Views & Reviews From the Frontline

Bad medicine: thyroid disease

BMJ 2012; 345 doi: (Published 09 November 2012) Cite this as: BMJ 2012;345:e7596

Re: Bad medicine: thyroid disease

If Dr Feltbower believes that the demand for treatment with levothyroxine is in order to get free prescriptions, he needs to consider:

Many people have simply no idea that they will get free prescriptions.

In Wales and Scotland there are no prescription charges. So what differences are there between diagnosis and prescription there and in England?

One would expect that the rate of new prescriptions for levothyroxine in England would be higher in order that these patients gain free prescription entitlement. Is this the case? It seems extraordinary for the doctor to assert that people are doing this, to have a source of information which could validate that, and yet offer no evidence whatsoever. (Presciption information is readily available by country.)

In this form, the comment is then anecdotal – a comment so often used about what we try to tell doctors. And certainly not worthy of a doctor’s response in the BMJ.

Only those not already on free prescriptions who also need prescriptions other than levothyroxine would see any benefit. (If you do not need any other prescriptions, then there is no advantage.) So that excludes the young, the old, those on various benefits or eligible for the low income scheme, those with other qualifying disorders, pregnant or new mothers. And one supposes the rich or even moderately well-off don’t really worry so much if they have to pay for a £104 a year prepayment certificate. Of course, the doctor needs to know that patients are not already eligible for the comment to make sense. Does he really know their circumstances? Maybe he does if they tell him – otherwise, it can only be a guess.

Does Dr Feltbower succumb to this pressure? If so, then he clearly does not seem to be practicing in the interests of his patients. If not, well what difference does a bit of pressure make?

Competing interests: No competing interests

19 November 2012
John Smith
Sion Mills, Strabane