[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!
The lap band has a pretty dismal success rate, given that it’s supposed to make you thin for the rest of your life. At ten years post-op, about 5% of patients have retained a significant weight loss. It has a better initial “success” rate than plain ol’ dieting, but in the end it’s the same, only with the expensive and risky surgery. 25% of people who get it have it removed in the first three years due to either adverse events or it not causing weight loss.
I detest that this kind of surgery is sold as “Mess with your digestive tract NOW or DIE OF TEH FATZ” with little discussion of side effects and dangers, and of course no mention that it’s possible to be healthy and fat. It’s claimed that it’s very safe because it’s removable, but a small but notable percentage of bands can’t be removed because it adheres to the stomach – even the manufacturer of the band doesn’t guarantee its removal past five years.
And yet there are many, many fat people desperate to have this procedure done because fat people are social pariahs and told what worthless moral failures they are and so on – and once they have it, the side effects like vomiting, reflux, malnutrition, etc, are “worth it” to be slim and avoid the supposed death-by-fat that looms. If someone who’s had their lap band “fail” speaks up, they’re berated for “not doing it right”. (And in the USA, often up-sold to the incredibly dangerous gastric bypass surgery).
I have actually had one doctor try to sell me the lap band surgery. He got quite cross when I told him I didn’t need a surgically-induced eating disorder. He seemed incredibly confused that a fat person existed who did not spend their days dreaming about what life would be like when they were thin and no longer a “failure”.
Hi La Di Dah – definitely. The presenter emphasised that the surgery was “adjustable and reversible” without qualifications. He very briefly presented a list of complications (erosion, slippage, etc) but rushed over them. He dismissed erosion as unimportant because it was “very rare”. I don’t call 1-7% (depending on technique) “very rare”, especially not when you’re looking at an operation that some people are proposing we perform on around half the healthy population.
[...] week, I wrote about the Allergan-sponsored “independent” Continuing Medical Education (CME) video lectures that dropped into my mailbox. The gossamer-disguised advertisement promoted Allergan’s [...]
[...] shares some of the promotional material she gets in her junk [...]