Letter to the Editor of Sunday Telegraph sent 4th August 2014
This is a letter I have sent to the Editor of the Sunday Telegraph in reply to their article on the 27 July 2014.
I am grateful to Ms Anna van Praagh for her article ‘Why are doctors being demonised?’ in the Sunday Telegraph Magazine on the 27 of July 2014.
I would like to start by quoting some statements by Panels who sat in judgment at Dr Skinner’s Fitness to Practice Hearings in 2007 and 2011.
The Panel at Dr Skinner’s Fitness to Practice Hearing of the General Medical Council in Manchester on Thursday 17 November 2011 said, and I quote ‘The Panel cannot fail to take notice of the fact that your approach to treatment, whereby both clinical and biochemical parameters are assessed, falls within the guidelines of Good Medical Practice. In this respect your assessment of your patients does not differ from Dr Akintewe. The difference of approach lies in the weight given to the respective clinical and biochemical findings’. On the same day the Panel also said ‘The safety and follow-up routine as described by you have allowed the Panel to feel confident that patient safety is not disregarded by you’.
Earlier at the Fitness to Practice Hearing in Manchester on Sunday 11 November 2007 the Panel said ‘It is clear that you (Dr Skinner) are a caring and compassionate doctor whose overwhelming concern is the care and well being of your patients’. The Panel also said ‘A large body of evidence has been submitted throughout this case demonstrating that many patients have benefitted from the medication you have prescribed’.
It is important to understand Dr Skinner’s background in order to explain his position as a doctor treating patients by applying his outstanding scientific knowledge and experience to medical practice.
Dr Skinner started his career in Obstetrics and Gynaecology then moved into research publishing extensively on herpes and other viruses, vaccine development and was one of the pioneers of research into the association of viruses to cervical cancer. The Nobel Prize given to Professor Harald zur Hausen for establishing the link between human papilloma virus and cervical cancer confirmed that Dr Skinner’s basic research idea was correct albeit a different virus was responsible. Dr Skinner was admired for his fearless and exceptional intellect, independence of thought and great analytical mind.
In his capacity as a Consultant Virologist at the Queen Elizabeth Hospital in Birmingham he was referred patients who were thought to have Chronic Fatigue Syndrome, Myalgic Encephalopathy (ME) and other problems thought to be related to viral infection; he felt that a number of these people had classical signs and symptoms of hypothyroidism and treated them with thyroid replacement with encouraging results. He then started working with a number of General Practitioners to address the possibility that there may be a group of individuals who have normal thyroid chemistry but are suffering from hypothyroidism. The British Medical Journal published a letter in 1997 from Dr Skinner and a number of General Practitioners bringing this to the notice of the medical world.
Dr Skinner’s work involved a specific group of patients who have thyroid chemistry within the reference range but clinical signs and symptoms of disease; he argued that blood tests should not be pivotal in the diagnosis and treatment of hypothyroidism as they had never been validated as a marker of optimal health. Secondly, in this particular group of patients it was not known what their blood test results were when they were healthy therefore using blood tests as the only criteria for diagnosis was not sufficient.
It must be emphasised that Dr Skinner was not doing anything new nor prescribing new medication for the treatment of hypothyroidism; patients were diagnosed and treated for this disease based on clinical signs and symptoms and medical examination before blood tests were established and thyroid replacement using natural preparations was the norm prior to synthetic preparations.
The treatment Dr Skinner used was one that has been used for many years namely thyroxine which is the drug of choice for most patients with hypothyroidism and in those who did not respond to this he used the natural Armour or Erfa Thyroid which were used in the treatment of hypothyroidism before synthetic thyroxine was manufactured. His methods were scientifically sound and he always wrote to the General Practitioners and other medical carers to inform them of his reasoning behind the diagnosis and treatment of patients.
Dr Skinner’s clinic in Birmingham was a professionally run establishment which was registered with the Care Quality Commission with regular inspections which resulted in glowing reports of our administration and Dr Skinner’s care of his patients. All patients were given details of possible side effect of treatment both verbally by him and in the form of an information sheet. We must not lose sight of the fact that most medications have side effects and responsible doctors manage patient care by regular monitoring and follow-up as did Dr Skinner. We also have to understand that patients must be allowed to exercise choice in relation to decisions about their healthcare.
Throughout his work with this group of patients Dr Skinner tried very hard to engage with the rest of the medical profession and address this difference of medical opinion which results in lack of proper medical care in this particular cohort. As far back at 1999 he organised a conference and invited Endocrinologists, General Practitioners and representatives of the Royal Colleges and Department of Health and other medical bodies to engage and discuss their difference of opinion and formulate a way forward for the diagnosis and treatment of these patients. No representative from any organisation except an epidemiologist from the Department of Health attended. The same pattern followed all efforts including further conferences, meetings and letters by Dr Skinner to have a public discussion with medical colleagues to address this shortfall in the care of this particular group of patients.
The Royal Society of Medicine’s reply to Dr Skinner’s repeated request for a conference to address this problem was to organise a conference on thyroid disease and refuse Dr Skinner’s request to speak on his experience in diagnosis and treatment of hypothyroidism. The only Royal College which sent a representative to speak at the World Thyroid Forum organised by Dr Skinner in 2012 was from the Royal College of Obstetrics and Gynaecology to speak on fertility problems in hypothyroid patients.
Dr Skinner vigorously opposed certain aspects of the UK Guidelines at the time they were being formulated and lodged his ‘Document of Record concerning UK Guidelines for thyroid function tests’ in 2005 with all the Royal Colleges, National and Local Health Organisations, the British Medical Association and tried with the Society for Endocrinology who rejected it. He also wrote to Dr G H Beastall, Secretary, Guidelines Development Group, British Thyroid Foundation in 2005 to comment on the pitfalls in the proposed guidelines.
It is disappointing that Dr Skinner’s medical colleagues have been and still are behaving like bullies in a playground forming their gangs and stopping all others from engaging with doctors they have chosen to cast out of their inner circle. Sadly, they have neglected their duty in caring for these patients resulting in a serious shortfall in their medical care leading to unnecessary suffering and years of mental and physical ill health.
These Endocrinologists and General Practitioners have harassed Dr Skinner and doctors like him and instead of constructive scientific discussions have resorted to firing their guns from the shoulders of the General Medical Council and patients and their needs have been completely forgotten. It takes a great deal of courage and determination to persevere in the face of such adversity and Dr Skinner’s bravery and belief in doing the best for his patients brought respect and loyalty from all those who knew him.
This is borne out by numerous patients attending the General Medical Council every time Dr Skinner appeared before them and by more than 2500 testimonials from patients presented before the General Medical Council at his Hearings.
By their own admission, the majority of Endocrinologists and General Practitioners would not treat the patients who were treated by Dr Skinner so they have no experience of diagnosing and treating these patients. Dr Skinner successfully treated thousands of these patients and accumulated a vast treasure of information including blood tests and clinical signs and symptoms at their first consultation and at follow-up.
The difficulty in publishing when one has a difference of opinion from the established medical world is that the so called ‘peer review’ journals are very much influenced by these self-professed ‘Experts’ who proudly proclaim that they are on the Editorial Boards of all journals of repute thus stifling any work which is contrary to their view. This has resulted in control of what is published and what is rejected by a group of scientists and doctors who are preventing important evidence in diagnosis and treatment of hypothyroidism from being debated in mainstream medicine. A difference of medical opinion has been turned into a territorial war at the expense of the patients.
Dr Skinner was a fearless doctor who was true to his Hippocratic Oath and behaved with integrity and carried himself with dignity in the face of callous and unprofessional opposition from Endocrinologists and General Practitioners who ganged up against him and tried very hard to discredit him; the support of patients whose lives have been dramatically changed by Dr Skinner’s care bears witness to his dedication and his determination to do the best for them. I hope in time doctors will be brave enough to once again put patients before all else and stop being so fearful of ‘senior colleagues’ and litigation.
It is a great loss to the scientific and medical world that this brave, articulate and fiercely independent thinker is no longer with us.
Afshan Ahmad PhD
Letter to Editors of Telegraph and Daily Mail sent 04-11-2010
I write as a medical practitioner who has focused on the problems of hypothyroidism for some fifteen years. I was interested to read your small paragraph on a patient who had been essentially undiagnosed for five to six years. I write to indicate that this is the least of it and in my experience this is one of the most serious shortfalls in modern medical practice.
I have come across literally thousands of patients who remain undiagnosed or do not receive an adequate level of thyroid replacement based on thyroid chemistry which has never been validated and is predicated on a ‘range’ of values (known as a 95% reference interval) notwithstanding the patient’s earnest solicitations that they do not feel well as would appear to be the case in the patient in your little piece
The matter has compounded by a recent extraordinary pronouncement by the Royal College of Physician and Family Practitioners who not only endorsed this erroneous view but further suggested that a certain thyroid reading - namely a TSH reading above 10 - is required to be at a given level which is statistically wayward to say the least and not even commensurate with clinical practice.
Responsible and sensible deputations to Government, Royal Colleges and the General Medical Council have to date fallen on stony water. We have one last resort namely to establish a World Thyroid Register and if this Register contains a reasonable number of people we may be able to change medical opinion or even - dare I suggest - engage in debate with Endocrinologists and Royal Colleges which to date not has been possible and indeed my futile attempt to join the Royal Society of Endocrinology resulted in my being thrown out prior to attending a single meeting; so much for academic interaction.
I write to advise pro bono publico of the World Thyroid Register and secondly to ask if it might be possible to write a considered and sensible article in your paper on the matter. Previously a journalist who did an exceptionally good job of investigating the issue was finally told that it would not do for the paper to go against the establishment which is an unusual stance for the ‘Fourth Estate’ and bodes ill for the future of our (presently) liberal society.
I hope you will give my note your sympathetic consideration; please do not hesitate to contact me if I can provide any further information on this serious shortfall in our present level of healthcare.