Concerning the hypothyroidism stuff in Alberto Salazar's open letter
It won't be long before I start to despise myself for spending time writing about the Oregon Project mess when I could be undertaking more productive endeavors: working on my novel, volunteering at a soup kitchen, or hiding in the bushes and throwing dog turds at passing children. Unfortunately, I'm not there yet.
Alberto Salazar published a letter on the Oregon Project Web site today intended to refute allegations of doping and suspicious behavior brought against him by some of his former athletes and other associates. Specifically, Salazar, in prose screaming for a copy editor's mercy, tries to counter the testimony of former assistant coach Steve Magness, athletes Adam and Kara Goucher, and massage therapist John Stiner. These people form just the tip of the accusatory iceberg, but theirs were the first fingers pointing publicly at Salazar, and the embattled coach has apparently chosen to deal with his detractors in order, although I suspect that he hopes to simply ignore many of them outright.
Instead of pointing out the various reasons this letter fails to do its intended job, I'll focus instead on a section of the letter that on the surface appears more benign than the rest of the content, which contains a lot of excoriating criticisms of Magness and Adam Goucher. The heading of this section is "THYROID AND ASTHMA MEDICINE IN THE OREGON PROJECT."
It begins with a bulleted list:
Athletes are not pushed to take medications
Of 55 athletes only 5 have been diagnosed with hypothyroidism after I had started coaching them (9.1%).
Only 8 have been diagnosed with exercise induced asthma (14.5%).
Claims I have manipulated the test for Exercise Induced Asthma are false, and the testing referenced is standard protocol as any basic research would show
As for the first and last points, we can only take Salazar at his word. The second and third involve hard data, though, and I'll examine the first of these more closely.
More from Al Sal first, though:
So the record is clear, I have coached 55 professional athletes in my career. Of those 55 athletes only 5 have been diagnosed with hypothyroidism after I had started coaching them and only 8 have been diagnosed with exercise induced asthma. That is 9.1% and 14.5% respectively.
Salazar's wording in the second bullet point implies that some of his athletes may have been diagnosed with hypothyroidism before joining the Project. In fact, this is true. Kara Goucher is one (she has Hashimoto's thyroiditis). That means that at a minimum, 6 out of 55 athletes (10.9%) carry a diagnosis of hypothyroidism. I'm not alone in strongly suspecting that there are more, but I can't and won't state this as a fact.
Now on to the prevalence of hypothyroidism in the U.S. population at large. (Note that Salazar incorrectly uses the term "incident rate" -- actually, this is an error within a mistake, because he must mean "incidence" -- the number of new cases of a disorder or condition per year -- when he really wants "prevalence" -- the percentage of people who at any given time have the disorder or condition).
According to the Cleveland Clinic, the prevalence of true hypothyroidism in the general population is less than 1 in 300. Going only by the results of blood testing in the absence of symptoms ("biochemical hypothyroidism"), this rises to about 1 in 22.
So when Alberto notes that "only" 5 out of 55 NOP athletes have been diagnosed with the condition since joining the program, I'm not sure what the "only" is supposed to mean, because even when one fails to factor in any "missing" cases (Kara Goucher, at a minimum), the Project for some reason boasts an improbably high prevalence of hypothyroidism.
To sum up the data:
0.3% of the population is clinically hypothyroid.
4.6% of the population is hypothyroid by serum analysis.
At least 12.7% of NOP runners carry the diagnosis of hypothyroidism. This is roughly 40 times what we would expect of a random sampling of the American citizenry.
Why the big difference? Enter one Dr. Jeffrey Brown, the NOP's own endocrinologist. As detailed in a post on the blog Science Based Medicine analyzing a Wall Street Journal article about Dr. Brown, this physician deviates markedly from his peers when it comes to establishing a diagnosis of hypothyroidism. Specifically, Dr, Brown uses a much lower threshold value of thyroid-stimulating hormone (TSH) to make the diagnosis. He claims to have scientific support for this practice, but his chief rationale is apparently "Because I feel like it" or more likely "Because this suits a valuable non-medical purpose":
According to American College of Endocrinology literature, the range of normal TSH level is broad, from 0.5 to an upper limit of near 5, depending on a patients gender, age and other factors. In practice, many endocrinologists consider TSH levels above 4combined with symptoms such as fatigueevidence of an underactive thyroid. Brown and a small camp of other endocrinologists argue that thyroid insufficiency can be signaled by a TSH level as low as 2, for which Brown cites some recently published research. By their standards, about 10% of the population is hypothyroiddouble the 5% that is cited by mainstream endocrinology.Jeffrey Garber, American College of Endocrinology president, said hypothyroidism increasingly is being diagnosed in people who dont have it, by endocrinologists whom Garber labeled as alternative. The alternative crowd is saying, Gee, this is why youre not feeling better, because these [mainstream] doctors are clueless, Garber said. So if this reporting is accurate, Brown is looking at the same test results and seeing what he believes to be thyroid disease, where his peers see normal thyroid function.
One of Salazar's concluding statements in this section:
These numbers show that I do not push my athletes to take prescription medicine that is not needed as alleged in the BBC/ProPublica stories. Again, the BBC/ProPublica writers did not want the facts to get in the way of their stories.
If Salazar could spend more time explaining why he thinks it's impressive that "only" 9.1% (again, really at least 10.9%) of his athletes are hypothyroid -- again, this is astronomical compared to the general population -- and less time complaining about the shoddy journalism underlying the BBC and Pro Publica pieces, I might be able to believe that he's not big on pushing pills. For example, could unusually hard training lead to an underactive thyroid in some athletes? As the WSJ article notes, Brown "stands almost alone" in the medical community in believing that it does, but Brown gets around this by simply declaring that a TSH level of 2.0 is "officially" low when others pin the value at 4.5 or 5.0.
What does this all mean? No one has to believe what I believe, but I will ask an admittedly leading question: If Salazar is distorting the truth about the issue of thyroid problems and medications among his athletes, why should he be trusted when it comes to far more explosive matters?