Until Drugs Get Better, How About Useful Services

By guest blogger Daniel Hoffman:

Nearly two out of three (63 percent) Americans are now obese or overweight, according to the U.S. Centers for Disease Control and Prevention. The incidence of conditions that typically result from obesity, such as Type 2 diabetes, has grown to epidemic levels. Obesity now afflicts pre-teens and teenagers at rates previously seen only among the middle aged. The fact that the pharmaceutical industry has not developed products to substantially address the obesity epidemic represents as much a failure of the industry's business model as a shortfall in its drug discovery.

Obesity remains an extraordinarily difficult condition to treat because it involves a behavioral problem as well as a metabolic condition. Despite obesity's long-term, physical consequences, many physicians don't think it can be successfully treated.

Pharma has long recognized that a really effective drug for treating obesity could generate enormous revenues, given the number of overweight people. Yet Roche's Xenical was the last prescription medicine approved for obesity, and that was in 1999. The failure to produce at least one blockbuster hasn't been for want of trying. Companies have spent billions searching for that golden goose, only to find their drug candidates either fail to win approval, don't work well and sell poorly, or cause unacceptable harm.

Philippe Burnham of West Caldwell, New Jersey launched Xenical and he now consults with companies looking to market their own anti-obesity drugs. "The problem with obesity drugs," he says, "is that there are no magic bullets. There's no drug that lets you eat poorly and stay slim." The best we can expect from drugs currently on the horizon, he says, is to kick start the loss of a few pounds while a person learns to eat properly, exercise and make major lifestyle changes.

Weight loss, according to Burnham, requires programs in behavioral modification because it's questionable whether a person can safely stay on a weight loss drug indefinitely. An FDA advisory panel expressed that same concern regarding long-term use when it recommended against approving two, new obesity drugs within the past several weeks.

Despite the importance of behavioral changes for conditions such as obesity, diabetes and some other chronic conditions, "physicians don't get paid to do the sort of counseling that's needed," Burnham notes. "Most of them avoid it because they don't want to put time into something that the studies show is likely to fail." That's where he feels pharma companies can play an important role. By partnering with physicians to offer comprehensive, rigorous, behavioral modification programs to patients, instead of the casual, infrequent counseling that even dedicated physicians could offer, the pharmas can help address a major, public health problem.

As an example related to exercise, pharma companies wouldn’t have to send out armies of personal fitness instructors. The Mayo Clinic found one activity consistently separates people who control their weight from those who add a few pounds every year. It simply involves just standing for part of the work day instead of sitting. People who work in an office could learn to stand when they're on the phone or raise the height of their monitor and keyboard to stand at their PCs part of the time.

Pharma can help people develop these kinds of simple techniques to improve outcomes. As short-term adjuncts to behavioral programs, a drug may even help some people develop healthy habits. But since the weight loss drugs on the horizon are only marginally effective and their long-term safety remains questionable, pharma can make some money and contribute to improving public health by providing professional, weight management programs. Until the time that pharmas do develop magic bullets, relationship services such as this represent useful adjustments to the industry's business model.

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