5lbs and 30%: Welcome to the defiant absurdity of the diet-drug industry.

By | September 16, 2010

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STOP EATING! It is generally not my wont to comment on studies and statistics, simply because I don’t put a lot of stock in them. This skepticism goes both ways, in fact. I may well be able to counter any anti-fat number with a pro-fat or at least fat-neutral one, but dismissing one set of numbers with another isn’t my idea of a productive conversation. The reality is that the vast majority of studies done on fatness and weight loss are paid for by corporations and organizations with a vested interest in the outcome, and thus, their science is rarely, if ever, totally objective and wholly pure, untainted by expectation, bias, or outright lying. When you know you’re likely to lose your funding (and possibly your job) if your work fails to find a certain result, the motivation to make that result happen, even by tiny tweaks of data, is unsurprising.

More than that, as I’ve recently noted in my post on public health, I believe these statistics are of limited use to the non-medical public. You and I aren’t concerned with a population; we’re concerned with ourselves, our own health, our own lives. The overuse of these statistics — and their misleading representation in news media — has contributed to a culture in which assigning blame to certain individuals for the ills of a nation is considered rational behavior. However, one individual fat person is not millions of fat people; neither are millions of fat people a monolith of identical behavior and health.

That having been said, yesterday evening I found myself reading an article posted on MSNBC.com with regard to the tenuous Food and Drug Administration (FDA) status of weight-loss pill Meridia. The short version is that a recent study found an increased risk of heart attacks and strokes (and related deaths) amongst folks with pre-existing heart conditions who were also taking Meridia. Regulators have already yanked Meridia in Europe on this basis, and so the FDA convened a panel and threw down a vote on whether Meridia ought to be pulled from the market. The vote resulted in a tie, leaving the drug’s future unclear.

The FDA’s reluctance to condemn Meridia is somewhat understandable, considering there are only three prescription drugs currently approved by the FDA. They are: Orlistat (also known as Xenical, and available over the counter as Alli), phentermine, and Meridia, of the dubious future. All three of these drugs operate in different ways.

Orlistat/Xenical/Alli is a “fat absorption inhibitor”. For the handful of you unfamiliar with the hilarity and horrors associated with this drug, please understand that the common side effects include:

“oily spotting in your undergarments; oily or fatty stools; orange or brown colored oil in your stool; gas with discharge [I believe the formal term for this is “shart”. – L.], an oily discharge; loose stools, or an urgent need to go to the bathroom, inability to control bowel movements; an increased number of bowel movements…”

You got it, folks: not only will it make you shit your pants, but the shit will be of an unusually disgusting quality, even by shit’s low standards. But don’t worry! These “are actually signs that the medication is working properly”!

Phentermine is best known as the “phen” in phen-fen, the popular off-label diet-pill cocktail that caused permanent damage to some folks’ heart valves, and at least one death. The plug got pulled on phen-fen when fenfluramine, also known as Redux, took the bullet for the heart-valve issues and was removed from the market in 1997. Turns out even less-fat people still need functional heart valves! Phentermine was determined to be an innocent bystander in the heart-valve incidents, although — mysteriously — its possible side effects include high blood pressure, tachycardia, and palpitations. Phentermine continues to be in use as a diet drug for its “stimulant” effects, filling the slot left behind by the dangerous amphetamines used by millions of women in the 50s and 60s for weight loss.

Finally, we come back to Meridia, which futzes with your brain chemistry and carries the banner of “appetite suppressant”, though apparently it doesn’t work all that well. Says the MSNBC article of Meridia’s effectiveness and the study that has caused its uncertain future:

The study was designed to show that weight loss with Meridia led to improved outcomes for patients with heart disease, diabetes or both. Because the study failed to show those benefits, some panelists questioned the rationale for keeping it on the market, considering its modest weight loss benefits. On average, patients lost 5 pounds while taking the drug and about 30 percent of patients achieved lasting weight loss while on the drug.

This was where I started laughing uncontrollably.

The FDA is debating the merits of a drug in which the expected outcome is a net loss of 5 pounds, and seventy percent of the people who do lose weight — FIVE! WHOLE! POUNDS! — while using Meridia will gain it back. How about Orlistat/Xenical? Those odds must be better, right? Maybe, but not by much: Orlistat is recommended to be taken for six months to a year, and according to several studies, the average loss experienced over the course of its use is 12.4 to 13.4 pounds. I couldn’t even find an average expected weight loss with phentermine on a reputable site; one Korean study found an average loss of about 5 pounds per month, which would be an improvement over Orlistat and Meridia, except phentermine carries a risk of being habit-forming and — in the US, anyway — is only recommended to be used for a few weeks, and certainly not long-term. Add in the possibility that the weight-loss numbers may in fact be inflated, and, well, the whole situation becomes absurd.

Ultimately, what we have here is a selection of three drugs whose weight-loss efficacy is laughably pathetic, and in exchange for a few short-term pounds lost you get some horrifying side effects and possible long-term health consequences. How can it be that these drugs are continuing to be prescribed and used, when their usefulness is so limited, even according to the statistics put out by the manufacturers themselves?

The reason is because weight loss is a business, and a singularly profitable one at that. As of 2008, it has been estimated that the US spends between $33 and $55 billion dollars on weight loss “products and services” annually. (For reference, the entire US fashion industry had a revenue of about $14 billion dollars last year.) In the US, the marketing and sale of weight loss drugs — like all diets, in fact — intentionally exploits our cultural investment in the power of the individual by encouraging folks to believe that even if the statistics are against you, you are going to be one of the few lucky ones to succeed where everyone else has failed. Because you are special, and all those other people were doing it wrong. Because you want it more than they did. Because you deserve it.

They lie. They lie because the companies that manufacture weight loss drugs are after profits; they don’t give a single solitary oily pants-poop about your health. Following the FDA panel vote to decide Meridia’s future, one panelist who voted in favor of keeping Meridia on the market said:

“I think that just because we didn’t measure the benefits scientifically doesn’t mean they don’t exist,” said Dr. Jessica Henderson of Western Oregon University. “I don’t think a consumer’s right to have that treatment should be taken away just because the scientists didn’t do their job.”

I could argue for the existence of Bigfoot using this same logic.* The benefits might exist! We just have to believe in them! (Clap your hands!) Beyond being a really terrible quote which I’m sure Dr. Henderson will shortly regret, this is a clear acknowledgement that the scientists running this study were tacitly charged with the task of producing a specific, predetermined result — in this case, to prove that Meridia improves the cardiac health of the people who take it — and not to make an objective assessment as to the overall safety and effectiveness of the drug. This missing result was expected because it would help Abbott Laboratories — the scientists’ employer! — sell more pills; if the scientists failed to produce the expected proof, the mistake is on their part, regardless of whether their findings are actually true.

And this is why I don’t trust statistics and studies without investigating their origins, kids. There’s a monumental chasm between a scientific inquiry driven by curiosity and one driven by profit. Know how to spot the difference.


* Or, because you can’t prove that I don’t have a pet unicorn named Glitterbum, I might have a pet unicorn named Glitterbum.

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