The Gee case: first expert witness.
Authors: C Dyer
Journal: BMJ (1985)

After a three day adjournment the trial of Dr Sidney Gee's libel action against the BBC moved into a new phase as the court began hearing the evidence of Dr Gerald Swyer, the first of the expert witnesses to be called on Dr Gee's behalf. A consultant endocrino logist in the department of obstetrics and gynaecology of University College Hospital and Medical School from 1951 to 1978, Dr Swyer told the court that he was one of two researchers who carried out what he believed was the first double-blind trial of dried thyroid and dexamphetamine, the results of which were published in Clinical Science in 1950. At that time, he said, use of dried thyroid and amphetamines as adjuncts to dieting in the control of obesity was fairly widespread. He and his coauthor had found that the administration of 5 mg of dexamphetamine three times a day produced a statistically signifi? cant increase in the rate of weight loss, he said. Although there was a greater weight loss when dried thyroid in a daily dose of 90 mg was given, the difference between that and the weight loss with placebo was not statistically significant. With dexamphetamine plus dried thyroid the weight loss was again greater than that with dex? amphetamine alone, but the difference was not statistically signifi? cant. He said no adverse effects had been encountered in the patients. Subsequent trials, particularly in the United States, had generally confirmed those conclusions but showed that the administration of thyroid hormone could assist weight loss after the use of calorie controlled diets. Dr Swyer said that he disagreed with the view, commonly held in Britain, that, on the one hand, dexamphetamine could be a perilous drug and, on the other, no person with a normal thyroid function ought to be given thyroid hormone treatment. In the United States the use of both thyroid and anorectic drugs had been widespread and still continued. Experimental activity using thyroid hormone treatment in conjunction with low calorie diets still went on in Britain, he added, and there had been recently published papers? for example, from Professor Mills's department in Cambridge. Dr Swyer said that he would consider a charge that Dr Gee had endangered the Uves of his obese patients by the drug therapy aspect of his treatment to be wholly unjustified. He found the allegation that Dr Gee's treatment had made Mrs Day thyrotoxic uncon? vincing. Michael Beloff QC, leading counsel for Dr Gee, took Dr Swyer through Mrs Day's alleged symptoms. Dr Swyer concluded that the symptoms were not inconsistent with an anxiety state. Mr Beloff referred Dr Swyer to Mrs Day's thyroid test, taken within a week after she came off the thyroid extract. Dr Swyer said that the thyroxine concentration of 156 nmol/1 was within the upper part of the normal range, bearing in mind that Mrs Day had been having thyroid treatment. The total thyroxine figure of 115 nmol/1 six days later was a wholly normal figure and would imply that the dried thyroid treatment was no longer having any effect on the blood test. With regard to Mrs Day's raised pulse rates, Dr Swyer said the fact that there were high readings several months after treatment had stopped led to the conclusion that there was a cause other than the treatment. He said he would come back to an anxiety state as being the most likely cause, no doubt made worse from time to time by increased stresses in her environment. Moving on to the case of Mrs White, Dr Swyer said that he had not seen any convincing evidence that hyperthyroidism had played any part in her condition. Intermittent palpitations pointed possibly more directly to a condition affecting the heart. On the evidence, he said, he did not think that the charge that Dr Gee's treatment had caused or contributed to Mrs White's death was made out, on the balance of probabilities. Asked whether it was more probable than not that Mrs Falconer had been made hyperthyroid by Dr Gee's treatment, Dr Swyer replied that the evidence was by no means satisfying. Mr Beloff asked him to look at Mrs Falconer's controversial thyroid test, carried out on the Thursday preceding her death. Dr Swyer said that the T4 value given?which he took to be the total serum thyroxine?was 146 nmol/1, within the upper range of normal. But the T3, if it meant the serum T3 concentration, was impossibly high. He therefore assumed, he continued, that it was shorthand for T3 resin uptake. The figures were precisely what one would expect to find in a woman taking oral contraceptives, when a relative raised total thyroxine and a decreased T3 resin uptake would be charac? teristic. Dr Swyer added that if his interpretation of the T3 figure was right then the figure of 200 for the free thyroxine index was wrong. Doing the calculations correctly would give a figure of 106, pretty close to the normal range. Looking at Mrs Falconer's postmortem report, Dr Swyer said that there was nothing that pointed directly to her having been made thyrotoxic by Dr Gee's treatment. The weight of her thyroid gland was on the low side, which could indicate that the gland had been suppressed, but that could have been caused by the administration of exogenous thyroid hormone. From the description of the cardiovascular system he inferred that she had significant coronary atheromatous disease, which had nothing to do with Dr Gee's treatment but might have had to do with her smoking and being on the pill. Moving on to the effects of Dr Gee's treatment in pregnancy, Dr Swyer said there was no evidence that thyroid hormone, provided it was not in excess, did any harm to a pregnant woman or her fetus. There was no convincing epidemiological evidence of increased incidence of congenital malformations in babies born to mothers who were taking amphetamine. Cross examined by Andrew Rankin QC, leading counsel for the BBC, Dr Swyer said that the 1950 article he had referred to earlier was the only original article he had written on obesity. In the endocrine clinic he ran before he retired, he said, he had seen at least one new obese patient at each clinic. It was always his practice to start off the medical history by asking about the family history, particularly of hypertension, cardiovascular problems, and diabetes. Every patient at each attendance had a urine test. Dr Swyer said that he had stopped giving thyroid hormones for obesity probably around 1965. Occasionally he would use thyroxine for patients whose thyroid function when measured was in the lower part of the normal range. Such patients would be started on a low London NW1