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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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September 6, 2006

Tell 'Em You Work On Something Else

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Posted by Derek

When I tell people that I work for a drug company, they often want to know what disease I'm working on. I've been able to give all kinds of answers over the years, and most of them go over well. Everyone's glad to hear that you're doing research on diabetes, cancer, Alzheimer's or other widespread high-profile problems. Of the areas I've spent time in, cancer probably has the most cachet on this scale, since almost everyone knows of someone who's had serious trouble with one form or another.

The antithesis of cancer's situation is probably obesity. No matter how many headlines come out on its epidemic nature, huge public health consequences, and so on, it still doesn't get you the respect that other indications do. There are several reasons for this, the first of which is the seriousness of the disease, as defined by life expectancy. For better or worse, obesity patients are going to survive for much longer periods than cancer patients.

Scientifically, this actually makes the field more difficult to work in. Frankly, with most of the current cancer therapies, all we can offer is a few more months or (in some cases) years of life for most patients, so until recently long-term side effect issues haven't been a big concern. (Note, though, that this is changing). But obesity therapies are going to be used for longer periods of time. Obesity is associated with a shorter lifespan, true, but the level of obesity that some people are wanting to treat doesn't have that great an effect on mortality, and the survival rate with even morbid obesity is one heck of a lot better than with most kinds of cancer.

Getting back to the seriousness problem, another issue is that for many people, it's hard to shake the image of obesity as something that could be better treated by just eating less food and getting off the couch. I realize that that's not always a fair judgement, and my heart does indeed go out to people who put on weight more easily than the average person. But that said, there can be little doubt that eating fewer calories and doing a bit more exercise would take off untold numbers of pounds nationwide. The question is, as physicians will tell you, is whether anyone is going to do those things. If they can be more motivated by taking an obesity drug along with changing their diet and doing some exercise, then perhaps the drugs will have partially proved their worth. Of course, you could argue that similar effects at that level might be obtained by pills filled with, say, oat bran, billed as wonderful new obesity therapies: Placebatrim, anyone?

No, we're not going to be able to get away with that one. That's a market for the "nutritional supplement" people. An obesity drug from a real pharmaceutical company is going to have to really do something to get past the FDA, and it's going to have to be extremely safe in order to stay on the market. (Thus the current state of the obesity drug market). Anything that meets these criteria will make a huge amount of money. But respect? Fair or not, that might be asking too much. . .

Comments (22) + TrackBacks (0) | Category: Cancer | Diabetes and Obesity


COMMENTS

1. Commenter on September 6, 2006 8:44 PM writes...

There seems to be an obvious ethical dividing line in obesity research. Discovery of drugs that might reduce appetite and food intake is laudable. However, in a world where many do not have enough to eat, it seems more difficult to justify research aimed at drugs targeted to affluent Western societies that allow people to eat whatever they want yet not become obese.

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2. LNT on September 6, 2006 9:24 PM writes...

One step farther down the totem pole: E.D.

I'm glad I don't have to tell people that I'm working on the next generation of Viagra...!

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3. Doc Bushwell on September 7, 2006 8:07 AM writes...

Derek, my sentiments exactly. I've ranted about obesity as a therapeutic area although in less measured tones than yours. My (biochemistry) department at Dark Overlords Pharmaceuticals, Inc. (DOPI) supports one target for obesity, and I confess to feeling uneasy about this given our limited resources. The safety hurdles, and the associated costs of clinical trials to ascertain relative lack of nasty side effects over the long term, are indeed formidable.

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4. Timothy on September 7, 2006 9:28 AM writes...

Obesity simply isn't an epidemic because it's not a communicable disease and it isn't caused by environmental factors, unless there's some sort of "fatocinogen" out there of which I'm not aware. Nobody caught The Fat from some coworker's grubby kid, nor from the old insulation at work. There's also the whole matter of the BMI being a total sham. Obesity isn't a public health problem because being fat doesn't hurt anybody but you, there are simply zero externalities to being fat.

That said, if people want to take drugs to get skinny, good for them. If something will motivate them to be healthier, good. And I can't see any reason not to respect research in that area given that there's a market for it, and it's probably just as difficult as any other research.

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5. S Silverstein on September 7, 2006 9:30 AM writes...

To those who say "obesity is something that could be better treated by just eating less food and getting off the couch", I say: cigarette smoking could be better treated by just not sticking the darn cancer tubes in your mouth.

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6. S Silverstein on September 7, 2006 9:34 AM writes...

p.s. by comment #5 I mean that human behavior is anything but rational, the causes of overeating are poorly understood, and pharmaceuticals that can help with addictions (to food, to opiates, to tobacco, etc.) are as important to public health as drugs meant to battle other diseases.

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7. finance guy on September 7, 2006 9:50 AM writes...

Then why are you guys so opposed to Accomplia? Granted its a first generation drug, but come on, it has the best clinical safety profile and efficacy in a long time. By far and away the most promising of obesity drugs. Is it perfect...of course not. However, my 62 year old father has just been diagnosed as borderline type II. Yes, he could change his diet on the road when he travels for business 4 days a week and wake up an hour earlier to exercise, but after 20 years of walking a golf course twice a week I doubt it will happen. I wish he could try Accomplia before he is type II.

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8. Jeremiah on September 7, 2006 10:21 AM writes...

Either your analysis or, most likely, it's the ultimate lifestyle blockbuster drug with minimal merit and detracts from the suposed purpose of drug companies: Finding answers that matter... of course. (at least that's what the cup on my desk says, doesn't mention anything about finding answers that rake in a crapton of money.)

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9. Kent G. Budge on September 7, 2006 10:49 AM writes...

Placebatrim, anyone?

Wonderful! Have you registered the trademark yet?

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10. Novice Chemist on September 7, 2006 10:53 AM writes...

Timothy:

Are there zero externalities to being fat? Perhaps I don't understand what 'externality' means; IANAE.

If obesity leads to future public health costs (Medicare costs for heart disease, diabetes), I don't think that working on obesity is all that self-serving. An ounce of prevention, of course. But I think that preventing obesity in the US is going to take more than an ounce; I think it will take vicious taxes on baked goods and forced calisthenics. (But let's not argue about that.)

I'd argue (along with LNT) that ED or perhaps male-pattern baldness are things that are lower on the totem pole.

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11. Don B. on September 7, 2006 11:04 AM writes...

Where do you put a drug to increase the "sexual experience" for women? Above or below ED?

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12. Ashutosh on September 7, 2006 11:26 AM writes...

Discovery of drugs that reduce appetite might spark off another conflict with corporate America. One of the big and very unnatural achievements of the era of processed food is that it turned demand for food into an elastic demand. Through diabolically clever advertising, the previously held notion that people don't necessarily eat more if you produce more was rendered redundant. Many of us, if not most, give in to advertising and often end up eating more than what we actually need. Michael Pollan's 'The Omnivore's Dilemma' makes this fact quite clear. If drugs that really reduce appetite became widespread (and started to be used by parents on their small children for example), it would mean untold losses for McDonald's, Hershey's and KFC, to name a few conglomerates. Since the primary aim of both the food industry and the pharmaceutical industry is to make money, it should be very interesting to see how this conflict turns out.

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13. tom bartlett on September 7, 2006 11:48 AM writes...

" Michael Pollan's 'The Omnivore's Dilemma' makes this fact quite clear."

Ira Flatow did a great interview with him on Scinece Friday some months ago-- check out the podcast. Ties together a lot of failings of our society with regards to both environmental degradation and public health.

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14. Harry on September 7, 2006 12:30 PM writes...

Ahhh yes.. the old "diabolically clever" advertising. We've heard this same old song since the 50's (Vance Packard, J.K. Galbraith) "Consumers are so sheeplike, they can be led to buy things the don't even want by the demonic forces of advertising!"

So, ashutosh, if demand for food is elastic, then if McDonalds, for example, say tripled their advertising, please tell me how much aggregate demand for food would increase? 10%? 20%? 50%?

The marginal elasticity of total demand for food is very low and I doubt if tripling total advertising for food would increase total demand even 1%. What advertising does is to change the type of food demanded.

McDonalds doesn't necessarily want to increase the total demand for food, because that would increase demand for foods other than the ones they sell and waste scarce advertising dollars. They want you to buy McD's instead of KFC or BK or Wendy's.

What you're actually seeing is that fast food advertising has taken away from home cooking. Look at the freezer section of grocery stores. Prepared foods, which are more convenient and quicker to serve have taken over a large section of the shelving that would have been devoted to fresh or canned foods that need preparation.

Certainly the prepared foods have high fat, sugar and salt content (depending , of course on the desired flavor), but I recall that the same dishes prepared at home also had high fat, salt, etc. Meat loaf, for example is probably similar in nutritional profile whether prepared from scratch or store bought- especially when individual preferences (such as topping with melted cheese) are taken into account.

I seriously doubt if ANY obesity drug (unless fed to people in the water supply) will significantly impact the either the total demand for food or the marginal propensity to consume food. In any event. Mcdonalds (et al) will simply adjust portion size to fit the customer's demand (smaller portion= lower cost) and still make money.

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15. RKN on September 7, 2006 12:34 PM writes...

Obesity isn't a public health problem because being fat doesn't hurt anybody but you, there are simply zero externalities to being fat.

Oh yeah - ever sat next to an obese person on an airplane?

Also, if I'm not mistaken, obesity is one of the leading cause of type II diabetes. Surely this causes a rise in the rates of everyone in a health insurance pool, due to a rise in the costs to treat the myriad of symptoms obesity causes, beyond just diabetes.

Without too much misleading, Derek could tell people he's working on indirect diabetes research, given this cause and effect relationship.

Fat chance everyone would believe him, but some might.

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16. Joshua on September 7, 2006 2:16 PM writes...

Timothy - I'm not trying to start a war with you, but it doesn't sound like you know very much about public health.

not a communicable disease: the word 'epidemic' is now commonly used to describe a large number of important public health problems that are not caused by infectious/chemical agents (you might want to search 'epidemic obesity,' 'epidemic drug addiction,' or 'epidemic mental health,' on PubMed... And you may want to check out a epidemiology textbook or look at Wikipedia for the definitions of epidemic/endemic...)

isn't caused by environmental factors: many public health professionals include the social environment (including socioeconomic status) and diet in the 'environmental factors' part of the epidemiological triangle...

Obesity isn't a public health problem because being fat doesn't hurt anybody but you, there are simply zero externalities to being fat: I think a lot of public health professionals would disagree with your narrow definition of a public health problem. Is smoking a public health problem? What about alcoholism? What about cancer? According to your logic, as long as you're not smoking while pregnant/near an infant or not drinking and driving, no one else is hurt, so it's not public health problem. And your definition doesn't include suicide or unintentional injuries as public health problems, though injury prevention is seen as one of the most important areas in public health (especially if you want to reduce the number of deaths in children/adolescents/young adults).

You could also (easily) argue that the financial strain obesity/type II diabetes/heart disease puts on our health care system diverts money from other diseases - since our resources are finite, the money has to come from somewhere/some other program. So I would argue that reducing obesity is an important public health problem...

Derek - apologies for the tirade (I'm certainly not trying to hijack the thread...)

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17. Daniel Newby on September 7, 2006 2:55 PM writes...

"Obesity simply isn't an epidemic because it's not a communicable disease ..."

Animal models strongly suggest that viruses cause at least a percentage of human obesity.

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18. srp on September 7, 2006 5:15 PM writes...

Joshua exactly pinpoints the intellectual and moral decay of the "public health" establishment. Expansion of the definitions of "epidemic" and "public health" from physical externalities (communciable diseases and pollution) to any condition of any kind has led to the unnecessary politicization of voluntary behavior. This has redounded to the self-interest of power-seeking ideologues and meddlers. I am doubtful that it is doing anything good for our somatic health, but in any case is sickening the body politic by undermining basic principles of liberty and responsibility.

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19. Novice Chemist on September 7, 2006 8:56 PM writes...

Don B.: I'm not sure; but PT-141, which is in Phase III, should help answer that question.

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20. MTK on September 8, 2006 6:56 AM writes...

Timothy, I would disagree that BMI is a "total sham". What is a sham is the labels associated with BMI, that is the definition of "Overweight (BMI>25) and "Obese" (>30). If you take BMI for what it is, a simple correlation between mass and height and risk of stroke or heart attack, then it's valid.

It's the labels that everyone gets hung up on, because no one wants to be "obese",

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21. markm on September 8, 2006 10:31 AM writes...

MTK: I've seen people that look like a blimp with legs that have a lower BMI than some athletes. Are you claiming that those athletes have a higher risk of heart attack and stroke than the blimps?

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22. Ashutosh on September 11, 2006 1:21 PM writes...

Harry, it would be interesting to see what the quantitative effects of price reduction on food consumption would be. I think advertising definitely plays a role, whether it is diabolically clever or not. The ideal situation for any corporation would be to keep prices high and yet induce people to consume more through advertising. Many corporations strive and come close to attaining this. Also, I think we should really think in terms of what food item's demand we are exactly discussing. For example, for Coke, demand seems elastic; when they started adding high fructose corn syrup instead of sugar, they could lower prices because the cost of production became low. In any case, people definitely started consuming more, and advertising played a role. So I think I should modify my original statement by saying that demand for some kinds of food under certain circumstances may become elastic for certain period of time. I would be very much interested in even knowing how such elasticity can be quantified, with all the complex variables involved.

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