February 27, 2012
By Mark Hyman. M.D.
This week, in an act of desperation to turn back the tide of the obesity epidemic that now affects almost seven out of every 10 Americans and more than 80 percent of some populations (African-American women), the advisory committee to the Food and Drug Administration (FDA) voted 20 to 2 to recommend approval of Qnexa, a “new” obesity drug that is simply the combination of two older medications, phentermine (the “phen” of phen-fen”) and topiramate (Topamax).
It is a misguided effort at best, and a dangerous one at worst. Mounting evidence proves that the solution to lifestyle and diet-driven obesity-related illnesses including heart disease, diabetes, dementia, and even cancer won’t be found at the bottom of a prescription bottle.
By 2020, more than 50 percent of the U.S. adult population will have Type 2 diabetes or prediabetes, with annual costs approaching $500 billion. By 2030, total annual economic costs of cardiovascular disease in the U.S. are predicted to exceed $1 trillion. By 2030, globally we will spend $47 trillion, yes trillion, to address the effects of chronic lifestyle-driven disease.
Prescription medication for lifestyle disease has failed to bend the obesity and disease curve. Statins have been recently found to increase the risk of diabetes in women by 48 percent. And large data reviews by independent international scientists from the Cochrane Collaborative found that statins only work to prevent second heart attacks, not first heart attacks, which means they are not helpful and most likely harmful for 75 percent of those who take them.
Avandia, the No. 1 blockbuster drug for Type 2 diabetes, has caused nearly 200,000 deaths from heart attacks since it was introduced in 1999. The drug was designed to prevent complications of diabetes, yet heart attacks are the very disease that kills most Type 2 diabetics. In 2011, the FDA issued stricter prescribing guidelines for Avandia, but the drug is still on the market.
The large ACCORD trial found in more than 10,000 diabetics that intensive blood-sugar lowering with medication and insulin actually led to more heart attacks and deaths.
Something is deeply wrong with our medical approach.
The problem of chronic disease, including obesity, diabetes, and heart disease, is not a medication deficiency, but a problem with what we put at the end of our fork.
The emperor truly has no clothes. Why would good men and women of science vote to approve a medication for a condition that is a social disease and requires a social cure? The social, environmental, economic, and political conditions of America and increasingly the global community have created an obesogenic environment.
Clearly we need to do something. But it is not better medication or surgery or more angioplasties and stents, which have no proven benefit in more than 90 percent of those who receive them. The data show they work for acute coronary events, but not stable angina or blockages.
We continue to pay for expensive treatments for chronic disease, despite the fact that they don’t work, while insurance does not pay for nutrition counseling unless the patient has kidney failure or diabetes.
Chronic disease is a food-borne illness. We ate our way into this mess and we must eat our way out.