Why Armour? How Synthroid?

Here’s a brief but informative article in the Times about drug companies’ promotions.

I want to say right away that I’m not one of these people who think that big corporations can do nothing right. Pharmaceutical companies have alleviated more suffering in the past century than practically anyone else, and everyone who depends on medications developed by these companies – for profit – should stop to think about just what would happen if the profit motive were removed from their operations.

That being said, the culture of regulation under which pharmaceuticals operate results in their doing some pretty atrocious things. I’m more intimately familiar with a slightly different example, but one that’s perhaps even more extreme than the psychiatric medications listed in the article, all of which are somewhat new.

The history of thyroid treatment is that natural thyroid hormone replacement therapy existed for a long time – since the 19th century – before technicians in a laboratory developed a synthetic pill meant to replace the natural version. The efficacy of natural thyroid was gauged by how well or poorly a patient recovered to the treatment under clinical observation; the success or failure of synthetic thyroid is measured by secondary blood tests.

I’ve observed and participated in discussions on the margin of the thyroid world for about six years (and suffered from Hashimoto’s for seven and a half years) and in that entire time, I’ve never heard of anyone who’s taken both natural thyroid and synthetic thyroid and prefers synthetic to natural. On the contrary, I’d estimate that roughly 80-90% of people in my circles prefer natural to synthetic moderately or strongly, with the remainder not having a preference.

Granted, people who are adequately treated by their physicians have no need to seek out an internet community, so I must account for some selection bias. But it’s nowhere near enough to explain that kind of tilt, especially when synthetic thyroid is prescribed way more commonly than natural thyroid.

How did it happen that Synthroid and its equivalents are vastly more popular than Armour and its equivalents, given most people’s preference for Armour and Armour’s lower cost? And how did it happen that there are no studies, or almost no studies, comparing the effectiveness (as determined by alleviation of symptoms) of one treatment versus the other?

The answer to both questions is: marketing. And by marketing, I mean money. When a company spends it, someone has to receive it; the people on the receiving end of Synthroid’s marketing budget are doctors. They may seem special in their white coats, but they are also human just like the rest of us – perhaps more so – and if they are presented with a slick and glossy argument on one side, and no argument at all on the other side (to the best of my knowledge, Armour Thyroid doesn’t have a marketing budget), they’re going to go with the slick and glossy argument nine times out of ten.

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