I don't take any medicine, but I bought a tiny tube of terramycin for the kitten's eyes, and it was $22. Last time I bought some it was $11. It is about an inch and a half long. I guess I am fortunate....that is the only medicine I have bought in a long time, except for a concoction I make for wound treatment on horses, and that is very inexpensive.

@ heatheron  - indeed. " Western medicine" certainly does recognise hypothyroidism, and has treatments for it. The hormone replacement  seems to be quite cheap (at least here in Australia), especially the generic.

Very cheap here in U.S., too. I know (and have known) several people who take it.

"I don't take any medicine,"

Do you get annual physical exams from a physician, including have blood work done? If so and no meds are prescribed, you're a rarity.

Folks - really, synthroid (Levothyroxine) is useless, it doesn't contain T1, T2, T3 or Calcitonin. All hormones essential in the treatment of hypothyroidism. Finding a physician that will prescribe Amour is difficult because they don't get the big kickbacks like they do from the manufacturers of Synthroid.

I've never heard of a physician refusing to prescribe a drug that's approved and indicated to treat a condition a patient is diagnosed to have. Find another doc.

Do you get annual physical exams from a physician, including have blood work done? If so and no meds are prescribed, you're a rarity.

I'm in my 60s and don't take any medications. I have a thorough annual physical, do all the screening tests, etc. When I had cataract surgery a couple of years ago, the anesthesiologist looked at my chart and said (jokingly) "No prescriptions? What kind of an American are you?"

ETA: my husband is 5 years older than I am, also sees his PCP regularly, and doesn't take anything.

This seems to be a decent summary of the hypothyroidism issue.

https://www.goodrx.com/conditions/hypothyroidism/armour-thyroid-vs-synthroid-dosing-cost-side-effects

Essentially, there is only one small clinical study comparing Armour vs levothyroxine; more of the participants preferred the former over the latter, but there were no/no differences in the clinical results.

Oh, and according to the article, it is Armour which is the more expensive drug.

Don't trust a study backed by a company in bed with the pharmaceutical business.

A healthy thyroid produces (and is the only source of) T1, T2, T3, T4 and Calcitonin, replacing them with only one of the five is little better than a placebo. Levothroxine is the left-handed version of the storage (inactive form) T4, a healthy thryoid produces < 5% of left-handed T4.

"Don't trust a study backed by a company in bed with the pharmaceutical business."

Really? Goodrx didn't conduct the study, they merely provided a link. The actual clinical study was conducted by researchers from the Dept of Endocrinology at Walter Reed National Military Medical Center and the Department of Preventive Medicine and Biometrics , Uniformed Services University of Health Science. I doubt either institution is "in bed" with big Pharma.

Here's the original:

https://academic.oup.com/jcem/article/98/5/1982/2536971

Yeah, no Goodrx study involved, it quotes one study. An interesting comment in that piece, which is a year or two old, is that Armour isn't approved by the FDA. Which is why reputable doctors would be reluctant to prescribe it (in the absence of compelling clinical studies) and why insurance doesn't cover it. Maybe it makes the person feel better to point a finger in another direction but that doesn't seem to be warranted.

As a parenthetical note, that one small study was conducted at what probably is the one medical school/research institution whose reputation puts it at or close to the very, very bottom of the list of US medical schools, the Uniformed Services (ie, US Military) medical school.

I'm in my 60s and don't take any medications. I have a thorough annual physical, do all the screening tests, etc. When I had cataract surgery a couple of years ago, the anesthesiologist looked at my chart and said (jokingly) "No prescriptions? What kind of an American are you?"

I got similar reactions from nurses for years.

I was fortunate until about 7 years ago when a diagnosis of psoriatic arthritis introduced me to the expensive world of biologics. I'm 68 and am now on a low dose of high blood pressure meds too. Still feel fortunate.

Elmer - I should have been more clear. That "one small study" was in fact conducted at Walter Reed. I am under the impression it has a decent reputation. Only one of the co-authors was from the other institution and she was the biostatistician for the paper.

I didn't rely on any portion of your explanation, not in any way. I don't believe your "impression" of Walter Reed Hospital is widely shared. There have been many scandals and problems there over the years though it's been a bit quieter on that front of late.

The Uniformed Services University of Health Sciences is co-located with Walter Reed (a military hospital), next door on the same military facility. The hospital is much older. The medical school uses the hospital and vice versa, professional staffing ranks are often shared/common. The USU medical school acts as a feeder of doctors, nurses, etc., into (mostly) military service. It's tuition free and also pays its students a monthly stipend, in that they're military officers in training. Active military duty following graduation is required for the number of years equal to the years of training at government expense. If a residency is also done in a military facility, that can add 3-5 years or more to the active duty obligation of 4 years for medical school. (Medical school in the US is 4 additional years spent after completing a 4 year undergraduate degree). The active duty obligation as the quid pro quo for the free ride is the biggest turn off to discourage applicants. A limited number of "military scholarships" are also available to students attending other of the regular medical schools in the US but they come with the same active duty obligation for the payback.

Our nation's best and brightest medical school aspirants aren't generally attracted to USU because of the strings attached. The few times I've checked over the years at undergrad and test stats for medical school matriculants, USU's numbers were very much at the low end. In order to receive accreditation, medical schools in the US are required to have reasonably robust research divisions (and hospital access for students) and offer access to same to students and trainees. That explains why there's research jointly done at Walter Reed/USU but not to the same extent at other US military hospitals around the country that aren't fulfilling a training function for a medical school.

A growing number of US medical schools have become tuition free. These tend to be mostly schools of high repute, with the exception of one new one connected to a large medical practice of mixed reputation (Kaiser Permanente) that may have figured it needed something extra to attract applicants. Though likely not. It's a nice gesture of an amount that's meaningful for students to forgo but not an earthshaking amount of revenue for the schools to miss out on in total. Competition for admission to these schools is high and has been anyway so the tuition free feature is likely not a factor in attracting applications as for USU.

If you were talking to me, yes, Elmer. I had a complete physical and blood work up about 13 months ago. Thank you for your concern. My doctor pronounced me in excellent health. (That included a pap smear, colonoscopy, and mammogram. Oh, and screening for osteoporosis, for which I take supplements....not medicine. And I see a dermatologist every year also.)

You're a very lucky person and good for you! For many of us, the annual visits often feature tweaking of prescription doses and offer a kick in the butt to continue efforts to lose weight.

"I didn't rely on any portion of your explanation, not in any way."

I'm sure you didn't. I did expect you to read what the actual paper said, though: "The proposed study design was a prospective, randomized, double-blind, crossover study, conducted at the Walter Reed National Military Medical Center in Bethesda, Maryland."

I had no trouble putting it into context and explaining the institutional setting, something that internet-only and cross-border distant "knowledge" often lacks.

Tell me, was that study subject to peer review before being published?

​"Tell me, was that study subject to peer review before being published?"

As is obvious from the link, the article was published in The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 5, 1 May 2013, Pages 1982–1990, https://doi.org/10.1210/jc.2012-4107.

 You seem unfamiliar with the process, but reputable scientific journals do not actually publish until peer review has been completed. That's why  one needs to be cautious about pre-print studies, which often don't make it to publication because they don't get through peer review.  And even peer reviewed articles get withdrawn if errors are identified. This one hasn't been withdrawn.

Anything else I can help you with?

jmm1837 - like I said above, western medicine doesn't recognize hypothyroidism as a legit disease, that's why they push an ineffective medicine as the only/best treatment. It's the same reason they label thyroid cancer as "the good cancer", because they assume if they remove the cancer, leaving the patient hypothyroid, that hormone replacement is unnecessary.

Raye, I think you need a new endocrinologist.

Calcitonin is NOT produced by the same cells in thyroid gland that are involved in thyroxine production, and it is NOT related to that part of thyroid function AT ALL.

Another post by a person who knows a little but not enough.

"You seem unfamiliar with the process,"

One of us is quite familiar, the other does frantic Google searches to continue a pretense.

I have family/relatives, friends and acquaintances who are or have been engaged in scientific and biomedical research. Their collective published papers number in the dozens (I'm not counting listings for "cited by others"). Individuals a few of whose project findings have been assessed as being so significant as to be granted publication in Science and Nature, considered to be the highest possible recognition and attainment for such things at the time of publication. You can pretend to know that but I'm sure you don't. These as well as numerous other publications, of course. Among the group I know are people whose project credits include being the first name mentioned in the study.

So another question for you to do a search on to pretend you know - Is there any significance to the order in which project/article authors are named for a published biomedical study? The answer is easily found but I'm sure this is another aspect of published research you are unfamiliar with.

raee_gw zone 5b-6a Ohio - wrong Calcitonin is produced in the thyroid, 3 three semesters of A & P plus 2 semesters of Anatomical Chemistry in college.

Calcitonin is secreted by the parafollicular cells of the thyroid gland. This hormone opposes the action of the parathyroid glands by reducing the calcium level in the blood. If blood calcium becomes too high, calcitonin is secreted until calcium ion levels decrease to normal.

Source: https://training.seer.cancer.gov/anatomy/endocrine/glands/thyroid.html

Just in case someone has the idea that there are two thyroid glands, nope there is only one and once it's been removed or (as in my case) the tissue is fully calcified there is no other internal source for those hormones.

Correct, just as I stated, the calcitonin is produced by different cells and has nothing to do with the production or regulation of thyroxine, T3 or T4.

Having your entire thyroid removed is a wholly different situation that having typical hypothyroidism (for which levothyroxine is an effective treatment- proven by assessing serum levels of TSH, T3 and T4.) As would having your thyroid gland be "fully calcified".

I disagree with your statement that "levothyroxine is an effective treatment" for those with removed or calcified thyroids. That's your choice and western medicines prevailing view but, unfortunately, that has left countless numbers of patients suffering with unresolved symptoms. The sad part is NDT (natural desiccated thyroid) is a safe. effective and inexpensive treatment that few patients find out about much less are given as a treatment option.

Elmer - the usual advice is, when you're in a hole, stop digging. That you would even ask whether an article published in a reputable, scientific journal had been peer reviewed tells me all I need to know about your grasp of the publication process.

I don't have to look up anything to know about peer review or about the order co authors are listed in a scientific paper. Anyone with even high school science, never mind university level courses, knows that, and why the statistician is listed second.

Just drop it. You can continue to bore us all with your repeated efforts to disparage me but none of it makes you right.

"That you would even ask whether an article published in a reputable, scientific journal"

You missed it - that question was deliberate, what we call an underhand toss, easy to catch or hit with a baseball bat.

Take your own advice - this is something I've long received first hand insights about from people close to me. And you clearly don't know much.

To answer my question that you passed over - the first name mentioned is called the First Author - it's the person who princiipally wrote the paper and did the lion's share of the work. And often conceptualized the investigation. It's their project. The following names are people who contributed, usually in decreasing order of importance. The last name mentioned is the Principal Investigator, also called the PI. In cases where different teams or labs are involved, there can be a few PI's mentioned at the end. But the very last name is the person under whose aegis the First Author worked. And usually whose lab provided all or part of the grant funding for the work.

Now you know more than before, without a search.

"Garcon" (waves hand) "Garcon" "Could you please bring a plate of medication for the KT, set it right in the middle, for overactive bladders, maybe that will do something to help end the pissing contests going on".

Oui, Madame. Tout de suite.

Lucille, I know you're trying to make a point but as an aside please don't call "le serveur" or "la serveuse" with the term garçon, it means little boy.

Sorry but the primary definition of 'garcon' is a male waiter. Always has been and continues to be so :-) Have you never been to France? Studied French?

If you insist on correcting people, get you facts straight!

gg, from what I understand it's considered outdated and practically rude to call a server garçon these days. And yes, I've been to France many times and speak the language passably well.

It's the comparable equivalent of calling a male waiter here "young man".....regardless of age :-) But then again, how many times when you dine out here do you wave your hands and call out for a waiter/server/whatever? It is not the most polite or subtle way to get anyone's attention!!

Don’t call the waiting staff anything. If a raised hand doesn't work just say ‘s'il vous plaît’.

I think that some people have (intentionally) missed the point of my prized sense of humor. (Or perhaps they are trying to attempt to start their own pissing contests, which I will not join, being perfectly willing to admit that I can't piss very far.) Besides, the only one answering was Elmer, who is well able to take care of himself although it is sweet that you leapt in to help.

Reading all this dialogue, the name of the drug, levothyroxine rang a bell. We had a Doberman many years ago, probably 30 yrs. who started have severe scratching, hair loss, weight gain. We took her to the vet numerous times. First he thought it was mites and did skin scrapings, (forgot, she also had a terrible smell about her), then when that was negative, had us change foods, etc. Cost us a small fortune and she was not getting any better despite trying various meds over the course of a few years. She smelled so bad it was embarrassing to have anyone over to the house. She was losing fur all over her body.

Finally in desperation, we got the name of a Veterinary Dermatologist in NYC. We took her and he diagnosed a thyroid problem and put her on levothyroxine. Within a month of taking the medication, her smell disappeared, her coat started growing back shiny and healthy. She lost weight and was back to her active self. After time she actually looked younger and healthier that she ever looked.

We were shocked with the change. I can't agree or disagree with anything in the previous discussion, but he diagnosed her with a low thyroid and this drug worked. She lived to be 16 yrs which is a long life for a Doberman.

Jane

Lucille, I'm not sure the issue was intentional with your joke. Some people take the written word very literally (npi), due to the lack of other context cues, perhaps.

I thought the comment was clever but as others have said, the use of the word garçon (don't omit the cedille under the c) is very, very outdated. Like, perhaps dating back to the immediately Post-WW2 days. It would be offensive and never used in the implied situation now. But its use was clear and cute, suggesting a request given to a waiter.

Sorry, to stir up trouble...but I cannot let this go without a response: "The US patient is subsidizing the cost of prescription meds to the rest of the first world, where their governments control pricing."

This is untrue on many levels. But most importantly, one of the main things our high prices actually subsidize is the totally unnecessary advertising: https://www.csrxp.org/dose-of-reality-breaking-down-the-big-pharma-dollar-part-iii/

and lobbying:

https://www.statista.com/statistics/257364/top-lobbying-industries-in-the-us/

In fact, although there is some controversy about how the figures are calculated (https://www.raps.org/news-and-articles/news-articles/2019/7/do-biopharma-companies-really-spend-more-on-market) it is safe to say big pharma spends about as much on marketing as they do on R&D.

Specifically: When you remove the expense of providing free drugs, the R&D number is higher than marketing," he [a pharmaceutical executive] said.

Well, if those costs are being imputed at list price, which is surely the case, that might be the case. If I sell a pill for $100 that cost me $1 to make, saying that providing it free "costs me" $100 is notionally absurd, even if it might be legal according to US tax accountancy principles. (I checked with lawyers and their pro bono work. Apparently it is not)

I'm not an anti-vaxxer. I'm glad our country has a robust research and pharmaceutical industry infrastructure that we were able to create life saving COVID vaccines as quickly as they did. But I will call a spade a spade...the myriad of ways big pharma (and "big medical" more generally, if you want to look at the broader industry) has control over the US healthcare system is one of the biggest scandals in the western world. I think there's a core psychological truth involved: matters of life and death can be so compelling, that rational thought goes out the window. Even the term "life saving medicine" is propagandistic. The medicine itself never leaps out of a bottle and prescribes itself. The medical processes of testing, diagnosis, and correct prescribing are what is life saving. So if anyone 'stands up' to big pharma and their lobbying and regulatory shenanigans, there's a sense that somehow you want to get in the way of 'saving lives'.

Lastly I have to respond to the incredibly irritating attempt to delegitimate a study because it was conducted at USUHS. The team who conducted that research have perfectly acceptable academic backgrounds...I looked most of them up. And as already pointed out, it was published in a respected, peer reviewed journal. The fact is, VERY little non-biased research on comparative effectiveness of pharmaceuticals is performed in the US...because there's simply not much of an incentive in our broken system! Most people just accept that this is the way it has to be, with the average primary care providers having very little inputs OTHER than from big pharma marketing.* When I search such topics in pubmed, I find much more of that kind of research is done overseas. It's no surprise whatsoever that the world's leading body to evaluate medical evidence was founded in the UK. To create a "collection of high-quality, independent evidence to inform healthcare decision-making."

* - not that I in any way need to provide a kind of bona fides, but although my health is good, a couple members of my family have alarming, long term, complex health problems. So I spend a lot of time reading research papers. Here is a current screenshot of searching my browser history:

"Lastly I have to respond to the incredibly irritating attempt to delegitimate a study because it was conducted at USUHS. The team who conducted that research have perfectly acceptable academic backgrounds.."

I didn't create its poor reputation (relative to other medical schools and biomedical science grad programs), I only mentioned it. Institutions held in high esteem tend to attract all star faculties, researchers with a track record of successful work that leads to robust and successful funding from multiple sources, and the best and brightest medical and grad students who want to take advantage of superior resources for training, learning and probably to a much lesser extent, to have some of the stardust rub off on them.

USUHS generally doesn't offer anywhere near the same degree of any of that as most other institutions do. It has the reputation it has.

Yeah but the fact you even "only mentioned" the lack of academic prestige of USUHS is based on a false assumption that the beneficence of an institution's research is highly correlated to its academic ranking - it is not. I could just remember off the top of my head, having read this article years ago, and was luckily able to find it again by googling: https://www.nytimes.com/2009/03/03/business/03medschool.html

I can't find much at the moment about whether a medical school/research institute's prestige is highly correlated to the quality of the research it produces, when adjusting for other obvious factors. Obviously places like HHMI, Harvard, etc., have access to better technology and resources than lower prestige organizations. What I can find is this, showing that you're no better off with a doctor who went to a highly prestigious med school: https://www.bmj.com/content/362/bmj.k3640

Granted, that obviously just applies to medicare patients.

My point stands that the sort of unexciting medical research originally cited in this thread, comparing 2 approaches to treating thyroid conditions, is often LEFT to the "low prestige" institutions. In the USA at least. Nobody else will bother doing it!

Are the outstanding reputation of top instructions, in fields including but also aside from medicine and biomedical science, equally invalid or misplaced as how you're suggesting ones with lousy reputations are viewed?

I don't think so. Employers and other academic institutions don't think so. Program directors in the medical field, who are immersed in that world, who choose applicants for residencies, fellowships, other post-doc positions, don't seem to think so.

How do any of these "choosers" know if their strategy is valid, if it helps them find top applicants? They know outcomes from past experiences.

None of these comments about USUHS are relevant (especially since the actual research was conducted at Walter Reed). The contribution from USUHS was made by a statistician, not a medical school graduate.

What is relevant is that the authors produced a small but well-constructed study which was peer-reviewed and judged to be of sufficient quality to be published by a reputable academic journal.

"None of these comments about USUHS are relevant"

Agree, your comments are not. You're persistent with your misinformation and misunderstandings.

"None of these comments about USUHS are relevant"

Agree, your comments are not. You're persistent with your misinformation and misunderstandings.

Says the person who first brought up that the study was in any way related to "academic pariah" USUHS.

Hilarious.

Are the outstanding reputation of top instructions, in fields including but also aside from medicine and biomedical science, equally invalid or misplaced as how you're suggesting ones with lousy reputations are viewed?

I didn't say reputation didn't matter - the notion your very convoluted words were trying to put into my mouth. It just doesn't matter in this case - as you apparently agree!

Over and out.

Once again, Elmer, you missed my point entirely. You are attempting to deny the credibility of a peer-reviewed article which has been published by a reputable journal because of what you think are the shortcomings of the institution one of the co-authors comes from, rather than because you have identified any errors in the paper itself. That is pretty much an "ad hominem" logical fallacy. As are all your personal attacks on me. You may think I've resorted to misinformation but you haven't actually been able to rebut a single point I've made, and that's the only test.

Just for your info:

"Ad Hominem (Attacking the person): This fallacy occurs when, instead of addressing someone's argument or position, you irrelevantly attack the person or some aspect of the person who is making the argument. The fallacious attack can also be direct to membership in a group or institution."