Lyme Disease Conflicts of Interest Uncovered

http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/R807A2F1.GIF
Note: Deer ticks carrying Lyme Disease do not turn back at the US border.

Patient advocates and physicians concerned with the treatment of chronic Lyme disease finally had their voices heard at a July 30 2009 hearing mandated by a legal settlement between Connecticut's Attorney General and the Infectious Diseases Society of America (IDSA). More than a year after an investigation by Atty. Gen. Richard Blumenthal into the 2006 IDSA Lyme Guidelines' development revealed conflicts of interest by members of the IDSA guidelines' panel, a new panel heard testimony on whether the guidelines required revision. Insurance companies use the current highly restrictive treatment guidelines to deny patients reimbursement for medical care. "This dialogue would not have happened without the strong vision and leadership of the CT Attorney General Richard Blumenthal, who investigated this controversy, uncovered the facts, and called for this review," said Diane Blanchard, Co-President of Time for Lyme. "We hope it sets the stage for further dialogue."

Link
Webcast - available through August 2010

Could it be that evidence of use of a "flawed" test has been hushed up and permitted at "world class" Canadian hospitals to shore up denial of insurance claims in the USA? Cdn "national security" Lyme tests.
Discussion

"You may never need another thyroid test again"

Listening to the patient. Empirical medicine. Sir William Osler would approve....

From the page:
“These blood tests – they don’t work for you. They didn’t help you over the last 15 years you’ve been having problems, even when your problems became worse over the last two. It is because these thyroid antibodies variably bind up the hormones you have. There is no way to tell how much thyroid hormone you need based upon blood tests.”

Michelle’s eyes were rolling back into her head and her mouth was sagging open.

She obviously needed more of an explanation. “Let’s try another analogy. When a traffic helicopter flies overhead, it sees all the cars on the road – and says, ‘There’s plenty of transportation to take people around the city.’ But what if a meter maid noticed they didn’t pay their parking tickets and put a red parking boot on some of them. They wouldn’t be able to go anywhere. In order to have enough transportation for the city – you might need twice as many cars. Unfortunately – there is no way to know how vicious that meter maid is – we just know that she is there. There is no way to know how much of a negative effect those thyroid antibodies are having, we just know that they are there. The presence of thyroid antibodies throws off every thyroid test, including the TSH.”

Michelle was exasperated. Slumping back in her chair, “Then how will I ever know how much medicine to be on?”

“You forgot, there is one more type of testing that will be most effective for you.” Michelle became interested again and leaned forward. “We should test the effect that thyroid hormones have on your body. With hormone resistance, it is often easier and more effective to test the function of the hormone, not the actual level. This idea isn’t new. In Type II Diabetes, we know there is insulin hormone resistance. We don’t check insulin levels – we check what it does by monitoring your blood sugar levels. There are many different types of thyroid hormone resistance. In addition to the Reverse T3 phenomenon and Thyroid Antibodies, some people are deficient of essential fatty acids or other vitamins, limiting thyroid hormone’s ability to get into the brain or other cells to have its full effect.9,10 We just have to check what thyroid hormone does in your body.

“Though active thyroid hormone is needed to lower cholesterol and blood pressure, to raise blood sugar when hypoglycemic, and to convert beta-carotene into Vitamin A, there is no specific blood test to show whether thyroid hormone is working properly or not. Dr. Broda Barnes, MD, PhD, who wrote one of the first books on hypothyroidism, ‘Hypothyroidism: the unsuspected illness,' described a simple temperature test using a mercury thermometer.11 Mercury thermometers are more accurate than digital ones, and because they are hard to find nowadays, I’ll sell one to you for a dollar (that’s all they cost me). Here is a handout to describe how to do the test.

“Lastly, I want you to take this sheet of paper that has ten, 10-point scales on it. I want you to write down the ten things most important to you. For the first line, fill in ‘Energy Level.' Zero will be where you can’t get out of bed, ten being where you are excited about travel and are planning a fun trip. If you are spending money you don’t have, you might be at a twelve. Please call me before they take away your credit cards.” Michelle smiled. “Fill in the other nine items with the things most important to you: weight, skin, and mood are three things you’ve already mentioned. Many people also put down constipation, hair growth/loss, nail quality, and cold/heat intolerance, menstrual periods, and libido. Lastly, there are checkboxes at the bottom for ‘Palpitations’ (sensations of your heartbeat) and ‘Anxiety.' If you feel like you have too much coffee or caffeine in your system, you might be getting too much medication. Every so often, scale yourself. If you are getting better – then we know you are on the right track.”

“I think I finally understand these tests, so what do we do now? You said I would have options in choosing my own care.”

Link

Sir William Osler tailored treatment for optimum patient wellness.

Mental status symptoms and thyroid

Illustration - low thyroid/hypothyroid/myxedema

If you look like the lady in this image and feel terrible -
but your doctor says you are endocrinologically "stable",
ask your doctor whether s/he treats lab tests - or people.

If your thryoid is not functioning well and your physician fails to recognize the source of your symptoms, you may be set for years of bad health and altered mental status.

Many psychiatric disorders and symptoms are related to thyroid hormones. Both underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid hormone blood levels can trigger panic attacks. In approximately 1/3 of patients with depression, borderline personality disorder, panic disorder, bulimia, alcoholism in remission, and anorexia nervosa the pituitary gland does not properly increase blood levels of TSH when signaled to do so by the hypothalamus. This can cause "hypothyroidism" with "normal" blood values. "Normal" is a statistic referring to the middle 96% of the population - it does not mean that "normal" is normal or healthy for you. "Normal" cholesterol by the middle 96% technique includes cholesterol levels of 300, whereas the middle statistically is 220, and the goal is less than 200.

From Low thyroid and mental illness
Also see Thyroid and Schizophrenia
Hypothyroidism and Psychiatric Illness
Treatment of hypothyroidism
Myxedema Madness
Myxedema Madness PDF
Anxiety and Thyroid Disease
Anxiety and endocrine disease
Efficacy of T3
T3/T4 Combination in Bipolar
29 Medical Causes of Schizophrenia


Getting locked into a position due to outdated information can be fatal for doctor and patient.

More on this issue to come...

"To get the best care, you have to go out and get it"

he desire to be seen as a person is a common complaint among cancer patients caught in a system that seems overwhelmed by waiting lists and swamped by test results, where phone calls tunnel through to voice mail and a busy doctor may have mere minutes to explain the most complicated, heart-stopping medical information.

Lynda Coghill recalls how her doctor barely spared a few seconds to deliver a curt death sentence. The Newmarket, Ont., school teacher was diagnosed with ovarian cancer at 39. At an appointment after surgery and radiation, she told her oncologist she was still bleeding. He did a quick exam, announced she had a new tumour, and said bluntly: “Your chances are slim to none.” He told her to wait a few weeks for the results of a biopsy, then left to treat a patient down the hall.

“I looked at the nurse in sheer disbelief,” Ms. Coghill says. “The doctor had proceeded to tell me, in less than 30 seconds, that I was going to die. He didn't seem to care that I had three small children.”

She cried for days, unable to eat or sleep. She and her husband planned her funeral. At last, she contacted the sympathetic nurse from the doctor's office and persuaded her to call for an “unofficial” biopsy report. The tumour was benign. Eight years later, Ms. Coghill remains angry about having been treated “like a numbered object on an assembly line.”

To get the best care, patient advocates say, it's not enough to wait passively in an appointment room. You have to go out and get it.'

From The Globe and Mail - Link

This article does not, we think, apply just to cancer patients...and it is telling that physicians dread falling ill, because then they would be cast in the role of... patients.

From the drama/film WIT with Emma Thompson. This patient was too good, and paid the ultimate price.
It's good to be patient - but not too patient...

Illuminations from THE RUNAWAY BUNNY by Margaret Wise Brown.

ACRE--A High Powered Harvard Stealth Pharma Front Group

Image inspired by Charles Pachter

ACRE--A High Powered Harvard Stealth Pharma Front Group
Saturday, 25 July 2009
ACRE's mission is to persuade physicians that MORE rather than less industry involvement in Continuing Medical Education programs is good for patients--much as industry's "Harry and Louise" ads were aimed at convincing the public that universal healthcare was BAD for them.
Daniel Carlat, MD , is Associate Clinical Professor of Psychiatry Tufts University School of Medicine Publisher and Editor The Carlat Psychiatry Report Co-chair, CME Committee Massachusetts Psychiatric Society. Above all, he is an independent psychiatrist whose informative blog contains fascinating information about powerful, financially compromised groups such as the APA Task Force that is currently engaged in further expanding psychiatry's diagnostic / practice guide, the DSM-V . Their perspective--given their financial stake--is in sync with Pharma's market expansion agenda.

ACRE is Pharma's latest, powerful, mostly Harvard-based front group: it is spearheaded by Harvard professor, Thomas Stossel, MD. ACRE's mission is to persuade physicians that MORE rather than less industry involvement in Continuing Medical Education programs is good for patients--much as industry's "Harry and Louise" ads were aimed at convincing the public that universal healthcare was BAD for them. Both attempt to confuse. ACRE poses as the Association of Clinical Researchers and Educators.

ACRE held its charter conference earlier this month at Harvard Medical School.l Its steering committee consists of physicians from Harvard Medical School, the State University of New York Downstate and the Mayo Clinic. Dr. Jeffrey Flier, Dean of the Harvard Medical School, introduced this high powered Pharma-physician conference, which was managed by Rockpointe, a science-based medical communications company that produces "educational programs" for doctors most often sponsored by pharmaceutical companies.

Below we post the financial ties uncovered by Dr. Carlat: the ties that bind ACRE steering committee to Big Pharma--ties that were undisclosed on the ACRE website. Of course, it would be most instructive to learn the secret dollar amount that Harvard Medical School--and its affiliated hospitals--rake in from these unabashed marketing promos masquerading as CME courses! Dr. Carlat dubbed the organization, “Academics Craving Reimbursement for Everything.” PharmaGossip renamed ACRE: Forum for University Corporate Kickbacks in Education as Determined by University Professors:

Why is ACRE very ripe for satire? As Dr. Carlat explains, because "it consists of rich doctors complaining that they want more money from drug companies, and such an organization lacks any inherent credibility, and seems, frankly, absurd."

Dr. Carlat noted that "In all the hoopla and excitement of forming a new organization such as ACRE, certain minor details are easy to overlook. One of these details is a listing of financial disclosures, which is conspicuously missing from the ACRE website."

Below are two of Dr. Carlat's ACRE posts--one about the undisclosed financial ties of the speakers and the post describing the flavor of the ACRE conference:

"...the eeriest presentation came from one J. Michael Gonzalez-Campoy, an endocrinologist who was flown out on the ACRE-jet from Minnesota. His job was to convince everybody that Minnesota’s 1993 physician payment disclosure law (the first in the nation) was an awful mistake. His tactic, theoretically, was a good one. “The law has been terrible for patients,” he declared, speaking in the ominous tones of a doctor notifying you of grim laboratory results.

“Oh boy,” I thought, pen poised, “finally, some data on the effects of transparency laws on patient outcomes.” But alas, Dr. Gonzalez-Campoy’s evidence base amounted to a single patient, a 73 year old man with severe diabetes. “Do you know what drug he was on?” He asked incredulously. “The cheapest drug money will buy—Glyburide….When I asked my patient why he was on that drug, I was appalled by his answer. He told me that his PCP said it is the most cost-effective drug.” It got worse: the patient had apparently been reading newspaper articles saying bad things about the newer diabetes drugs, like Avandia. The kicker was when he told Dr. Gonzalez-Campoy that “I’ve read that doctors are getting brain-washed by drug companies to prescribe these drugs.” Don’t you see what the Minnesota disclosure law has wrought? Patients getting prescribed generic medications. Patients reading the newspaper. Patients questioning the morals of their physicians.
The ACRE conference, it would appear was "full of sound and fury signifying nothing."
Posted by Vera Hassner Sharav
Link

Harvard Medical Students Rebel Against Pharma-Ties
Tuesday, 03 March 2009
200 Harvard Medical School STUDENTS are confronting the administration demanding an end to pharmaceutical industry influence in the classroom.
A front page report in the Business section of the New York Times should bestir some of Harvard Medical School alumni. 200 Harvard Medical School STUDENTS are confronting the administration demanding an end to pharmaceutical industry influence in the classroom.
"The students say they worry that pharmaceutical industry scandals in recent years - including some criminal convictions, billions of dollars in fines, proof of bias in research and publishing and false marketing claims - have cast a bad light on the medical profession. And they criticize Harvard as being less vigilant than other leading medical schools in monitoring potential financial conflicts by faculty members."
Harvard received the lowest grade--an F--from the American Medical Student Association, a national group that rates how well medical schools monitor and control drug industry money. Harvard Medical School's peers received much higher grades, ranging from the A for the University of Pennsylvania, to B's received by Stanford, Columbia and New York University, to the C for Yale.

The revolt began when a first year medical student "grew wary" when a professor promoted cholesterol drugs and "seemed to belittle a student who asked about side effects." He later discovered that the professor, a full-time Harvard Medical faculty member, was a paid consultant to 10 drug companies, including manufacturers of cholesterol drugs.
Link

What happens when drugs, science and money mix at Canadian institutions of learning today? Blandishments and mis-education may well lead to a dangerous lowering of the standard of care.
Read Blind Faith here.

Whatever would Dr. Osler say?

Suggestions for an Approach to the Management of Thyroid Deficiency

http://thyroid-disease.org.uk/index.php?option=com_content&task=view&id=18&Itemid=31

SUGGESTIONS FOR AN APPROACH TO THE MANAGEMENT OF THYROID DEFICIENCY

by Dr Barry J Durrant-Peatfield M.B., B.S., LR.C.P., M.RCS. Approved Civil Aviation Medical Examiner

From the article:
"The clinical syndrome of thyroid deficiency is very much more common than is generally realized; (Dr. Broda) Barnes, in several publications, drew attention to this in the last two decades, as has the present writer more recently. One reason for this, is a tendency to think of hypothyroidism and myxoedema as one of the same thing, when this is quite wrong. Myxoedema, as doctors were taught in medical school, is the end result of a progressive disease process resulting in more or less total absence of thyroid hormone; whose symptoms and signs are no doubt perfectly familiar. But this state of deficiency has to start somewhere, winding down over a variable period to the terminal state of myxoedema. Symptoms and signs will naturally vary according to the extent of the level of deficiency reached. Clearly, a 10% loss may have little to show for it; whereas a 25% loss may have several very definite symptoms and signs; and a 40% loss even more so. Furthermore, patients show very individual response to any given level of dysfunction; while one may complain of excessive fatigue and weight gain, another may be more troubled by depression and menstrual problems.

That the diagnosis is all too frequently missed, is an inevitable result of this fundamental misunderstanding, and is commonly the result of an incomplete clinical appraisal in favor of the standard thyroid function tests. These tests are the real problem in diagnostic failure since there are inherent problems in interpreting blood levels of thyroxine and/or thyroid stimulating hormone (TSH) when blood levels may differ widely from tissue blood levels. Since the diagnosis may very properly, and easily, be made clinically, unreliable blood levels should NOT take precedence over clinical judgment.

Equally unsatisfactory is the acceptance by doctors and patients alike of poor response to thyroid replacement.

The present writer has been constantly alarmed and dismayed by hypothyroid patients who for years, all too often, have been obliged to accept a much less than satisfactory amelioration of their illness, being taught to expect no more than some improvement. It is perfectly possible that complete and long lasting remission should be obtained, and neither doctor nor patient should accept anything less. Further, the response should be monitored, not just by the doctor, but by the patients themselves. Since there often is a dynamic situation, the patients should be educated and taught to monitor themselves, making their own adjustments to dosage. In this connection, frequent monitoring by blood tests may be quite misleading and unhelpful. Surely it must be more satisfactory for the physician to ask the patients how they feel; and guide the informed patient in establishing the right dosage levels of replacement therapy."

We are sure Dr. Osler would agree. But if our physician does not listen but instead turns us out of his office after a woefully inadequate fifteen-minute appointment, and our lives are ruined as a result, what then?

Signs of the Times

Osler computer wallpaper, with neither the great doctor nor a patient anywhere in sight...
These days it seems doctors want to be like "Doogie Howser MD" - a sort of precocious Peter Pan physician.
HOUSE MD, another popular medical television show, features a disabled hero who is friendless and addicted to drugs. Neither character is a proper role model for healers.



When you hear physicians talking together in your hospital, are they discussing health or holidays, medicine or mortgages? If perks and a big salary represent your physician's most precious goals, maybe it's time to hand him a golf ball and tell him to Tee Off.