Health insurance? Or disease and accident insurance?

A couple of months ago, Dr. Jonathan V. Wright featured a couple of articles in his newsletter that spoke to some of the issues that I've been slowly discovering through experience and sorting through in my mind.

In his lead article, Wright suggests we need to take a different approach to health insurance.

[W]hat's generally called "health insurance" really isn't about being healthy at all. It's about being able to pay for doctors, hospitals, and patent medicines--all of which are very expensive--just in case we get sick, or are in an accident. A more accurate term for this kind of insurance is "disease and accident insurance."

Real health insurance helps insure that we stay healthy! Real health insurance isn't cheap, but it's a lot less expensive than "disease and accident insurance." Real health insurance includes an excellent diet, appropriate exercise, a positive mental attitude, getting enough sleep, and avoidance of toxins, including tobacco and other addictive substances, and no more than a little alcohol.

But the most commonly consumed toxins--herbicides, pesticides, other agricultural and food chemicals, as well as artificial flavorings and preservatives--are somehow regarded as too costly to avoid.

Wright continues with a powerful argument for (doing what Sarita and I have begun to do in the last several months) avoiding conventionally-grown fruits and vegetables and eating organic instead. (See The Organic Center's report about the Nutritional Superiority of Plant-Based Organic Foods (19.5MB PDF) or, at least, the Executive Summary (1.8MB PDF).)

Are organics expensive? Oh, yes! But are they as expensive as the kinds of issues that the SAD (Standard American Diet) is creating in so many of us, the problems associated with obesity and inflammation and heart disease and diabetes? I don't think so.

On the other hand, as numerous people have pointed out, the federal government of these United States subsidizes the lousy foods (with our tax money) and then makes us pay full boat for the good stuff. (More about that subject in a later post.)

Wright concludes his article with the words,

While it's very important for optimal health to avoid as many herbicides, pesticides, and other agricultural chemicals, it's also now well established that organically grown foods have not only higher levels of many important nutrients, but a wider, more diverse set of nutrients than conventionally grown foods.

Now that's really "health insurance"! Why not buy it for your family?

A couple of pages later, Wright then quotes a letter he received from a doctor (MD) who has been moving more and more toward a "natural" or "naturopathic" approach to medicine.

He wrote to Wright with the following story about "what I see in practice much too often."

I thought, "Good grief! This is my experience!"

"Dear Dr. Wright," he began,

Sometimes it is a curse to have generous health insurance.

Last week, I saw a 55-year-old woman who is very, very sick due to insurance-covered treatment with patent medicines.

Ten years ago she had her gallbladder removed. She never was told about needing to take bile salts with oily meals from then on so she'd absorb lipid-soluble vitamins and other nutrients. [I have to ask my daughter, who just had her gallbladder removed, whether she has been told any such thing. --JAH]

Eight years ago she was said to have "gastro-esophageal reflux disease" (GERD) and has taken a proton pump inhibitor ever since to suppress her stomach acid. Nobody ever told her that stomach acid helps break minerals from their matrix (for absorption), helps break down proteins into amino acids, and keeps the stomach free of intestinal bacteria. [Yeah. No one mentioned that when my doctor casually prescribed Famotidine for my gastric reflux. Oh, yes! It gave me almost immediate relief from a number of problems for which I had not realized I could enjoy relief. Wonderful! . . . Until I started reading about the downsides of this approach to acid reflux. --JAH]

Seven years ago she was diagnosed with adult onset diabetes mellitus (AODM), hypertension, and hyperlipidemia and was put onto an insulin pump (her condition was too brittle for anything else), a statin to lower cholesterol, and strong anti-hypertensive drugs. She started to get muscle aches, cramps, and very poor endurance. Nobody told her that statins interfere with the body's ability to make Co-Enzyme Q₁₀, nor did they put her on a healthy daily dose of Co-Enzyme Q₁₀. [Gee! Is this surprising? I had the same experience. "You've got elevated cholesterol. Let's put you on a statin." --Now that particular doctor also put me on CoQ₁₀, but he never explained that the two were related, nor that it might be possible to lower overall cholesterol and rebalance it through non-pharmaceutical means. --JAH]

Five years ago she started to get peripheral neuropathy (pain with numbness) and skin lesions, which she was told were of unknown cause. ("You have dry skin. Here, rub on this emollient cream.") More drugs for neuropathic pain.

Three years ago she was diagnosed with monoclonal gammopathy of unknown significance ("MGUS"; overproduction of gamma-globulin from a single line of blood cells). Old Human tactic: if you don't know what it is, put a name on it to make it less scary.

Two years ago she was diagnosed with severe anxiety, so she was given Xanax and other psychotropics. . . .

Naturally, with all of this, her liver enzymes are up, and so is her creatinine (indicating early kidney failure)!

She is postmenopausal, but never has been tested, never been put on bio-identical hormone replacement. She can't sleep, of course, so there goes another patent medicine into the mix. . . .

Incredibly, the list of ailments and failed (and failing) pharmaceutical "fixes" continues!

Wright says this is a good description of "what 'great insurance coverage' can do to good health. It's a tragic description of how 'health insurance' can do exactly the opposite, actually insuring a more rapid progression of illness, as well as allowing disease to proceed because patent medicines never, ever address causes, but just cover up symptoms for a variable period of time."

How do you get off the conveyor belt of declining health? Wright suggests eating healthy foods and pursuing naturopathically oriented doctors like those you'll find through the American College for Advancement in Medicine, the American Academy of Environmental Medicine, the American Association of Naturopathic Physicians, or the International College of Integrative Medicine. Of course, it wouldn't hurt to read a well-researched and heavily referenced newsletter like the one Wright publishes.

Thyroid difficulties . . . and the U.S. government

I first wrote the majority of this post last October, but abandoned it when I felt it wasn't quite ready for publication.

Following my post about my encounter with the naturopath, however, I thought I should provide this as a kind of "background"--and, perhaps, as a wake-up call to those who are unaware of the issues I describe, and, finally, perhaps, as useful information for someone who is struggling with thyroid issues.
*******
---The following text was written in October 2009---
I had my thyroid destroyed back in 1984 as a result of a hyper-hyper case of Grave's Disease. --The lab that did the tests said they had never seen thyroxine levels as high as mine; they were "off the charts."

So my doctor gave me the radioactive isotope Iodine-131 to destroy my thyroid gland . . . and a few months later I had none.

I have been taking thyroxin/thyroxine tablets ever since. For some time, now, I've been taking the "natural" stuff sold under the Armour^® brand name by a company named Forest Phar­ma­ceu­ti­cals (what, in just the last few days, I found out are desiccated and pulverized pig thyroid glands formed into pills). Most of the time, however, I've been taking synthesized thyroxine sold as generic levothryroxine or a branded product like Synthroid^®.

What's the difference between the two? I mean, physiologically . . . for the person like me who is ingesting the stuff?

I will confess that, for me, I haven't really been able to tell the difference. But then, I haven't been all that attentive to my physical condition until the last couple of years.

For many people, however, the difference between the two concoctions is dramatic, though the majority of doctors seem to believe the difference is all in hypothyroid sufferers' heads.

Happily, only one of my doctors has actively opposed my use of the Armour^® tablets. But despite his opposition, I've been able to use the Armour^® product for the past seven years or so.

This last year, however, I started bumping into supply difficulties. Back in January I was told the pharmacy didn't have 120 mg tablets (the daily dose I needed at the time). . . . Happily, they "simply" gave me the equivalent in the form of two 60 mg tablets per day. No big deal.

Last time I refilled, in late May, I still had almost a month's worth of pills left when I got a three-month supply of 60 mg tablets from our insurer's mail order pharmacy. . . . Then, only a few days after I got my three-month supply, I was told I should reduce my dose to only 90 mg--1½ tablets--a day. So in mid-October, I was just coming to the end of my supply.

Meanwhile, in mid-October I had another blood test to see how my thyroxine levels are.

My doctor wanted to run with the "standard" TSH-only (thyroid stimulating hormone-only) test. I said I believed we really needed the T4 and T3 levels measured as well. (Since then I have found some interesting data on the need for all three tests.)

TSH measures what your body "thinks" it needs in the way of thyroxine. T4 and T3 measure actual thyroxine levels in the blood--and, based on tests I've been having done throughout this past year on the direction of my longevity and vitality doctor, I know that one or more of these numbers can be "out" of range while TSH is "in" range.

My doctor relented.

The tests came back: TSH and T4 levels both indicated a significant deficiency, but T3 was slightly out-of-range on the high end.

"How about bumping your dose back up?" my doctor asked.

"Sounds reasonable," I said. (I had gotten the sense, somehow, that my body was slowing down a bit.)

But what should we make of the T3? Why is that so high?

Is it that kind of anomalous/strange number that got Armour's thyroxine in trouble, here, in the last year [so that it is unavailable for purchase]?

I still have a few weeks' worth of Armour left if I take it at 120 mg/day.

Meanwhile, I asked, "Is there any 'natural' thyroxine that can/will replace Armour while they are out of production?"

I thanked him for any help he could provide.

He replied:

1. I've been in touch with my pharmacologist. She states that since Armour is an animal product, the amount of T3 and T4 will vary from batch to batch which might explain the high T3 and low T4. Synthetic products like synthroid are more consistently dosed.

2. I don't think Kaiser has any of the other brands of the natural thyroid of any kind so we might have to get you to get it elsewhere during the shortage.

Somehow, I had this feeling the pharmacologist was misinformed. I can't imagine Armour/Forest Pharmaceuticals has been able to get away with inconsistent product quality for all these years.

So I did a little research. And then some more. And then a lot more.

I'm astonished at what I have found.

• First--not terribly astonishing, but worth noting: The pharmacist really was "blowing smoke." Armour Natural Thyroid is carefully controlled for potency and purity:
  

  The amount of thyroid hormone present in the thyroid gland may vary from animal to animal. To ensure that Armour Thyroid tablets are consistently potent from tablet to tablet and lot to lot, analytical tests are performed on the thyroid powder (raw material) and on the actual tablets (finished product) to measure actual T4 and T3 activity.
  
  Different lots of thyroid powder are mixed together and analyzed to achieve the desired ratio of T4 to T3 in each lot of tablets. This method ensures that each strength of Armour Thyroid will be consistent with the United States Pharmacopeia (USP) official standards and specifications for desiccated thyroid lot-to-lot consistency. The ratio of T4 to T3 equals 4.22:1 (4.22 parts of T4 to one part of T3).

• Despite these statements by the manufacturer, you can still read claims such as this:
  

  Armour Thyroid was the only treatment for hypothyroidism for about 50 years, but it was found that the amounts of T3 and T4 varied greatly from batch to batch. Eventually, synthetic T4 (Synthroid) was being produced and widely used because it did not have similar problems of standardization in common with the naturally derived Armour Thyroid.

  And even stranger and more inaccurate information from the American Thyroid Association.
  
  But, as Mary Shomom notes in the About.com Guide to Thyroid Disease, there may be good reasons for this kind of disinformation "from the top." Just follow the money--from Abbott Laboratories, maker of Synthroid, to the American Thyroid Association, for example. [Look toward the bottom of this article for the evidence.] --Or how about the payments from all the synthetic hormone manufacturers to the FDA in order to get their products approved in the early 2000s after virtually all of them were found to show "significant stability and potency problems"?
  
• Armour REFORMULATED its thyroid product in the spring of 2009--changing its binders and excipients . . . and causing a bunch of problems for many patients.
  
• Whether Armour thyroid is efficacious or not, it turns out there really is no source of natural thyroid in the United States as of this moment. And, it appears, the FDA may have actually outlawed--or may be in the process of outlawing--the manufacture of this product in the United States, a product that has been on the market and helping people like me for more than 100 years.
  
  The more I have read, the more disturbed I have become at this turn of events.
  
• Despite the shortage here in the United States,
  

  Canada has a generic natural desiccated thyroid drug, referred to as 'Thyroid,' which is made by ERFA Drugs . . . [and s]ome of the foreign pharmacies that ship to the US may have some remaining stock of Nature-Throid, Westhroid, Armour Thyroid, or foreign brands of natural desiccated thyroid like Thyroid-S.

  It took a while, but eventually I discovered the natural thyroid preparation made by Greater Pharma of Thailand: a product that goes by the brand name Thiroyd and available in wholesale quantities at a wonderful price. I also found a Canadian source with very good prices of the ERFA Thyroid and in a wide variety of specific dosages.
  
  I had my doctor write me a highly "generic" prescription for natural thyroid along the lines of the following advice from the http://is.gd/4hhvT article:
  

  During the shortages, ask your doctor to write your prescription for desiccated thyroid as broadly as possible. For example, a prescription for 'desiccated thyroid, 1 grain' can be filled with Armour, Nature-Throid, Biotech, or a generic. But if they write 'Armour Thyroid, 60 mg' for example, you won't be able to get 'Nature-Throid.'

• I should have learned these things years ago, but I just now discovered: the synthetic thyroxines normally prescribed by the medical profession supply only one form of thyroxine, "T4"--tetra­iodothyronine--commonly formulated as levothy­ro­xine sodium (a synthetic thyroxine molecule that contains four molecules of iodine bonded by sodium). Our bodies, however, use T4, T3 (triio­dothy­ro­nine--i.e., thyroxine with three iodine molecules), T2 (diiodothyronine--thyroxine with two iodines), T1 (monoiodothyronine), and something called cal­ci­to­nin, a hormone that participates in and/or regulates calcium loss from bone, calcium levels in the blood, and, possibly (proven in rats and monkeys; not yet demonstrated in humans), satiety.
  
  Not only do our bodies use all five of these hormones, when they are healthy, our bodies manufacture them. If--as happened to me via Iodine-133 therapy--your thyroid has been knocked completely out of commission, the only way you're going to get the T2, T1 and calcitonin is if you take natural thyroid. Yes, your body can convert some T4 to T3, but, I am given to understand, it cannot further break down the T3 to T2, T1, or calcitonin.
  
• An article published in the February 11, 1999 issue of the New England Journal of Medicine (1999;340:424-429, 469-470) reports that treatment with thyroxine [T4--the commonly prescribed synthetic levothyroxine/Synthroid hormone] plus triiodothyronine [T3--rarely prescribed by American doctors, but available under the brand name Cytomel] improved the quality of life for most hypothyroid patients. Indeed, "Among 17 scores on tests of cognitive performance and assessments of mood, 6 were better or closer to normal after treatment with thyroxine plus triiodothyronine. Similarly, among 15 . . . scales used to indicate mood and physical status, the results for 10 were significantly better after treatment with thyroxine plus triiodothyronine [i.e., T4 plus T3]."
  
  Of course, that is a dispassionate medical/scientific statement.
  
  A more partisan description comes from the StopTheThyroidMadness website:
  

  [I]n nearly ALL patients on T4 meds, the T4 does NOT convert into an adequate amount of T3, leaving you with symptoms that neither you OR your uninformed doctor realize are related to inadequate treatment—poor stamina compared to others, chronic low grade depression, thinning hair or outer eyebrows, feeling cold when others are warm, cholesterol problems, aches and pains, hard or small stools, easy weight gain, memory problems, foggy thinking, a diagnosis of Chronic Fatigue Syndrome or Fibromyalgia, difficulty conceiving . . . the list is long and pathetic. In other words, healthy thyroids are NOT meant to rely solely on T4-to-T3 conversion!

• Despite the fact that the medical profession recently tightened the definition of "normal TSH" to no more than 3.04 mU/l (they used to say "normal" went as high as 5 mU/l), a 1997 article in the British Medical Journal concluded, "Thyroid stimulating hormone concentrations above 2 mU/l are associated with an increased risk of hypothyroidism." --And again the author at StopTheThyroidMadness.com ups the ante:
  

  Around 1973, the TSH lab test was developed. Based on a sampling of several volunteers, a so-called “normal” range was established—.5 to 5.0 (recently lowered to 3.0). But volunteers with a history of family hypothyroid were NOT excluded, leaving us with a range that leans towards being hypothyroid! In fact, the TSH RARELY corresponds to how a patient feels [i.e. to actual hypothyroid symptoms]. There is a large majority of patients who have a “normal” TSH, even in the “one” area of the range, and have a myriad of hypo symptoms. There is a complete chapter on the TSH with more information in the Stop the Thyroid Madness book.

• Nature-Throid and Westhroid have served many people well. But the Armour shortage--together with a shortage of USP desiccated thyroid powder--has now created a shortage of these alternatives.

---End of October 2009 Text---
Yesterday, as I spoke with my naturopath, I was surprised to hear him tell me that the desiccated thyroid products are now readily available in the US.

I have to confess, the mess last year kind of "converted" me away from US suppliers. After a while, when you get hassled every step of the way here in the US, and you find that their price is somewhere around $1 per per day, the easy access and 11- or 12-cent/pill prices of overseas suppliers become pretty attractive. So I hadn't even looked at U.S. suppliers in almost a year (since last I worked on the article above).

One last note: I thought I should at least check on what I wrote last October before simply posting it.

I found the following update in About.com's Thyroid area:

A brief status update on "Current Drug Shortages" posted at the FDA website on March 2, 2010, states that, as of February 12, 2010:

"Forest reports manufacturing issues involving the raw material and RLC reports increased demand. FDA has not ordered Forest or RLC to remove these thyroid (desiccated) tablets from the market. This has been a long term shortage and any new information will be posted as soon as it becomes available. FDA approved levothyroxine products continue to be available from multiple manufacturers."

It's good to see that the FDA felt it necessary to include the brief statement that they have not ordered Forest or RLC to remove these thyroid (desiccated) tablets from the market. This very likely reflects a concern on the part of the FDA that it not be perceived as taking action that can endanger the many thyroid patients who rely on natural thyroid drugs, and may be a response to thousands of inquiries by telephone, email and fax the FDA received from thyroid patients and practitioners regarding concerns about various FDA actions regarding natural desiccated thyroid drugs.

The FDA's statement does not address a critical issue for thyroid patients however. According to the natural desiccated drug manufacturers, the FDA has indicated that they still consider natural desiccated thyroid drugs "unapproved," and intend to call for a new drug application process for natural desiccated thyroid drugs.

This leaves us with several important questions:

• When will the FDA requirement for new drug application for natural desiccated thyroid drugs be issued?
  
• Will the FDA call for the faster (and less costly) abbreviated new drug application (ANDA) or the lengthier, costlier complete new drug application (NDA) process?
  
• Will natural desiccated thyroid drugs be allowed to remain on the market during the ANDA/NDA process?

We still do not have answers to these questions, though manufacturers are still working behind the scenes with the FDA and with their own scientific experts, doing their best to ensure that natural desiccated thyroid drugs will continue to be available in sufficient supply to all patients who need them in the short term, and throughout a federally-mandated approvals process.

--Natural Desiccated Thyroid Drugs: An Update
March 2010 - - Where Are We Now?

Thorough doctor

I continue looking for help with my rheumatoid arthritis.

The other day, Sarita saw an article in The Week about studies that have shown "a link between certain pollutants, including PCBs and DDT, and conditions such as heart disease, hypertension, diabetes, and rheumatoid arthritis." Moreover, "people who'd lost 22 pounds or more in a decade had the highest levels of pollutants in their bloodstreams."

Hmmmm. I did make an effort, beginning about three years ago, to cut back and lose some weight. Indeed, by the time the rheumatoid started hitting, I had lost a good 30 pounds or so. (The day I hit 199.5, I said to myself, "So far and no further!" I'm now bouncing somewhere between 159 and 163.)

And there is the matter that Jonelle has been going to an ND (Naturopathic Doctor) in hopes of "healing up" or "strengthening up" to be able safely to bring another baby to term.

In evaluating Jonelle's present condition, the doctor discovered she is high in a number of heavy metals . . . and has been giving her certain injections to help remove them from her system. (It's called chelation.)

After reading the article in The Week, Sarita said, "I want you to go to Jonelle's doctor."

So I called the office and set up an appointment, which I kept yesterday afternoon.

Prior to the appointment, however, the doctor sent me a patient profile/health history questionnaire the likes of which I have never seen. Eight pages of fine details.

I thought: "Man! If I didn't have at least a vague idea of why he asks all these questions [except the one where he wants my Social Security #!], I might think he was massively invading my privacy."

After we met, however, I was even more impressed by the thoroughness of his interview and exam. We spent two hours together . . . and I am scheduled to go back in a week for beginning diagnosis and health improvement plan.

*********

While I'm at it, let me share two things he said that struck me during our time together yesterday.

1. "Let me tell you about my philosophy of health. I believe we were created to be healthy. We are supposed to be healthy. We should be able to self-heal . . . if we could only get out of our own way. So when I meet a person who is unhealthy, I ask, 'What is this person doing--or not doing--that is getting in the way?"
   
   He said that he believes good health is based on four legs or foundations:
   
   1. What we ingest--i.e., what we eat or don't eat and what we drink or don't drink.
      
   2. Movement or exercise.
      
   3. Sleep--both quantity and quality. And,
      
   4. What he called Interconnectedness--which includes not only social relations, but spirituality. How are we doing in relation to others (which may include God or the spirit world).
      
   "Take that four-legged bench over there," he said. "With four legs under it, you and I could both sit on it and it will hold us comfortably. Because it has four strong legs.
   
   "If I remove a leg, it will still stand. And, in fact, if I am careful, I could even sit on it and it would hold me. But if I sit in the wrong place, I'm going to collapse it.
   
   "And if it has only two legs? It cannot stand any longer. It will collapse.
   
   "So I want to know how you are doing with your four foundation pillars."
   
2. We got onto the subject of thyroxin--a hormone I have had to take ever since I had my thyroid removed back in the mid-80s as a result of Grave's Disease.
   
   I mentioned to him some of the hassles I have faced as a result of seeking to use natural thyroxin (desiccated and processed bovine or porcine thyroid gland) rather than the synthetic variety. (Natural thyroxin contains the full complement of thyroxin variants--T4, T3, T2, T1 and calcitonin, at least, while the standard synthetic contains T4 only. There is an additional synthetic that includes T3. None for T2, T1, calcitonin, or any of the other minor fractions that may be present--and unstudied--in desiccated thyroid gland.)
   
   My regular doctor, for example, is convinced that synthetic is better. He really doesn't want me to be taking the natural stuff. (I had one doctor who refused to treat me if I refused to take the synthetic. My current doctor was unwilling to help me locate natural thyroxin when the FDA made it almost impossible legally to acquire it last year. Happily, though he is obviously critical of my approach, he lets me "do my thing," as it were.)
   
   My naturopath, yesterday, said he has found, in his practice, that 9 out of 10 patients do better on the natural thyroxin, but, for some reason, one out of 10 seems, actually, to do better on the synthetic. (Point--which I had not considered before: I ought not simply to assume natural is better.)
   
   But what really bothered me was what he had to say about why he believes most doctors prefer to prescribe synthetic hormones.
   
   He referenced John Abramson's Overdosed America as his source.
   
   He said that Abramson shows how the Journal of the American Medical Association has a practice (policy?) of printing only those scientific studies that are critical of the non-synthetic hormones or that show them in a bad light. "There are ten studies showing the efficacy of the natural hormones, but JAMA won't talk about them. But when it gets one study that is critical, it will publish that immediately."
   
   Supposing he had accurately recalled Abramson's data, and supposing Abramson is right, he concluded, "With that kind of input, you really can't criticize mainstream medical doctors for believing that natural hormones are ineffective."

And I wonder: Can't we?