Another drug bites the dust. In the past few weeks, we have seen sibutramine (Meridia) pulled from the shelves due to an increased risk of heart attacks, and now lorcaserin (Lorqess) has failed to pass muster with the FDA because of concerns about cancer. Many years and millions of research dollars later, our only remaining pharmaceutical arm in the fight against obesity is orlistat (Xenical), with the convenient side effects of bloating, stomach upset, and the need to have a public restroom app on your iPhone in case of emergencies.  So what’s a health care system to do?

On one hand, you might argue that Big Pharma has failed us in the obesity space.  So should they throw in the towel? The drugs work poorly, have gross side effects, and increase our health risks in other ways. Some say, why don’t we save the millions of dollars spent on drug research and instead invest them in education, legislation, and regulations that will help us eat better and exercise more? Put the money toward the health costs of the uninsured. Or, use it to fund research in diabetes, heart disease, or any of the other countless complications of obesity.

But is it too early to admit defeat?  If we had done the same for cholesterol medications or diabetes medications, or even smoking patches and pills, we’d be paying for it in countless ways.  So is there something unique about developing medications for obesity?  Obesity is considered by many to be purely a “lifestyle” disease, and some are biased against the obese as a result.  Given that we already have proven treatments (eat less and exercise more), some argue that we are wasting our time by investing heavily in a pharmaceutical solution.

As a physician who believes strongly in the power of personal choice to influence one’s health outcomes, I tend to favor an investment in healthy lifestyles.  But in all fairness to the other side of the debate, one can also argue that prevention hasn’t worked out so well either.  Despite the fact that we have effective treatments, we are not very effective in their prescription or compliance.  For example, aggressive lifestyle modification can lower heart disease risk as effectively as cholesterol medication for many people — but the fact of the matter is, some people would rather take a pill.  Obesity has skyrocketed despite our efforts at communication.  So, it looks like the health care system has failed as well.  Could our failure as health care providers actually position obesity drug research and development as the most important pharmaceutical goal of the decade?

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