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Naturopath Penalized for
Unprofessional Conduct

Stephen Barrett, M.D.

In 1998, Richard A. Marschall, N.D., a naturopath licensed in the State of Washington, was found guilty of unprofessional conduct on one count of diagnosing and treating an out-of-state patient without a physical examination. The charges brought against Marschall alleged that he had treated these patients for "functional hypothyroidism." The case was resolved with a consent order under which he agreed not treat out-of-state patients without physically examining them and coordinating their treatment with a health-care professional from the patient's home state. The proceedings did not address whether Marschall's diagnosis or treatment of his long-distance patients was appropriate.

Wilson's Syndrome

For about ten years, "functional hypothyroidism" has been promoted as "Wilson's Syndrome," a term concocted by E. Denis Wilson, M.D., who practiced in Florida in the early 1990s. The syndrome's supposed manifestations include fatigue, headaches, PMS, hair loss, irritability, fluid retention, depression, decreased memory, low sex drive, unhealthy nails, easy weight gain, and about 60 other symptoms. Wilson claims to have discovered a type of abnormally low thyroid function in which routine blood tests of thyroid are often normal. He states that the main diagnostic sign is a body temperature that averages below 98.6° F (oral), and that the diagnosis is confirmed if the patient responds to treatment with a "special thyroid hormone treatment." [1]

In 1992, the Florida Board of Medicine fined Wilson $10,000, suspended his license for six months, and ordered him to undergo psychological testing [2]. Although he does not appear to have resumed practice, his ideas are still promoted by the Wilson's Syndrome Foundation.

The Case against Marschall

In May 1994, a local newspaper reported that Marschall had learned about "Wilson's Syndrome" by studying Wilson's publications and had consulted Wilson by phone. The article said that Marschall was treating more than 200 Wilson's Syndrome patients and that the cost of the initial diagnosis, including the blood test, was $400 [3]. Court documents filed on September 30, 1997, by Washington's Secretary of Health state:

• In 1994, Marschall "met" Patient A, a California resident, through an online computer service and discussed Patient A's health concerns via the online service. Soon thereafter, Marschall mailed the patient a personal history form, a fee schedule, a patient/physician contract to read and sign, and instructions on how to take her temperatures. After reading Patient A's completed personal history form and temperature log, he diagnosed the patient as suffering from a thyroid problem and determined treatment for that diagnosis in a telephone conversation with the patient.
• Marschall never performed a physical examination of Patient A and did not order or perform the standard laboratory tests used for appropriate diagnosis of thyroid malfunction.. Despite this, on or about January 20, 1994, he prescribed a synthetic thyroid hormone (liothyronine) that was mailed to patient A from Bellgrove Pharmacy in Bellevue, Washington.
• In 1995, Marschall diagnosed and treated between 75 and 100 long-distance patients for "functional hypothyroidism" solely via telephone, online computer services, and/or by mail. He prescribed liothyronine for at least five of them who resided in states other than Washington.
• The standard recommended dosage of liothyronine is between 25 and 75 micrograms per day. Marschall prescribed dosages as great as 300 micrograms per day, with about 25% of his "functional hypothyroidism" patients receiving doses greater than 200 micrograms per day. Overingestion of liothyronine is hazardous and can result in death. Unprofessional conduct, as defined by Washington's laws and regulations, includes conduct that "creates an unreasonable risk that a patient may be harmed." [4]

In March 1998, Marschall claimed that he had based his diagnosis of Patient A on laboratory records obtained from the Kaiser Foundation Hospital/Kaiser Permanente Medical Group. However, Kaiser personnel stated that the records were not requested until 1998, and Patient A stated that she had not signed any release for Marschall to get her records [5].

In July 1998, the Washington State Department of Health suspended Marschall's license for 30 months with the provision that he could continue practicing if he did not treat out-of-state patients without physically examining them and treating them in tandem with a health-care professional from the state where the patient resides. He also agreed to pay a $3,000 administrative fine and to permit a Health Department investigator to audit records and review what he was doing twice a year for a two-year period [6]. The proceedings did not address whether "Wilson's Syndrome" is a genuine entity or whether the factual details in the complaint were accurate.

In 1999, the American Thyroid Association concluded that there was no scientific evidence supporting the existence of "Wilson's Syndrome." [7] In a strongly worded statement, the association concluded:

• The proposed basis for this syndrome is inconsistent with well-known and widely-accepted facts about thyroid hormone production, metabolism, and action.
• The diagnostic criteria for "Wilson's syndrome"-- nonspecific symptoms and body temperature measurement -- are imprecise.
• There is no scientific evidence that T3 therapy is better than a placebo would be for management of nonspecific symptoms, such as those that have been described as part of "Wilson's syndrome," in individuals with and normal thyroid hormone concentrations,
• T3 therapy results in wide fluctuations in T3 concentrations in blood and body tissues. This produces symptoms and cardiovascular complications in some patients, and is potentially dangerous.

Note: Although "Wilson's Syndrome" -- as defined by E. Denis Wilson, M.D. -- is a bogus diagnosis, there is a Wilson's disease, a rare condition caused by a defect in the body's ability to metabolize copper.

References

1. Wilson ED. Wilson's Syndrome: The Miracle of Feeling Well, 2nd edition. Orlando, Florida: Cornerstone Publishing Co.
2. Disciplinary actions: E. Denis Wilson (MD #0048922) Longwood Florida, 2/12/92). Board of Medicine 8(2):10, 1992. Florida Department of Professional Regulation, Tallahassee, Florida.
3. Dawson M. 'Miracle' cure has side effects. Peninsula Daily News, Port Angeles, Washington, May 8, 1994.
4. State of Washington, Department of Health, Naturopathy Program. Statement of charges. Docket No. 97-09-B-1045 NT, Sept 30, 1997.
5. State of Washington, Department of Health, Naturopathy Program. Amended statement of charges. Docket No. 97-09-B-1045 NT, April 17, 1998.
6. State of Washington, Department of Health, Naturopathy Program. Stipulated findings of fact, conclusions of law, and agreed order. Docket No. 97-09-B-1045 NT, July 20, 1998.
7. American Thyroid Association statement on "Wilson's Syndrome." Revised Nov 16, 1999.

 

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