The Behavior Control Crowd Goes After Diet Drugs

Lucien Abenhaim, Yola Moride, Francois Brenot, Stuart Rich,
Jacques Benichou, Xavier Kurz, Tim Higenbottam, Celia Oakley,
N Engl J Med 1996;335:609-16
Joann E. Manson, Gerald A. Faich
N Engl J Med 1996;335:659-60



Researchers have estimated that obesity contributes to 300,000 deaths in the U.S. every year. Putting aside the junk science nature of this estimate (i.e., population or "attributable" risk estimates are inherently faulty), given the relative severity of the obesity problem, you would think that anyone REALLY interested in public health would be in favor of whatever helps people lose weight and keep it off.

Anyone, that is, except many in the public health community. With them, it's "their way or the highway." And their way is behavior control. No fast food, sweets, snack foods, Chinese food, Italian food, grease, taste, flavor... you get the picture. And eat less of whatever it is you do eat.

A current example of this is the new fat substitute olestra.

Now, the target is diet drugs. And, not coincidentally, just in time for the first diet drug approved by the Food and Drug Administration in 20 years.

Abenhaim et al concluded that the appetite suppressant drug Redux substantially raises the risk of pulmonary hypertension, a life threatening lung condition.

The researchers found that those who had used the drug for more than three months had a 23-times-higher rate of pulmonary hypertension than nonusers. Sounds like a lot BUT:

Based on their data, the authors acknowledge that pulmonary hypertension is very rare (i.e., 1 case annually per 500,000 inhabitants). In comparison, the reported annual rate of lung cancer in nonsmokers is 1 in 10,000. So while the "relative" risk is great, the "absolute" risk is minuscule.

The Washington Post (August 29, 1996) reported that drug has been used in Europe for eight years by "nearly 10 million people with few adverse health effects" (whatever that means).

In an editorial in The New England Journal of Medicine, Manson and Faich estimate that the benefit-risk ratio of Redux is 20:1 (i.e., 280 lives saved as compared with 14 deaths caused by the drug per million person-years of treatment).

The risk estimate of Abenhaim et al. may have been significantly inflated due to biased data. And that risk may not even exist at all.

Publicity about a possible association between diet drugs and pulmonary hypertension may have increased referral of patients treated with drugs to study hospitals (detection bias). Unaccounted for differences between patients and controls in their recall of drug treatment may have also biased the data (recall bias).

According to Manson and Faich, if only five additional control patients had been treated with appetite suppressants, the risk estimated by Abenhaim would have been halved. (As if it wasn't microscopic enough already!)

Because Abenhaim et al.'s analysis did not entirely eliminate the possibility that at least some of the pulmonary hypertension observed was independently caused by obesity, a causal association between Redux and pulmonary hypertension could not be clearly established.

Thus, although appetite suppressant drugs may not be absolutely risk-free, obesity is a far more serious risk.

This story made me think of those immortal lyrics of the late Root Boy Slim,

Dare to be fat,
Fat's where it's at.
Having a ball,
With cholesterol.

"Death by chocolate" certainly beats being told how to live based on junk science!

Material presented on this home page constitutes opinion of the author.



Copyright © 1996 Steven J. Milloy. All rights reserved. Site developed and hosted by WestLake Solutions, Inc.

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