Selling "obesity" hysteria

Paul Ernsberger, Ph.D. of Case Western Reserve Medical School gave me permission to share the following perspective on the etiology of "obesity" hysteria, which he posted on a private egroup for fat studies scholars:

I trace the onset of the the current medical war on obesity to the marketing blitz for fenfluramine, dexfenfluramine and phen-fen. These drugs created a network of 4 drug companies to promote pills that caused only a small amount of weight loss. The only way to get physicians to prescribe dangerous drugs that cause minor weight loss was to exaggerate the health risks of high weight. They created a speakers' bureau and they sent famous obesity warriors all over the country to "educate" physicians about the "dangers of obesity." These included all the usual suspects, whose careers were tremendously advanced by these lecture tours. The traveling lecturers (really propagandists) also came to dominate the talking heads on TV whenever a fat-related news story appeared.

The companies also sponsored "symposia" where speaker after speaker (most of them diet clinic directors) hammered on the epidemiology supporting a link between obesity and ill health. I attended many of these. As far as I recall, they never asked an epidemiologist to speak about epidemiology. These symposia took place at major medical conferences, and to draw a large crowd to fill the ballroom they included (very fattening) full dinner and often an open bar as well. No expense was spared. The odds are good that your personal physician or perhaps a senior physician that he or she trusts has been to one of these one-sided "symposia."

Because of FDA rules, companies are not allowed to promote drugs that are not yet approved. So how do they advance promotion legally? By promoting the indication. The makers of subutramine and orlistat started sponsoring symposia promoting a hysterical view of obesity years before they won FDA approval.

There you have it: a first-person account of the tactics used to sell the concept of obesity as a horrible, life-threatening disease, which in turn would obstensibly justify the prescription of medications with dangeous side effects. (Read Alicia Mundy's Dispensing With the Truth for a closehand look at this in regards to the diet-pill combo of phen-fen).

I doubt this process is limited to the selling of "obesity," by the way. Ernsberger's remark about epidemiologists not being asked (or paid) to speak about epidemiology at these industry-produced "symposia" reminds me of a meeting of a local health professionals' association I attended in Nashville, TN several years ago.

The meeting was held at an expensive restaurant and sponsored by a drug company, which provided free appetizers and meals to the physicians and psychologists in attendance. I arrived too late for the lobster appetizers, but my steak dinner was delicious.

The drug company also provided a physician who gave a 30-minute Powerpoint presentation on depression and the treatment of depression. Not once in the presentation did this physician mention psychotherapy, counseling, or any other non-pharmaceutical "treatment" of depression.

The physician who presented this unbalanced perspective was a gynecologist. Gynecologists, like other non-psychiatrist physicians, get about six weeks' worth of training in "mental health" issues in medical school. I wonder if a psychiatrist would have felt obligated to include non-pharmaceutical perspectives on depression. Possibly not, since psychiatric education has become almost entirely biologically oriented over the past couple of decades.

Ernsberger's quote above was posted in response to a post I made about the book Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients (Ray Moynihan & Alan Cassels). That book contains a section on a New York ad agency staffer whose job was to work with drug companies to create new diseases (or rather the concept of new diseases) that could be marketed to the public in order to sell them the "solutions." I almost wrote "cures," but the goal really was/is to develop lifelong consumers of the product, not "cure" anything.

Selling Sickness opens with an anecdote about the former CEO of Merck saying (one might think almost wisfully) in an interview 30 years ago that what he really wanted was to be able to sell drugs to healthy people--vastly increasing his potential market. As Cassels and Moynihan noted, his dream has come true.