First, in response to a few questions that folllowed my Qnexa post (also the associated post on my Psychology Today blog).
On Feb 22 the FDA Advisory Committee voted to recommend approval - which usually signals that approval will be granted; but the final decision is to be made mid April. In other words, as of now, Qnexa does not have FDA approval for obesity.
But these questions about approval stirred my curiosity about the level of buzz Qnexa has generated.
How can one gauge that?
Well here is what I did.
I decided to use a reputable medical meta-search engine and compare the number of hits for Qnexa with the number of hits for some other new medication for a different indication.
I've chosen Trip Database as my meta-search engine. Trip Database not only provides a very solid search tool but also presents the search results in a format that makes it easy to differentiate between the different types of retrieved data (eg, original research, guidelines, textbooks or news). I then compared the search results for "Qnexa and obesity" with the search results for "asenapine and schizophrenia".
Why choose asenapine? Asenapine is neuroleptic that got FDA approval for the treatment of schizophrenia back in 2009. As such it's still a relatively new medication (for a fair comparison with the very new Qnexa) and at the same time it's been around for long enough to generate some news (or so you'd think).
Why choose schizophrenia? As, similar to obesity, it represents another major public health issue. In case you don't know the most recent global burden of disease data form the World Health Organization place schizophrenia at #9 on the top 20 causes of disability word-wide. For comparision sake I should also mention that obesity, while a major health issue in the US, doesn't even make it on the same world wide top 20 list.
What are the results?
In a couple of my prior posts I used the "asenapine and schizophrenia" example to discuss on how to search for the best evidence (Tripping for Evidence Part 1 and Part 2). So last night I just re-run the same search for "schizophrenia and asenapinelast" on Trip Database and I got 20 hits (search results as of March 12, 2012). The "Qnexa and obesity" search on the same site returned 32 hits total.
So we got thirty percent more hits (ie, publications) for a drug that is yet to get FDA approval.
But it gets even more interesting than this: from the 20 asenapine results about 15% (N=3) were news reports. For Qnexa 100% (N=32) of the hits are news results.
Granted, this are proxi measures at best. However, as a indirect measure of the buzz out there when it comes to different public health issues, in this case, schizophrenia and obesity, the results are pretty telling.
And the story they tell is that as a society we seems to be overinterested in issues related to weight and body image. That in itself might be part of the problem.
© Copyright Adrian Preda, M.D.
Showing posts with label obesity. Show all posts
Showing posts with label obesity. Show all posts
Tuesday, March 13, 2012
Monday, February 27, 2012
Qnexa: the Wonder Working Diet Pill or Else?
As a doctor, I am usually happy when a new pill comes around. With this one though and I mean Qnexa,a new weight lowering drug, I have mixed feelings.
Here is the issue: There is an epidemic of obesity in the United States. The small print implication of "epidemic" is that we are looking at a medical problem. Meaning, simplistically put, a problem rooted in some biology gone astray.
The implicit message: As we are looking at a medical problem, a medical intervention is warranted.
Therefore the solution: If pill that can contain this epidemic would come along, we shall approve it.
And of course, if all this were to be true, Qnexa, which has been proven to decrease weight, sounds like a great idea, doesn't it?
But what if, those premises that I just stated, are only half-truths?
Let me re-phrase it...
Here is the real issue: While there is an epidemic of obesity, which no one disputes, epidemic only indicates that the number of cases of a certain disease in a population is hight; however, there is no indication if the observed phenomenon is the result of biological, psychological, social or cultural factors.
And then here is the real question: Is obesity a medical (read biologically based only) problem and as such an appropriate target for medical interventions, including medications?
And the real answer? While there are patients with a diagnosis of morbid obesity, a medical condition, thus an appropriate indication for a medical treatment, for the majority of patients obesity is the final result of a complex inter-play of psycho-social contributors.
Thus a pure medical solution to non-morbid obesity is unilateral, does not address the root causes of obesity and conceivably increases the risk of masking the original psycho-social causes of obesity.
If we agree that symptomatic treatments should be temporary and always second-line when etiologic treatments are available, any medical solution for non-morbid obesity should follow the implementation of solid preventive medicine and health education policy changes.
My concern is that with the approval of Qnexa we will see patient who will want to take the "wonder died pill" while keeping up their unhealthy dietary and/or sedentary habits.
Food for thought: Our biology does not change in the course of a century. If we have an epidemic of obesity now, that cannot be the result of altered biology. It is rather the result of a change in our life habits that now overwhelm a system designed for a much higher caloric output with a much lower caloric intake. In other words, a much more active life style with significantly lower food intake.
My concern is that Qnexa will not make it any easier for doctors to persuade their patients that good dietary habits, an active and balanced life style and responsibility for saying no to the too many dietary temptations need to always come first.
Suggested Reading:
The Fattening of America: How The Economy Makes Us Fat, If It Matters, and What To Do About It
Food Fight: The Inside Story of The Food Industry, America's Obesity Crisis, and What We Can Do About It
© Copyright Adrian Preda, M.D.
Here is the issue: There is an epidemic of obesity in the United States. The small print implication of "epidemic" is that we are looking at a medical problem. Meaning, simplistically put, a problem rooted in some biology gone astray.
The implicit message: As we are looking at a medical problem, a medical intervention is warranted.
Therefore the solution: If pill that can contain this epidemic would come along, we shall approve it.
And of course, if all this were to be true, Qnexa, which has been proven to decrease weight, sounds like a great idea, doesn't it?
But what if, those premises that I just stated, are only half-truths?
Let me re-phrase it...
Here is the real issue: While there is an epidemic of obesity, which no one disputes, epidemic only indicates that the number of cases of a certain disease in a population is hight; however, there is no indication if the observed phenomenon is the result of biological, psychological, social or cultural factors.
And then here is the real question: Is obesity a medical (read biologically based only) problem and as such an appropriate target for medical interventions, including medications?
And the real answer? While there are patients with a diagnosis of morbid obesity, a medical condition, thus an appropriate indication for a medical treatment, for the majority of patients obesity is the final result of a complex inter-play of psycho-social contributors.
Thus a pure medical solution to non-morbid obesity is unilateral, does not address the root causes of obesity and conceivably increases the risk of masking the original psycho-social causes of obesity.
If we agree that symptomatic treatments should be temporary and always second-line when etiologic treatments are available, any medical solution for non-morbid obesity should follow the implementation of solid preventive medicine and health education policy changes.
My concern is that with the approval of Qnexa we will see patient who will want to take the "wonder died pill" while keeping up their unhealthy dietary and/or sedentary habits.
Food for thought: Our biology does not change in the course of a century. If we have an epidemic of obesity now, that cannot be the result of altered biology. It is rather the result of a change in our life habits that now overwhelm a system designed for a much higher caloric output with a much lower caloric intake. In other words, a much more active life style with significantly lower food intake.
My concern is that Qnexa will not make it any easier for doctors to persuade their patients that good dietary habits, an active and balanced life style and responsibility for saying no to the too many dietary temptations need to always come first.
Suggested Reading:
The Fattening of America: How The Economy Makes Us Fat, If It Matters, and What To Do About It
Food Fight: The Inside Story of The Food Industry, America's Obesity Crisis, and What We Can Do About It
© Copyright Adrian Preda, M.D.
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