Why Physicians Don't Listen

August 26, 2008

At about the same time that medicine became less of an art and more

of a science, there was a dominant philosophy called Behaviorism.

This philosophy basically distrusted the mind and its ability to

make judgements. Behaviorism exhalted the " objective " test while

discouraging, nay ignoring, the " subjective. " As a consequence, the

poorly founded " objective " test was and is considered to be far

superior to any " subjective " test however expertly judged.

The doctors do not need to talk much. And with economic pressures

they don't have time for such subjective drivel. The lab tests will

do the patient's talking.

Ah but, the tests have their own say of lying because they are

routinely statistically based as well as being based upon

theoretical assumptions based upon empirical observations and

opinions. Thus, we can ask Is Objective Correct? Is an objective

test truly objective if it is based upon subjective assessments and

assumptions?

Nonetheless, we have the tests, and with their subjective

assumptions, they rule.

Consider TSH levels. Originally, the TSH limits of normalcy were

determined statistically by assuming that 95% of the population were

normal. That is 2.5% hyperthyroid and 2.5% hypothyroid. This

choice was made in spite of Dr. Broda estimation of 40% of

the population having the symptoms of hypothyroidism. Current

estimates proclaim about 5% are being treated and another 5% need to

be treated. So just how good is the TSH? Well, in the UK the

treatment starts when TSH>10. In the US, it was 5.5 and is now 3.

In Germany it is 1.5.

About the only thing one can do is raise the issues. For example,

Baisier, Hertoghe, and Eeckhaut found that 24-hour urine T3 test

correlated with symptoms far better than TSH....

Why TSH? It was an outcome of the Boots / University of Southern

California dipute over research and subsequent paper on the

bioequivalency of various brands of levothyroxine sodium. TSH made

the Boots product Synthroid look better....

Have a great day,

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