Government 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 (HCG) for weight loss. In 2013, in response to this conviction, the board disciplined him again. In 2015, he surrendered his naturopathic license. In 2017, he was convicted again for illegally marketing HCG. 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. Excessive ingestion 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 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, HCG 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 Marschall. In July 2009, customs agents detained a similar HCG shipment and sent Marschall another detention notice. Despite these notices, Marschall 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 Marschall'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 HCG-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. At the sentencing hearing, Marschall told the judge:
It is clear to me that I made a mistake by ordering HCG over the Internet. I will say in my defense that HCG is something that has been used in the world since the 1930s, and it has been used for heart disease and rheumatoid problems, prostatic hypertrophy, for immune system disregulation, as well as for weight loss. I have been using it for all those different things.
So when my sources in America were unable to provide me—and I contacted every possible compounding pharmacy from California to the East Coast to try to get HCG through my normal channels. I never ordered off of the Internet for any other reason than this.
I felt, knowing that it was at least a misdemeanor to do so, that in my belief system, according to the philosophy I was trained under at the University of Santa Clara, you can break a civil law in pursuit of a higher moral law. So in my opinion, in my belief at the time, getting HCG for patients who had benign prostatic hypertrophy, who were struggling with cancer as well as weight problems and an inability to get pregnant and heart disease and several of the conditions that this amazing compound, this natural compound was providing benefit for, if they couldn't supply—if the three American manufacturing suppliers couldn't provide it for me and the Canadians had documented safety evidence for their HCG, which is what they told me and what I was aware of from other sources and other patients who were getting it from the same place, then I did break the law and I did do that.
And as soon as—I guess you might say some people would have said to me that you are a victim of your own success, meaning about the 13th clinic that I could ascertain by 2008 to provide HCG for any reason, other than undescended testicles and infertility which the FDA has approved it for. I was training other doctors around—some of my fellow naturopathic doctors who are endocrinology trained in our own way.
They started ordering, and we couldn't get it domestically, so in fact we got it this way, not just myself, but as many Americans do, when they can't get their own pharmaceutical drugs that they either can't get or afford, they do it through that way. I was looking for another source and within just several months, it came available in Florida. And at the time the FDA actually took my HCG, they took domestic HCG from my clinic, a thousand dollars worth which they never returned, and it only has a shelf life of six months, so that's the case.
I guess if I had to do it over again, I wouldn't have done it. It was a mistake. Look what it has gotten me into here. Even with the benefit of these patients, I broke the law. So I don't intend to ever do that again, ever .
Further Government Actions
In 2012, following his conviction, the Washington Department of Health (DOH) charged Marschall with unprofessional conduct [12 ]. 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 DOH fined him $10,000, suspended his license for at least one year, ordered him to take continuing education courses in ethics, endocrinology, and obesity.
- Marschall was ordered 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 .
In 2014, while his license was under suspension, the board learned that Marschall was still holding himself out as a practicing naturopath, soliciting patients, and prescribing drugs. In fact, pages on archive.org indicate that he continuously advertised naturopathic services at his Natural Healing Clinic until at least the the end of 2014 . In September 2015, he signed an agreed order that required him to pay a $5,000 fine and permanently cease and desist from practicing naturopathy in the State of Washington without a requisite health credential . However, he continued doing business as "Rick Marschall, N.D." at his Natural Healing Clinic. The clinic Web site stated:
After 31 years I have retired from prescriptive practice. I have let go of my license to practice medicine or naturopathic medicine in the State of Washington and I am not licensed to prescribe prescription drugs in the State of Washington or plan to do so anywhere else. I have learned how to help people with significant health challenges in a more effective, sustainable and inexpensive way without the need for drugs for most issues. Read on and then call me at no charge to discuss whether this diet and lifestyle change is of interest to you.
The treatments mentioned on his site included "nutritional counseling," "sex hormone balancing," "constitutional homeopathic energy medicine," but government investigators found that he was still prescribing HCG to patients. In 2017, Marschall pleaded guilty to introducing misbranded drugs into interstate commerce and was fined $2.000 and sentenced to two months in prison to be followed by one year of supervised release. Documents in the case state:
- Between February 2014 and February 2017, Marschall prescribed HCG to about 60 individuals for weight loss.
- Marschall obtained the HGH from various compounding pharmacies by lying about the states of his license and DEA registration number.
- In September 2016, two Washington Department of Health investigators went undercover as patients and listened as Marchall touted HCG for weight-loss and described how he would set up a program of injections for them.
- Later that fall, Marschall communicated via email with an undercover FDA criminal investigator, conducted a one-hour telephone screening, and, without meeting or examining the patients, mailed HCG to her at a cost of $550 for a one-month supply [16,17].
The striking thing about Marschall's case is that despite his long history, no regulator has sought a court order that would permanently stop him from seeing patients. Although is he unlikely to obtain a naturopathic license in the future, he could easily resume practice in a state that does not require licensure.
- 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, Case No. CR11-5222BHS, April 22,, 2011.
- Plea agreement. U.S.A. v Richard Marschall. U.S. District Court. Western District of Washington at Tacoma,Case No.. CR11-5222BHS, May 9, 2011
- Transcript of September 26, 2011 sentencing hearing. USA v. Richard Marschall. U.S.A. v Richard Marschall. U.S. District Court. Western District of Washington at Tacoma,Case No.. CR11-5222BHS. .
- 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.
- Natural Health Clinic home page, archived Dec 30, 2014.
- Stipulated findings of fact, conclusions of law, and agreed order to cease and desist. In the matter of Richard A. Marschall. Washington Department of Health, Secretary of Health, Case No. M2015-742, Sept 21, 2015.
- Plea agreement. U.S.A. v. Richard Marschall. U.S. District Court for the Western District of Washington. Case No. 3:17-cr-05226, filed July 6, 2017.
- Government's sentencing memorandum. U.S.A. v. Richard Marschall. U.S. District Court for the Western District of Washington. Case No. 3:17-cr-05226, filed Oct 13, 2017.
This article was revised on November 5, 2017.