important to prevent any undue shortening of our muscles (good use of the self, Alexander Technique) or to restore any loss of muscle elasticity (Mézières' Method). There's more than one way to skin a cat and there is more than one way to deal with stiffening and overgrowth of connective tissue.

Maybe muscles joined end-to-end may 'communicate' via the fascial fabric as Tom maintains, but I am still convinced, from experience and observation, guided by Mézières' discoveries, that it is the overlapping of poly-articular muscles which is the decisive factor in the conduction and transmission of tension and compensations leading to distortions, pain and malfunction. Ironically, some tests made by a Rolfer give grist to the mill of Mézières' concepts. In an article entitled Explorations of the Neuro-Myofascial Net, Robert Schleip asks himself and all faculty members of the Rolf Institute: "Is it possible that most of the structurally important restrictions in our client's bodies are just caused by a high muscle tonus…?" To me there is no doubt that the answer is 'yes' and that this excess of tonus lies in what Mézières called Muscular Chains.

However, progress cannot be made by sclerosing our opinions, and it is to Tom's credit that he is willing to open up debate in this important subject.

Joël Carbonnel
joelcarbonnel@hotmail.com

Editor's Note

Readers are also invited to read Joël Carbonnel's review of Thomas Myers' book Anatomy Trains which appeared in Positive Health Issue 76 May 2002.

Help: Soy Products for Menopause

I refer to the published debate on Soy in the July, Issue No 78, of Positive Health.

I suffer from hypothyroidism and I am also currently going through the menopause. As I did not wish to go on HRT and also as I am a vegetarian, my consultant at Royal Free Hospital has recommended me to take Red Clover one-a-day tablets (40mg per tablet).

Red Clover also appears to contain the same isoflavones as Soy (Genistein, Daidzein, Biochanin A – Methoxy Genistein and Formononetin – Methoxy Diadzein).

I am now confused as to whether I should continue to take Red Clover in view of the toxic effect of Genistein and Daidzen on the thyroid.

I would be most grateful for the advice available to put my mind at rest.

Thanking you in advance for your assistance
Miss J Shah London

EU Supplement Directive Update

Outcome of discussions re tolerable upper intake levels for vitamins and minerals of the Scientific Committees Scientific Committee on Food.

Terms of Reference

The European Commission has requested the Scientific Committee on Food (SCF):

1. To review the upper levels of daily intakes of individual vitamins and minerals that are unlikely to pose a risk of adverse health effects;
2. To provide the basis for the establishment of safety factors, where necessary, for individual vitamins and minerals which would ensure the safety of fortified foods and food supplements containing these nutrients.

Workplan

It is planned that all the vitamins, essential minerals and trace elements which were included by the SCF in its report on recommended dietary intakes (SCF, 1993) will be considered in this review on upper levels, i.e. vitamin A (retinol and beta carotene), vitamin D, vitamin E, vitamin K, thiamin, riboflavin, niacin, vitamin B6, vitamin B12, folate, biotin, pantothenic acid, vitamin C, sodium, potassium, chloride, fluoride, iodide, magnesium, calcium, phosphorus, iron, zinc, copper, manganese, selenium, molybdenum, and chromium.

On 19 October 2000 the SCF expressed an opinion on guidelines for the development of Tolerable Upper Intake Levels for vitamins and minerals, together with opinions on Tolerable Upper Intake Levels for the following nutrients: beta carotene, vitamin B6, vitamin B12, folate, manganese, selenium and molybdenum.

On 22 November 2000 the SCF expressed an opinion on the Tolerable Upper Intake Level of vitamin B2.

On 11 July 2001 the SCF expressed an opinion on the Tolerable Upper Intake Level of vitamin B1.

On 26 September 2001 the SCF expressed two opinions on the Tolerable Upper Intake Levels of Biotin and Magnesium.

On 17 April 2002 the SCF expressed two opinions on the Tolerable Upper Intake Levels of pantothenic acid and nicotinic acid and nicotinamide (niacin).

On 26 September 2002 the SCF expressed two opinions on the Tolerable Upper Intake Levels of iodine and preformed vitamin A (retinol and retinyl esters).

Opinions on the remaining micronutrients are being prepared by the Committee to fulfil the request by the Commission and will be published in due course.

Reference

Scientific Committee for Food (1993). Nutrient and energy intakes for the European Community. Reports of the Scientific Committee for Food, Thirty First Series. European Commission, Luxembourg.

Source: Christine Doyle; christinedoyle@ntworld.com

CODEX: No News Allowed

I have just organized a camera crew to the CODEX meeting and attempted to [enter] the meeting with a film crew. Even though I have a valid press pass issued by the CODEX Organizers, they stopped us at the gate with camera rolling behind me. We captured my attempt to get into the meeting and the conversation in German between the guards of the gate and the people inside. I had to leave the camera crew behind (as expected) and then go into the building to plead for Press Freedom.

When I got into the building, I was escorted in true regime style to the press office and was told that no cameras are allowed into the building even if we are press. This took place during a tea break, so we explained that we wanted to interview delegates. The answer was a resounding "NO". I did, however manage to force the press secretary to let the crew through the gates and stand at the main doors of the meeting hall upon advising them that I was going to make a call to the South African Embassy. I then fetched the crew and concluded my speech on camera before leaving them behind. In my opinion this is the worst type of scam I have ever witnessed. There were only two accredited members of press present at the meeting, namely myself and another from India who is on our side. Yesterday, I asked the Press Coordinator why there was so few press representatives and I was told "We did not encourage the press or invite them because there is really nothing of interest for them here". I think that restricting natural health, as used by 80% of the world's population is newsworthy.

Dr Anthony Rees Naturopath, South Africa
www.honeri.org
Source: J Hammell www.iahf.com

This brief message demonstrates the absence of 'transparency' and democratic participation at Codex. We might want to cite this to our elected representatives should the time come when Codex overrides freedoms afforded by domestic laws – as EU legislation is about to do to member countries. This shows that press coverage and public opinion is important and we may still have a chance to overcome the very restrictive regulations that are being proposed.

Richard Elwood
elwood.richard@nowfoods.com

CODEX Update

By Josef Hasslberger

The Codex Alimentarius Committee on Nutrition and special dietary foods met in Berlin on 4-8 November.

Codex Alimentarius is the name of a global food-standard setting body that is attached to the Food and Agriculture Organisation of the United Nations' WHO. The deliberations in Berlin this past week of a committee charged with developing guidelines for vitamin and mineral supplements have shown progress towards a risk based approach for regulating vitamins and minerals. This is a positive development in view of the substantial agreement that had persisted in the past, for an RDA-based approach which would be disastrous for both consumers and industry, but especially for public health world wide.

Two days before the beginning of the week-long discussions which took place in Berlin from 4 to 8 November 2002, the Dr Rath Foundation had organised a large conference attended by over 2500 people, where the results of scientific studies were made available. The studies and the personal successes of people taking vitamin supplements on the advice of Dr Rath prove the overwhelming importance of changing from a pharmaceutical and symptom-based approach to illness to a nutrition based, cellular-level approach. Perhaps more importantly, Rath's conference brought together a group of representatives of organisations from several countries, all concerned with preserving freedom of choice for natural methods of prevention and cure.

Two days later, on the morning that saw the beginning of the official Codex conclave, many of the participants in the Rath event were demonstrating outside the gates of the building hosting the meeting, loudly demanding that their health choices be respected.

Vitamin and mineral supplements

Days of deliberations brought little visible progress. Towards the end of the three-day conclave the subject of food supplements was once again on the agenda. Developing nations see vitamin and mineral supplements as another 'blessing' to be bestowed on them by the same hated multinationals, the giant global pharmaceutical and food industries. We must view the Codex discussions on food supplements against this backdrop.

The proposal for a guideline on vitamin and mineral supplements, first made in 1994 by the German Codex delegation, seeks to extend the philosophy of control so prevalent in that nation and in much of the rest of continental Europe, to the whole world. The draft proposes to set strict limits on the composition and potency of these extra nutritional foods, relegating everything exceeding 'nutritionally necessary' dosages to the world of medicine, a world which today is clearly dominated by pharmaceutical interests.

To be fair, some progress has been made over the years, at least on the issue of dosages, towards a consensus that would safeguard the rights of consumers to take care of their health in a manner consistent with their own choosing. More often than not, consumers see their nutritional needs in a way that differs remarkably from 'official recommendations', and so do some medical doctors, witness the research of Dr Rath, Linus Pauling and many others.

Scientific approach to limits

Early in the discussions of this particular Codex session, the importance of a scientific approach to regulation was stressed by FAO, the Food and Agricultural Organisation, and the WHO. The majority of delegates agreed that such an approach would be possible and indeed desirable. Risk analysis and risk management, an emerging branch of science, is part and parcel of such a scientific approach. Yet, on food supplements, the German chairman Rolf Grossklaus proposed to "protect consumers" for the next four or five years by establishing both lower and upper limits to product dosages, while waiting for the squadrons of risk managers to get up to speed.

Two options were to be discussed, RDA-based limits and risk based scientific evaluation. Needless to say, no agreement could be reached which path to follow. While most of the industrialized nations including Europe and the US asked for a risk based scientific approach, the feeling among some of the African, Asian and South American developing nations was that this would open their markets to a host of products they could not control.

When discussing the preamble of the draft guideline, remarkably, the South African delegate strongly stood up for the free availability of supplements, to the extent of lambasting the participants for what she called a hypocritical approach to health and even a "return to the dark ages". In the face of scientific data indicating that supplementation is potentially life saving, Ms. Booyzen said, Codex should not be thinking of putting limits on safe products such as vitamin and mineral supplements. She suggested, quoting scientific studies, that supplements might be useful to prevent many of the diseases of civilization, the so called degenerative diseases which are due to sub-optimum supplies of certain nutrients in the body.

This was a refreshing new development, warmly welcomed by non-governmental delegations and observers concerned with consumer choice. In the more than lively discussion that followed, several delegations echoed the European Union representative who stated in full earnest that anything with preventive, let alone curative, properties must be considered a medicine and is therefore outside the Codex mandate and is not part of the things to be legitimately discussed by the Committee.

An obvious contradiction

The discussion brought a glaring, basic contradiction inherent in our health policy into plain view: We are told to eat fruit and vegetables, possibly five helpings a day, to stay healthy and to prevent heart disease and even cancer, yet we may not take the nutrients we seek in the form of supplements for the same purpose! It is another way of saying that 'there is a pharmaceutical monopoly on medicine and health, that must not be touched'. Food has nothing to do with health, according to this particular twisted view, and before you may even obtain high power nutritional support, you must first get sick!

Respecting the existence and the overriding character of that pharmaceutical monopoly, the Codex Committee on Nutrition and special dietary foods could not agree on the purpose of supplementation. Nutrients, after all, have nothing to do with prevention, which remains exclusive territory of pharmaceutical medicine. The preamble of the proposed guidelines therefore remained open to discussion. Chairman Grossklaus then proposed to concentrate on the issue of possible dosage limits so as to afford some temporary 'protection' to consumers, but found that a divided assembly could not make up its mind.

What's the score

The 'scorecard' of the discussions on dosage limits confirms our suspicions of a 'larger game' going on in the background, unseen and unacknowledged by many of the participants. Far from living up to its fragile consensus on the necessity of introducing scientific risk management into decision making on public health, the committee's members again divided into two opposing camps.

The European Union and its member states voiced support for the 'second option', that of letting science decide where the dividing line should be drawn between what is allowed and what is not. They were supported by Australia, New Zealand, the US, South Africa, Japan, Switzerland, Canada, the UK and, remarkably, Russia, Korea and Peru. Norway was adamant, on the other hand, that its citizens should not have access to any supplement of vitamins and minerals that contains more than the RDA, the recommended dosage which is associated with an absence of the classical deficiency diseases such as scurvy, also called the 'sailors' disease'. No matter that scurvy was eradicated when the British Royal Navy started following the advice of James Lind, who said eating a few lemons could prevent and even cure the dreaded disease. The Vikings found allies for their restrictive views in Brazil, Indonesia, Thailand, Benin, Malaysia and Nigeria.

In view of such widespread discord, the Chairman of the Committee could not but concede defeat and propose that the guideline should "remain on step three" of the eight-step approval procedure. He invited governments once again to make written comments on the draft text before, one year from now, the Committee will consider the matter anew. Unfortunately, or should we say fortunately, there was no time left to continue discussions.

In conclusion, and in a more than one sense, consumers and the health food industry as well as natural medicine were 'saved by the bell'. What remains to be done is a lot of education on the beneficial and indeed life saving character of nutritional supplementation. While a year may seem to be a long time to some, there is great urgency to act.

Codex, globalization and the pharmaceutical monopoly on health

The issue should also be examined in a broader context. Codex Alimentarius and its proposed guidelines are but the tip of the proverbial iceberg. The discussions mirror the deadly embrace of two giants – global pharmaceutical and food industries allied with 'western medicine' on the one hand and the age-old traditions of herbalism and 'traditional medicine' with the more recently developed nutritional approach of 'cellular medicine' on the other. Clearly, the Codex issue cannot resolve until there is a recognition of the fact that medicine must not be monopolized by any one particular system.

We need to approach health from a viewpoint of plurality, and that includes abandoning the currently widespread insistence of western governments that 'foods must not be used to cure or prevent any disease'. Codex cannot escape its responsibilities for our health by saying 'we deal only in foods', or, put into different words, 'medicine is none of our business'. A balance must be struck between prevention based on nutrition and traditional means on one side and the pharmaceutical approach to health on the other.

Globalization of health care under the domination of our particular brand of pharmaceutically dominated 'scientific western medicine' will inevitably lead to a broadening of the conflict we observe in these discussions. Insistence on a pharma-centered approach to health has turned out to be so wasteful that governments are now unable to bear its costs. The system is breaking down, western populations are killed by diet-related scourges such as heart disease and cancer, while the use of supplements for preventive purposes is officially frowned upon. At the same time, properly approved and prescribed pharmaceutical drugs have become the third or fourth most widespread cause of death in the 'civilized' nations.

What to do?

The forces proposing a pluralistic approach to health must wake up and start working together. Time is short. One year, the time that will pass before this particular Codex Committee is to meet again, is nothing in the time scale of legislative developments. For the sake of our health we should advocate our right to choose – loudly if needed – to eat real food, preferably organic, to use nutrients for prevention and to return to scientific medicinal traditions that have stood the test of millennia and have served us well. We must combine these age-old scientific traditions with new research and knowledge of biochemistry, but we should also be wary of 'scientific adventures' such as genetic modification of our foods, the invention of ever new 'xeno-biotic' drugs, the poisoning of our environment in the name of 'pest control' and 'weed killing'.

Let's get to work to build a great alliance. Codex is the spark, but the real prize is our health, if not the survival of our children and of future generations.

Josef Hasslberger, Rome, 9 Nov 2002
Tel:+39 06 635884 sepp@lastrega.com
www.hasslberger.com

Consumers favouring freedom of choice: www.laleva.cc
News on the health front: http://consumers.laleva.cc

Misinterpretation of Thyroid Function Tests

Over the last eight years I have been researching into the misinterpretation of thyroid function tests results. My subsequent research over the latter years has led me to believe that the reference interval for thyroid function test results is too wide. The medical profession relies totally on the blood test results; subsequently many patients suffering with thyroid dysfunction are not diagnosed. Where is the baseline of each individual in the reference range when well? I stated this in the first edition of Tears Behind Closed Doors published in 1998.

Stig Anderson and colleagues recently measured the thyroid function of 16 normal men every month for a year. The variation within an individual lay in a range that was much narrower than the laboratory reference range.[1] This means that a result may be abnormal for an individual but still lie within the reference range.

There are no data on the relative importance of biochemical thyroid function tests and clinical symptoms and signs in assessing thyroid dysfunction.[2]

In experiencing data in the medical journals a smaller sample of the population was used to determine the reference ranges for thyroid malfunction; these require updating. The environment has changed. Lifestyles, diet and living habits of the population have changed. iFurthermore, technological advancement has enabled us to utilise the sophisticated methods and machines that are now available.

I know that the diagnosis and management of thyroid dysfunction is controversial, and highly sensitive. I would like to use the results of my own blood test as an example, although I am not asking for any individual comment.

In 1993 the results of my thyroid function test were as follows:

TSH 1.95 (R. Range 0.4 – 5.4)

FT4 17.3 (R. Range 11.5-23)

At that time I had received treatment for myasthenia gravis for two and a half years and needed the use of a wheelchair.

Twelve months later I was diagnosed with hypothyroidism. I was treated for the condition and have been well for the last eight years. I missed out on diagnosis because the blood test results were misinterpreted.

Previously, over a twenty three-year period I was misdiagnosed six times with serious diseases and treated for them all, bearing in mind that in reality I did not suffer from any of them. They are namely, epilepsy, coeliac disease, depression, polymyalgia rheumatica, ME and finally myasthenia gravis. Suffice to say what a waste of time and money spent by the NHS. I missed out on twenty-three years of a good quality of life.

I assisted at a thyroid clinic for two and a half years and I personally have seen hundreds of patients with a thyroid condition return to good health after treatment with thyroid hormone replacement therapy. The patients were considered by the National Health Service as 'not needing treatment' because their blood test results for thyroid function fell within the reference interval (normal range).

During the eight years I have been well I have researched the problem of diagnosis and management of thyroid dysfunction. There is sensitivity within the medical profession on two counts.

1. The medical profession is advised to use the blood test results for thyroid function as the sole determining factor for diagnosis and management of thyroid conditions. Signs and symptoms are viewed as irrelevant, history is rarely gone into and clinical appraisals almost never carried out. The reliance on blood test results means that the doctors cannot be sued!

2. Biochemists feel that they are unfairly criticised in relation to the blood test results and maybe they are. The actual testing of blood is not the issue here. If only they wouldn't write on the blood test result slips 'normal'. By doing this the biochemist takes away the doctor's initiative to interpret the blood test result, alongside signs, symptoms, patient history and a clinical appraisal. Thus the doctor's thoughts on diagnosis of the patient do not even come into the equation because the decision has already been made, by the biochemist, regarding the patient's diagnosis with that word 'normal' on the returned blood test result slip.

My comments are that the medical profession should not use the blood test results as the sole determining factor for diagnosis and management of thyroid malfunction and that signs, symptoms, history, and a clinical appraisal should be taken into account. You may agree with this – BUT IT IS NOT HAPPENING.

A research trial was set up to determine whether treatment with thyroxine, in patients with signs and symptoms of hypothyroidism, is more effective than treatment with placebo. The trial was conducted by Departments of Medicine and Biochemistry, Stobhill Hospital, Glasgow. The trial was a double blind, crossover placebo-controlled trial. With 25 patients (presenting with signs and symptoms of thyroid malfunction) and 10 normal controls (healthy people). Initially some patients and normal controls received thyroxine (100mcgs) and others a placebo. After a 12-week period, followed by a six-week break, there was a crossover and those on thyroxine were given a placebo and those on a placebo were given thyroxine (100mcgs) for 12 weeks. Participants were assessed at the beginning of the trial and after each treatment period, using a variety of clinical, biochemical and psychological measures.

Discussion

The duration of treatment was far too short. Many hypothyroid sufferers can take up to two years to regain their health. The dosage was never taken to the optimum for each individual patient. 100mcgs was the optimum dosage given. A dosage of 100mcgs is usually the minimum optimum dose of replacement therapy for patients with low thyroid. The majority of patients need a higher dose for maximum health. Thyroxine was the only preparation of thyroid replacement therapy used in the trial. Some patients may have had a conversion problem whereby the T4 (thyroxine) conversion to T3 (triiodothyronine) is lacking and replacement therapy for these patients is Tertroxin (tri iodothyronine) T3 or a natural thyroid containing all the hormones.

Dialogue is needed. Dr Gordon Skinner MD (Hons), DSc, FRCOG, FRCPath invited eminent endocrinologists, biochemists, representatives from the Department of Health, representatives from The British Thyroid Foundation and many more to a meeting to discuss a reasonable and logical way forward for the diagnosis and management of thyroid dysfunction. All parties declined.

Recommendations To The Department Of Health

1. A newly defined reference range for thyroid function based on a well designed epidemiological study. A larger sample of euthyroid subjects should be used to reduce the variance;
2. Doctors to re-appraise their knowledge of thyroid conditions. A consensus of opinion within the medical profession on diagnosis and management of thyroid disorders;
3. Nurses to counsel newly diagnosed thyroid sufferers;
4. Literature on thyroid conditions available to patients at GP surgeries;
5. Patients who believe that they have low thyroid function because of presenting signs and symptoms and low thyroid hormone levels, who would like to take some responsibility for their own health and wish to try a trial of thyroid replacement therapy, should be given the option of a disclaimer. Provided that both the advantages and disadvantages of the therapy are explained then neither the doctor nor patient would be disadvantaged. Heart patients monitor themselves and diabetic patients inject insulin and monitor themselves;
6. Everyone from the age of twenty-one to be given the option of a thyroid function test to determine a baseline;
7. Blood test results not to be the sole determining factor for diagnosis and that signs and symptoms and patients' history are taken into account and a clinical appraisal carried out;
8. I am calling for an external policing body over the medical profession;
9. Prescription exemption certificates for patients suffering with thyroid conditions should be for thyroid medication only. There could be great savings for the NHS if this code of practice was followed;
10. All over-the-counter products containing fluoride, including dental hygiene products, should carry prominent warnings on labels and packagingwhich contra-indicate all such products for people with thyroid dysfunction. Artificial fluoridation of drinking water for populations is an indiscriminate practice, which should be discontinued immediately.

In creating awareness of this problem patients will benefit from being informed and thus can make an informed choice.

References

1. Whose normal thyroid function is better – yours or mine'? The Lancet. 360. August 3, 2002.
2. Thyroid function tests – time for a re-assessment. BMJ. 320. 13 May 2000.

Diana Holmes
diana@holme78.fsnet.co.uk

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