psycho slimming

12 December 1998

Reality Cracking

In an old comics of "Mandrake the Magician" (the very old ones are incredibly interesting for advanced reversing purposes) there was a war, in some other dimension, between a civilisation based on plants and a civilisation based on machines. Incredibly 'ecologically correct' for those times: Mandrake himself (with Lothar, of course) was sort of 'caught' between the two completely different society models at war. The 'plant' society had a lot of quite 'modern' ecological stuff (like genetic transformed trees that grew houses and flying seeds for transport purposes) and the 'machine' society was pretty scary, in fact it had only one habitant, a sort of 'rebel' that always did run some personal activity, all alone, since everybody else was 'enjoying life' without doing anything at all, served and entertained by machines. All the other habitants died because they simply went 'too dick', since they almost never moved and lived more and more in a 'virtual reality'... remember me of somebody like us... yeah, this is a good introduction for Cioff's work below... at least I like it.

...ah yes, finally, thanks Mandrake, the 'lonely machine survivor' happily married the queen of plants... a typical American happy end that will not bless our future... since we definitely miss the ecological counterpart to the machine and obesity world...

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Regards Cioff

Cioff slashes off some psycho slimming

Cracking some official thinking from a major drug company

Drugs are expensive because there's got to be so much research to find them. Endless laboratories with incredible bright Nobel laureates doing all this glorious brainwork. Millions and millions of rats. Millions and millions of people for tests. So when these drugs reach the market, they are all safe and effective.

Digression (?)

It doesn't cost me much, really. About the equivalent of a bicycle wheel per year (150 Euro). Did you say drugs were expensive? Not to me, anyway.

But theres a snag. My daily dose of 300 milligrams costs about 15 Euro. 5500 per year. I would probably be able to afford it, but I'd rather not.

So it is paid my my national Social Security system. Those nice people who use other people's tax money to pay my expenses. Most people think it's OK, by the way, to pay this part of my expenses . Nobody would like to have my kidney and my drugs. They'd rather have their own.

Sandimmun is a rather low-profile drug towards the public (not like Valium or Prozac or Viagra). It is used by a few patients, relatively speaking, and prescribed by specialists for rare diseases or sub specialists in the transplantation hospitals, and nobody wishes to prescribe or use it except when in dire need. Price doesn't really matter to the decision. The drug is expensive, but the patients are few, and hi-tech medicine always carries status. High transplantation rates are nice to boast about for the politicians and physicians.

But waitaminute. The price of Sandimmun kills, though not in my country. In a poor country this price does kill. If I were a transplant patient of a poor country, My Sandimmun costs could pay a lot of polio vaccine or measles vaccine or intestinal worm killers or antimalarials or antituberculosis drugs  (if you went to the world market to buy them  - from India, for example). The expenses for one single person will deprive whole villages of medicines altogether. Either the transplanted person will die, or all those others. The hell of a choice of you have a conscience.

Anyway, the ruling class of the poor countries don't care about the poor. They rather pay for the excecutive jets, or the St. Peter Cathedral replicas, or the guns and tanks and fighter planes, or the fortified Mercedes Benzes).

Novartis gets away with this price without a public outrage because transplantations are mainly carried out in the rich countries that can afford it. And transplantations in the poor countries are mainly done on the rich, who have already stolen the money they need.

OK, I'm digressing.

Wellcome were the ones with the first anti-AIDS drug: Retrovir - zidovudine, also known as AZT. You know AZT, don't you? The wonder drug (for a while) which was approved prematurely because the manufacturer had made the American homosexuals believe that this drug was THE cure and had to get immediately on the market to save the lives. It was a disappointment, as you all know.

Later on Wellcome were bought (Was it 12 000 000 000 Euros, or was it more - I don't remember exactly) by the UK firm Glaxo and fused into Glaxo Wellcome.

Later new drugs arrived, and today, with triple therapy with the protease inhibitors and the reverse transcriptase inhibitors - well, the HIV infected people don't die of AIDS any more when they are given this drug combination. At a price, of course. The drugs are highly profitable.

Anyway: Glaxo Wellcome obviously are among the heroes in the struggle against AIDS. Let's see what's on their minds. And for simplicity: let's go to the Web.

Fravia+ has taught me a lot about searching. But this time I resort to simple guessing and just type www.glaxowellcome.com in the location window of Netscape - and it's a hit.

The site says nothing, but transfers me nicely into the United Kingdom site.

http://www.glaxowellcome.co.uk

And what do we find on the homepage?!: A menu. Some quite trivial scientific stuff, and some spam. But one item on it is a literature odyssey. mmm - Interesting. The scientific thinking of the company. Its philosophy. Its ethics. So we take a look.

Some subjects we leave alone for a while - like AIDS and hepatitis C. And asthma. If you have read my previous essays on Fravia+' site, you might know some of my points of view. Anyway, those pages seem harder to crack. Maybe later. So we delve into today's winner, the easy crack:

http://www.glaxowellcome.co.uk/health/odyssey/obesity/

They page is still there on 4th December 1998 - God knows for how long. Anyway, I've got a mirror on my hard disk 8--]

On we go to the next page.

http://www.glaxowellcome.co.uk/health/odyssey/obesity/obes1.html

It's a nice summary of the body weight situation in some countries.
 

Introduction In the past two decades, obesity has emerged as an increasingly important healthcare problem around the world, with both developed and developing countries experiencing a dramatic increase in its prevalence. It is estimated that about 100 million people now have a body mass index greater than 30.   Body mass index: Take my mass, 75 kg, and my height, 165 cm. This gives a body mass index of 75/(1.65x1.65)=28 (Cioff's comment).  The trend reflects economic changes taking place in the developing world, as well as a global tendency towards urbanization and the use of labour-saving machinery. Furthermore, as distribution systems improve and people's disposable income increases, more tasty, variable, and rich food becomes available to more people. As a result, more people are overeating at a time when their energy expenditure is dropping. The energy balance equation is shifted positively and populations relentlessly gain weight.  The United States exemplifies the rapid change that has occurred in the prevalence of gross overweight. According to the latest National Health and Nutrition Examination Survey (nhanes), which was carried out on a representative sample of the population from 1988 to 1991, 33% of the American public is obese. This represents an increase of eight percentage points since the previous N.Hanes survey one decade ago, when 25% of the population was found to be obese. Some groups of people are particularly at risk, such as African American women. The prevalence of obesity in this group has risen to 48.5%, and to as high as 60% in African American women aged between 40 and 60. In Britain, the number of clinically obese people has doubled in the past 10 years to 17% of men and 13% of women. More than 50% of the population are overweight.  Horrible, isn't it? I suppose it's facts. Nothing to crack.Then there are lengthy chapters about causes and sophisticated studies on metabolism. I don't want to go into the details; they are code cracking exercises. In this essay I go for the Zen crack.  So we make an unconditional jump to the treatment part     Lean times ahead Pharmacological approaches As the chronic nature of obesity has become clear, clinicians have realized that a long-term commitment to obesity treatment is necessary.    The first investigator to take this concept seriously was the American researcher Michael Weintraub, who in 1992 published the results of treating obese patients with 34 weeks of combination drug therapy. The two drugs administered (phentermine and fenfluramine) have different mechanisms of action: adrenergic and serotoninergic. Weintraub obtained excellent results by supporting the drug therapy with a behaviour modification programme, which included detailed advice on nutrition and an exercise prescription. The resultant weight loss appeared to be sustained as long as the drugs were taken.   (This is the notorious "phen-phen" that you can find lots of stuff about if you look up fda.gov - Cioff's comment) Weintraub's work led to a conceptual shift in obesity management, away from an exclusive focus on traditional behaviour modification techniques. The idea has gained ground that obesity is an incurable condition like hypertension or diabetes, for which the appropriate treatment includes dietary intervention as well as drug therapy - and in which drug therapy, if instituted, is long-term. The problem is that the drug armamentarium for treating hypertension and diabetes is much richer than that for treating obesity. One new drug designed for long-term use, dexfenfluramine, has recently come onto the market in the United States, and has been used in Europe for more than eight years. Two other drugs - sibutramine and orlistat - are undergoing clinical trials and their manufacturers hope to have them on the market by 1997. All three drugs clearly have a greater effect on weight loss than a placebo, but none is a magic bullet. They are modestly effective in improving the possibility of weight loss, and further testing is necessary to determine their effect on weight maintenance and on the potential adverse health effects of obesity.   Pharmaceutical companies have large teams at work in an effort to develop new medicines, and it is likely that more powerful drugs will be marketed in the future as more knowledge is gained about food intake regulation and thermogenesis. It remains to be seen how successful this new era of pharmacology will be, but it seems clear that the present drugs will only work if they are part of a treatment package that includes nutritional and exercise components.

 

This looks nice and scientific, doesn't it? The authors talk disinterestedly about obesity, disinterestedly about genetics (I've skipped it here; see for yourself if you like), disinterestedly about lifestyle, and rather critically about the drugs (two of which were recently withdrawn recently because they caused fibrosis of the heart).

The crack

This is the way to put the newbies on the hook. The old cracker and reverser will take one step back, download the pages, take a pipe and pack of matches, and smoke over the text for a while. No hurry. Leaf back and forth a few times. Make a printout and some squiggles in the margin and some underlinings of key words. Maybe take a small drink. Glass of wine or something. Play some music. Slowly the hidden pattern will appear.

It's Zen cracking.

The clue can be found in the concluding paragraphs.

Their concluding message is guarded. They promise little, but show you the goals of the game: Just you wait. Let's go on searching for the cause of fatness. Sooner or later we'll find the drug that manipulates your appetite or your digestion or your metabolism in such a way that you won't need to get fat if you buy our products. The products of today will probably not work alone; you will have to modify your diet and do exercise as well.

Reversing?

 The cause of fatness is not metabolism or genes or whatever, but a sick society that has based its economy on a sick lifestyle.

I heartily agree with +ORC on his supermarket series. But I would like to supplement his views: I say that the drug industry is one of the institutions that makes the sick system tick. Not only for constructive ends in the individual patient who really couldn't make it without (like me, for example), but for sustaining the system which is destructive to people and to the planet. For spreading dangerous and useless drugs (the slimming drugs are a nice example) that damage individuals and keep people centered on their individual metabolic problems instead of the structural disease of the entire society, of which they themselves are the most pitiful victims.

So I offer to make it my role, in Fravia+' site, to take care of a sort of 'sublab' on this industry. I'm thinking about an exercise - a reality cracking strainer. There are lots of nice Web pages from the pharmaceutical industry around, and they are all waiting to be cracked. Good solutions may earn the author a question mark ahead of (or inside) her or his name, please write me at halcioff(at)yahoo(point)com.

Ci?off

Reality Cracking

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