A thought: Is thyroid endocrinology like programming?
Endocrinology seems to be a field that thinks it already knows all the variables in the box of thyroid therapy, and all the problems exist outside the box.
My husband is a self-taught computer programmer.
He and I had a conversation today about programmers and how they think differently from many other people.
I wonder if the analogy applies to some leading thyroid endocrinologists.
They teach that their job is to “program” our thyroid hormone health by normalizing the TSH. Normally when TSH is in range, so are thyroid hormones.
If not only our TSH but also our thyroid hormones are in the normal population’s range, we are fixed and their job is done.
He said something like this.
“When programming, you have to know all the variables there are. Everything inside the box of variables is known.
What is outside the box does not matter because it’s out of your control.
Things like other people’s software or hardware messing up your program’s way of interfacing with them is not your fault.
You must be capable of controlling and defining all that is inside the box, since that’s your responsibility, or else you are a bad programmer.
There is nothing unknown inside the box of variables in a given program. It’s just not possible in programming.”
“Well that’s nice and all in the world of programming, but that’s not how perception works in reality.
There are sometimes many things inside the box of variables that we can’t see because we don’t believe they can exist or we don’t want them to be true.
Many variables outside the box may intrude in the box, and no one but the programmer may be able to fix those problems.”
“If you want to be able to persuade such a person that a possible variable exists in the box that they have not yet perceived, you might first have to understand how this person thinks.
This is an impossibility in programming.
I’m not sure how you’ll be able to help them get beyond their world view in which they believe everything in the box of variables is known.”
That’s the crux of the problem.
The program can’t usually teach the programmer, just like the patient can’t usually teach the doctor.
Perhaps some endocrinologists are certain they know all the variables.
Certainly, after so many decades of scientific endeavor, all of the variables must now be known? (Unfortunately, this is false; there is much the field collectively chose to forget or misremember, much they refuse to study because it may reveal failure and health risk under the standard therapy paradigm, and many valuable publications that don’t get read or cited.)
If we patients are like a program with a bug to fix, and they are absolutely sure they’ve fixed us, a third party might have to stand outside the box to show them that something else truly exists inside the thyroid therapy box that they didn’t see before, based on reasoning and evidence.”
Comments by patients
The following comments were made by patients in response to this post appearing in our private Facebook support group.
I have used pseudonyms (fake names) to protect their privacy in the public sphere.
- Sudma: “a pretty good analogy.”
- Hoana: “Yes. I love this. And the lesson is to understand that medical practitioners can only work within their toolbox. It may be a big comprehensive toolbox with tools they have obtained and added out of personal interest, with the latest tools and information, or it may be the toolbox they were given in medial school that is dusty and they can’t be bothered adding to it.
Find the ones with the best toolboxes and avoid the ones with dusty ones. They are the ones who don’t care and will keep you sick.
The other thought is you may need more than one with different toolboxes that individually give you what you need. It may not all come from one person and one toolbox. Then add your own tools from your own toolbox of research, as it’s a team effort to manage chronic health with you at the helm.”
- Paliah: “Very good. I think Endocrinologists feel that because they can programme the medication, that it’s been rigorously tested, trials conducted, peer reviewed — that’s all that’s needed in the box. All patients have to do is step into the box with the medication… fixed.
But people come in all box sizes, shapes and internal configurations, and they haven’t been peer reviewed, tested for aberrant algorithms, trialed to find their individual box size etc. and they are aging, subject to malfunctions… so many people-boxes might need to have different combinations of medication depending on their current state.
- Weycat: “My Endo did nothing for me.”
- Forekati: Weycat, I’ve had two and they are useless.
- Fadisy: Weycat, I’m on my 5th.
- Fadisy: “But who is that 3rd party? Us? We’re neither programmers nor endocrinologists. Who will listen?”
- Febrom: “What your looking for is a unicorn, a Dr. that knows he doesn’t know everything and probably never will. A Dr. that realizes medicine is like everything else in life: no matter how much you know about a subject there is always more to learn, especially if it involves people.
And as I said to my granddaughter, ‘Yes Baby girl, unicorns are real, they’re just really hard to find.’ and that sucks.”
- Hansao: “I think medical education and undergraduate prerequisites need to be targeted. Requirements in disability studies and scientific history for one. I think these issues are rooted in ableism and lack of scientific thinking.
Who, with a grounding in science history, would imagine an obsolete medical textbook told them everything there is to know? Or that guidelines don’t shift? It’s all so siloed.”
- Poula: “Shouldn’t everything inside the box be that…everything? The problem being that there is a box…lots of boxes…one for thyroid…one for heart…one for lungs…one for skin…etc…The fact that everything inside that one box is dependent on what is happening in all the other boxes and vice versa?
What we need is holistic thinking, connecting all the boxes…hyperlinks from box to box.”