Regulatory Actions against Richard A. Marschall, N.D.
Stephen Barrett, M.D.
Naturopath Richard A, Marschall has operated the Natural Healing Clinic in Port Angeles, Washington. for many years. In 1998, the Washington Board of Naturopathy disciplined him for unprofessional conduct that involved treating an out-of-state patient he had not examined for "functional hypothyroidism"—an alleged condition sometimes referred to as "Wilson's Syndrome. In 2010, Marschall was criminally convicted of illegally marketing a growth hormone product for weight loss. In 2013, in response to this conviction, the board disciplined him again. This article describes these enforcement actions in detail.
For more than 20 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." 
In 1992, the Florida Board of Medicine fined Wilson $10,000, suspended his license for six months, and ordered him to undergo psychological testing . Although he does not appear to have resumed practice, his ideas are still promoted by the Wilson's Syndrome Foundation.
Wilson's syndrome is not recognized by the scientific community as a legitimate diagnostic entity. In 1999, the American Thyroid Association issued a strongly worded statement that concluded:
- The proposed basis for "Wilson's 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 Dr. Wilson—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.
Disciplinary Action in 1998
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 . 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, in January 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." 
During the proceedings, 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 .
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 . The proceedings did not address whether "Wilson's syndrome" is a genuine entity or whether the factual details in the complaint were accurate.
In February 2009, customs agents intercepted a package of human chorionic gonadotropin (HCG) that was addressed to Marschall from India. To be properly labeled, HGH must contain a warning that it has not been demonstrated effective for the treatment of obesity. The FDA then sent Marschall a detention notice which said that the drug was improperly labeled and would be released to him only if he provided a good reason to believe that the product complied with the law. He replied:
I am an endocrinologist, a hormone expert. I use Human Chorionic Gonadotropin to treat infertile patients. I require it in 5,000 units ampules most of the time. Some times use 10,000 unit ampules which I can get from American pharmaceutical manufacturers. But American manufacturers do not make 5,000 unit ampules. HCG has only a 60 day shelf life so when I need 5,000 unit ampules to treat over a longer period of time I must purchase them from pharmaceutical manufacturers who make it that way and they happen to be in other countries. I have been in practice 23 years and I have a lot of experience with HCG. The HCG that I get from these suppliers works just as well as the HCG I get from US manufacturers and cost about the same.
I hope you will release my shipment soon, I have several patients in need of treatment. If I can answer any other questions you have please email me .
The FDA did not release the shipment to Marshall. In July 2009, customs agents detained a similar HCG shipment and sent Marschall another detention notice. Despite these notices, Marshall ordered (and received) illegally manufactured HCG from a compounding pharmacy in Florida—which FDA investigators found by searching the trash picked up at his clinic. In 2010, federal agents searched Marshall's clinic and seized computers, patient files, and dozens of boxes of HCG. During the search, Marschall falsely told FDA official that he prescribed HCG for infertility. However, his Web site stated that he used it for weight-loss. (In fact, in 2009 and 2010, the site claimed that users of his HGH-Slim program would "lose a pound a day and keep it off for life.") In 2011, Marschall was charged with one count of causing the introduction of misbranded drugs. .Shortly afterward, he entered a guilty plea in which he acknowledged that he had lied to the FDA . The court sentenced him to 2 years supervised release and ordered to provide 250 hours of community service and pay a $2,000 fine plus a $100 special assessment.
Further Disciplinary Action
In 2009, the Washington Board of Health became aware that Marschall was not only prescribing HGH for weight loss but also distributed kits to patients he had not examined. In 2012, following his conviction, the Board charged Marschall with unprofessional conduct . The charges included (a) improperly representing himself as a "bariatric endocrinologist" and (b) being convicted for trafficking in human chorionic gonadotropin (HCG), which he was illegally prescribing as a weight loss drug. The charges were settled with an agreed order under which:
- Marschall admitted that between 2008 and 2010, he prescribed HCG to approximately 170 patients who lived outside of Washington State and had never seen him in person.
- The Board fined him $10,000, suspended his license for at least one year, ordered him to take continuing education courses in ethics, endocrinology, and obesity.
- The Board ordered him to remove references to HCG from his Web site and indicate that all new patients must be examined during their initial visit.
- If his license is reinstated, he must serve seven years on probation with semi-annual record audits for one year and annual audits for four years .
- Wilson ED. Wilson's Syndrome: The Miracle of Feeling Well, 2nd edition. Orlando, Florida: Cornerstone Publishing Co., 1991.
- 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.
- American Thyroid Association statement on "Wilson's Syndrome." Revised Nov 16, 1999.
- Dawson M. 'Miracle' cure has side effects. Peninsula Daily News, Port Angeles, Washington, May 8, 1994.
- State of Washington, Department of Health, Naturopathy Program. Statement of charges. Docket No. 97-09-B-1045 NT, Sept 30, 1997.
- State of Washington, Department of Health, Naturopathy Program. Amended statement of charges. Docket No. 97-09-B-1045 NT, April 17, 1998.
- 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.
- Petroff K. Application for a search warrant. The Natural Healing Clinic. March 1, 2010.
- Information. U.S.A. v Richard Marschall. U.S. District Court. Western District of Washington at Tacoma, NO. CR11-5222BHS, April 22,, 2011.
- Plea agreement. U.S.A. v Richard Marschall. U.S. District Court. Western District of Washington at Tacoma, NO. CR11-5222BHS, May 9, 2011.
- Statement of charges. In the matter of Richard A. Marschall. Washington Department of Health Board of Naturopathy, Sept 17, 2012.
- Stipulated findings of fact, conclusions of law and agreed order. In the matter of Richard A. Marschall. Washington Department of Health Board of Naturopathy, Nov 15, 2013
This article was revised on February 26, 2014.