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Obesity drugs grow as fat society's crutch
As Americans get fatter and fatter, a healthy diet and regular exercise are
giving way to an easier - albeit more costly - approach to staving off obesity-related illnesses: prescription drug therapy. More and more, overweight Americans are being prescribed drugs to treat the conditions that can lead to diabetes, heart disease and stroke. These are not drugs that actually help you drop pounds. Instead, they allow people to maintain their unhealthy habits and sidestep early death. Bolstered by studies that show the success of aggressive drug therapy for elevated blood pressure and abnormal cholesterol levels, some doctors are pushing for greater reliance on drugs for a younger, much larger population. "Many health care professionals have thrown in the towel with lifestyle, saying we can't get our patients to change their behavior - eating right and exercising - so we have to go strictly to the medications," said John Foreyt, a clinical psychologist and director of the Behavioral Medicine Research Center at Baylor College of Medicine in Houston who works with diabetics. "We are treating the symptoms, but we are not getting at the real cause." On the other side are those who say it's great to tell everybody to lose weight and live healthy - but not realistic. For most people, these doctors say, the choice is medication or early death. "A patient comes in and has coronary artery disease. I can wag my tongue at them, scold them and tell them they need to change their lifestyle," said Dr. Steve Nissen, a cardiologist at the Cleveland Clinic in Ohio. "What percentage actually do? Very few. Until we come up with other solutions, drugs are a reasonable approach. "I don't think it's a bad thing. It's a good thing. While it does allow them to live a bad lifestyle, it partially reduces the harm they do to themselves." In fact, say Nissen and others, there is evidence that in some cases drug treatment works better than exercise and diet alone. "Primary-care doctors emphasize lifestyle, lifestyle, lifestyle - which is not bad - but their hesitation to turn to drug therapy is too high," said Dr. Christopher Cannon, whose recent study found that the risk of a second heart attack was reduced by 50 percent in people who were given higher-than-normal doses of the cholesterol-lowering drug Lipitor. "In fact, they go together." Cannon is among those who say that while there is no definitive research on the issue, he foresees a day when people at all levels of risk will take statins - a class of drug that reduces cholesterol - much as they would a multivitamin. "It's not a bad idea," he said. For its part, the pharmaceutical industry is banking on an acceleration of the nation's obesity epidemic and the American penchant for a quick fix. The two top-selling drugs in the United States last year were statins, accounting for 6.4 percent of all drug sales and 3.7 percent of all prescriptions, according to IMS Health, which tracks pharmaceutical sales. Calcium blockers, beta blockers and ACE inhibitors for high blood pressure accounted for 4.3 percent of the market and 9.1 percent of prescriptions. The conditions that put people at risk for heart disease and type 2 diabetes are so common that, when combined with a big belly, they've been given a name: "metabolic syndrome." The problem is estimated to affect one of every four American adults. Although there are no drugs approved specifically for use against metabolic syndrome, market researchers recognize a potential gold mine. In an analysis published in February for D&MD Publications, which does pharmaceutical industry research, authors Sreten Bogdanovic and Beata Langlands reported: "Specific components of the syndrome ... represented a $54 billion worldwide market in 2003 and are forecast to grow to $98 billion by 2008. The emergence of the metabolic syndrome ... is predicted to have profound implications for developers of all drugs." A big part of the sales increase stems from treatment guidelines adopted in 2001 that lower the threshold at which cholesterol is considered abnormal enough to warrant drug treatment. Between 2000 and 2003, sales of statins jumped from about $9 billion in the United States to nearly $14 billion. Analysts and physicians alike are especially excited about drugs that tackle more than one obesity-related condition in a single pill. The Food and Drug Administration in February approved Caduet, made by Pfizer and the first drug to treat both high cholesterol and high blood pressure. AstraZeneca's Galida, used to lower blood glucose and cholesterol in type 2 diabetics, is going through its final tests in patients worldwide. The breathless enthusiasm with which many doctors and researchers look to drugs as the answer troubles some in the medical community. Art Caplan, a bioethicist at the University of Pennsylvania, said the emphasis on drugs shifts responsibility from the individual, the food industry and society at large, to the medical profession. "People love to find a quick fix. They can say, 'Oh, well; I'm not indulgent, I'm just sick,' " Caplan said. "The U.S. is suffering from a severe case of medical addiction. We are in love with the idea that medicine can bail us out of all kinds of woes, ailments and problems. And even though we complain the costs are killing us, we can't stop." Part of the problem, said Cindy Moore, a registered dietitian and spokeswoman for the American Dietetic Association, is that physicians are not trained to help people change their lifestyles. "Having a physician tell a patient 'you need to lose weight and lower your cholesterol' isn't going to provide them with the specific tools they need." She added that most insurance plans allow someone to see a registered dietitian only if they already suffer from chronic diseases. Studies show that only 2 percent to 5 percent of people who try to lose weight on their own are successful at keeping it off long-term. So some of those pushing to address obesity through lifestyle changes are themselves using a highly "medicalized" approach. The Coronary Heart Disease Reversal Program at UC Davis pulls in doctors, dietitians, therapists, exercise physiologists and high-tech machinery for a multipronged attack on the underlying factors that lead to illness. Patients already suffering from obesity-related conditions also are prescribed drugs, but the goal is to reduce or eliminate reliance on medication. For many in the program, it took serious illness to motivate them to make changes. Even with a diagnosis of type 2 diabetes, said Davis resident Charlotte Maggard, 64, it took her eight years to commit to giving up junk food and getting some exercise. "When you first learn about it, you are kind of in denial," she said. But over the years, the diagnoses - and drugs to treat them - mounted: high blood pressure, high cholesterol, diabetes-related vision deterioration and heart problems. Since joining, she has quit eating red meat and lost 10 pounds. Her goal, she said, "is to get off the medication." Similarly, Sacramento resident Michael Guzman, 51, said that following his heart attack in 1999, he tried to get more exercise, but didn't stick with it. Despite being diagnosed with diabetes, he couldn't quit his barbecued pork habit and at one point weighed 291 pounds. Since joining the UC Davis program two months ago, he has sworn off all forms of meat. On a recent visit to the Sacramento Natural Foods Co-op with other patients, he filled his cart with products such as tofu ravioli and fat-free refried beans. "I'm finding there are a lot of foods that are real tasty," he said. Dr. Tissa Kappagoda, the cardiologist running the program, said the diet and exercise regimens are proven to work. He followed a group of his own patients for 10 years and found that those who stuck with the program for two years had a significantly lower incidence of major heart attack or stroke. In addition, he said, 80 percent of the dropouts were taking medications to lower cholesterol compared with 40 percent of those who remained in the program the full two years. "We are living in an environment where you think drugs will solve every medical problem," Kappagoda said. "But these are diseases of lifestyle. ... Keeping people obese and alive with medication really doesn't, in my view, address the issue." |
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Obesity drugs grow as fat society's crutch
-----BEGIN PGP SIGNED MESSAGE-----
Hash: SHA1 On 14 Apr 2004 03:43:29 +0200, Dorsey Griffith wrote: Picky, picky, picky... those fat folk can't do anything right. Why are you using an anon remailer if you really believe in posting this off-charter baloney from God's eyebrow to the devil's asshole? Is it because you are a liar as well as a thief? (you are stealing bandwidth) and a coward? Another idiot has been hatched folks. I even think we all know who it is too.... LV Lady Veteran - ----------------------------------- "I rode a tank and held a general's rank when the blitzkrieg raged and the bodies stank..." - -Rolling Stones, Sympathy for the Devil - ------------------------------------------------ People who hide behind anonymous remailers and ridicule fat people are cowardly idiots with no motive but malice. - --------------------------------------------- "To Do Is To Be" Socrates "To Be Is To Do" Plato "Do Be Do Be Do" Sinatra - ------------------------------- -----BEGIN PGP SIGNATURE----- Version: PGP 8.0 - not licensed for commercial use: www.pgp.com iQA/AwUBQHya5ukoPZAZfLgsEQLMsQCeMBNGX2D+4J6uwYN+xk42ih 5qY78AnRmf IjZnQuWJv+yp6PxrogTARnHA =X6VR -----END PGP SIGNATURE----- |
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