[update 14 Jun: I've fixed the video now, I think.]
So what should I find in the unsolicited mailbag this week? This little “Healthed Clinical Pearls” video CD:
Apparently, “Healthed is one of Australia’s most popular and respected providers of education for health professionals.” Healthed is a place where “Leading Experts Present Their Independent Views”.
But Healthed didn’t bring me this very special presentation. There’s an Acknowledgement on the inside of the cunningly-sealed envelope: “This clinical pearl has been made possible thanks to an unrestricted educational grant from Allergan.” They were also kind enough to slip an ad into the envelope along with the CD: “Have you explored all weight loss options for your patients?”, with a worried tape-measure-wielding fat woman, and a diagram and photo of the LAP-BAND Obesity! Management! System! By the end of this presentation, we’re all supposed to be panting “Help me, LAP-BAND! You’re my only hope!”
Needless to say, the included video lectures include blatant breaches of this touted Healthed protocol: “In line with RACGP guidelines we request speakers to avoid using product brand names and logos wherever possible.” For instance, there is this full-screen ALLERGAN advertisement:
Oh, and this slide. No brands names here, noooo. Shhh, don’t mention the “Optifast”! Whoops, too late!
Allergan chooses its presentations carefully. In an effort to appear fair and balanced, they present one lecture about “medical management of obesity” along with the surgical marketing. Joe Proietto declares his conflict of interest at beginning of his lecture – he is chairman of the Novartis Optifast medical advisory board, and is also on advisory boards for the companies that make Reductil (sibutramine, Meridia) and rimonobant. Sanofi-Adventis has been trying to get rimonabant (Acomplia), an endocannabinoid receptor antagonist, onto the US market for over three years now. The FDA has rejected rimonabant unanimously because of concerns over it causing neurological problems, psychiatric problems, and suicide. Makes you skinnier, but it makes you want to kill yourself. Doesn’t that sound splendid?
But Proietto isn’t exactly enthusiastic about his 12-week VLCD (Optifast) programme. His presentation talks at length about the genetic basis of fatness, and the homeostatic regulation of body weight. He openly declares that long term success in medical obesity treatment is “dismal”. Their one-year dropout rate is 50%; he doesn’t disclose 5-year dropout.
The only hope in terms of medical treatment, he says, is to follow up the 12-week liquid starvation programme with intensive diet and exercise therapy in combination with drugs. Surprise, surprise, the two drugs he talks about are the two he has advised the pharmaceutical companies on – sibutramine and rimonabant. But the drugs are expensive, he whines; his hospital won’t put it on the formulary and it costs too much for patients. For those who still regain, he says (and they all do, say his graphs), he refers for bariatric surgery.
So on to the main event – the LAP-BAND ad. Presented by surgeon Steve Watson, “The Surgical Treatment of Obesity” opens with a classic headless fatty, this time stripped and ready for surgery. “This is an example of the sort of people we’re having to treat“, he says in his Clinical Pearl, somehow managing to refrain from wrinkling his nose.
He follows up with another photo of teh fat, this time from the inside, declaring with contempt “In here you can see the stomach that’s surrounded by a sea of fat!”
There is the usual obesity-”epidemic” graphing and such, but he drops a right clanger in the mortality graph. Check this out. People with a BMI of 16 have the same mortality as people with a BMI of 25? Reeeeally? Mmmm? Might want to check your facts, there, Mr Watson.
But at least he, also, declares his intentions from the outset, complete with Freudian slip:
“I’m putting it to you that surgery via laparoscopic technique for obesity is the way to help ourselves and our patients.”
You know what? I’ve come to the conclusion that matter how many layers of shine you lay on a pearl, inside there’s still a little grain of shit.
Here is the beginning and end of this lecture. With an abrupt cut in the middle, on account of how I’m crap at video editing. Enjoy.
P.S. Kate speaks for me. Read this before commenting, if your back is up about how how all Fatty McFatfats are going to get Teh Diabeetus and be dead within five years. Actually, wait, just don’t comment at all. If your comment is not going to be at least one of amusing, novel, or feminist, fuck off. This is my new mantra!