Dr John M

cardiac electrophysiologist, cyclist, learner

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Medical innovation cannot cure fatness…

August 1, 2010 By Dr John

Possessing great intelligence is not a guarantee for being right.

Judges and professors are surely smart, but the quagmire that is the obesity epidemic can fell the smartest of the smart.  So it is when a professor of public policy and a famous federal circuit judge, author and senior lecturer at the University of Chicago wax prophetically on the topic of obesity in America.

In an opinion piece in Saturday’s WSJ, these two academics correctly point out many important truisms on the obesity problem.  As they eloquently say, society has advanced to the point that regular life burns fewer calories.  That’s obvious.  Not only do people burn fewer calories at work, as they argue, but more importantly, except in health oases like Boulder Co or Bend Or, suburbia makes it challenging to safely commute anywhere without an automobile.  In my representative middle American city it would be unsafe for me to ride or walk to work.  Likewise, my child could not walk or ride safely to school.

On the other side of the obesity equation (the calorie intake side), they also correctly point to the decreasing costs of high calorie food.  Correct again.  The middle of the grocery store–that portion of the store with the highest amount of high fructose corn syrup and inflammatory trans-fat–is increasingly less expensive.  The dollar/calorie ratio is clearly decreasing.

Furthermore, in pointing out the obvious observation: as education on the importance of diet and exercise in controlling obesity has increased, so has the weight of Americans, they argue correctly that lack of knowledge is not the problem.  America knows about obesity.

They also debunk the simplistic myth that taxing junk food will help; as taxing over-indulgence in calories is impossible.

So far, so good.  The professor and the judge are three for three.  But in the last inning of the close game, where it really matters, they strike out with the bases loaded.  I had to read their conclusions numerous times, as it was with great disbelief that such a cogent piece from incredible minds could conclude in such wrongness.

After all their rightness, the professor and the judge conclude that medical innovation may be the most promising solution to the obesity problem.  They make two outrageous conclusions.  (Not counting the false analogy that obesity-related behavior is like HIV-related behavior.)  
  • They argue that medical research will devise a way to minimize the effects of obesity.  Their words speak for themselves.
  • True, if R&D led to better treatment or even prevention of the diseases that obesity gives rise to or exacerbates, including heart disease, joint problems, surgical complications, and especially diabetes, this would reduce the incentive to lose weight. But if most of the adverse health consequences of obesity were eliminated, obesity would cease to be an issue, except perhaps from an aesthetic or emotional standpoint.

  • To illustrate medical innovation, they cite the example of Vivus’s obesity wonder-pill, Qnexa (they misspelled it ‘Onexa’).  Yet, two weeks ago, an FDA panel of experts recommended against approving this pill.   It seems “instant willpower” in a pill comes with the potential for depression, arrhythmias and birth defects.  Such adverse effects were cited as the primary reason for recommending against approval.

At the risk of being considered myopic, it is impossible for me to imagine that we can medically innovate our way out of the obesity problem.  Carrying excessive body fat will always be detrimental to our organs and joints.  Saying that modern medicine can some day eliminate the adverse effects of obesity is simply ludicrous. Any judge or professor who would like to know more about the obesity problem should spend a week or so in a cardiologist’s office.  The wrongness of their present notion would quickly become evident.

Stapling the stomach or taking pills to change brain chemistry are not now, nor never will be the answer to fatness. The solution to obesity is not in medical innovation, but rather in a complete societal paradigm shift.

In solving our fat crisis, a Mom is substantially closer to the treasure than two powerful academics.

JMM

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Filed Under: General Medicine, Health Care, Healthy Living Tagged With: Heart Disease Prevention, Qnexa, Vivus

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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