Archive for the ‘Prescription drugs and medical treatments’ Category

FDA Warns Consumers About Weight Loss Pills

February 27, 2009

The FDA has issued an updated warning about tainted weight loss pills. See the details here.

Nurture vs. nature? Experience vs. genes? How about “all of the above”?

November 14, 2008

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As a psychiatrist (now happily retired) I have long been disgusted with my profession. When I started out in the 1970s, psychiatry was emerging from an era of mindless adherence to the doctrines of psychoanalysis and/or behaviorism (essentially the notion that our experience/environment dictates who we are and how we act). Then, after only a few years of very exciting and rich eclecticism, the pendulum got stuck at the other pole: mindless adherence to the doctrines of bio-medicine and/or pharmacology  (the belief that “genes” and various proteins and chemicals determine all that we are and do).  Many of us tried to restore balance by arguing that there is a rich and complex interaction among all of the various bio-psycho-social factors that influences who we are and how we behave. But the leaders of the profession (department chairs, academic gurus, the APA) were too blinded by the huge amounts of easy money from the pharmaceutical and insurance industries (both of which promote simplistic “biomedical” explanations) to pay attention.

Well, I am glad to see that finally some sanity is returning, not necessarily to psychiatry, but to medical science.  Two recent articles in the New York Times illustrate what I am talking about. They both report on exciting research trends that support the notion that experience and genes and a variety of poorly understood factors ALL INTERACT on a very basic level. Bio-psycho-social is now the wave of the future.

Here are some quotes from the 2 articles that may help explain what I am excited about:

Two scientists, drawing on their own powers of observation and a creative reading of recent genetic findings, have published a sweeping theory of brain development that would change the way mental disorders like autism and schizophrenia are understood.

… [E]xperts familiar with their theory say that the two scientists have, at minimum, infused the field with a shot of needed imagination and demonstrated the power of thinking outside the gene. For just as a gene can carry a mark from its parent of origin, so it can be imprinted by that parent’s own experience.

The study of such markers should have a “significant impact on our understanding of mental health conditions,” said Dr. Bhismadev Chakrabarti, of the Autism Research Center at the University of Cambridge, “as, in some ways, they represent the first environmental influence on the expression of the genes.” [see this article]

and

The gene … is in an identity crisis.

This crisis comes on the eve of the gene’s 100th birthday. The word was coined by the Danish geneticist Wilhelm Johanssen in 1909, to describe whatever it was that parents passed down to their offspring so that they developed the same traits. Johanssen, like other biologists of his generation, had no idea what that invisible factor was. But he thought it would be useful to have a way to describe it.

“The word ‘gene’ is completely free from any hypothesis,” Johanssen declared, calling it “a very applicable little word.” …

These new concepts [described in the body of the article] are moving the gene away from a physical snippet of DNA and back to a more abstract definition. “It’s almost a recapture of what the term was originally meant to convey,” Dr. Gingeras said. [see this article]

What does this have to do with health and fitness?  Everything. As I have argued elsewhere, we are not simply the end products of fixed-in-place genes that determine, for example, how much we weigh.  Nor are we defined only by our early childhood experience. It is way more complex, and there is much room for variation in our health and lifestyle. Now, with the new respect in medical science for complexity and subtlety, there may even be room for “willpower.”  Admittedly, that is stretching the point, but I firmly believe that there are far more ways to impact our personal destinies than my former colleagues in psychiatry have acknowledged.

Weight loss supplements and diet drugs

May 22, 2008

Should you take willow bark, or drink green tea, to help you lose weight? Here is an article summarizing the latest scientific thinking about food supplements and chemicals marketed as weight loss aids. You have to register (and may have to be a healthcare professional) at http://www.medscape.com/home before viewing the article titled “The Skinny on Weight Loss Supplements: Fact or Fantasy?” at http://www.medscape.com/viewprogram/12613_pnt.

This website has connections with the pharmaceutical industry, so may have a bias in favor of the benefits of drugs (which I do not share). The bottom line is that FDA approved Orlistat has minimal value as “an adjunct to a diet low in saturated fat.” All the other supplements mentioned (Bitter Orange, Chitosan, Chromium, Conjugated Linoleic Acid, Fiber, Green Tea, Guar Gum, Guarana, Hoodia, Hydroxycitric Acid, L-Carnitine, Natural Licorice, Usnic Acid, White Kidney Bean Extract, Willow Bark, Yohimbine) have minimal or no efficacy, and many can cause serious side effects. Of the group, White Kidney Bean Extract (a dietary “carb blocker” which delays or attenuates the absorption of starch and carbohydrates) had a small weight-loss effect in one study.

The article concludes: “Before recommending such products, clinicians should inform patients of potential risks as well as questionable benefits. Lifestyle modifications, such as caloric restriction and exercise, should always be the first-line treatment for obesity. However, clinicians should recognize the popularity of products currently on the market and the likelihood that their patients may be using them.”

My take: Always beware of quick and easy solutions to losing or maintaining weight. As yet, there are no really good weight-loss drugs or supplements, and all of them come with significant downsides (cost, side effects, unknown long-term effects, interaction with other drugs and supplements you may be taking). See my website www.wmfyl.com for excerpts from my book and also click on Frequently Asked Questions to see more of my approach to weight management.