> food : pills : diet

pill no-food: battling excess with drugs

diet pills: the most lucrative development of swallowable sized foodstuffs involves reduction of consumption, rather than feeding or sustenance.

the most recent serious chemical attack on fat originated over twenty years ago: fenfluramine was approved in 1973 by the FDA to treat the severely obese.

fenfluramine, in the form of dexfenfluramine (ask a chemistry major), was later marketed for more popular use under the "Redux" brand name, by Wyeth-Ayerst Laboratories. Redux is the ideal diet pill for "the information age" - redux, fenfluramine combats obesity by changing the way a user perceives their food intake:

"Based upon its clinical pharmacology, Redux is believed to increase the activity of serotonin, a neurotransmitter that has been shown to influence appetite, and thereby to reduce calorie consumption and excess body weight in obese patients. People taking Redux are believed to experience satiety, or to "feel full," faster than usual when eating."

- "FDA clears Redux (dexfenfluramine) for marketing to treat obesity," press release, Interneuron Pharmaceuticals Inc.

it is astonishing that the language used above is so straightforward - what a marvel! the patient "experiences satiety!" satisfaction! call up mick jagger!

here the drug user and the drug/technology-givers (the doctor, Wyrth-Ayerst Labs, etc) agree to hallucinate the drug user. this did not scare people off, at least at the outset, judging by redux's introductory phase: "Just three months after the introduction of Redux, doctors are writing 85,000 prescriptions a week." (Michael D. Lemonick, "The New Miracle Drug?," Time Magazine)

of course this tinkering with brain chemicals for happiness is a relatively passé phenomenon in our society; witness the popular "anti-depressant" drugs prozac, zoloft, etc. this particular miracle drug fenfluramine becomes threatening in the hands of the prescribing authorities, and that's where technology discourse takes place.

in 1992 it was discovered that that fenfluramine, when coupled with phentermine, another weight-loss-oriented drug, drastically reduced weight levels, seemingly without side effects. the combination, dubbed "fen/phen," reached phenomenal levels of use (estimated 60 million users worldwide).

in 1997, doctors at the Mayo Clinic announced that up to 30% of sampled patients using the fen/phen drug combo came up with serious heart valve problems.

the mistakes in this case were made by physicians. fen/phen is a drug combination, rather than a specific drug. physicians are permitted to make combinatorial use of prescriptive drugs (see b. krentzman); the FDA only regulates specific drug products. successful mixings are communicated between doctors, demanded by patients, and touted by drug companies.

patients ingesting fen/phen did see great results, partially because people who want to lose 20 pounds can lose it extremely fast with drugs designed for people extremely overweight.

the Mayo Clinic, and the FDA, our voices of responsible science, stepped in to slow down the diet drug euphoria.

"We are concerned that the Phen-Fen combination may have important implications regarding heart valve disease, but more information is required. In the mean time patients taking these medications should consult with their physicians to assist them in weighing the potential risks of the medications versus the benefits of weight loss."

- Heidi M. Connolly, M.D., Bob Krentzman transcript of July 1997 Mayo Clinic press conference.

i was initially at a loss here, being primarily at risk of sinking in the pool; proponents of weight loss techniques with potentially grave side effects argue that obesity is its own serious health problem:

"Both the FDA and Wyeth-Ayerst Laboratories, which markets Redux, knew about the possibility of brain damage at high doses. But they also knew people who are morbidly obese--individuals who weigh 30% more than average--face even greater risks that they will die young from heart disease, diabetes or stroke."

- Christine Gorman, "Redux On The Ropes," Time Magazine, June 23, 1997 Vol. 149 No. 25

with olestra, the choice between intestinal discomfort versus weight loss is a consumer level choice. with diet drugs, the lines between protective expertise and consumer choice have been blurred by the intense desire and marketing surrounding weight loss. consumers are provided with detailed information in small print beneath exciting claims, and then advised to speak to doctors for a prescription. often, patients can be provided with a list of doctors who will provide the drugs with little examination (such as one patient, who experienced problems with redux, who "...obtained the drug at a weight-loss clinic whose presiding doctor was rarely available to talk to patients." (Michael D. Lemonick, "The New Miracle Drug?," Time Magazine)

in this case, the sober folks at the Mayo clinic advise their listeners to speak with their physician.

this supposes an intimate relationship between the patient and the professional, somewhere between public health and individual maintenance: informed medical participation, a kind of filtering. in the case of fen/phen, the filter seems to have been clogged some by both consumer desire and business's greed.

let it be meridia...

the hunt for a quick weight loss solution is never over; since the Mayo clinic findings, the diet drug industry has been searching for a replacement drug to proffer to the marvellous market opened up and reluctantly relinquished by fen/phen. a new drug from knoll laboratories "meridia" promises similar results:

"Boosts serotonin and norepinephrine in the brain to cut appetite and burn calories... Research suggests it increases the feeling of fullness and speeds up the rate at which bodies burn calories. Possible side effects include dry mouth, insomnia, constipation and headaches. It is also meant to be used in combination with diet, exercise and behavior modifications."

- "Meridia Page on the Science of Obesity and Weight Control," the web site of Ben Z. Krentzman, M.D.

here the behaviour modifications "meant to be used in combination" with meridia are made explicit, the behaviour modifications are likely to spring from the drug use, but taken on their own, "diet, exercise and behaviour modifications" are the constituitive elements of weight loss. combining pretechnological means of weight loss with the impetous of a diet pill shares the responsibilty for treatment between the patient and the prescription.

below, however, the doctors behind the drug present a means of saving us from a public health crisis. in a press release from Knoll,

"Obesity is a major public health threat that ranks as the second leading cause of preventable deaths in the U.S." said Carter Eckert, President of Knoll Pharmaceutical Company. "For people whose excess weight puts their health at risk, losing weight and keeping it off can be a matter of life and death. It is for these individuals-for whom even a modest weight loss can make a meaningful health difference-that MERIDIA is appropriate.

- "Knoll Pharmaceutical Company Receives FDA Clearance to Market MERIDIA," december '97 press release, Knoll Pharmaceutical

preventable death - preventable by whom?

if one were more prone to conspiracy, i might hunt the corporate links between the people developing diet drugs and their investments in ice cream companies (or streamlining the purchasing process: how about a new Ben and Jerry's flavour "meridia macademia?").

calling obesity a public health crisis, and designing drugs to deal with it neatly avoids the roots of the problem. obesity rates continue to rise in this country as our plenty surrounding us becomes all the more accessible and sumptuous, and our occupations and recreations involve less and less physical movement. changing all of that would require more than drugs, or maybe diet pills with serious psychedelic components (see: terrance mckenna). we are leading the lifestyles we have chosen, consuming what we want; all this facilitated by technology, and now we develop and pay for further technologies to address the unfortunate side effects.

regardless, these men cast themselves working to save lives. and in the initial stages of medical technology distribution, they just might be. as the technology intended to correct a problem of a few people becomes more widely available, the creative human race puts it to use for unintended, perhaps idle or vain, purposes; and the originally helpful technology becomes potentially dangerous, or demands other technologies to address its side effects.

eventually, a pill, or technology, that helps those who are physically unable to help themselves ends up being sold to those who are too lazy or afraid to help themselves. both fen/phen, and its following drug contenders work on the mood of the patient. nothing physical, in the sense of nutrient provision, takes place with the drugs. rather, the patient is less interested in food, more interested in what?

one of america's popular voices on health, Dr. Andrew Weil, sez:

"I encourage you to explore other methods for losing weight and keeping it off -- an area where most weigh-loss treatments fail miserably, including these much-touted drugs. You have to add a regular program of exercise to your life and change your eating habits. It's simple, but not always easy: You must eat less and exercise more. Also keep in mind that the more gradually you lose the weight, the more likely you are to maintain your slimmer self."
- "Why was Redux Pulled Off the Market?" Ask Dr. Weil

there are a few concepts anathema to many diet druggers in the paragraph above; work, exercise, and perhaps most of all, patience. so diet drugs, deadly and useless alike, illustrate the delicate balance between health and sustenance, in the face of plenty, afforded by technology.

foodpill II: what a deal!

one imagines distribution of appetite suppresant drugs to the hungry. if we don't have proper food distribution to share our plenty around, could we, should we, give people going hungry drugs to diminish the pain? this might truly be misguided priorities, unless perhaps we fortified the pills with essential nutrients. now we're back at the concept of food in a pill, except we've added making people feel satisfied! what a deal! technology!