Consultants in two specialties: Compare and contrast

[helvella]

In the recent High Court case determining whether the NHS is allowed to continue using Avastin rather than the far more expensive Lucentis (or the even more expensive alternative) one thought has repeatedly come to me.

In treatment for wet macular degeneration, the consultants have been very strongly behind making available an affordable and effective treatment. They can see the obvious, that using Lucentis would result in far fewer treatments being provided. Therefore, it is obviously in the interests of the population of patients that Avastin be used in preference to Lucentis.

When it comes to liothyronine, however, I really have not seen any support from endocrinology consultants for ensuring access to a less expensive source than UK licensed medicines. We all know that many endocrinology consultants are not persuaded that liothyronine (or any form of combination treatment) should be provided. However, even those who agree with using liothyronine do not appear to have lifted their little fingers towards ensuring that it really is made available. The most we have seen is semi-furtive advice to buy their own from Germany – and, if they are really lucky, a prescription that can be used to do so.

Of course, some endocrinology consultants might be working behind the scenes to this end. I’d like to know if they are. For now, unless I see contrary evidence, I shall just assume that we are being let down big time.

[StitchFairy]

You've quite obviously missed the point... Repeat after me "T4 is the cheaper alternative to T3"

[helvella in reply to StitchFairy]

Doh! Silly me.

New maths: T4 = T3 and T4 < T3 - at the same time??

[crimple]

very well said Helvella. It really is head banging stuff that they persist in ignoring the bl.....ing obvious. I still think there is sexism involved! Most patients are women of a certain age and most consultants...….. go figure!!

Keep up the good work on our behalf. One day the scales will drop from their eyes!! Well you do have to try to be positive, hope I live long enough!

[nightingale-56]

So long as they are drawing their salary for just paying attention to the useless TSH, I am sure they are not going to bother fighting our corner. We can only hope a few of them will suffer and will eventually see the light.

[Hidden in reply to nightingale-56]

Well said 👏

[Nanaedake]

Do you think that part of the problem is around the quality of the research relating to thyroid hormones?

[helvella in reply to Nanaedake]

I very much do think that.

However, we have seen a succession of thyroid papers, not least from diogenes et al., but also from quite a number of others around the world, which appear to have been totally ignored in clinical practice. So, on top of the poor quality of research, we have poor uptake of the work that does exist.

We could say that even the best research doesn't get converted properly to the benefit of patients.

[Nanaedake in reply to helvella]

So, how to effect change??

[helvella in reply to Nanaedake]

The hardball answer is formal complaints right up to court cases. Whether based on ethics, on malpractice, or any other grounds.

I think it is very difficult to get there in a way that does not antagonise and further harm whatever relationship exists between patients and professionals.

[Nanaedake in reply to helvella]

I think there is a general problem in how hormonal health is treated and perceived in the NHS. It's fundamental to women's (and mens) lifelong health but feels like it's not taken seriously in the health system. However, we can't afford to be dysfunctional when needing to work and earn so it's serious from the patient's perspective.

[TSH110 in reply to helvella]

Are any of them actually at the forefront of research and if not why not? Speaks for itself - not remotely interested in their supposed specialism.

[Fruitandnutcase]

I don’t understand it, other consultants seem to work for their patients like the opthalmologists have done. From personal experience I’d say rheumatologists seem to work for their patients too yet so many people on here feel totally unsupported by their endocrinologists. So many people are working their way to better health by treating themselves. Why is this? Thyroid patients - especially hypo ones - and I almost hate to say it, female patients - have a really hard time.

I know I had a hard time in getting diagnosed when I had Graves, but in a way I’m thankful that I was hyper and I’m thankful I was way past menopause age. In spite of that I was made to feel that I was a complete hypochondriac - until I was finally so very ill that it was obvious.

[TSH110 in reply to Fruitandnutcase]

Same for neurologists and gastroenterologists and the bone lot (forget their official title orthopaedics I think) that I have seen. Mind you my endocrinologist was a lot better than most here seem to encounter but in a T4 monotherapy approach at least aiming for Toft numbers. No mention of alternative treatments though. Is endocrinology regarded as an undesirable area of medicine to specialise in, so does not attract the more driven and questioning minds? Something is drastically wrong with it.

[cein in reply to Fruitandnutcase]

This is just my own opinion ...

A gynecologist should be the person treating thyroid conditions not an endocrinologist .. I have been treated by both and for me there is no comparison as all hormones need to be balanced.

I never had the problems with my thyroid in S Africa like I have now . I was diagnosed and treated by a gynecologist .. all my hormones were checked every six months when my thyroid hormones were checked and all adjusted up or down accordingly. Every year the full thyroid check was done.

Sorry I know there are guys out there with thyroid conditions too but I don't know what the male equivalent of a gynecologist would be but guys have hormones too just different ones.

[SilverAvocado]

I think the explanation has to be something like discrimination or skullduggery at some point in the process.

Two obvious areas of discrimination are sexism (and to some extent age-ism, too), but also that chronic illnesses are not dealt with well in conventional medicine.

Several other specialisms have been mentioned where people had good experiences, but I wonder how many of those are dealing with a long term chronic condition. A friend with cerebral palsy has had terrible experiences with doctors similar to our own, and diabetes sufferers certainly have a lot to complain about, being pushed into high carb diets, etc. Although there is a small charity run drop in centre for cancer sufferers near me, and the brilliant staff there don't take much prompting from me to start bemoaning the doctors they hear of, and cancer is treated as more of an acute illness, rightly or wrongly.

I think the skullduggery started with the introduction of Levothyroxine in the first place, and how it replaced NDT using smoke and mirrors rather than research evidence. Seems to be the beginning of a story where financial interests has a strong grip on thyroid treatment, at the expenses of healing patients.