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Despite the myriad menu of FDA-approved medications for weight loss, they’ve only been prescribed for about 1 in 50 obese patients. We worship medical magic bullets in this country. What gives? One of the reasons anti-obesity drugs are so “highly stigmatized” is that historically they’ve been anything but magical, and the bullets have been blanks, or worse.

Most weight-loss drugs to date that were initially approved as safe have since been pulled from the market for unforeseen side effects that turned them into a public threat. As you may remember, it all started with DNP, a pesticide with a promise to safely melt away fat—but instead melted away people’s eyesight. (It was one of the things that actually lead to the passage of the landmark Food, Drug, and Cosmetic Act in 1938.) Thanks to the internet, DNP has “made a comeback…, with predictably lethal results.”

Then came the amphetamines. Currently, more than half a million Americans may be addicted to amphetamines like crystal meth. But “[t]he original amphetamine epidemic was generated by” drug companies and doctors. By the 1960s, drug companies were churning out about 80,000 kilos a year, which is nearly enough for a weekly dose for every man, woman, and child in the United States. Billions of doses a year were prescribed for weight loss. Weight-loss clinics were raking in huge profits. A dispensing diet doctor could buy 100,000 amphetamine tablets for less than $100, and turn around and sell them to patients for $12,000.

At a 1970 Senate Hearing, Senator Thomas Dodd (father of “Dodd-Frank” Senator Chris Dodd) suggested America’s speed freak problem was no “accidental development.” He said the pharmaceutical industry’s “[m]ultihundred million dollar advertising budgets, frequently the most costly ingredient in the price of a pill, have, pill by pill, led, coaxed and seduced post-World War II generations into the ‘freaked-out’ drug culture.”

I’ll leave drawing the Big Pharma parallels to the current opioid crisis as an exercise for the viewer.

Aminorex was a widely-prescribed appetite suppressant—before it was pulled for causing lung damage. Eighteen million Americans were on fen-phen before it was pulled from the market for causing severe damage to heart valves. Meridia was pulled for heart attacks and strokes; Acomplia for psychiatric side-effects, including suicide… and the list goes on.

The fen-phen debacle resulted in “some of the largest litigation pay-outs” in the industry’s history, but it’s all baked into the formula. If you read the journal PharmacoEconomics—and who doesn’t—sure, a new weight-loss drug may injure and kill so many that “expected litigation cost” could exceed $80 million. But Big Pharma consultants estimate if successful, the drug could bring in over $100 million. So, do the math.

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