This story endeavors in a noble task: providing readers with an assessment of the landscape for obesity drugs. We wish more stories took this broad view when writing about new drug studies or approvals. The article does a good job of framing the key issues, asking, essentially, whether is there enough benefit to justify the side effects. Not often do stories address this issue, and we applaud their approach. The story comes close to achieving a balance in its attempt to answer this question. For example, the statements by Thomas and Wolfe are excellent alternative opinions to the views espoused by the obesity drug expert camp. But we wish this story had gone beyond a he said/she said look at the evidence and that it had not relied so heavily on sources that have strong ties to the pharmaceutical industry, which is pushing hard for looser restrictions on anti-obesity drug approvals. There also is some clear disease-mongering in the article, which gives it the unsavory taste while you read it.
As this story notes, a third of the US adult population is obese, and the situation has only worsened in recent years, despite concerted public health efforts to address this serious public health threat. Pills, though, are just one part of the equation. From reading this story, people might believe that the only reason people are obese is because they don’t have access to the right pills. How does this explain the huge contrast between the US and other developed countries in terms of obesity? How does this explain the rapid rise in average body-mass index over the past three decades and the resulting rise in diabetes, heart disease and other health problems? The story accepts as its underlying premise that obesity would melt away if drug companies could find the right pill and that they are being scared away by the big bad FDA. Even a story that is primarily focused on the drug industry and not the root causes of obesity should have given more weight to the evidence about the health problems resulting from obesity drugs.
The story never mentions the costs of drug or surgical treatments, even though it discusses numerous treatments. We wish it had spent some time on this point. The story mentions that diet programs can be not “affordable” in the long term, but what about drug treatments? Especially those that have only modest efficacy? How much does a drug like Contrave typically cost a patient? These would have been easy issues to address.
The benefits of these drugs are not quantified. Instead, the benefits of exercise and diet are cited, but only to note that those remedies are ultimately ineffectual. This seems to be a selective reading of the literature.
Although some harms are mentioned, the story never quantifies them. It should not have to recite detailed rates of adverse events for every drug mentioned, but it would have been nice to see at least one example detailed.
This story is all about the quality of the evidence. Dr. Thomas’ quote is a case in point. “”It’s a balance,” Thomas added. Each panel carefully weighs a drug’s effectiveness against its safety. If weight-loss results look good, then potential side effects (unless they’re extremely serious) might not be weighed so heavily. But if a drug isn’t very effective, “then the safety issues become magnified.” So, for example, in the case of lorcaserin, panel members were hesitant to recommend approval because trials “barely proved” effectiveness, Thomas said.”
The story engages in disease-mongering by presenting obesity as a disease that can be cured, if only the right pill is developed. Obesity deserves to be treated as a disease, but it doesn’t necessary follow that pharmaceuticals offer the only real hope of effective treatment or prevention.
This story is framed as forecast of a frightening future in which drug companies stop investing in experimental weight loss pills… as if the central problem is heavy-handed regulation, rather than the difficulty of altering metabolism and other biological systems in a way that doesn’t produce unhealthy side effects. While there are independent sources that present a variety of viewpoints, readers should have told about the ties some of them have to the pharmaceutical industry. The Obesity Society, which provides the first source in the story, is funded almost entirely by drug companies. One of the quoted experts, Dr. Judith Stern, is an accomplished obesity researcher, but she is also the co-founder of the group that is now the Obesity Society. Dr. Ken Fujioka received $12,400 from drug companies in 2009. None of these conflicts is noted.
The story does compare the pill approach to other methods, but we feel that the comparisons are made merely to knock down all other alternatives. This was not a serious comparison.
The story’s focus is on the lack of treatment and the inability for any obesity drug to gain any traction. It does a good job on this score. It takes readers carefully through the history of anti-obesity drugs and presents, in broad terms, their successes and subsequent failures.
The story does a great job explaining how difficult it has been to find a drug that will actually reduce people’s weight without raising their risk for other problems, particularly cardiovascular problems.
The story does not rely on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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