Thursday, November 21, 2013

Creating a Gold Standard of Care in a Mommy Nation

Sounds great right?  Who could possibly be against creating a Gold Standard of Care?  But ask yourself, who creates it?   Who determines what makes up that Gold Standard?  If a Doctor creates it, one would think they would do it because they care about the health of their patients and they have created it based upon their lifetime of experience.  You would hope it at least.  In a true free market economy, this would be true.  In a free market economy, if a patient was not receiving a Gold Standard of Care, they would be free to go elsewhere and seek better care.  This gives a Doctor a powerful incentive to make sure their Gold Standard, truly is.   If an insurance company creates it, what do you think their motivation is?  The sole goal of an insurance company is to maximize their profits to satisfy their share holders.   The insurance company makes money by denying claims and care.  If an insurance company has any say in what makes up a Gold Standard of Care, what do you think the result would be?  Now that the federal government has mandated care and mandated insurance, what do you think the new Gold Standards will be?   Let me show you an example of the failure of this approach.  

The moving bar of the TSH Test.

In the case of hypothyroidism, the insurance companies have pushed doctors to accept that the TSH Test is the Gold Standard in determining treatment for hypothyroidism.  You have one test, you get one number, and there is one treatment authorized.  There are many fallacies with this approach. 

The changing lab numbers. 

For many years, the laboratory community had been using various reference ranges around 0.45 to 4.50.  These have always been controversial and never universally accepted.   Here are just a few of the disputes over the years. 

In 2001, The American Association of Clinical Endocrinologists (AACE) issued a press release (since scrubbed from their website) "Even though a TSH level between 3.0 and 5.0 uU/ml is in the normal range, it should be considered suspect since it may signal a case of evolving thyroid underactivity."

In 2003, the AACE issued recommendations that the new reference range of the TSH test should be from 0.3 to 3.0.  For some strange reason there was the sound of crickets in the medical community when this recommendation was released.  (and since scrubbed from their website archives)  For the next 9 years, doctors and labs disavowed any knowledge of this recommendation.   Never heard of it.  Nor had they ever heard of the 2001 recommendations either. 

"In a statement from the AACE, Hossein Gharib, MD, FACE, and president of AACE at the time, said, "The prevalence of undiagnosed thyroid disease in the United States is shockingly high...The new TSH range from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health - such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression."

The vast majority of my TSH test results from 2008 to 2013 all list a range of 0.45 to 4.50.

In 2012, the AACE suddenly reversed itself in conjunction with the American Thyroid Association (ATA) and issued a new "Clinical Practice Guidelines for Hypothyroidism in Adults."  Under this new guideline, they defined "overt hypothryoidsm as Thyroid Stimulating Hormone (TSH) level above 10 mIU/L, and sublincical hypothryoidsm as a TSH less than 10 mIU/L, with lower Free Thyroixine (Free T4) levels."  (besides stating that Armour doesn't work and shouldn't be used)  The thyroid world exploded in anger when this was released. The first thing that author Mary Shomon  pointed out was that some of the members of the task force have known financial ties to the long controversial thyroid drug Synthroid.    (Also known as SynCrap for a long laundry list of reasons).   Additionally, blood samples for TSH testing are almost never handled correctly by testing labs leading to inaccurate results for almost everyone.   And why would they state that Armour doesn't work when there is 120+ years of evidence that it does?  Would it again have something to do with the fact that some of the task force members have a financial bias towards another drug

Too bad the NIH has announced they will be conducted a study into Armour type medications.  SynCrap stock holders have to be nervous, after all, they already took a drubbing in 2009 when a Danish study was released that found the best way to treat Hypothyroidism is from a combination of T3 and T4 medications, not T4 only.  That's not all.  Other major institutions are bucking the SynCrap/Levo bandwagon and also conducting their own studies.

"At the Endocrine Society Annual Meeting, which took place June 15 through 18, 2013 in San Francisco, Dr. Thanh Hoang, a staff endocrinologist at the Walter Reed National Military Medical Center in Bethesda, MD, presented results of his research on natural desiccated thyroid drugs."  Yeah, turns out his study found that 49% of participants preferred Armour and it was found to be perfectly safe.  

The other interesting thing about the 2012 AACE guideline was the fact that 95% of "Doctors" seemed to be instantaneously aware, quoting, and parroting the guideline.  Why is that?  All of the past years guidelines have led to the sound of crickets across the medical field but now suddenly in 2013, every "Doctor" around and all their staff have heard that the magic new number is 10!  If you are below 10, well there ain't a damned thing wrong with you, you malingerer.  

The studies. 

There have been many studies over the years conducted to set a "baseline" of what is an accurate TSH number.  The vast majority of these studies are fatally flawed by the fact that they made ZERO attempt to screen out study participants who have active thyroid disease.   They studied sick and well patients and then “averaged” the number.   Who doesn't see the wrong of this approach? 

During the reign of Empress Maria Theresa, the death rate in her Kingdom was so high that 98 of 100 newborns died in Graz alone.  To address this issue, she passed a law still in effect today that declared that every single death that occurred in a hospital in Graz was mandated to have an autopsy.   She changed the world.  The results of these now hundreds of thousands of autopsies over the years have proven many medical theories and disproved others.  The main one important for this article was the fact that 100% of all residents in the Graz area were discovered to be hypothyroid.  Dr. Broda Barnes, a top thyroid expert, personally studied over 70,000 of these autopsies and used the results in his research.  Dr. Barnes was a prolific researcher and author whose work has suffered from a constant attempt to discredit him from the mainstream medical community that now make tremendous amounts of money off of drugs and procedures that a correct treatment of thyroid issues would make unnecessary.  Yet at the same time numerous studies in the years since have actually proven Dr. Barnes research to be true.  Follow the money and you will always find the truth.  

If anything, the results of the Graz autopsy effort shows beyond a reasonable doubt that no TSH study that includes White Europeans of Germanic descent can ever be counted to be accurate due to their high level of thyroid disease.

JAMA published the results of an interesting study in 2005.  "It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction."   And it referenced a 2002 study, "Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter."  Actually it was more than that.  The NACB stated that the true level they found was 0.4 to 2.5.  What did this 2005 study do that was different than the others?  It studied African-Americans because as a population group as a whole, they have a low incidence of Hashimoto’s disease.   Guess what the study found?  It came back with a "mean TSH level of 1.18 mU/liter strongly suggest that this value is the true normal mean for a normal population."  1.18. 

While research continues to show that the TSH numbers are artificially high, the moving bar of that TSH test in 2012 and beyond is now 10.  The insurance companies, in a goal of denying care to as many as possible to maximize their profits, are pushing doctors to accept that anything "below 10" is now the new "normal" for a thyroid, while pushing that Synthroid is the only acceptable treatment while hiding that some of them will have a financial benefit from this approach. 

The fallacy of the TSH test.

Taking into consideration you have a test developed under controversy, with lab number results under controversy, what about the test itself?

The American Thyroid Association (ATA) itself defines the test as, "The pituitary gland secretes TSH to control thyroid function."   The TSH test determines pituitary function.  It doesn't actually determine anything about the thyroid.  Hypothyroidism is an umbrella term for many different conditions to include autoimmune inflammation responses (Hashimoto) and cancer.   The TSH test does not actually test thyroid function, it only tests pituitary function.   What if the thyroid is not working from either an autoimmune attack or cancer?  This test will not discover that.  What if the thyroid IS working but the bodies autoimmune system is attacking and killing the circulating hormones?  This test will not discover that.  What if the thyroid is working, the hormones are circulating but the body has hypothyroidism at the cellular levelThis test will not discover that.   What if you have a condition such as leptin resistance  that is leading to an excessive build up of Reverse T3, which causes the thyroid hormones in your blood to pool (giving artificially high test numbers) and not be accepted by the body.  This test will not discover that. 

Why is the TSH Test the Gold Standard of anything?  Can you ever polish a turd so much that it ceases to be a turd?   If you can, please show me.

All across ObamaCare Nation, Bureaucrats, Doctors, Insurance Companies, and Big Pharma all have their hands in the pot creating Gold Standards for your disease, your condition, and your life.   If the TSH test is a turd in dressing, what is your Gold Standard? 

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