Friday, December 14, 2007

Limits of Technology - Limits of Medical Intervention

Cholesterol Lowering and Obesity Control

The U.S. government estimates the mean cholesterol of the typical adult American has dropped to 199 from about 210 a decade ago. This drop is attributed to increased public awareness of dangers of high cholesterol levels, to 60% of 70% Americans knowing their cholesterol levels, and to millions of Americans being on statins such as Lipitor, the all-time best selling drug, with $80 billion of prescriptions sold in the last 20 years.

But while we may be winning the fight to lower cholesterol, we’re losing the battle against obesity. According to the Center of Disease Control and Prevention, the average weight for men in the U.S. increased by 24 pounds from 1960 to 2002, with similar increases in women. We’re fast becoming a nation of fatties.

In a book review of Obesity : Epidemiology, Pathophysiology, and Prevention, CRC Press, 2007), Margo Denke, MD, of the University of Texas in San Antonio, remarks,

Obesity is an appropriate target for intervention, and one would have thought that almost any weapon would help to make us a worthy opponent of the enemy. But clinicians have been humbled by obesity. Each new inroad researchers have made into understanding the mechanism of obesity appears to been met with yet another battalion in the enemy’s army. Our efforts to manage obesity have been soundly defeated.

Today men are consuming 7% more calories, and women 24% more calories than in yesteryear. Food is often downed as an afterthought, as an escape from the pell-mell rush of American life. Labor saving devices, fast food consumption, large restaurant portions, sedentary time before TV and computer screens, lack of exercise, and door to door car transit – all beyond physician control – make for formidable obstacles to overcome.

The answer to obesity comes down to social and personal responsibility, often among parents. Adolescent obesity is on a rampage and will almost certainly overcome the benefits of lowering cholesterol in reducing coronary artery disease (“Adolescent Overweight and Future Adult Coronary Disease,” NEJM, December 6, 2007).

Maybe the pharmaceutical industry will come up with a blockbuster drug to defeat obesity, as Merck and others are striving to do, but chances of developing such a drug based on new chemical manipulation seem remote, as the industry lays off chemists (“As Drug Industry Struggles, Chemists Face Layoffs,” Dec. 11, WSJ, “Big Pharma Faces Grim Prognosis, Dec, 6, WSJ), as the industry fails in its quest to find new wonder drugs like Lipitor based on reshuffling of existing chemical compounds.

Perhaps doctors will find a way to quell the epidemic through patient education and counseling, but I doubt it. As we all know, the problem is cultural and societal, not medical. The question is; How can doctors help persuade people from digging their graves with their own teeth? I don’t have an answer, or a set of answers, do you?

1 comment:

concerned4hc said...

I don't have anything to add to what you said about obesity but I did want to leave a comment becasue I've noticed that days may go by without anyone commenting on your blog. I just wanted to say how much I enjoy your writing and your point of view!