Vol. 2, Num 4: Contents | Editorial | Up Front | Abstracts

EDITORIAL
Scott C. Ratzan

The recent decision to ban the prescription use of diet drugs Fen/Phen and Redux, exemplifies the way we reach an understanding of health and risk issues in the United States.

Even today, while we know there are risks with obesity and being overweight, over 30% of the US population is classified as such by the Centers for Disease Control and Prevention. However, according to reputable pollsters, over half of Americans believe they are overweight. The American perception is that each of us should lose weight and possess the skinny or "healthy" look.

The prescription of these drugs highlights the willingness for people to take "risks" for beauty regardless of potential health hazards. Now each of us has learned many of the risks of using Fen/Phen and Redux. While over 18 million people in the U.S. have taken diet pills, projections suggest nearly one thousand could die from primary pulmonary hypertension or heart valve disease, from the Fen/Phen phenomenon.

Even though the combination was never approved by the FDA for use together for weight loss, Fen/Phen, and another approved diet drug, Redux, have recently been prescribed together with sometimes deadly results.

An overweight individual could be nine times more likely to die of primary pulmonary hypertension (note that primary is a code word for unknown origin in medical talk) than if they did not take the drugs. While this seems high, statistical models suggest that only one in 20,000 who take the drugs might die from such use. However, an individual could benefit from significant weight loss by gaining cardiovascular health and psychological well-being heightening their chance for longevity.

The public does not know the real answers or "truth." In this day and age, facts of science are decided in courts of law rather than laboratories, or by the media rather than medical science. Ideally, decisions on facts of science and health could be made by an appointed body who makes the decision based on careful deliberation of scientific fact, valid evidence and reasoned arguments.

Today, we rely on a broken system to supposedly find truth related to health issues. The Fen/Phen case initially came to our attention from the legal system in April. Following a young woman's death allegedly caused by the use of Fen/Phen, a wrongful death suit was filed on her behalf. The problem of diet drugs escalated to include documented heart valve damage in a number of deceased women who took the drugs.

With an American population that is the most overweight of industrialized countries, our hunger for a drug like Fen/Phen is presented in the beauty, health and fitness sections in magazines, television shows, and in many newspapers. Of course, the dangers associated with diet products was limited.

Such health information became "factual" through repetition and personalized anecdotal stories in the mass media. Many of us repeat what we have heard or read with increased confidence and knowledge.

Media often quote studies or research by saying "they say this about...." Today, "they say" from television and radio can threaten our understanding of how to make the best decisions regarding our health with oversimplification of risk. However, it is increasingly difficult for most of us to find out who "they" really are. Is "they" the -- pharmaceutical manufacturer, the media, the FDA or other interested party? Now, "They say" that Fen/Phen is bad. In people's quest for ultimate perfection, people are eager to try a new substitute -- a Fen/Pro combination, with Prozac instead of phentermine.

Unfortunately, health stories do not occur overnight, nor do they often fit into succinct stories or sexy soundbites. While true scientific discovery takes time, today's marketplace has limited patience. Regardless, controversy, lawsuits, and "discoveries" gain instant credibility. They are news just because they are good stories to cover given the propensity to gain market share.

Of course, all of us should share the ideal that accurate information should be presented so we can decide about what is good for us; rather than reliance on a jury or other outside force. So, if we continue on the same path with a free-for-all, "grab" the public's attention with health information, who knows what is next in our fat free frenzy?

The message is regardless of what we do in life, it carries risk. There is no such thing as a risk-free drug or a magic "cure-all" pill. We also must exercise common sense in deciding to take medication, in choosing popular advice or in embarking on a "new" diet regimen.

In a marketplace of litigation rather than deliberation, market share over care, and decision-making going from hospital to home, we must hope that a trustworthy health source can emerge. Perhaps the appointment of a Surgeon General can offer this advice as "America's Doctor." Regardless, as we all share a common appetite for valid health information, we must aim for the truth so that we can digest understandable information for our optimal well-being.