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other physicians without the same level of specialty training in endocrinology may assume that bioequivalence does equal therapeutic equivalence.  In the patient, the consequences of important differences in bioequivalence and therapeutic equivalence between products become obvious over time, as demonstrated in the health or ill health of the patient.  The differences can even result in serious complications, complications that could have been avoided.

We urge you to focus on patient effects and accept that bioequivalence is not therapeutic clinical equivalence for a hormone such as levothyroxine.

In conclusion, I would like to again point out that our participation today was in the interest of the patient.  For your information, a disclosure statement regarding those clinicians involved in the review of this issue and the development of this testimony, as well as financial relationships to the manufacturers of thyroid products, is included in our written testimony provided to each of you.

Thank you.

DR. KIBBE:  Thank you, Dr. Dickey.

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