Archive for the “Bad Medicine” Category

I received an interesting email from the American Diabetes Association more than a week ago, but I saved it until today because I’m reasonably sure it’s intended to be an April Fools’ joke.  Here it is, with my comments:

Dear ,

Yup, that’s an exact quote.  No name after Dear , just a space for my name should I care to insert it.

Our country is headed down a costly, and dangerous, path – leading to 1 in 3 adults having diabetes by 2050.  However, you can act to change that, and it only takes a minute!

Well, I’m a pretty busy guy, so I don’t know if I have can spare a full minute to save the country from diabetes.  But okay, I’ll keep reading.

Congress needs to know that the cost of diabetes to our nation – over $245 billion a year – is unacceptable.

Congress needs to know having nearly 26 million Americans with diabetes and 79 million more with prediabetes is unacceptable.

Congress needs to know that inaction is unacceptable.

So that’s why we have so many diabetics these days – not enough action by Congress.  Back when diabetes rates were a fraction of what they are today, Congress must’ve been all over the issue.  I suppose my daughters will eventually endure a history lesson in school explaining how diabetes was low during the Great Depression because of a New Deal program that was later canceled by Ronald Reagan, leading to the current epidemic of diabetes.

(Sara was recently taught that the New Deal lifted the United States out of the Great Depression.  She asked my opinion on that lesson, which led to one of those heart-to-heart conversations she’ll remember fondly when I’m gone.)

Can I count on you to take just one minute and act now?

The letter was signed by someone whose official position at the ADA is National Advocacy Committee Chair.

Now, I have nothing against advocacy per se.  I consider myself a health advocate.  But when I come across the words advocate or advocacy in an organization’s name or a person’s title, little alarm bells go off in my head … because it usually turns out that advocacy translates to trying to get Congress to spend a shootload of the taxpayers’ money on our cause.

So I clicked the COUNT ME IN! link in the email and ended up at a page with the headline Tell Congress to take action to Stop Diabetes! Here’s some of the text:

Some Members of Congress want to derail ongoing diabetes research and undermine proven prevention efforts despite the fact a staggering 100+ million Americans either have or are at risk of developing diabetes.

So let me wrap my head around this:  1) we have proven prevention efforts, but 2) diabetes rates are through the roof.  Those proven prevention efforts must not be working out so well.  And if we already know what the proven prevention methods are, what’s the big concern with derailing diabetes research?  Sounds as if the ADA has it all figured out already.

We must act now – Congress is in the process of making crucial budget decisions about vitally important diabetes research and prevention programs.

Send an email and urge your Members of Congress to support funding for diabetes research and prevention and add your voice to those of Diabetes Advocates who will be in Washington, D.C. next week for our Capitol Hill Advocacy Day.

Translation:  Yes, we receive a ton of funding from the makers of food-like products consisting largely of sugars and grains – but it’s not enough.  TELL CONGRESS TO GIVE US MORE OF YOUR MONEY!

Your email will have more impact if you personalize it, so please take a moment to explain the impact diabetes has had on your life.

Diabetes hasn’t had an impact on my life because I ignore the ADA’s advice.  Well, okay, that’s not entirely true.  One of my relatives who’s a type 2 diabetic recently went into the hospital and was served pancakes and syrup for breakfast.  Then an obese dietician stopped by to tell him to follow the ADA guidelines and eat plenty of carbohydrates while avoiding fat.  That made me really, really mad.  So I guess that had an impact on me.  My cortisol levels went up for awhile.

Just so we don’t personalize that email to Congress too much, the ADA was kind enough to write most of it for us:

Dear [Decision Maker],

As your constituent, I stand with the American Diabetes Association in urging you to support funding for diabetes research and prevention programs.

A 2013 study showed that diagnosed diabetes cost our country $245 billion in 2012 alone, up 41% from 2007. Nearly 26 million Americans have diabetes and another 79 million have prediabetes. Our country is facing a diabetes epidemic and we need a stronger federal investment in diabetes research and public health initiatives.

And remember, Congressperson, if we spend the money now, it will save money in the long run! (Everyone who wants to spend taxpayer money uses that line.  That’s why we’re awash in government budget surpluses these days– all that federal investment during the last 40 years that saved money in the long run.)

I urge you to request the following actions of the Appropriations Committee:

Allocate $2.066 billion for the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the primary federal agency that conducts research to find a cure and advance treatments for diabetes.

Provide $137.3 million for the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation (DDT) whose mission is to eliminate the preventable burden of diabetes through research, education, and by translating science into clinical practice.

So now I’m picturing my representative receiving this email from me and thinking to herself, “Man, this ordinary citizen is really specific in his demands for appropriations … exactly $2.066 billion for NIH, exactly $137.3 million for CDC … he must have really done his research to come up with those figures.”

The annual costs of diabetes will continue to skyrocket unless we invest in stopping the spread of diabetes and finding a cure. If Congress does not take action, diabetes will overwhelm the healthcare system with tragic consequences for all Americans.

Yes, the cost of diabetes could indeed overwhelm the healthcare system.  I don’t care if we’re talking about private insurance, Medicare, ObamaCare, or all of the above; when a third of population is diabetic or pre-diabetic, we’re going to run up medical costs we can’t afford to pay without sinking the rest of the economy.  No method of payment will solve that, because no method of payment will generate wealth that doesn’t exist.

But I’m pretty sure getting the federal government more involved isn’t going to avert this disaster by fixing the diabetes epidemic.  In fact, I’m reasonably sure federal involvement in the food-production and dietary-advice business is part of what got us here in the first place – along with helpful advice from the ADA, which still tells people to avoid saturated fat and eat plenty of whole grains.

Happy April Fools’ Day, ADA.  Thanks for the laughs.

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As I’m sure many of you know, a large new study concluded that saturated fat doesn’t cause heart disease.  Here’s a quote from one of the many media articles about the study:

Many of us have long been told that saturated fat, the type found in meat, butter and cheese, causes heart disease. But a large and exhaustive new analysis by a team of international scientists found no evidence that eating saturated fat increased heart attacks and other cardiac events.

For decades, health officials have urged the public to avoid saturated fat as much as possible, saying it should be replaced with the unsaturated fats in foods like nuts, fish, seeds and vegetable oils.

But the new research, published on Monday in the journal Annals of Internal Medicine, did not find that people who ate higher levels of saturated fat had more heart disease than those who ate less. Nor did it find less disease in those eating higher amounts of unsaturated fat, including monounsaturated fat like olive oil or polyunsaturated fat like corn oil.

This ought to drive a stake through the heart of the Lipid Hypothesis, but it won’t.  Here’s part of a blog post by Dr. Malcolm Kendrick, offering his prediction:

You see, the entire edifice of the cholesterol hypothesis is held together by two links in a chain. Link one is that saturated fat consumption raises cholesterol levels. Link two is that raised cholesterol levels then cause heart disease.

This is the cholesterol hypothesis, or the lipid hypothesis, and it has driven medical thinking for the last sixty years.

I have had it painstakingly explained to me, by very clever people, exactly how saturated fat raises cholesterol levels. Indeed, you will find ‘evidence’ for this almost universally accepted fact in literally thousands of clinical studies.

Okay, let us accept that eating saturated fat does raise cholesterol levels. However, if consumption of saturated fat does not increase the rate of heart disease then …. Then raised cholesterol levels can have nothing whatsoever to do with causing heart disease. Just keep chasing the implications of that statement around in your head for a while.

So what happens now? We now have a cholesterol/lipid hypothesis that just had its head blown off. Yet, it still continues to wander about, unaware that it is actually dead… I suspect it will continue to rampage about, stomping on puny humans for many years, before it finally keels over and admits that it is dead.

The cholesterol hypothesis is not only blissfully unaware of its demise, its proponents are pushing harder than ever to beat down everyone’s cholesterol levels.  Take a look at the latest news on guidelines for prescribing statins:

The new American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for the treatment of cholesterol would increase the number of individuals eligible for statin therapy by nearly 13 million people, an increase that is largely driven by older patients and treating individuals without cardiovascular disease, according to a new analysis.

Awesome.  So we’d be giving statins to more older people (the group least likely to benefit from statins) and people who don’t have heart disease (the other group least likely to benefit from statins).  Makes perfect sense.  I don’t have cancer, but I’m considering signing up for chemotherapy just in case.

Among older adults, those aged 60 to 75 years old, 87.4% of men would now be eligible for the lipid-lowering medication, which is up from one-third under the old Adult Treatment Panel (ATP) III guidelines. For women of the same age, the percentage of those now eligible for statins would increase from 21.2% under ATP III to 53.6% with the new 2013 clinical guidelines.

Headline from the future:  Doctors baffled by sharp rise in Alzheimer’s, arthritis among elderly.

The increase, say investigators, is the result of more patients being eligible based on their 10-year risk of cardiovascular disease.

Yeah, that must be it.  It couldn’t be the result of a desire to sell more statins.

The new guidelines identify four groups of primary- and secondary-prevention patients for physicians to focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate “intensity” of statin therapy in achieving relative reductions in LDL cholesterol.

These four groups include individuals with clinical atherosclerotic cardiovascular disease, individuals with LDL-cholesterol levels >190 mg/dL, diabetic patients without cardiovascular disease aged 40 to 75 years old with LDL-cholesterol levels between 70 and 189 mg/dL, and those without evidence of cardiovascular disease, an LDL cholesterol level 70–189 mg/dL, and a 10-year risk of atherosclerotic cardiovascular disease >7.5%.

In other words, resistance is futile.  Almost everyone needs to take statins at some point.  Go get yours before the Christmas rush.

Let’s suppose that statins do prevent heart attacks in some people … say, middle-aged men already known to have heart disease.  Does that make statins the best possible treatment?  I hardly think so.  Take a look of part of an article reporting on a comparison of statins vs. fish oil:

A clinical trial reported in the Archives of Internal Medicine compared people who took statin drugs with those who just took fish oil capsules.  Both these groups were compared to a control group that took a placebo.  The statin group decreased mortality by 10% over the placebo group; however, the fish oil group decreased mortality by 23% over the placebo group.  In other words, the participants who took the fish oil capsules had over twice the health benefit of those who took the statin drugs.

Hmmm, statins or fish oil … tough choice.  Statins cause muscle pain, joint pain, mitochondrial damage, liver damage and cognitive impairment.  By contrast, here’s what WebMD has to say about omega-3 fatty acids, the type of fats found in fish oil:

Hundreds of studies suggest that omega-3s may provide some benefits to a wide range of diseases: cancer, asthma, depression, cardiovascular disease, ADHD, and autoimmune diseases, such as rheumatoid arthritis.

And I’m guessing fish oil probably won’t turn you stupid and make your joints hurt.  The trouble is, nobody’s going to rake in $30 billion per year from fish-oil tablets or wild-caught salmon.  As far as I know, you can’t patent a fish — although it wouldn’t surprise me to learn Monsanto has tried patenting a laboratory salmon that can’t reproduce.

The cholesterol hypothesis has indeed had its head blown off, but I agree with Dr. Kendrick:  it will continue to stomp us tiny humans for years, or at least until nobody’s making a hefty profit selling cholesterol-lowering drugs.

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Dr. Malcolm Kendrick plugged his data into that new risk calculator developed by the American Heart Association and the American College of Cardiologists and discovered that he’s overdue to begin statin therapy.  As he reported on his blog:

I now find that I should have started statins eight weeks ago. Naughty, naughty, me. My blood pressure was a bit higher than the calculator liked 138/82, my cholesterol quite a bit higher at 6.0mmol/l.

Which means that I have already passed the 7.5% ten year risk score. O….M…..G. (I think my picture makes me look a bit younger than I am, although it was only taken last year – honest.)

What to do?  I am now well beyond my ‘Statin by date.’ No longer can I be healthy without taking a statin.

Can I be reassured that my parents are both alive and healthy in their late eighties? My grandmother, on my mother’s side, lived to one hundred and two.

You can read the rest here, and I suggest you do if you enjoy a good laugh.

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Dear American Heart Association and American College of Cardiology:

I’m writing to thank you for issuing your new expanded guidelines on prescribing statins.  I must admit, I was hopping mad when I first read about them.  I mean seriously, we’re talking about a drug with lots of nasty side-effects that prevents maybe one heart attack (not necessarily one death) for every 100 people who take it – and that’s only for men who already have heart disease.   So you can understand my anger when I read paragraphs like these in an online article by New York Post:

The nation’s first new guidelines in a decade for preventing heart attacks and strokes call for twice as many Americans — one-third of all adults — to consider taking cholesterol-lowering statin drugs.

The guidelines, issued Tuesday by the American Heart Association and American College of Cardiology, are a big change. They offer doctors a new formula for estimating a patient’s risk that includes many factors besides a high cholesterol level, the main focus now. The formula includes age, gender, race and factors such as whether someone smokes.

“The emphasis is to try to treat more appropriately,” said Dr. Neil Stone, the Northwestern University doctor who headed the cholesterol guideline panel. “We’re going to give statins to those who are the most likely to benefit.”

Well heck, you guys, I knew even before I continued reading that “treat more appropriately” would somehow translate to “give statins to even more people.”  And you didn’t disappoint me:

Doctors say the new approach will limit how many people with low heart risks are put on statins simply because of a cholesterol number. Yet under the new advice, 33 million Americans — 44 percent of men and 22 percent of women — would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for only about 15 percent of adults.

Only about 15 percent of adults may not sound like much, but as you and I both know, that’s only because adults includes people in their twenties and thirties.  One-fourth of American adults over the age of 45 are already taking statins, and since I read elsewhere that the new guidelines could double the number of statin-takers, I figure that means your long-term goal is to sell statins to at least half of the over-45 population.  We all know why:

Roughly half the cholesterol panel members have financial ties to makers of heart drugs, but panel leaders said no one with industry connections could vote on the recommendations.

“It is practically impossible to find a large group of outside experts in the field who have no relationships to industry,” said Dr. George Mensah of the heart institute. He called the guidelines “a very important step forward” based on solid evidence, and said the public should trust them.

Riiiiiight, we should all trust the panel of experts who have financial ties to statin-makers.  I’ll rank that one right up there with “Read my lips – no new taxes!” and “If you like your current healthcare plan, you can keep it – period!”  If any of you members of the panel ever decide to give up medicine, you should seriously consider running for office.

Anyway, as if I weren’t already suspicious enough of the new guidelines, I read these tidbits in a New York Times article online:

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

Mistakenly suggest? Heh-heh-heh … as we programmers like to say, “That’s not a bug.  That’s a feature.”

The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal. The professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the problems a year earlier when the National Institutes of Health’s National Heart, Lung, and Blood Institute, which originally was developing the guidelines, sent a draft to each professor independently to review.

This week, after they saw the guidelines and the calculator, Dr. Ridker and Dr. Cook evaluated it using three large studies that involved thousands of people and continued for at least a decade. They knew the subjects’ characteristics at the start — their ages, whether they smoked, their cholesterol levels, their blood pressures. Then they asked how many had heart attacks or strokes in the next 10 years and how many would the risk calculator predict.  The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population.

On Saturday night, members of the association and the college of cardiology held a hastily called closed-door meeting with Dr. Ridker, who directs the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston. He showed them his data and pointed out the problem. On Sunday, officials from the organizations struggled with how to respond.

Here’s how I’d suggest you respond:

“What we said was that if you like your insurance, you can keep your insurance, period, as long as it meets certain conditions we’ll write into the law later.  And besides, it wasn’t the law we passed that canceled your insurance; it was your insurance company.  And we actually did you a favor by passing a law that canceled your insurance because your insurance was substandard.  But even though it wasn’t the law we passed that canceled your lousy insurance and we actually did you a favor by canceling your lousy insurance, we’re now going to fix the law we passed that didn’t cancel your lousy insurance so you can keep your lousy insurance for another year.”

Wait … sorry.  That was my advice to someone else who got caught lying.  In your case, I’d suggest going with something like “Dr. Ridker’s study subjects didn’t have nearly as many heart attacks as our risk calculator predicted because he accidentally studied unusually healthy people.”

The chairmen of the guidelines panel said they believed the three populations Dr. Ridker and Dr. Cook examined were unusually healthy and so their heart attack and stroke rates might be lower than expected.

Good work.

Anyway, the New York Times article goes on to explain that under the new guidelines, “your average healthy Joe” would end up being told to take statins.  And that’s why, in spite of my initial anger over your brazen attempt to sell more statins, I’m now writing to thank you.

What prompted my change of heart (pun intended) was receiving an email from someone who liked one of my old blog posts – the one in which I thanked the USDA for giving my kids a competitive advantage in life by ordering schools to serve crappy grain-based meals to the other kids and thus suppress their brain development.  That in turn got me thinking about the movie Idiocracy, in which a soldier with an average IQ participates in a botched experiment and wakes up hundreds of years later to discover that he’s now the smartest guy on the planet.

That’s when I realized how much your new guidelines will benefit me personally.  You see, as a software programmer, I’m what’s known as a “knowledge worker.”   My livelihood depends entirely on my ability to memorize, conceptualize, and think my way through complex problems.  In my field, experience is considered a major asset, largely because solving a software problem often involves recalling how we solved a similar problem in the past.  It’s no coincidence that most of the other programmers I work with are in their 40s or 50s.

So as I was chuckling to myself about a couple of the scenes in Idiocracy, it occurred to me:  How much more valuable would I be if my fellow programmers all started taking statins and became a bit stupid?  Give them a few years on a high dose of Lipitor, and I daresay I could triple my billing rate.  I’d be the only one remaining with enough cognitive ability to tackle the really tough assignments.

I could probably even get away with relaxing my programming standards.  Since I’m not a government contractor, I test and test and test the software I design before rolling it out – partly because I’m persnickety by nature, but largely because in private industries, people who launch mission-critical software systems that crash and burn tend to get fired.  But if your new treatment guidelines convince everyone over age 45 to start taking statins, I’m pretty sure I could avoid the blame for any lousy software I created.  I suspect the conversations would go something like this:

“Naughton!”

“Yes, boss?”

“The foreign incoming royalties module of the payment distribution system keeps crashing!  Did you write that module?”

“Well, I … uh … No, sir.  It was Crockett.”

“Crockett!”

“Yes, sir?”

“Did you write the foreign incoming royalties module?”

“Uh … I don’t remember.  Maybe.”

“Well, fix it!”

“But I don’t remember the logic.”

“Well, damnit, get Naughton to help you.”

“If I’m going to help Crockett fix the mess he made, I’m going to need another bump in my billing rate.”

“Yeah, yeah, okay.  Just promise you won’t quit.”

So while I know providing me with job security wasn’t your intention, I’m grateful nonetheless.

By the way, would it be possible for you to convince the federal government to subsidize statins and provide them to needy people in the developing world, sort of like the USDA does with grains?  It would be awesome to know I won’t lose my programming gig to some guy in India.

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Here’s part two of the ABC Catalyst documentary Heart of the Matter, which examines the iffy science behind The Lipid Hypothesis. This episode examines the problems with statins … and it’s so well done, I tweeted the producer and suggested she avoid dark alleys for awhile.

The show was immediately blasted by statin-pushers who warned that people may be frightened into giving up their statins – and DIE AS A RESULT!

Yes, if people stopped taking statins, that could be disastrous … for the pharmaceutical companies.  After all, we’re not just talking about $30 billion in profits from statins; we’re also talking about lord-only-knows how many prescriptions for painkillers, diabetes medications, memory-loss treatments and erectile-dysfunction pills that doctors hand out to treat the side-effects of taking statins.

I’ve seen those effects up close and personal.  My mom ended up taking painkillers for the joint and muscle pains she experienced while on statins — two drugs for one non-existent problem.  (Her cholesterol was a whopping 220 or thereabouts.)  Her doctor, of course, never connected the muscle pain to the statins.  I did, after reading Dr. Malcolm Kendrick’s terrific book The Great Cholesterol Con.

My dad, who was on a high dose of Lipitor for two decades, started having occasional episodes of profound confusion and temporary memory loss in his early 60s (not much older than I am now), became increasingly confused in his late 60s, and was diagnosed with full-blown Alzheimer’s by age 72.  I can’t prove the Lipitor caused his condition, but knowing what I know now, let’s just say I don’t think we’re looking at a coincidence.  As far as I’m concerned, that @#$%ing drug robbed him of the chance to enjoy his retirement, work on his golf game, travel with my mom, see my girls grow up, etc.

Fortunately, we’ve been seeing more media articles about these “wonder drugs” over the past few years, as I’ve reported in previous posts.  Here’s a quote from an article in the Pacific Standard:

Dr. Greg Burns (not his real name) is a 72-year-old retired radiologist living in Connecticut. Until early last year, he ran with his dog at canine agility meets, skied, ice skated and played 18 holes of golf. He is now unable to walk and is taking a course of medication that will postpone, by a few months, his death.

Burns’ rapid decline began in December 2007 when he suffered a short-acting stroke from which he fully recovered.

His cholesterol level was elevated and so as a preventative measure his doctor prescribed a 20mg daily dose of Crestor, a cholesterol-lowering drug in the “statin” class. Statin drugs are designed to inhibit cholesterol synthesis, and about 20 million people are taking statins, most for life.

A few months after beginning Crestor, Burns developed muscle cramps. He was assured by his doctors that these were not serious side effects of taking the drug. But in December 2008 when tests showed that his creatine phosphokinase — an enzyme that is released into the blood stream when muscle cells are damaged — was elevated, Dr. Burns stopped taking Crestor. When his enzyme levels returned to normal, he began taking Pravachol, another statin drug. He quickly developed weakness in his lower legs and a right foot drop. In January 2010, following an extensive neurological exam, Dr. Kevin Felice at The Hospital for Special Care in New Britain, Conn., diagnosed Burns as having amyotrophic lateral sclerosis or ALS, commonly known as Lou Gehrig’s Disease.

And another quote from TIME magazine:

Doctors say the majority of current statin users are healthy people who don’t have heart disease but who, like Segal, simply have high cholesterol. Use among this group, known as the primary prevention population, has made these drugs one of the world’s best-selling classes.

But Segal’s statin ended up preventing her from living a heart-healthy lifestyle. A month after she started taking the drug, she suffered muscle pain so severe, she had to stop all physical activity and was unable to sleep at night. Although her husband, who was worried about her risk of heart attack, pleaded with her to stay on the drug, she discontinued using it. The muscle pain receded. “My husband was scared for me. Doctors scare you. But I was in so much pain, I told him I would have rather died than stay on them,” says Segal.

That grim situation could have been avoided, researchers say. An estimated 12 million American women are routinely prescribed statins, which carry a risk of serious side effects. Yet there is little evidence that they prevent heart disease in women.

Even the FDA is finally admitting statins can have nasty side-effects:

Federal health officials on Tuesday added new safety alerts to the prescribing information for statins, the cholesterol-reducing medications that are among the most widely prescribed drugs in the world, citing rare risks of memory loss, diabetes and muscle pain.

It is the first time that the Food and Drug Administration has officially linked statin use with cognitive problems like forgetfulness and confusion, although some patients have reported such problems for years.

Those are newspaper and magazine articles.  I’m not sure how many people have read them.  Like it or not, a lot of people get most of their information from their television sets.  That’s why I’m delighted to see a TV network taking a shot at statins.  Now let’s hope some U.S. networks do likewise – but with all the pharmaceutical ads on TV these days, I’m not holding my breath.

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I was a guest on the Sun News Network in Canada this morning, talking about the American Medical Association’s decision to classify obesity as a disease – not as a marker of disease, but as a disease in and of itself.  (That will come as a shock to the many obese people who live into their 80s and 90s while suffering from the disease – and yes, that happens.)

Obesity is not a disease. Obesity correlates with disease because the main drivers of many diseases – chronically elevated glucose and insulin levels – can also make you fat. But lots of obese people are healthy in spite of being fat, and lots of lean people are unhealthy. I mentioned awhile back that a small, lean co-worker asked me to look at his latest lab tests. His HDL was abysmally low and his triglycerides were way too high. Meanwhile, back when I was still classified as “obese” with 31% bodyfat, my HDL was high and my triglycerides were low. My lean co-worker is at much greater risk of dropping dead than I was back in my “obese” days.

As for why the AMA decided to classify obesity as a disease, Dr. William Davis already spelled it nicely out on his Wheat Belly Blog, so I’ll just quote him:

Well, it’s hard to know how the internal discussions at the AMA went until we get a look at the transcripts. But let’s take a look at the Obesity Action Coalition (OAC). I believe it tells the whole story.

The OAC Board of Directors is filled with bariatric surgeons, such as Drs. Titus Duncan and Lloyd Stegemann, people who make a living from procedures and surgeries like gastric bypass and lap-band. The largest contributors to the OAC? Eisai Pharmaceuticals, maker of BELVIQ, the new drug for weight loss; Ethicon EndoSurgery, makers of laparoscopic operating room supplies; Vivus, Inc., another obesity drug maker; the American Society for Bariatric Surgeons; and Orexigen, developer of the combination drug naltrexone-buproprion for weight loss, now in FDA application stage. (Recall that naltrexone is the opiate blocking drug taken by heroin addicts but now being proposed to be gain approval for weight loss.)

In other words, while it is being cast as something being done for the public good, the motivation is more likely to be … money: Bariatric surgeons gain by expanding the market for their procedures to patients who previously did not have insurance coverage for this “non-disease”; operating room supply manufacturers will sell more equipment for the dramatically increased number of surgical procedures; obesity drug manufacturers will have the clout to pressure health insurers to cover the drugs for this new disease.

As always, follow the money.

Over the weekend, I dug out the original footage from my Fat Head interview with Dr. Eric Oliver, author of Fat Politics, and put together a sequence of clips addressing the topic of obesity and disease. He told me back in 2008 that insurance coverage for weight-loss drugs and procedures was behind the push to label obesity itself as a disease.  Looks like that push is working.

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