Novels should have good first lines: “Call me Ishmael”; “It was the best of times, it was the worst of times”; “Every happy family is happy in the same way”; “There was no possibility of going for a walk that day”; “It is a truth universally acknowledged… etc.” One does not expect scientific papers to grab one’s attention in quite the same way.
But a paper published in a recent edition of the New England Journal of Medicine opens interestingly, if not quite with the same literary flair as that of Melville, Dickens or Tolstoy, etc. It begins:
The increase in the rate of obesity, a chronic disease with serious health consequences, largely explains the recent trebling of the prevalence of type 2 diabetes.
This is an odd way of putting it, as if the authors themselves did not quite believe what they were saying. They would not have written “Cancer, a chronic disease with serious health consequences…” because to have cancer is to have bad health. Poverty is not caused by having too little money; poverty is having too little money.
Perhaps it doesn’t matter much what one calls obesity—disease or the wages of sin, or at least of weakness—because everyone is agreed that it is a bad thing and ought, if possible, to be reduced.
The authors conducted a double blind trial against placebo of a drug called liraglutide, which was injected daily subcutaneously for 56 weeks. 3731 fat patients from 191 clinics on 5 continents with a high body-mass index were allocated either to the drug or to placebo (2487 to active treatment, 1244 to placebo), both groups being given standard advice about diet and exercise.
The first thing to note is that only 71.9 percent of the treatment group, and 64.4 percent of the placebo group, completed the trial. When one considers that compliance during trials, with the relatively intense attention it gives to patients, is considerably higher than in normal clinical conditions, the actual usefulness of the drug, at least in the epidemiological sense, is much reduced.
But the drug was certainly successful from the point of view of helping to reduce the weight of patients. 63.2 percent of those on the drug, but 27.1 percent of those on placebo, lost more than 5 percent of their body weight. 33.1 percent against 10.6 percent lost more than 10 percent; and 14.4 percent against 3.4 percent lost more than 15 percent. Moreover, the risk factors for diabetes were considerably reduced in those who took the drug.
The question of side effects is important in any trial of a new drug, of course. Nearly a tenth of the patients on the drug abandoned the trial because of intolerable side-effects; intriguingly 3.8 percent of those on placebo did so as well (a good example of the so-called nocebo effect). Gallbladder disease was twice as common among those taking the drug as those taking placebo, and pancreatitis four times, though not at so high a rate, or so seriously, as to cast doubt of the value of the drug.
But it is early and the precedents with weight-reducing drugs have not been very happy. Fifty-six weeks’ trial on 2487 patients is far too short a time, and far too small a number, to declare the drug safe in the long term. A trial is proceeding in France against a drug company that marketed a slimming drug which is thought to have killed more than 500 patients, and which the company knew was dangerous. My best advice is not to get fat in the first place, but for hundreds of millions it is already too late.