Help need pulse article

There is a couple of excerpts which you could highlight:. The following for instance:-

Excerpt 1:

In the early 1990s I was involved in the initiation of

guidelines in medicine, in the UK at least, when President

of the Royal College of Physicians of Edinburgh. It was

one of many errors of judgement in my long professional

career. Their development was encouraged by government,

during one of its recurrent financial difficulties, in order to

deliver a higher level of healthcare throughout the country

without having to replicate major teaching hospital services

in smaller and often geographically remote hospitals. The

unforeseen consequence is that guidelines have assumed a

clinical and legal importance far beyond that which was ever

intended by their protagonists. Although their consensus

recommendations are rightly qualified by the acknowledged

variability of the quality of evidence, it is the key statements

which are seized upon by the non-expert, and not the

reservations. It is as if guidelines, like the tablets given to

Moses on Mount Sinai, have been carved in stone for a new

generation of doctors that seems duty-bound to follow each

edict slavishly. The impression is that young physicians have

ceased to think, ceased to challenge received wisdom and

ceased to recognise that patients come to the consultation

as individuals, expecting to benefit from the opinion of an

open-minded and experienced professional

Excerpt 2:

The facts of the matter are that the current guidelines for

LT4 replacement therapy in primary hypothyroidism are not

fit for purpose and the continued reluctance to approve

additional treatment with liothyronine denies the patient the

precision medicine which we are encouraged to adopt,

10 and which many patients crave. In the future, D2 genotyping may

play a role in identifying those patients likely to benefit from

treatment with both thyroid hormones.

18

In the meantime, I am so concerned about the state of advice on the

management of primary hypothyroidism that I am increasingly

reluctant to suggest ablative therapy with iodine-131 or

surgery in patients with Graves’ disease, irrespective of age

or number of recurrences of hyperthyroidism. Treatment with

a thionamide, in which the hypothalamic-pituitary-thyroid

axis remains intact, making interpretation of thyroid status

simpler, is currently a more attractive proposition. It is not

that I am unprepared to disregard guidelines by prescribing

‘a little too much’ LT4 or combined thyroid hormone therapy,

but I know that an increasing proportion of primary care

physicians, advised by guidelines, will not accept my

advice. Experience of managing more patients with thyroid

disease than most over a period of some 40 years is being

trumped by inflexible guidelines; truly a remarkable state

of affairs. Others hide behind guidelines to avoid the cost

of prescribing liothyronine, which in the UK is exorbitantly

priced by the sole supplier at some £250 for two month’s

supply of 10 μg daily, when well-travelled patients can obtain

supplies for a few euros in Italy and Greece and beyond.

(ps have highlighted in bold)