Were Redux and Phen-Fen really so bad?

Factual Questions
1

Compared to say . . . dying of an obesity related disease like adult onset diabetes, cancer, or heart disease?

I took Redux for three months, right before the recall came out. It’s the only time in my life when I actually understood what my skinny friends meant when they said things like 'Oh, I’m just not hungry". It was the first time in my life when food just didn’t matter.

When they recalled Redux, I went back to my doctor, had my heart listened to, was pronounced clean and stopped taking it. Now I’m kind of wondering . . .

It seemed like a decent tool to help me get my weight under control. I understand there’s a chance of heart valve problems after taking it for more than six months, but . . . how bad is that chance compared to the near certainty that my health is going to suck because of my weight.

(And yes, I understand eat less, exercise more. I’m working on it. I just want all the help I can get.)

“I think he said ‘Blessed are the cheesemakers.’”

2

Yes, it’s not a good drug. Some other drugs that work similarly are being looked at. But I would wait.

There are drugs that retain fat.These will give oily stools. You learn to not eat any fatty foods when you are on them.Or stay close to a rest room.

You need to hang in there.This is a big market and there will be new products soon.Don’t trust them all, either.

Very sound advice: avoid fats and carbohydrates together, like french fries. Stick to vegetables, whole grain bread and meats.Avoid sugared pop.This sugar is no good for anyone in this quantity.

Wine and light beer are good options for drinks.

end of lecture

3

I think any “solution” that could destroy your health and even kill you is an unacceptable one, period, end of story.

As you say, however, there are other solutions. HONESTLY, how much of an effort have you REALLY given in regards to implementing them? How much exercise have you gotten in the last week, the last month?
Have you been to a physician?

Sweetheart, we all have problems, and if they were that easy to solve, we wouldn’t have them in the first place :)! Still, potentially life-threatening pills cannot be considered an acceptable alternative to hard work, discipline, and the help of a qualified physician.

So, in short, my answer is, "Yes, it is “so bad”.

4

That’s the standard FDA line, all right. And it’s completely wrong. All medication risks have to be measured in comparison with the risks incurred by not taking the medication.

For instance, let’s say Phen-Phen has a 1/100,000 chance of killing you (and that’s probably close to the actual number since it was in widespread use and there were only a handful of deaths associated with it). Now, if you are overweight to the point where there is a 1/1000 chance that your extra weight will kill you, then taking Phen-Phen CLEARLY improves your chance of a longer life. In other words, it’s risky to NOT take it.

It’s easy to spout platitudes about how all these poor overweight people have to do is exercise and eat right, but clearly it’s not that simple. People in our society have tremedous peer pressure to be thin. Being overweight can mean not getting jobs, not finding a mate, being ridiculed, etc. And yet people are still overweight, even though they may cry themselves to sleep over it every night. Some people go on and off diets all their lives, buy every exercise gizmo on the market, and are still overweight. It just may not be possible for them to change without medical help. If Phen-Phen helps, and their doctors know the risks on both sides of the equation and still prescribe it, they should be allowed to take it.

5

dhanson:

Your sympathy is appreciated, but it is misplaced, I think. (And if it is EMpathy, then i think you need to pay attention.) I agree, having lived with it my entire life, that being overweight sucks righteously and that the way society deals with overwight people blows bigtime.

HOWEVER… the cure is not a pill. Especially not a pill that could blow out your heart before you know about it, never to be repaired, but no pill at all.

Problem is this: pills don’t work. Oh sure, they can keep you from eating until you get thin. But you can’t take them for the rest of your life, and it is virtually GUARANTEED that if you lose weight using a chemical crutch (and I’m referring here to significantly overweight people who have been overweight for a significant amount of time; not the naturally trim who gained weight during pregnancy or something) you will gain it all back and MORE when you give up the crutch. Guaranteed. You have not addressed the underlying problems, both physical and emotional, that led to the weight gain in the first place, AND you have been dicking around with your metabolic rate in the process, screwing it up one more time so that after years of this shit, you may finally find yourself unhooked from food to a large degree, and yet fatter than ever before!

SO, Phouka, while I’m sure it was really nice to be losing weight without too much trouble, the price you would have paid in the end would have been, at the very least, to be fatter than ever before. Really. I’m not just saying this because I’ve been there, although I have, but because millions of others have been there too. My suggestion to you: therapy…to help you deal with the fact that you have lots and lots of issues in your life that make and keep you fat, and lots and lots of issues that result from that fact.

The pills will end up doing you much more harm than good in the end. Please believe me.

This is a non-smoking area. If we see you smoking, we will assume you are on fire and act accordingly.

6

Phen-phen is two different drugs taken in concert.

Only one of them is outlawed.

You can still get the other phen…phenteramine. It can suppress your appetite. Ask your doctor for it.

Contestant #3

7

Was Phen-Fen back in the news recently? I’m guessing yes, based on this OP, plus the fact that my phone’s been ringing off the hook all last week.

Let me explain. My name’s Michael Weintraub. A few years ago, I was a contractor in the Center for Drug Evaluation and Review at the FDA. The head of the division there which “passed” Phen-Fen was also named Michael Weintraub. This led to a lot of confusion, including mail getting mis-sent, e-mail for him was sent to me (and vice versa), and, most importantly: someone screwed up good and listed my home phone number as his office number.

So, not only do I get the occasional call for him, but recently, in the last week or so, a bunch of people have been calling me looking for him. Since we’re both former of the FDA (I left my contract about a month after he retired), I have no means of redirecting the calls.

Anyway, what’s happened recently to prompt these phone calls? One day, I’ll get my PhD, so I can answer to “Dr. Weintraub” when these people call me. One day.

8

Stoidela: Who says you can’t take the drugs for life? There are lots of drugs that you take for life. I don’t know much about Phen-Phen, but was it prescribed only for temporary use?

Anyway, part of the weight problem is also habitual. You think about food more often than normal people, you crave it more often than normal people, and it becomes a very strong psychological addiction. If the Phen-Phen can reduce your cravings and you take it long enough, it should be possible to break the psychological addiction.

Of course you’re right if the problem is physical. My wife is normally very trim, but a few years ago her thyroid gland shut down. Until we figured out what was going on, she gained something like 40 lbs without changing her diet at all. She was finally diagnosed, put on Thyroxin (for life, probably), and shed all the weight and is back to her lifetime normal weight of 125 lbs or so.

I was addressing a larger issue, which is that the FDA tends to use a one-risk-fits-all standard, which damages people on both ends of the risk scale. The notion that you’re an idiot to take a drug simply because a few people have died from it is misguided. Everything we do in life has risk. If you eat a grilled porkchop, you are taken on a cancer risk. A very small one, but a real risk nonetheless (if you ate a grilled porkchop a week, you’d ingest about twice as many carcinogens as if you sat in a smoky bar inhaling second-hand smoke 8 hours a day).

The ‘no risk is acceptable’ mentality has no basis in reality.

9

Well said - bravo.

I have this debate (in real life) all the time. It usually takes two forms, either:

(1) Either society does A, or !A. Doing A causes X deaths/yr, so people argue for !A. However, !A is predicted to cause Y deaths/yr, with Y>X.

(2) Some preventable event A causes X deaths/yr. Under the “if it saves even one life!” argument, people argue for spending some large sum of money to prevent A. However, A is in fact quite rare (X is small), and if the same amount of money was applied to preventable event B instead, it could potentially save Y lives, with Y >> X.

I run into the second one a lot with automotive related issues. I.e, someone hears that 3 people were killed in a MVA by some cause that might have been prevented if the car had been designed differently. So, the argument goes, even though dying from that cause in a motor vehicle crash is rare indeed, GM/Toyota/whatever should have spent 100 million to change it before this point (“no price is to great to save a life”). The trouble is that the same 100 million could be (and maybe was!) spent to improve other factors related to safety that would statistically benefit far more than 3 people per year. Which, even though it might optimize aggregate safety, still leaves GM/Toyota/whatever open to huge lawsuits by relatives of those 3 people, because, yes, whatever killed them could have been prevented.

Until everything is perfectly safe all the time, the old “if it saves even one life!” argument can always be used. The problem is that it can be used in any situation and thus conveys no information about what actually should be done, given limited resources.

–
peas on earth

10

I should amend my opening post by adding that:

  • I am considered medically obese. That is, I am more than 100 pounds over my ideal body weight. Every person I mention this to is honestly surprised, so all I can think is that I carry it well, but that weight does have an effect on my health no matter how well I carry it.

  • I am emphatically NOT looking for a magic bullet. I understand and agree that to lose weight permanently requires a complete lifestyle change of eating better and less and exercising more. However, I am looking for whatever help I can get to make that change.

  • I accept full responsibility for my own weight and bad health. As far as I can tell, it’s a combination of really lousy eating habits, poor exercise, genetics (I have the same shape as my grandmother, and she ended up weighing 300 lbs before she died), and a hormonal imbalance that may be genetically related (I have a condition known as Polycystic Ovaries, which results in - among other things - a tendency towards obesity and great difficulty in losing weight).

I took Redux for three months. I don’t like taking medication, but Redux made the difference between me trying to lose weight and failing and losing weight successfully. I’m not sure how it worked. All I know is that for the first time in my life, food was a non-issue. I finally understood the perspective my non-obese friends had when they could take or leave any particular food. All of a sudden, I had the detachment to make healthy decisions about eating that I had lacked before hand.

It was as powerful a difference as that between a healthy person and someone with clinical depression (which, yes, I’ve experienced as well). All I can think is that there is some aspect of brain chemistry that is different between my friends and I. I don’t know if it’s inherent, or if it’s something I’ve gotten stuck with after fifteen years of accumulated bad eating. Whatever it is, I sure would like something to help me deal with it.

Crutches help people walk when they would otherwise be unable to. Some people have to be on crutches for their entire life, some people only need it for a little while. I would at least like the chance to see if this particular crutch can help me - temporarily or permanently.

11

A new study indicates that the drug combo might not be linked to heart damage after all. Check this news story out: http://abcnews.go.com/sections/living/DailyNews/fenphen990930.html

12

Phouka:

Please believe me when I tell you I KNOW your struggle. Intimately and with perfect empathy. I’ve been in it for 30 years.

The problem with the chemical crutch is that unlike a real crutch, the “injury” (your compulsive eating) does not heal! You are looking at the fat as the injury, when it is merely the symptom. You can make the symptom go away temporarily, but the injury remains, usually worse than before.

Think of it like a football player with a busted ankle…the team doc shoots his ankle full of Novacain…the symptom of pain is removed for awhile, so he goes out and plays. When the Novacaine wears off, his ankle is in WORSE shape than it was before, the chemical mask worsened his injury! Diet drugs are the same thing, and anyone who has done or studied the research on it will tell you the same thing.

I don’t know how old you are or how much dieting you’ve done, but it’s pretty much accepted at this point that serious, morbid obesity (which you and I suffer from) is extremely uncommon EXCEPT for the United States. Why? Because we get a little chubby, and diet like maniacs, binge and gain, starve some more, binge some more…the net effect is that you end up fatter than you ever would have been had you never starved yourself in the first place. Because they have no effect on the underlying problem, diet drugs just enable you to drop alot of weight easily and wuickly, then dump you back on the tarmac of your problem and walk away. When you get up, you find you are STILL addicted to food just as much as you ever were, you binge, you gain. Meanwhile, your metabolism is flipping out…starve, gorge, starve, gorge. Your body will become more and more efficient at getting and keeping fat. You will turn around one day and find tha tyouare 200 pounds overweight instead of 100.

PLEASE…I know how much we all want that easy solution, and we rationalize that it will help us learn how to be different. But it makes about as much sense as saying “if I hangglide every day for a year, maybe I’ll sprout wings and learn to fly on my own!” You may understand the sensation of birds when they fly (read:thin people who have no issues with food), but that doesn’t mean you’ll become one.

There is NO evidence WHATSOEVER that drugs “help” compulsive overeaters CHANGE. There is LOADS of evidence that they help you get FATTER.

Please…I’m sharing this with you because I want to spare you the wasted years…you need both emotional therapy, and behavioral therapy. You need to address the reasons for the eating, and get real, useful tools to help you alter your behavior. You CAN do it.

I really, sincerely, wish you all the luck in the world.

PS: TIPS:
Set realistic goals for yourself. It sounds like you have alot of factors at work keeping you heavy…don’t dream of being Calista Flockhart. Think HEALTH first. Take small chunks: “My goal, my ONLY goal right now is to lose 5 pounds. Period. I won’t think about anything else.” Get in touch with your body, how you feel. Listen to it. LOVE YOURSELF.

There is an author that I think can really help you, her name is Geneen (sp?) Roth.
Breaking Free from Compulsive Eating – Geneen Roth; Paperback
When You Eat at the Refrigerator, Pull Up a Chair : 50 Ways to Feel
Thin, Gorgeous, and Happy (When You Feel Anything But) – Geneen
Roth, et al; Paperback
Why Weight? : A Guide to Ending Compulsive Eating – Geneen Roth;
Paperback

She has really great things to say…

Good luck.

This is a non-smoking area. If we see you smoking, we will assume you are on fire and act accordingly.

13

Stoidela: My wife works with eating disordered patients, and follows the literature religiously. She says that the yo-yo dieting effect you are speaking of has being thoroughly debunked. Going on and off a diet will not change your metabolism and make you more prone to gain weight.

What may happen is that the dieting focuses more of your attention on food, so that when you go off the diet you binge more, ingesting more calories on average than you did before the diet. That’s why drugs like Phen-Phen may help, because they take your focus off the food.

When you are on a diet, food assumes a bigger and bigger role in your life. You think about it all the time, crave it, etc. If you diet with Phen Phen, the opposite happens - you realize that food isn’t as important as you thought it was.

Your analogy with painkillers allowing someone to run on a damaged foot is wrong. That is a case of the medication actually helping you to promote a physical injury. In the case of being overweight, it is the weight itself that is physically damaging, and not the compulsions that make you gain it. By removing the weight you improve your health.

I’m still not convinced that Phen Phen needs to be a temporary solution. Similar drugs like Dexedrine and Ritalin are prescribed to people with ADD and Narcolepsy, and they are typically prescribed for life. I see no reason why an overweight person couldn’t keep his or her weight under control through continuous use of such drugs. Or, like ADD, the overweight person may find that after a year or two of having normal habits enforced by the drug they can maintain those habits without it. Time heals all wounds and all psychological compulsions. Phen-Phen may give you that time.