Another obesity drug taken off the shelves

The National Obesity Forum, the 'independent charity' has taken another blow today, as the BBC reports:

Top obesity drug sibutramine being withdrawn

A leading obesity drug is being withdrawn from use in the UK amid fears it increases the risk of heart attacks and strokes.

Dr June Raine, of the MHRA, said: "Evidence suggests that there is an increased risk of non-fatal heart attacks and strokes with this medicine that outweigh the benefits of weight loss, which is modest and may not be sustained in the long term after stopping treatment."

This is a blow for the National Obesity Forum because they have previously defended sibutramine (AKA Reductil) against claims that it has fatal side-effects, as in this press release:

NOF continues to view sibutramine as a safe and effective treatment against rising tide of obesity

The National Obesity Forum (NOF) today confirmed its view on sibutramine (Reductil) as a safe and effective treatment option for medically obese patients and supported the Medicines Control Agency (MCA) statement that: "Patients currently treated with sibutramine can continue to take their medicines as usual."

And when the evidence mounted, NOF chairman David Haslam insisted that there was no need to ban it.

"This is information we need to take very seriously because we should not be prescribing it to the wrong people," the Daily Express quoted Dr David Haslam, chair of the National Obesity Forum, as saying.

He added: "Anything that lapses blood pressure control could have side-effects.

"Anyone who has had a heart attack or a stroke should stop taking it but those who haven't should be assured there are no danger signals for them."

This mirrors the situation in 2008 when the weight-loss drug Rimonabant AKA Acomplia was approved for NHS use, despite fears that it caused suicide, and despite it having already been banned in the USA. Even its manufacturers, Sanofi-Aventis, found that it doubled the risk of psychiatric disorders. The National Obesity Forum, on the other hand, warmly welcomed its approval:

"This is a very good drug, and there are very many people who have tried everything else, including other drugs, with little success, who might benefit from it." 

Once approved, it took only a few months for the European Medicines Agency to urge doctors not to prescribe it, citing safety fears, and it was taken off the shelves. Still the (new) NOF chairman was eager to defend it:

Dr Colin Waine, chairman of the National Obesity Forum, said: "My patients were doing very well on it, and they will now have to stop and come off it."

Why such eagerness to defend these drugs? Other public health spokesmen have condemned them or been luke warm at most. Could it have anything to do with the fact that the pharmaceutical industry gives it thousands of pounds a year?



Or is it because Big Pharma paid for its website?



Or is it that Big Pharma almost entirely funds its annual conference?

Dr Matt Capehorn, GP, founder of Rotherham Obesity Institute and trustee of NOF presented a Sanofi-Aventis sponsored lecture...

Prof Colin Waine, Chair of NOF presented a Roche sponsored lecture entitled: ‘Weighing Up The Burden of Obesity’...

Dr Terry Maguire, Queen’s University, Belfast presented a GSK sponsored lecture titled: ‘Supporting overweight and obese patients; What role can pharmacy play?’

Prof Dr Luc Van Gaal, Professor of Medicine, Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital delivered an insightful presentation, sponsored by Abbott...

Now, I have no problem with industry funded pressure groups or charities. God knows, the government funds enough astro-turf 'grass-roots groups' to push its policies and industry is, if anything, under-represented. But I don't believe I have ever read a media report involving the NOF which mentions the fact that they are overwhelmingly funded by Big Pharma. 

Surely, in the interests of transparency, this conflict of interest should be explained whenever they are encouraging the sale of drugs, especially when they may well be deadly.

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The politics of the playground

Like many a political leader before him, the Mayor of Santa Cruz is learning that when it comes to tobacco, nothing you do is ever good enough to satisfy the prohibitionists.

As reported previously, Santa Cruz recently enforced an outdoor smoking ban to go along with its many other anti-smoking laws. Santa Cruz resident Ethan Epstein describes how 'comprehensive' these bans are:

In this bastion of “tolerance,” smoking has been banned throughout all indoor public spaces, outdoor dining areas, parks, beaches, and downtown thoroughfares. My (exorbitantly overpriced) apartment building has imposed a smoking ban that even covers private residences. 

I don’t smoke, but my girlfriend does, and she is forced to shiver in the bitter – for California – cold when she wants to light up. That smell wafting into your apartment is not cigarette smoke: it’s illiberalism and intolerance.

And what does the American Lung Association in California (ALAC) do to reward Santa Cruz's slavish devotion to the anti-smoking cause? It awards the city a 'D' in its Tobacco Report Card.

Treating this arbitary rating system with absurd high seriousness, ALAC spokesman Paul Knepprath said the city was oh-so-close to getting a 'C'.

Paul Knepprath, vice president for advocacy and health initiatives with the American Lung Association in California, said although Santa Cruz city code identifies "smoke" as a public nuisance, the wording isn't strong enough.

Knepprath said if the code specifically referred to second-hand tobacco smoke, it would have meant an additional bonus point, which after the errors were fixed, would raise the overall grade.

"That's how close it was," he said.

In other words, Santa Cruz could have only got a 'C' if its politicians lied and said that smoking outdoors posed a health risk to nonsmokers. There is, of course, no evidence for this.

What makes all this funnier, is that the Mayor has taken the news very badly indeed and has started throwing his toys out the pram. He scribbled an angry letter to the ALAC, saying...

"This is ridiculous and, frankly, it does not motivate me to press my City Council colleagues to take further action to reduce smoking: quite the reverse."  

Quite the reverse? You mean you're going to take action to increase smoking just because the ALAC hurt your feelings?

"I feel we are being abused and that the rating system is clearly a fraud and meaningless."

And Mayor Rotkin was still throwing a hissy-fit when the press caught up with him...

"Frankly, it makes me so angry I don't ever want to talk to these people again," he said in an interview.

Is this the level of school-yard politics we've be reduced to? Draconian laws being introduced to impress the bigger boys and then petulant name-calling when they don't get the pat on the head they feel they deserve?

I don't claim to be an expert on local politics in America, but aren't politicians supposed to be acting in the interests of their electorate rather than trying to to earn gold stars from out-of-town single-issue campaigners? Rotkin's reaction makes it pretty clear that climbing up a league table comes ahead of serving his electorate.

Rotkin himself is a rum fellow. He teaches 'Community Studies' at the University of California ("yes, I think I will have fries with that"). This includes an Introduction to Marxism, which I'm sure he teaches in a balanced and reasoned way, as you would expect from someone who edited The Socialist Review for ten years, describes himself as a "Marxist-Feminist" and lists his interests as...

Marxist theory, capitalist system, community power structure, institutional analysis, and affirmative action.

According to Discover the Networks:

Rotkin's ideals are outlined in his 1991 PhD thesis (entitled Class, Populism, and Progressive Politics: Santa Cruz, California 1970 - 1982), which describes his stealth strategy to implement socialism in the United States. A chapter from this thesis, titled "A Three-Part Strategy for Democratic Socialism," currently serves as an assigned reading for his "Introduction to Marxism" course. 

Part one of this strategy is Grassroots Organizing, which means finding groups with grievances against society and helping them to "wrest concessions," as he phrased it in his thesis. Borrowing from Saul Alinsky's tactics, Rotkin advocates hiding his true socialist agenda from the people he helps while "preparing the ground" for subsequent stages.

I don't wish to offend the good people of Santa Cruz who have elected him as Mayor four times, but from where I'm sitting this man sounds like an asshole.

And it gets better. Mayor Rotkin - who, let's say again, has banned smoking outdoors - is a board member of the American Civil Liberties Union. Is this guy for real, or what?

It's interesting to note that Santa Cruz's recent outdoor bans were brought in to curry favour with the ALAC after getting a 'D' last year.

The city received a "D" for 2008, which partially prompted the council to pass the ban on smoking along Pacific Avenue, West Cliff Drive, the Santa Cruz Municipal Wharf and other public sites. The ordinance, which took effect in October, expanded earlier prohibitions against smoking in restaurants and in lines for movies and concerts.

All of which makes last year's debate over whether or not to bring in these bans look like a bit of a charade. Policy seems to be being dictated by unelected pressure groups rather than the council. The silver lining is that the ALAC seem to have gone too far this time and alienated the childish and self-absorbed politicians upon whom they rely. I predict Santa Cruz will be getting a 'C' sometime soon.

Thanks to Becky for the tip

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An honest conflict of interest statement

What represents a conflict of interest for those who write studies about tobacco control? Some people would think that being a professional 'secondhand smoke consultant', receiving money from the makers of nicotine replacement drugs or being a member of a hardcore anti-smoking group would be worth mentioning if the individual is working on research that might lead to legislation. 

In practise, such interests are rarely mentioned as potential sources of financial or emotional bias. Dr Kamal Chaouachi has taken a very different approach in his recent study published in Medical Hypotheses. Instead of simply saying 'no conflict of interest', Chaouachi has opted for full disclosure, including all those Big Pharma ties that others overlook. In doing so, he hints at what a full conflict of interest statement might look like if those working in tobacco control went to the same trouble. 

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David Kessler: "Food is like cocaine"

This blog has mentioned John Banzhaf's graduation from anti-tobacco fanatic to anti-food fanatic before. I haven't yet documented David Kessler's same slide down the slippery slope.

When he was in charge of the Food and Drug Administration (FDA) in the 1990s, Kessler made concerted attempts to bring tobacco within his regulatory domain (see Velvet Glove, Iron Fist, pp. 189-93). At around that time RJ Reynolds Tobacco placed ads in US newspapers, asking 'Today it's cigarettes - will high fat foods be next?'

It seemed an absurd comparison at the time but, as we now know, an assault on food was the 'next logical step' and, again, Kessler is involved.

On Thursday, Kessler appeared on Channel 4's Big Fat Diet Show, attacking the 'food industry' for making food enjoyable. This is what he said...

"Back 30, 40 years ago, what was the most salient stimuli [sic] for many people? It was tobacco. It was cigarettes. That hi-jacked our brains.

Today, what's the most salient stimuli [sic] for millions of people? It's food! That's hi-jacking our brains."

And when you get rid of food, what will be the next most salient stimulus? Do we keep going until there are no stimuli at all?

The reason food 'hi-jacks our brains' is because our bodies send signals to tell us when we need to eat and, when we do, our brains need to tell us we enjoy it. It's pretty simple, and pretty important. Pleasure is not a bad thing in itself, you know. 

"We now know that fat and sugar can stimulate the brain's neural circuitry like amphetamine and cocaine."

What he's talking about is dopamine, which is released in the brain and creates the feeling of pleasure. Kessler refers to cocaine to make it sound as if fat and sugar are evil and unnatural. It's a cheap trick. 

In fact, dopamine is released by doing virtually anything we enjoy, including watching television, playing sport, eating any type of food (so long as you like the taste of it), sex, smoking, a good joke etc. etc. etc. 

If someone ever tells you that [fill in the blank] acts like a class A drug, just walk away, because they're just talking about dopamine and they're using scare tactics. 

The drug references don't stop there...

The food industry has optimised food to achieve the maximal bliss point. They've constructed food to get us to keep on eating. It's this momentary hit. It's this momentary rush. And then you try to chase it again. We always knew that drugs can hi-jack our brain. Now we know that fat, sugar and salt - when put together in the right combination - can do the same.

A momentary "hit" that you have to "chase". Get it? Food = drugs. Let's regulate it! Needless to say, Kessler thinks that fast food is addictive and is paving the way for it to be taxed. Do this sound familiar?

His argument is hokum, of course. A war against anything that causes dopamine to be released is, by definition, a war on pleasure. People like Kessler insisted that they were not embarking on such a puritanical crusade in the 1990s when the tobacco issue came to a head (and he was explicitly warned about the slippery slope then. See this letter.)

Easting food is pleasurable. It's an evolutionary response to a biological necessity. The 'food industry' have made food that people want to eat. Nothing more, nothing less. 

Don't consume more calories than you will burn off. It's very simple but it's still a personal choice.

You can see Kessler's performance here (30 minutes in). Thanks to JB for the tip.

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Rumblings of sanity

"During times of universal deceit", said George Orwell, "telling the truth becomes a revolutionary act." 

The following stories appeared in the last week. All of them involve statements that are so transparently truthful that they are obvious to anyone who does not have a vested interest in saying otherwise. Consequently, in the early days of 2010, they are considered controversial.

Outdoor Smoking Bans Spread Without Science

WeHo News 

West Hollywood, California (January 11, 2010) - Half a dozen LA County municipalities have banned smoking near their outdoor dining facilities, with a few banning it from publicly-owned property - sidewalks, medians etc. - across their city entire.

All did so citing public health concerns, but none did so based on scientific evidence that second hand smoke (SHS) near an outdoor area poses a health risk, because no such peer reviewed study existed.

Smoking defended by Quebec doctor

CBS News

A Quebec psychiatrist has sparked controversy with a new book that comes to the defence of smokers and even promotes some benefits of smoking.

The former president of the province’s Association of Psychiatrists said smoking can be helpful for those suffering from deep depression.

"Sometimes antidepressants aren’t enough — it is an individual approach for everyone," Bourque said in an interview with Radio-Canada.

Bourque said the concerns about the dangers of second-hand smoke are overblown.

"The idea that is promoted by the Quebec government, that second-hand smoke is more dangerous than the smoke inhaled by someone who is smoking, is completely off the rails," Bourque said.

'Shaming' smokers makes it harder to quit: study

Tom Blackwell, National Post

Years of anti-smoking laws and campaigns have amounted to a public shaming of smokers that could make it harder for them to quit, a group of UBC researchers argue in a new report.

Katherine Frohlich, a public-health expert at the University of Montreal, said studies by her research group found that poorer smokers feel the policies have discriminated against them by, for instance, restricting their social interaction and isolating them at home.

"We shouldn't dismiss the fact these interventions have been incredibly successful," she said. "[But] we have to take into consideration the fact that there are some pretty serious unintended consequences."

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Unbelievable ignorance

For my sins, I'm currently reading a book called All Consuming by one of Gordon Brown's former advisors, Neal Lawson. In a nutshell, the author attempts to exploit the recession to persuade readers to turn against the free market. 

The book is riddled with factual errors and outrageous statements, as you might expect. Here's one of each:

Even the new [railway stations] like Liverpool Street and St Pancras are just shopping malls attached to platforms and ticket offices. Everywhere and everything is an excuse to sell.

Victorians, on the other hand, made stations that were more sensual and authentic. It was a joy to be in them to sit and wait. Now there are so few seats that you have to buy a coffee just to sit down. 

The trains are not part of a grand public service but engines for private profit.

Er... not quite. The railways were very much "engines for private profit" in Victorian times, what with them being entirely run by private companies. Britain's rail network wasn't nationalised until 1948, when British Rail was created. They then proceeded to close down hundreds of miles of track, ripping down countless "sensual and authentic" Victorian stations in the process.

That, however, is merely an hors d'oeuvre for this piece of swivel-eyed lunacy:

Totalitarianism, the accusation levelled against Communism...

That's right, "levelled". As if the jury was still out.

... is a system of control that regulates every aspect of public and private life. Consumerism and Communism are two different versions of totalitarian societies: both offer a pseudo-vision of freedom but operate to systematically refine their dominance. 

Good grief. That could very easily be the most stupid thing I've ever read. 

Totalitarian Communism (is there any other kind?) involves secret police, murder, torture, mass starvation, no freedom of speech, no freedom of the press, no freedom of religion, a one party state, rationing, endless queueing and forced labour. Oh, and 100 million deaths.

Consumerism involves people sometimes buying things they don't really need.

I'll take the electric toothbrush over the Siberian concentration camp, if it's all the same to you.

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Costs and benefits of alcohol

Over at The Spectator, Alex Massie has been taking apart the notion that alcohol "costs" Scotland £3.65 billion. Meanwhile in England, the Conservative party has announced its alcohol strategy. As Taking Liberties reports, this strategy is based on the belief that alcohol "costs" the UK £20 billion a year.

As Alex says, these figures are based on little more than guesswork. The fact that the Scottish estimates, in particular, have risen dramatically in a few short years makes one suspect that they are based more on politics than mathematics.

We are victims of Government-Sponsored Study Inflation. In 2001 a study for the Scottish Executive argued that drink cost the country about £1bn a year; in 2004 another report estimated the cost at £1.1bn before, in 2007, yet another claimed that hangovers and bar-room brawls and liver disease and all the rest of it cost £2.25bn. Chicken-feed in comparison to this year's numbers. 

So here too we can suppose that you can do the sums any way you please and that, consequently, it probably helps to decide what you want the result to be before you begin the whole sorry process.

Some of the supposed costs are so intangible as to be unmeasurable. How, for example, is one to quantify the financial cost of "family breakdown" or "grief"? Of the £20 billion alcohol allegedly costs the UK, £4.7 billion - almost a quarter - comes from the "emotional impact suffered by victims of alcohol-related crime". But if we are to start putting a price on misery, what price do we put on joy? As Alex says:

The hundreds of millions of pounds it says are lost through "pain" and "grief" is nowhere balanced by the equally arbitrary figures once could concoct for all the (life-long!) joy and contentment alcohol brings. To say nothing of its positive impact on the birth-rate. (Happy, boozy pregnancies almost certainly outnumber booze-related premature deaths. This must be worth billions in the pro-drink column. These are the workers of the future!)

Factor in the social cohesion - to use a favourite piece of government-speak - provided by public houses and the happiness-inducing impact of a dram at home and it seems to me that the ruinous impact of drink has, unsurprisingly, been vastly over-stated.

If emotional costs are ultimately unmeasurable, we can certainly quantify the economic benefits. The £20 billion estimate is regularly mentioned by politicians, but the document that gave us that figure also gave us this little nugget, of which we hear almost nothing [PDF]:

The alcoholic drinks market is valued at more than £30bn per annum, with around one million jobs estimated to be linked to it. Excise duties on alcohol raise about £7bn per year and, like other sectors, the industry pays local and central taxes.

Even if we take the £20 billion "cost" seriously, it is immediately outweighed by the £30 billion we gain. To put it another way, if alcohol control policies succeed, for every £2 we save, we will lose £3. 

Faced with these hard economic facts, most public health professionals will huff and puff before saying that the issue is not about money, but about health. They would say that saving lives is more important than saving cash. Fair enough, and if they want to make that argument, they should do so, but let's not pretend that alcohol is a drain on the economy. It isn't and it never has been.

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