Mary Shomon has responded on the BMJ 'Bad Medicine: Thyroid Disease' article

Mary Shomon has responded on the BMJ 'Bad Medicine: Thyroid Disease' article

Just went back to the BMJ article posted by GP Des Spence on 9th November 2012, to see if there had been any more action recently and noted that Mary Shomon has posted a response today (10th December).

Here's the direct link to the response page

bmj.com/content/345/bmj.e75...

For those who have not seen the original article, I am reproducing the text below, as it seems many people have difficulty accessing the page.

Bad medicine: thyroid disease

Our sense of wellness is one of nature’s greatest gifts to humanity. A recent review has confirmed huge overdiagnosis of breast cancer through screening. So, over the past 20 years 80?000 women in the UK (equivalent to every person eligible for screening in Edinburgh) have been falsely diagnosed with cancer, enduring surgery and chemotherapy.1 This is the theft of wellness on the grandest of scales. Overdiagnosis is everywhere,2 and a problem still hugely underappreciated.?

Are we overdiagnosing thyroid disease? Subclinical hypothyroidism is where thyroid hormone is normal, but the thyroid stimulating hormone is mildly raised. This is common, found in as many as 10% of the general population.3 In the past we tended to reassure, to suggest repeating tests, with the results often reverting to normal. This was not hypothyroidism, ran the logic, but natural variation, and did not need thyroid replacement.

But in recent years UK specialists have suggested the treatment of subclinical hypothyroidism in patients only with clear symptoms. In the United States they go further: the endocrinologists’ and thyroidologists’ consensus statement “favors routine screening” and “early detection and early treatment,”3 with some even suggested lowering the current threshold for diagnosis.4 I fear these expert opinion statements because they always have a whiff of conflict of interest.

The problem is that thyroid symptoms are non-specific; indeed, the very fact that we are carrying out thyroid function tests suggests patients have symptoms. Also, hypothyroidism is a disease that patients understand and can hang a lot of life’s problems on. Patients can therefore pressure doctors for treatment, and doctors can fear legal claims for failure to treat. A trial of treatment, therefore, is offered but, once started, thyroxine is almost impossible to stop. I now see many young women who will be taking drugs lifelong. But the thyroid has a sensitive and complex feedback system that has evolved over millennia for a purpose. What effect does crude medical replacement have over decades?

The epidemiology is poorly studied, but evidence suggests that subclinical hypothyroidism spontaneously corrects in 80% of patients in two years.5 Also, systematic reviews show no evidence of benefit from treatment with thyroxine (perhaps other than in pregnancy).6 7 Despite this, thyroxine prescribing has doubled in the past decade, which cannot reflect a true rise in incidence of hypothyrodism.8 9 The only conclusion is that we are overdiagnosing and overtreating thyroid disease. Again, through overdiagnosis, doctors are systematically failing in our duty to protect the well, which is the worst medicine of all.

bmj.com/content/345/bmj.e7596

There is now a total of 13 responses, running onto two pages, so if you're new to this, do make sure to click onto the second page so that you don't miss the very first ones that were posted.

And of course, don't forget to click the 'Like' button as you feel appropriate!

bmj.com/content/345/bmj.e75...

21 Replies

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  • What? THE Mary Shomon!! Thyroid Advocate in the U S of A!!!!!

    I'll run out of exclamation marks soon!!!!!!

    :-) :-) :-) :-)

  • Better ask Santa for a new keyboard then :D

  • There are three previous blogs about this article, which can be found here:

    thyroiduk.healthunlocked.co...

    thyroiduk.healthunlocked.co...

    thyroiduk.healthunlocked.co...

  • YAY :D

  • Thank god for Mary Shomon ! as for Dr Spence - I never wanted my thyroid out! my gp started the whole debate one day not me I never said a thing.

  • Heh heh :D

  • Some fantastic letters. Everyone should read them and tick "like" (if they agree of course)in the appropriate place. Copy them and keep them for future fights with the GP.

  • Old Des Spence got a bit of a roasting there didn't he, and it was nice to see a wide range of professionals replying to his utter tosh. I will definately be saving this to my favourite's and using it for future reference.

    Thanks RedApple.

    Moggie x

  • Maybe more of us should leave comments?????

  • He deserved his roasting! I liked Dr Hudd's point about re-introducing metabolic testing, as long as it doesn't go the way of the blood test and become the only way thyroid disease is diagnosed, ignoring patient symptoms.

  • Another great response which I have of course "liked" :) I wish the OP would reply to all of the subsequent comments... :D

  • Oooh there is another response to "like" too :)

  • And another...

    15 as I write.

  • Wow Mary Shoman already has 188 likes :)

  • I *think* you meant:

    Wow Mary Shoman already has 188 likes :-(

    :-) :-) :-) :-)

    People must be "liking" her post and ignoring the rest - which is a great pity as the standard of posting has been high. But being somewhat more serious, it is good that the whole thing is gaining further exposure. Mary has put in a lot and deserves credit.

  • Yes :( :)

    Hopefully more people will like the other posts too. But as you say more people seem to be commenting now which is good.

  • When I read opinions like those of Dr Des Spence I feel so angry and frightened also thankful he is not an Endo or in my area. Sadly he will not be a lone voice in the profession.

    This October I found a relative not seen since we were children. We communicate on line/phone and hope to meet again 2013.

    She lives near his part of the country and she has worked closely with GP's for decades.

    She also has had thyroid problems.

    I have resisted the 'sob' stories and ill health in conversation until we meet next year. Looking forward to hearing her experiences. Don't want to put her off me too soon!

    This is the fourth blood relative to have thyroid problems that I know of.

    Thank goodness for Mary Shomon and others like her. Thanks to Red Apple for posting I have not been getting newsletters from About.com and could have missed this.

    Pity no ink in printer (might get to library) am collecting info and will select the best to present to Endo next year when I request trial of T3.

    My GP suggested I take Dr A. Toft's book to quote from!!

    wyn

  • I was left until I was very seriously ill. I was close to being in a coma, so the hospital told me. so I have to have thyroxine or some form of thyroid assistance, if not thyroxine then what???

  • There have been several more responses posted since I wrote this blog. Another three have appeared this morning, making a total ofI 18 responses now!

  • Keep up at the back!

    19 last I looked.:-)

  • Oh the number of responses have shot up -now in the hundreds! it is pleasing to see that those liking the responses are responses of those in protest over this dreadful article. So whilst i felt incredulous when i read the article I took great heart from those medics who protested heavily and put great counter arguments that were of more validity then the article itself.

    However i have to ask -how did this article ever appear int the BMJ journal? -it's spurious claims have no scientific evidence to justify them! I find that very worrying. Shame on the BMJ for publishing!

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