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Who decides what's 'normal' in medicine?

Posted By Lee Hieb, M.D. On 04/22/2013 @ 11:54 am In Diversions,Front Page,Health | No Comments

When you go to the doctor and he does tests, ever wonder how “normal” is determined?

Ideally normal should be “optimal.” But, what is optimal for you is not always optimal for me. And, sadly, how we determine “normal” in standard medicine has nothing to do with what would make our bodies’ the healthiest.

Take thyroid levels for example. When labs “norm” the studies, they get volunteers – many times hospital and/or lab employees, ask them if they are well that day and make them part of the random sample. Now, of the 50 or so employees used to norm the test, some may not be normal. In fact, due to genetic drift, lack of iodine in the diet, bromine exposure and other factors, a great number of people’s thyroids are not working normally, and they are actually hypothyroid, but haven’t been diagnosed as such. Nevertheless, these abnormal people become part of the pool of people to determine the normal range of thyroid. Therefore the “normal” range actually is skewed to the abnormal.

Continuing with the case of thyroid, TSH is a measure of thyroid function, and as the thyroid fails the TSH gets bigger, We know from studies in the heart as well as bench analysis that if the TSH is above 1, the thyroid function – its effects on different body tissues, is abnormal. Cardiac output, the ability of the heart to pump blood diminishes with a TSH above 1. Yet our lab range of “normal” continues to be 0.4 to 4.5 – a range so broad as to include a lot of sick people.

Secondly, take the numbers for male testosterone levels. Lets say a normal 25-year-old has a testosterone of over 150 on average, a level found in young, virile, healthy males. Now you, the patient, are a 55-year-old male who has noticed lack of energy, increasing abdominal girth, inability to get benefit from working out and loss of libido. You just don’t feel like yourself.

So you go to your doctor and ask, “Doc, could it be my testosterone level?”

The doctor gets a blood sample, and your testosterone is 75, which puts you just above the bottom of the “normal range,” and your doctor says, “No, your testosterone is normal – see?”

Of course, what is normal for a 60-year-old may be quite abnormal for a 25-year-old. And certainly, the diminished level of testosterone confirms no biologic advantage. As testosterone declines, muscle wastes, fat deposits rise and thereby estrogen levels in men rise. The risk of prostate cancer in men is actually less in those who maintain healthy, youthful testosterone levels, and higher testosterone is associated with a higher survival from heart attack – to name just a few benefit of having a youthful testosterone level.

But we in medicine need to change the way we think about normal. And to help that transition from old to new thinking, you as patients need to ask pertinent questions, such as, “Well, if that is normal now, what was normal when I was 25?”

We now have sophisticated testing that assesses “normal” functionally. Instead of taking the average from a bunch of strangers, these tests actually asses the levels of various substances needed to optimize growth and function in an individual patient.

To find a physician who uses state-of-the-art testing, you will generally need to go outside the government system of one size fits all. To be treated like an individual, you must function as an individual who takes ownership of his health care, and this means paying cash for such outpatient services. You can find a doctor through WorldHealth.net, or by asking locally. This is the medicine I practice for myself and my family and friends. At 60 years old I feel better than at 45 and continue to improve. Free market medicine for free people also is the best quality medicine. And this truly should be the “new normal.”


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