Talk:Wilson's temperature syndrome

message: Some people believe that they have the right to restrict freedom of speech, and this is interfering with other people's health. It would be considerate and professional if people would keep their opinion to themselves unless they are adding something positive to a discussion in an area where they can provide references that indicate your opinion is based on unbiased research, personal experience, or a diploma from an accredited institution that qualifies you to render an opinion on a topic.  — Preceding unsigned comment added by Nanoatzin (talk • contribs) 00:09, 28 January 2011 (UTC)
replies: text: You may wish to read WP:NOTFREESPEECH and WP:RIGHTGREATWRONGS.  If you are unhappy about the status of naturopathic medicine in the State of Florida, contacting politicians in Florida will be more appropriate than complaining about it here.  WhatamIdoing (talk) 02:25, 28 January 2011 (UTC)
replies: text: Blessings and thank you for the considerate reply. Doctor Wilson raises an interesting point that low body temperature means something entirely different than facts accepted as common medical knowledge. Sustained low body temperature in the absence of thyroid disease is interpreted by MDs as indicating people have a short time to live (i.e.: time to call the priest for last rights). While it is rare, sustained low body temperature without thyroid disease is not a death sentence. My first concern is that the Medical Board of Florida has made research, diagnosis, and treatment of Wilson's Syndrome illegal in Florida, which is where Doctor Wilson lives, and that outcome is based on one fatality that would not otherwise be considered all that unusual given the accepted medical facts regarding low body temperature. The Medical Board of Florida lacks a physician with a degree from an institution that would make that organization competent to render an opinion on this topic. The scope of a regulatory organization is law and not medicine. My other concern is that discussions about almost every rare disease disappears down a censorship rabbit hole that starts with a reference from Quackwatch, and Quackwatch has indicated that lack of research information on a topic is a valid reason to stop everybody else from discussing that topic. Attempts by an organization to limit the growth of knowledge by hindering free speech on any topic would render that organization not suitable as a reference for an encyclopedia if that activity is related to a conflict of interest. The only way Quackwatch would be free from a conflict of interest on this topic would be if the organization includes a naturopath, which it does not. 207.233.106.102 (talk) 04:33, 28 January 2011 (UTC)
thread_title: Free speech

message: I haven't been able to find patients treated with Sustained-release triiodothyronine (T3) in the literature prior to Dr. Wilson using it and describing its use in the 1991 Doctor's Manual. Since then, The New England Journal of Medicine mentioned "The ideal replacement regimen when thyroid-gland function is absent or nearly absent might consist of 10 µg of triiodothyronine daily in sustained-release form (because the hormone is rapidly absorbed and metabolized), along with enough thyroxine to ensure euthyroidism." And, the ATA is mentioning a study reported in the journal "Thyroid" in 2004 concluded that a sustained-release preparation of T3 results in less variation in Serum T3 concentrations than ingestion of standard T3. The NEJM and the ATA do not agree with it being used in patients with normal thyroid gland function but report advantages in using SR T3 over standard T3 in certain circumstances. MedBoard2 (talk) 21:23, 10 April 2010 (UTC)
replies: text: That's the problem with cherry-picking the medical literature. You cite one trial from 11 years ago which suggested a potential benefit to partial T3 replacement. In fact, there have been at least 6 subsequent randomized trials attempting to reproduce the NEJM findings - all of which were unsuccessful (cf. , , , , , ). There have also been at least 2 meta-analyses addressing the question, both of which found no benefit to T3 (, ). The current medical understanding is that there is no advantage to T3 therapy in the general population, although there is some interest in studying a small subgroup of hypothyroid patients with a specific genetic polymorphism who might hypothetically respond well.As to "sustained-release" T3, I'm not entirely clear what you're talking about. The only form of T3 that is approved as safe and effective, at least in the US, is liothyronine, which has a half-life of approximately 2.5 days. I'm aware that some compounding pharmacies will jerry-rig formulations of T3 which they describe as "sustained-release", but I'm not aware of any medical literature supporting such a concept, or even supporting the idea that such formulations are released any differently than liothyronine. If know of such data, please point me in the right direction. MastCell Talk 07:08, 11 April 2010 (UTC)
replies: text: Yes, I cited that reference to show that some see a potential advantage of sustained-release T3 over standard T3. In 1991 Dr. Wilson described (in the Doctor's Manual) using T3 compounded, by a pharmacist, with Hydroxypropyl methylcellulose (HPMC) into a hydrophilic matrix system. As I'm sure you know, drug manufacturing is regulated by the FDA, and compounding is regulated by state boards of pharmacy.  It is within the legal scope of a pharmacist's profession to make (compound) a medicine according to a doctor's prescription.  Of course, that doesn't mean that pharmacists always do a good job of making medicines but it is within their regulated scope of practice.  The article quoted by the ATA above is "Thyroxine Plus Low-Dose, Slow-Release Triiodothyronine Replacement in Hypothyroidism: Proof of Principle" Thyroid 2004;14:271-5. They note in the introduction that studies comparing the effects of giving T4 alone versus a fixed T4/T3 combination have showed different results, as you point out. They quote 2 editorials calling for studies to solve the discrepant findings (with one recommendation being the use of T3 in a sustained release manner). In the present study, they used an "in-house slow-release preparation and using Cytomel® as T3 compound." I believe this article supports the concept that compounded T3 preparations can release T3 differently than standard liothyronine. Also, an article "Bioavailability of ibuprofen from hard gelatin capsules containing different viscosity grades of hydroxypropylmethylcellulose and sodium carboxymethylcellulose" (European Journal of Pharmaceutical Sciences Volume 1, Issue 2, June 1993, Pages 109-114) showed that the ibuprofen in capsule with one of the grades of HPMC showed marked sustained drug absorption. Here, Hypromellose (HPMC), it says that HPMC (depending on the grade) has been used in oral tablet and capsule formulations as a "controlled release agent to delay the release of a medicinal compound into the digestive tract." The Dow Chemical company says that "Hypromellose has familiar, well-understood properties. Of the available range of cullulosic controlled-release agents, hypromellose is the most widely used."--MedBoard2 (talk) 22:07, 12 April 2010 (UTC)
replies: text:  I think you missed MastCell's point, which the pharmacologically savvy will understand, that there is absolutely no point in making a "sustained release" preparation for a drug or hormone which already has a biological half-life of more than two days, and a very large volume of distribution. Whether you absorb T3 in 2 hours or 8 hours (you aren't going to get more from simple HPMC), it all goes onto your body's reservoir of albumen and transthyretin, and is stored there. There's no reason to think that the duration of release would make any difference in a substance with those kinetics. SBHarris 01:05, 27 May 2010 (UTC)
thread_title: Sustained-release T3

message: The lead of this article is quoting what Dr. Wilson and WTS advocates attribute the cause of the symptoms.  Notice how low body temperature is not listed as a symptom on the symptom checklist. Advocates do not think of low body temperatures as a symptom but as part of the pathophysiological mechanism (it's Wilson's Temperature Syndrome). On page 26 of the Doctor's Manual it states that the symptoms are attributed to low body temperatures due to impaired peripheral conversion of T4 to T3. The bottom of that page states: "Wilson's Temperature Syndrome can be thought of as a persistent, maladaptive, stress-related, reversible impairment in the conversion of T4 to T3." On page 41 is states, "More than just a reflection of metabolic rate, I feel the body temperature, through enzyme conformation, actually mediates the symptoms of Wilson's Temperature Syndrome."  —Preceding unsigned comment added by MedBoard2MedBoard2 (talk) 22:49, 10 April 2010 (UTC)
thread_title: Cause of the Symptoms

message: (Courtesy of )...
* The Wilson Syndrome, Orlando Sentinel
* Lakeland Ledger
* Longwood Doctor is Censured, Orlando Sentinel
* Cleveland Clinic Guide to Thyroid Disorders, p. 191
Presumably some or all of these would be useful sources for our article. MastCell Talk 16:44, 26 May 2010 (UTC)
thread_title:  Additional sources 

message: One thing that I think would help this article is adding some context about the normal human body temperature.  Wilson's main diagnostic standard actually means that more than 50% of working-age adults have this "condition".  WhatamIdoing (talk) 22:15, 26 May 2010 (UTC)
replies: text: I agree this could be a valid criticism of the diagnosis of this disease, but I am not sure such a criticism has been published.  Such a section might run afoul of original research.  --TeaDrinker (talk) 23:15, 26 May 2010 (UTC)
replies: text:  Read the American Thyroid Association statement referenced, which gives a cite for this very point. SBHarris 00:56, 27 May 2010 (UTC)
replies: text: Helping the lay reader to understand the background to this article would benefit from some context on normal human body temperature. There's no need to present any uncited criticism, merely to present what good quality sources say about body temperature. That would allow a reader to gain a clearer view of the significance or otherwise of Dr Wilson's claims, without any editorialising on our part. --RexxS (talk) 01:54, 27 May 2010 (UTC)
replies: text: Now don't tell me you're suggesting that we present data and have the reader draw their own conclusion from it?! There's too much data in the world to do that. In order to present data in such a way that the reader is led to the correct conclusion, you'd have to present it with heavy selectively, as though arguing toward a point. Fortunately for me, the American Thyroid Association already did that for me. If they hadn't, you'd technically be out of luck.  The problem wtih Wikipedia is that it's based partly upon a false premise, which is Jimbo Wales' completely ad hoc and unreferenced assertion that if a thing is true, you should easily be able to find some published source in which somebody argues or points out that it is true. Unfortunately, every professional in any field knows that's not the case. Let's see you find me a cite for the fact that Charles Dickins originally wrote David Copperfield in English, for example. The fact that it is obvious-by-inspection means you can't find anybody who actually says it in print (since it's not worth printing). So technically, you can't write it on Wikipedia, either. Examples abound. Another class is the logical problem we have here, where you can get a reference that says all B's are a subset of A's, and another than says all C's are a subset of B's, but unless somebody specifically says that C's are a subset of A's, you can't state that either. Nor can you put down the two other facts side-by-side, if by doing so you wish to advance the position that C's are A. SBHarris 02:12, 27 May 2010 (UTC)
replies: text: I'm not sure any of us disagree.  I stand corrected, there is a reliable source which makes this point, and I think it is a notable one.  One of the key points of criticism is the vagueness of the diagnostic criteria, and this makes that point very concrete.  We generally do not "present the data;" that's neither possible nor desirable in an encyclopedia.  Notable, reliably sourced interpretations of data (which is exactly what the ATA statement is), should be included. --TeaDrinker (talk) 03:04, 27 May 2010 (UTC)
replies: text: Sorry if I gave that impression, Steve. I was rather trying to say that it would only be necessary to give readers an idea of much normal body temperature can vary, for them to be able to see what the article says in context. It's a piece of missing information that is required for a proper consideration of the second paragraph in Origins, claims, and disciplinary action and we don't need to perform any OR to do that. On the other hand, a quote from the ATA statement works as well. --RexxS (talk) 04:32, 27 May 2010 (UTC)
thread_title:  Context 

message: I think that this is pretty clearly an inappropriate edit. It cites studies of T3 in major depressive disorder () and bipolar disorder (). Neither of these papers has anything to do with "Wilson's syndrome", which is clearly distinct from recognized psychiatric diagnoses such as MDD and bipolar disorder.It is original synthesis to cite papers on unrelated diagnoses here, particularly as they seem to be used to imply a biological basis for Wilson's claims. If a reliable source has linked Wilson's syndrome to these findings, then we should cite that source. We should not be cherry-picking the psychiatric literature for positive results with T3 and then citing them here. Aside from the obvious violations of content policy, such an approach misuses the cited papers to editorially confer legitimacy to "Wilson's syndrome" - certainly not the intent of the papers. MastCell Talk 20:51, 2 December 2010 (UTC)
thread_title:  Citing literature on major depression and bipolar disorder