Thursday, 30 October 2008

Popery

Like all other practices in the UK we have recently been advised that rimonabant, a treatment for obesity, has been withdrawn because of the increased risk of psychiatric problems including suicide. So I did a search on our computer system and found that none of our patients is currently being prescribed rimonabant. Indeed, we have only ever prescribed it for one patient.

I am not sure how to feel about this. Should we congratulate ourselves for being cautious and careful prescribers? Or should we hang our heads in shame for being stick-in-the-muds who have denied our patients effective treatment for the terrible and devastating disease that is obesity? It is interesting that our only prescription of the drug occurred just last month, and was instigated by our youngest, keenest and most up-to-date partner.

When I was at medical school they taught us this couplet by Alexander Pope, and I think he got it about right.
Be not the first by whom the new are tried,
Nor yet the last to leave the old aside.

7 comments:

The Armchair Daddy said...

Should we congratulate ourselves for being cautious and careful prescribers?

Yes.

Or should we hang our heads in shame for being stick-in-the-muds who have denied our patients effective treatment for the terrible and devastating disease that is obesity?

No.

It is interesting that our only prescription of the drug occurred just last month, and was instigated by our youngest, keenest and most up-to-date partner.

Good on him or her and I hope they remain young, keen and the most up-to-date.

Anonymous said...

I don't think it is a bad thing at all to be honest. I'm skeptical about drug treatments for obesity and baulked when I saw an 18 year old woman get referred for a gastric bypass on Embarrassing Illnesses this week.

I'm also not enamored with the standard GP diet sheet approach - impractical! Normal eating doesn't involve following a diet. (Sorry to break it to you - but no-one actually eats what's on the diet sheets!)

I would say it given my job, but psychological therapies have proven effectiveness for treating obesity. And I never knock the Susie Orbach approach to eating distress, although I'm unsure whether there's evidence enough to convince NICE.

It will be interesting to see whether the new Improving Access to Psychological Therapies might take some of this work on. I certainly think it would be an excellent use of resources - and a far better approach to obesity management than any of the conservative diet and exercise approaches (which don't work because people don't follow them) or the aggressive drug therapies and surgical options.

Trainee Clin Psych

dutchdoctor said...

I'm doing the same. I wait first for more data about new medication before prescribing it. Seems to be safe practice.

Xavier Emmanuelle said...

I have tried to leave a comment here twice, and each time the internet has died on me. Thus, I shall be brief, and hopefully it will go through this time!

I agree with your view -- history of medicine has taught me that while often medical advances are wonderful, in most cases they should still be approached with caution. Thalidomide, the early oral contraceptives, the swine flu vaccine of the 70s, I could go on but you get my point...

Yay for approaching new drugs with caution, especially when it's not for something acutely life threatening.

Dragonfly said...

Good quote.

Anonymous said...

I'm a GP in Australia, and am similarly careful about prescribing new treatments like this, especially for obesity. There are so many factors in obesity; perhaps a drug could treat a certain smallish percentage of obese, but mostly it's false hope for the patient and often with nasty side effects. Likewise with the various weight loss surgeries. I've become interested in the paradigm of Health At Every Size, which is about encouraging patients of all weights to eat and exercise well: focussing on the concepts of re-learning hunger and intuitive, healthful eating after years of dieting or disordered eating; and exercise as an enjoyable part of daily routine instead of merely a means to burn kilojoules. It's hard for many, especially obese women, but I have been encouraging them to take their minds off the number on the scale and get excited instead about lowered BP, BG, lipids, improved mental health, self esteem, and so on. It's a more sustainable method of lifestyle change than traditional diet and exercise plans based on weight reduction as a primary measure of success. Google 'Rick Kausman' and 'If not dieting' -- Kausman is fairly well-known here for this kind of personal, psychological approach.

Dr Andrew Brown said...

Thanks everyone for your helpful and interesting comments, as always. I shall do some more thinking about the treatment of obesity.