The diet drug tragedy, and why we
haven't seen the end of it yet

by Conrad H. Blickenstorfer Ph.D.

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In this editorial I'll address the diet drug situation. The recent diet drug controversy proves that sometimes reality is stranger than fiction. What started out as just another run at marketing the Miracle Pill turned into a tragedy and now into a gold rush. Let me recap.

Diet drugs have been around for many decades, and it's easy to see their allure. Unlike reducing food intake, going on an exercise program, or following weird and often expensive food regiments, pills promise to do all the work. But there is no free lunch. In the 50s and 60s, most diet drugs were little more than amphetamines--speed--and I know many fat people who can tell horror stories about them. Eventually, even the medical profession realized that prescribing speed to fat people wasn't a good thing to do, and in the 1970's the practice stopped. Despite a frantic search for alternatives to speed, the pharmaceutical industry was only mildly successful. About 20 years ago, the FDA approved a drug called fenfluramine for the treatment of obesity. The FDA only approved use for a three month period; wise, but sort of strange considering that diet drugs only work as long as people take them. Fenfluramine didn't have much of an impact, and for many years pretty much languished on pharmacy shelves. Then two things happened.

On April 29,1996, an FDA advisory committee recommended approving long term use of the diet drug Redux on a 6:5 vote. The FDA approved Redux despite the fact that experts warned of at least two alarming side effects-primary pulmonary hypertension (PPH) and irreversible brain damage (neurotoxicity). The diet industry's own experts calculated the risk of contracting these "side effects" at between 20-30% for people using the drugs for a year or longer. The headline of the July/August 1996 NAAFA Newsletter was "FDA Caves In" and presented an alarming commentary by size acceptance activist and Council on Size and Weight Discrimination director Lynn McAfee, who had made presentations at the FDA hearings. Yet, the FDA had spoken and it was now legal to take Redux.

Around the same time, the combination of the drugs fenfluramine and phentermine, first used a couple of years earlier, took off. Practically overnight, "fen-phen" became one of the most hyped drugs in history, sort of a modern snake oil. Even though the combined use of the two drugs had never been approved, physicians were free to prescribe it, and they did. Millions of fen-phen prescriptions were written, against better judgement. There are many substances that are harmless when ingested separately, but lethal when taken together. Alcohol and certain medications don't mix, for example. Everybody knows that, and in general we take warnings of drug interaction seriously.

When it approved the new drug Redux, the FDA said it would require additional testing, but then refused to answer reporters' questions about the testing. McAfee referred to that in a status message on diet drugs reprinted in the July1997 issue of Dimensions. She said, "The longer the company weasels around this the more I feel afraid that they are hiding something." In July, the bomb dropped. The Mayo Clinic called a news conference and stated their concern that the fen-phen combination could cause heart valve disease. This finding was slated to be published in a future issue of the New England Journal of Medicine, but the clinic considered the public health impact so dramatic that it released the information early. Subsequent reports revealed additional cases of irreversible heart damage. Panic set in. Some of the most prominent fen-phen pushers publicly repented. The State of Florida banned fen-phen.

On September 5th, 1997, NAAFA, the Council on Size and Weight Discrimination, and six former patients with serious side effects filed a federal law suit asking for a ban on Redux and the off-label use of fen-phen. Only ten days later, the FDA asked drug manufacturers to withdraw fenfluramine and Redux from the market. The drug companies immediately complied.

The size acceptance community widely hailed the withdrawal as a triumph of sanity over greed, and also as a sign that the movement had come of age in its fight against an increasingly ruthless diet industry. Yet, not everyone agreed. The use of fen-phen and Redux was so widespread even within size acceptance circles that many people bitterly complained about no longer being able to get the drug. NAAFA received an anonymous note stating, "I would gladly have to have a heart valve replaced to be a healthier size. I hope the people that took this away... would f***ing die!!!"

Then the legal profession swooped in and the diet drug tragedy turned into a modern day gold rush. By now there are hundreds of individual and class action suits. Lawyers boast that the fen-phen payoff will be bigger than that of the breast implant case. TV and radio ads from law firms solicit diet drug users. And with fen-phen and Redux gone, the diet industry, and a legion of hucksters, already plug replacements. Products called "nature's Prozac" and "herbal phen-fen" are luring consumers, stressing their "natural" origin, as if natural were synonymous with "safe."

This whole circus will go on for years. The diet industry suffered a temporary setback. But it won't cost them nearly enough to back off. Selling the promise of a slimmer figure remains as lucrative as ever. Why would the pharmaceutical industry spend money on finding ways to make fat people healthy when diet drugs sell so much better? It's a totally messed up situation. Size, just like race, age, gender, etc., is a fact of life and not something to justify discrimination and exploitation. When will the world realize that?

Editor at Large