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PBS’s FRONTLINE program, which always achieves an incredible level of journalism, recently ran a program on healthcare systems around the world. The premise of the program is whether the U.S. could learn anything from other modern, post-industrial, capitalist societies. The answer, of course, is “yes, the U.S. has a lot to learn.”

[From FRONTLINE:sick around the world | PBS]

What ever happened to the part of the Hippocratic Oath that says «do no harm»?

Tucked away in one of my wife’s magazines this week was an advertisement for a drug called «alli». The drug, manufactured by GlaxoSmithKline, is a non-prescription version of an existing, so-called «weight-loss» drug called Orlistast (the prescription form of the drug is called «Xenical»), a lipase inhibitor (more on that in a moment). As far as I can see, the only difference between the prescription and non-prescription is the dosage, 60mg for the over-the-counter version versus 120mg for the prescription version.

Orlistat has to be one of the worst pharmaceutical products on the market right now.

What bothers me most about the drug is that it doesn’t seem to do anything useful at all. It certainly does things to you. A lipase inhibitor, for those who don’t know, is a chemical that binds to digestive enzymes that break down triglycerides (fats) from food that is eaten into monoglycerides and free fatty acids that the body can absorb and process. If these fats are not broken down, they simply pass through the digestive tract. As a result, a person who takes this drug and then eats too much fatty food will experience the «treatment effect» (GSKs term, not mine) of too much fat simply sliding through the digestive tract. Yuck.

It is this «treatment effect» that is supposed to show the patient that the drug is working. In reality, the only thing that Orlistat does is punish someone who cheats on their diet. I’m not sure when the only side effect of a drug becomes a main reason for taking the drug, but I’m sure someone will be suing GSK over this drug (either for this effect or for the marketing claims of a 50% reduction in weight versus not taking the drug).

The other potential health risks (including vitamin-deficincy diseases and conflicting research about colon cancer) aside, the drug has no positive benefits. In order to be effective, according to the marketing literature, you must “commit[] to a reduced-calorie, low-fat diet.” I’m not sure how they conducted a controlled study of the drug when there are also the free variables of «reduced-calorie diet», «low-fat diet», and, given the requirement implicit marketing materials, «exercise». What diet plan does not include these? Would there really be a 50% weight-loss benefit for taking this drug and doing the things you are supposed to do to lose weight? Given that the weight-loss industry is enormous ($35 billion according to CBS news), GSK has every incentive to push another drug onto the market, even if that drug has no pharmaceutical value at all.

The drug was just approved this February, and this is the first marketing material I’ve seen for the drug «alli». I’m not usually one for litigation, but I think this is an instance where the threat of a lawsuit will pull a legitimately bad product off the market.

I’ve been having a horrible bout with insomnia. At least I thought it was horrible, until I started to read the Washington Post. In yesterday’s post (6 Mar 07; I’m never sure if it’s today or yesterday, what with the time zone difference and all), there was a story in the health section extolling the virtues of insomnia. What a strange coincidence.

In the Post article, the author suggests that, for some people, the battle against sleep (see Vladimir Nabokov) is a virtue, a time when they are most creative. The author cites to a number of famous people to support his claim: W.C. Fields, Groucho Marx, Marlene Dietrich, Alexandre Dumas, Franz Kafka, Teddy Roosevelt, and Mark Twain. I noticed that there are no lawyers on this list…

Whatever its value, insomnia is a bizarre phenomenon. I’m just hoping to get a couple hours sleep before I go to class. I think I also need to find ways to be more productive during these periods instead of wasting my time trying to go back to sleep.

On the train ride to Baltimore today, I was listening to NPR’s On the Media. On the program, they had a guest discussing the success and failure of the spinach industry (if it is an industry in an of itself) in marketing their product. One of the many points made during the current E. coli outbreak in spinach crops. The guest, Michael Pollan, suggests that if the outbreak was in contaminated hamburger, which has happened more than once, the government’s response would have been completely different.

I think this guy might be on to something.

Escherichia coli O157:H7, the strain that is making everyone sick, is a micro-organism that grows in the small intestines of mammals, largely cows. It only infects plants like spinach through contaminated water, run-off from fields and such.

The last time the hamburger supply was contaminated with E. coli, the government did not tell the American public en masse to throw out hamburger; instead, the government told Americans to “cook your hamburger thoroughly”. This time, with spinach, the government is instructing that all bagged spinach be thrown out. Why the difference? Certainly, it is more likely that spinach will be consumed raw rather than cooked, creating a bigger health risk. But isn’t the risk of undercooked hamburger just as great? Why not tell everyone to cook their spinach for a while instead of wasting tons of produce? Wouldn’t it be more consistent to either throw out both potentially contaminated beef or cook potentially contaminated spinach? What’s going on USDA?

Not to sound like a conspiracy theorist, but I think the beef lobby has a bit more clout than the Popeye lobby.

In a report listed on the BBC, 26% of obese people have no desire to lose weight, according to the results of a new survey from this story on the burgeoning medical supply business for obese patients. The Post discusses 5XL hospital gowns (“AmpleWear”), four-foot wide wheelchairs, and high-capacity scales capable of weighing patients up to 650 pounds. The article also discusses how patients were tired of having to find other solutions to their health problems and how this lack of basic medical services prevented many obese people from finding health care.

I for one think that accommodation is not the solution to America’s growing waistline. While it may be a valid medical condition in some cases, most obesity is caused by poor eating and exercise habits. The increased medical costs of treating the obese are raising medical costs overall and, in turn, raising costs for medical insurance. I try to eat well, and I do work out (I’m a distance runner). I should not have to be punished for the irresponsibility of others, nor should millions of other Americans. Obesity is a drain on our economy, not to mention our overall image here and abroad.

Keep your New Year’s resolution: lose some weight.