Don’t panic.  I don’t have a paid ad for the RealAge Test stretching across the top of my blog post today.  This one is for illustration purposes only.  If you are like me, however, you’ve run across this banner countless times in your online surfing.  It seems to pop up everywhere.  Or at least it used to.  It hasn’t too much lately since the big New York Times exposé, more about which later.

But first let’s take a look at something else brought to the public by the team of Roizen and Oz.  I came across this page on their RealAge website while I was googling something else.

According to these two (or their team of ‘world-renowned scientists and doctors’) we should all avoid fructose and load up on glucose, the ’sugar that staves off hunger.’

Sugar is sugar, right? Maybe not. Turns out that there is one type of sweetener that helps fill you up, while another leaves you craving more.

The two sugars in question: glucose and fructose. Glucose appears to quell hunger, and fructose seems to ramp it up.

The sugars may affect your appetite differently because of the unique ways in which they affect malonyl-CoA, an important appetite-suppressing molecule in the brain. Glucose causes malonyl-CoA to rise, resulting in less food intake. Fructose, on the other hand, lowers malonyl-CoA, resulting in more food intake.

The implication of their message is that if you eat glucose you won’t be hungry, but if you eat fructose you will.  They go on to discuss how important it is to cut fructose from the diet since fructose makes you eat more.  And, by implication, to add glucose.

I agree that we should all cut most of the fructose from our diets, but not for the reasons these guys (and their team of purported experts) give.

I would assume that both of these docs went to medical school and had many years of post-medical school training.  I would also assume the same about their ‘world renown’ staff of experts.  What I don’t understand, then, is how they can make such stupid statements that have no grounding in actual biochemistry.

The ‘important appetite-suppressing molecule’ under discussion is malonyl-coenzyme A (malonyl-CoA), which is one of the major signaling molecules in the body.  Malonyl CoA sits at the crossroad of fat storage and fat burning and drives the reaction one way or another.

If we’ve eaten a lot, especially a lot of carbohydrate, malonyl-CoA levels increase.  Increased levels of this substance then shift the flow of fat away from burning and toward storing.  Among its activities, Malonyl-CoA stimulates fatty-acid synthase (FAS), the enzyme that converts carbohydrate to fat.  And it inhibits the enzyme (CPT-1) that carries fat into the mitochondria where it is burned for energy.

If we haven’t eaten, or if we have been eating a low-carb diet, the opposite happens.  Malonyl-CoA levels are low, which removes the inhibition of CPT-1.  Fat is shunted away from storage in the fat cells and instead is transported into the mitochondria where it is burned.

Since malonyl-CoA is one of the main substances in the body that determine what happens to fat, it would make sense that this molecule would somehow be involved in the regulation of hunger.  Elevated malonyl-CoA levels indicate that we’ve got plenty of fuel aboard and that the body is in the process of getting it stored away, so it would stand to reason that these elevated levels may affect the hunger centers in the brain, sending the message not to eat any more.

Researchers have looked into this notion, and it indeed appears – in rodents, at least – that elevated levels of malonyl-CoA do suppress the hunger centers in the hypothalamus.

If you do a quick thumb through any decent medical biochemistry textbook looking for what makes malonyl-CoA go up, you’ll find that it is driven up by insulin and glucose, the surrogates for being well fed.  But here is where Roizen/Oz and the team of experts go off the rails.  The glucose in question isn’t dietary glucose – it’s blood glucose.  As I’ve written about before, the entire amount of glucose we have circulating through us if we have a normal blood sugar level is around 4 grams, a little less than one teaspoon.  If we eat a medium-sized baked potato, we ingest about 50 grams of glucose (potato starch is made of pure glucose), which is more than ten times the amount regularly circulating in our blood.  Our bodies quickly deal with this excess by increasing insulin and driving the glucose into the cells.  As a practical matter, dietary glucose never really impacts malonyl-CoA.  What does impact it is the level of blood sugar.  So if blood sugar is higher than normal, then more malonyl-CoA is made, and more fat is stored.  Which is one of the reasons type II diabetics are usually obese to some extent.  These people have the double whammy of too much sugar and, since they’re almost always insulin resistant, too much insulin.

Any readers who have type II diabetes will have increased levels of malonyl-CoA.  I will ask those of you who have this condition: are you less hungry?  I didn’t think so.  Despite the fact that in rodents (and probably in people who are normal weight) malonyl-CoA may suppress hunger, it doesn’t seem to do so in those who are overweight and insulin resistant.  It may a little, but there are other forces driving hunger more than the malonyl-CoA suppresses it.  And in any case, it doesn’t have anything to do with dietary glucose – a fact our illustrious crew of ‘world renowned’ experts should have known.  Their implying that adding glucose to one’s diet will decrease hunger is just plain stupid.

But let’s look at something a little more sinister than just plain ol’ stupid.

These same guys are behind the RealAge test that (until fairly recently) was popping up every time you turned on your computer.  I saw the ads for this test over and over and over again, and I wondered what they were selling to justify the huge expense such unremitting advertising requires.  Then I read a New York Times article that explained it all.

As it turns out, the RealAge test is a means for Roizen/Oz et al to gather health information from those who take the test.  I’ve taken the test, which requires many pages of questions, and discovered that I am about 8 years younger than my chronological age.  I also discovered that I would be younger yet if I didn’t eat so much red meat.  You can guess how to perform well on the test: tell them you eat no red meat and a lot of soy.  (My choices on the red meat were: no red meat; red meat once per week; or red meat more than once per week.)

During the course of the test, after a long list of medical problems that are to be checked if the test-taker suffers from them, this question pops up:

If the answer is yes, you may be bombarded with information from various pharmaceutical companies that make drugs to treat the checked diseases. Or if, according to the Times, you decide to become a RealAge member.

Yep, that’s right.  These guys who seem so compassionate and are giving away their RealAge test (after capturing your email address) and providing all kinds of lifestyle change recommendations are really capturing your info and peddling it to Big Pharma.  Which, of course, is how they can afford the many ads for their ‘free’ RealAge test.

Says the NY Times:

But while RealAge promotes better living through nonmedical solutions, the site makes its money by selling better living through drugs.

Pharmaceutical companies pay RealAge to compile test results of RealAge members and send them marketing messages by e-mail. The drug companies can even use RealAge answers to find people who show symptoms of a disease — and begin sending them messages about it even before the people have received a diagnosis from their doctors.

While few people would fill out a detailed questionnaire about their health and hand it over to a drug company looking for suggestions for new medications, that is essentially what RealAge is doing.

Pretty sleazy, if you ask me.

They still provide their RealAge test, but as far as I can tell, only if you go to their website.  They are probably waiting for the fallout to be over from the Times piece.  Until then, they are dragging people to their website with idiotic pieces such as the one I discuss above.  If you are googling a health problem, nutrient, diet, etc., you may come upon their website and be presented with the RealAge test.

But, if the article I read is any indication of the value of their advice, I would be real leery.  The advice may be stupid, but the strategy behind the RealAge test is definitely sleazy.

Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.

Acupuncture and some of the hands-on manipulative therapies fared a little better.

As for therapies, acupuncture has been shown to help certain conditions, and yoga, massage, meditation and other relaxation methods may relieve symptoms like pain, anxiety and fatigue.

The article didn’t give a rundown of every alternative or non-mainstream therapy tested, so I don’t know what they all are, but I can add one to the list if it wasn’t tested in this $2.5B testorama.  I would add the use of HCG for weight loss.

Many practitioners are using injections of human chorionic gonadotropin (HCG) injections coupled with an extremely low-calorie diet to help their patients lose weight.  Many practitioners and many patients swear by this regimen.  But, a number of randomized, double-blind, placebo-controlled studies have shown that the HCG regimen is no better than placebo.

But if this is so, how come so many patients and practitioners believe so strongly in this HCG/diet combo?  Simple answer.  Because it works.

But if it works, why is it a worthless regimen?  Because it doesn’t work any better than placebo.

If you go to a doctor who tells you that he/she is going to start you on an extremely powerful weight-loss program that involves multiple injections along with a stringent diet composed of specific foods to be eaten on a rigid time schedule (especially if these foods add up to only 500 calories per day), you will come away convinced that you are going to do well.  Especially after you’ve paid the bill, which is considerable in these HCG centers.

If you go in for all the injections and scrupulously follow the diet, you will lose a fair amount of weight pretty quickly.  And you will develop and unshakable believe that this regimen did the trick for you.  You will tell your friends, all of whom have witnessed your rapid weight loss, and they, too, (at least those who can afford it) will go to the same practitioner and fork over for the treatment.

Problem is this treatment works the same if the patients are given a salt-water shot or an HCG shot.  There is no difference in outcome.  The HCG doesn’t do diddly.  It’s the fact that you get a shot that makes the difference.  If you simply went on the 500 calorie per day diet you would lose the same.  But it’s the magic of receiving the shot, especially after being told (as most are) at the practitioner’s office that the shot will help overcome the hunger of being on a drastically calorically-reduced diet.  And it does.  But it doesn’t matter if it’s a saline shot or a dose of HCG.  It’s the magic of having something done.

Which is why in the $2.5 billion tests, the manipulative therapies worked and the others didn’t.  There is something about having a procedure done that makes you feel like your getting a more powerful treatment.

I can’t tell you how many people came in to see me when I had a regular medical practice who demanded a shot because they were convinced that shots worked better than oral medications.  For some things they do, but for most, they don’t.  But you couldn’t convince most of my patients of that.

There are a few of what many would consider alternative medicines that do work.  I posted on one that does here.  But, as the large conglomeration of studies reported on by the AP showed, most don’t.

As you might imagine, the report of the failure of most alternative therapies was like catnip to mainstream physicians, researchers and writers.  They were absolutely giddy with joy.  Here are just a few representative comments:

Well, since I’ve been bagging on the alt-med nonsense lately, I simply couldn’t pass up this headline.  And folks… the headline says it all… “No Alternative Cures Found”… Zilch… Nada… Zip… Zero!  Despite their inability to understand the most basic aspects of science and the associated math, I think that zero is a number that even alt-med woo-meisters can grasp

(Woo is the derogatory term these mainstreamers have come up with for any treatment or therapy not taught in traditional medical schools or developed by Big Pharma.)

I never thought I’d see it, but I have. After an a decent article on the infiltration of quackademic medicine into American medical centers and a very good article on cancer quackery, Marilyn Marchione of the AP has done it again:

AP IMPACT: $2.5B spent, no alternative med cures…

I’ve documented the woo funded by NCCAM on multiple occasions. I mean, NCCAM is funding studies of that woo of woos, homeopathy, fer cryin’ out loud! I”m [sic] glad that the mainstream media is finally noticing.

One more.

Here’s a shocker for you: after a decade and 2.5 billion (with a b, folks) dollars spent, a government study shows that almost no alternative medicines worked.

So, they used actual scientific testing processes instead of anecdotes, and found that most of these simply don’t work. Like I said: shocker.

… the studies have shown that most of these remedies don’t work. And will this change the minds of their advocates?

HAHAHAHAHAHAhahahahahahaha! Oh man, sometimes I crack myself up.

This is just one more arrow in our quiver, but the alternative medicine believers will continue to move the targets around. Stay vigilant, and remember: people waste money, people get sick, and people die because of this antiscientific thinking. That’s why testing this, publicizing it, and fighting the misinformation is so important.

Believe me, this is just a small sampling of what I came across on the internet when I searched for links to the AP article.

Hostile and condescending as the tone of these remarks is, the people who made them are pretty much on the money.  These treatments need to be evaluated in the harsh glare of double-blind, placebo-controlled studies.   Now they have been, and, just as with the HCG regimen for weight loss, they’ve been found lacking.

But that’s not necessarily the end of the story.  We don’t know the details about these studies.  Was there just one study for each alternative therapy?  Or were there multiple studies, each of which demonstrated no effectiveness?  If just one, then the above criticisms may not be valid.

Absence of evidence is not necessarily evidence of absence.  Just because we can’t get a positive result in one study doesn’t mean there isn’t a positive result to be had.  Science is the continual testing of hypotheses until the evidence is overwhelming that the hypothesis is valid or it isn’t.  But even overwhelming evidence doesn’t always prove out in the long run.  Newton’s laws were held to be valid after centuries of testing, then Einstein came along.

What interests me so much about the glee with which these mainstreamers greet the failure of alternative medicine (at least the failure shown by $2.5B worth of research) is that the vast majority of these same folks believe in the notion that people are overweight because they eat too much and exercise too little, an idea that scientifically holds little water.  A myth, really.  But they all believe it because on the surface it seems to make sense to them.  All the scientifically valid arguments that, say, Gary Taubes makes fall on deaf ears.  (Here is a video of a recent lecture Gary gave to doctors at Dartmouth.  Do you think any of them were moved to give up their antiquated views by the science presented?  It’s highly doubtful.)

And while most of the people pooh poohing woo are doing so, they are out pushing statins for all their worth.  And statins – other than for a small group of people – have the same efficacy as the alternative medicines they are so quick to disparage.  Let’s see, how did that one writer put it?  “…Zilch… Nada… Zip… Zero!”

That’s right.  The category of drugs that are the top selling drugs worldwide have no efficacy in terms of reducing overall mortality, at least as shown by randomized, double-blind, placebo-controlled studies, in any group except men under the age of 65 who have been diagnosed with heart disease.  This doesn’t mean men under 65 who have elevated cholesterol, but men under 65 who have actually been diagnosed with heart disease or who have had a heart attack.  And even in that group, the efficacy is questionable.

The mainstreamers such as those quoted above don’t question the effectiveness of statins even though at least $2.5 billion has been spent to test them and found them lacking, but readily discount alternative medicines simply because they don’t fit with their belief system.  Based on the evidence at hand, I wouldn’t give people Echinacea, shark cartilage and all the rest because the studies show they don’t work better than placebo, but for all the same reasons, I wouldn’t give a patient a statin either.  In fact, I would probably give the Echinacea before I gave the statin because, as far as I know, no one has died taking Echinacea, of which the same can’t be said of statins.

If alternative medicines are going to be held to scientific standards, so should be pharmaceuticals.  Snake oil is snake oil no matter what its bottle it looks like.

I’ve made mention in these pages numerous times of the dubious practice of medical researchers being on the payrolls of the pharmaceutical industry.  I’ve known about these shady alliances for my entire career, but what I didn’t know was just how lucrative they were for the researchers involved.  This past weekend both the Wall Street Journal and the New York Times reported on drug company payments to a prominent Emory University psychiatrist and researcher and former editor of the journal Neuropsychopharmacology.

Senator Charles Grassley (R. Iowa) is probing into this mess because any federally-funded research is supposed to free of financial conflicts of interest.  Enforcement of these rules is usually left to the universities employing the researchers, which are apparently easily flim flammed by the researchers involved.  In the specific case reported by both papers, the Emory researcher Dr. Charles Nemeroff, was instructed by Emory not to take more than $10,000 per year from GlaxoSmithKline, the drug company for whom he was doing research on their bestselling antidepressant drug Paxil.  But despite his assurances to Emory that his income from Glaxo was within the limits, Dr. Nemeroff’s take was just a little more.

From 2000 through 2006, Dr. Nemeroff received just over $960,000 from Glaxo, but reported to Emory that he received no more than $35,000.

Though the $960,000 payment by Glaxo is a king’s ransom, it may be only the tip of the iceberg.  Apparently Dr. Nemeroff was on the payroll of a number of other drug companies as well.

In a June 2004 Emory report obtained by Sen. Grassley, the school concluded Dr. Nemeroff had committed violations of its conflict-of-interest policies.  At the time, he had consulting arrangements with about a dozen companies, including Merck & Co., Bristol-Meyers Squibb Co. and Eli Lilly & Co.

And don’t think this behavior is an aberration limited to this one physician.  Many, many more are on the teat of the pharmaceutical industry.  From the New York Times article:

Mr. Grassley began his investigation in the spring by questioning Dr. Melissa P. DelBello of the University of Cincinnati after The New York Times reported her connections to drug makers. Dr. DelBello told university officials that she earned about $100,000 from 2005 to 2007 from eight drug makers, but AstraZeneca alone paid her $238,000 during the period, Mr. Grassley found.

Then in early June, the senator reported to Congress that Dr. Joseph Biederman, a renowned child psychiatrist at Harvard Medical School, and a colleague, Dr. Timothy E. Wilens, had reported to university officials earning several hundred thousand dollars each in consulting fees from drug makers from 2000 to 2007, when in fact they had earned at least $1.6 million each.

Then the senator focused on Dr. Alan F. Schatzberg of Stanford, president-elect of the American Psychiatric Association, whose $4.8 million in stock holdings in a drug development company raised concerns.

What do these researchers do to get paid this kind of money?  They promote the companies’ drugs.  The Wall Street Journal gives us a glimpse of what goes on.

On March 19, 2004, the senator [Sen. Grassley] said, Dr. Nemeroff addressed questions from Emory’s Conflicts of Interest Committee in a letter in which he wrote: “Apart from speaking at national symposia, such as the American Psychiatric Association, for which GSK might serve as a sponsor, my consultation to the company is limited to chairing their Paroxetine Advisory board and for that, I am remunerated $15,000 per year.” Paroxetine is the chemical name for Paxil.

Just three days earlier, however, Glaxo paid Dr. Nemeroff $3,500 for a talk he gave on Paxil in Orlando, Fla., Sen. Grassley alleges.

The next day, March 17, he gave another $3,500 talk about Paxil in Kissimmee, Fla. In the week after writing to the conflict-of-interest committee, Dr. Nemeroff gave three talks on Paxil, for $3,500 each, at various locations in New York, according to the senator.

On July 6, 2004, Dr. Nemeroff promised the university he would limit his consulting work to Glaxo to under $10,000 a year, according to Sen. Grassley. But a week later, in two days of work, he exceeded that limit, according to records provided by the senator. He said that on July 12, 2004, GSK paid Dr. Nemeroff $3,500 in fees and $505.40 in expenses for a talk he gave on Paxil in Las Vegas; and that he was paid $7,000 for two talks he gave for Glaxo the next day.

In an Aug. 4, 2004, letter to a university dean, Dr. Nemeroff said he had “taken the necessary steps to be in compliance with the recommendations” of the Emory conflicts panel, “namely my consulting fees from GSK will be less than $10,000 per year throughout the period of this NIH grant, its renewals and final collections of data.” He said Glaxo had been informed of the step and was supportive.

But according to Glaxo records, Dr. Nemeroff exceeded the $10,000 limit that month.

It’s apparent that Dr. Nemeroff got a fair amount of his money from giving talks to doctors about Paxil.  Given the circumstances, I doubt that he was discouraging its use.

I don’t know why Sen. Grassley is so hell bent on rooting out financial improprieties in the world of antidepressant research when those drugs account for only a fraction of the sales that statins do.  Although I haven’t seen reports in the major media, I would assume that these kinds of violations are rampant among statin researchers since there is many multiples of the money available there as opposed to that available for promotion of psychiatric drugs.

Although I can’t find the actual quote, I think it was George Bernard Shaw who said “I find it hard to trust a man who tells me my gall bladder needs removing when he stands to make £300 for removing it.”  I, myself, find it hard to trust a man who tells me I my patients need to take Paxil when he stands to make $960,000 for telling me so.  Multiply that sentiment by a factor of at least 10, and that will tell you how much I trust a man who tells me I need to take a statin.

Apparently a large number of people who were expecting to get large settlements for damage they had sustained as a consequence of taking the fen-phen weight-loss drug regimen were fleeced by a group of less-than-savory lawyers who were in cahoots with a crooked judge. In my view the story is on its way to a happy ending because all the people involved got or are getting shafted.

All the people who thought they were going to get something for nothing got something, but a lot less something than they anticipated because their lawyers shafted them. The lawyers who shafted them are now embroiled in multiple lawsuits that will more then likely eat up all their ill-gotten gains, and they face the possibly criminal proceedings. The judge that helped the sleazy lawyers get their rapacious fees, robbing the folks who expected something for nothing, got hammered by the Judicial Conduct Commission. He was formally reprimanded by the commissioners who said his actions were

disturbing, inexcusable, and shocking to the conscience.

Heh, heh, heh.

For those of you who don’t know what this is all about, here is a summary. Years ago doctors everywhere were prescribing fen-phen for weight-loss to zillions of patients. As with any drug, there were side effects. A small number of people taking phen-fen suffered heart valve disease, sometimes to a degree requiring valve replacement. As reported on the FDA website:

On July 8, 1997, the Mayo Clinic reported 24 patients developed heart valve disease after taking fen-phen. In five patients who underwent valve replacement surgery, the diseased valves were found to have distinctive features similar to those seen in carcinoid syndrome. The cluster of unusual cases of valve disease in fen-phen users suggested that there might be an association between fen-phen use and valve disease.

On July 8, FDA issued a Public Health Advisory that described the Mayo findings. The Mayo findings were reported in the August 28 issue of the New England Journal of Medicine, along with an FDA letter to the editor describing additional cases. FDA has received over 100 reports (including the original 24 Mayo cases) of heart valve disease associated mainly with fen-phen.

When you think about the enormous numbers of people who took fen-phen, these valvular problems, though serious in some cases, represented a tiny, tiny fraction of people who took the drug. Had it stopped at that, there probably wouldn’t have been a big problem. But, it didn’t. What really caused the situation to snowball was the echocardiograph findings of several physicians. From the FDA:

Recently, FDA has received reports from five physicians who had performed heart studies (echocardiograms) on patients who had received fen-phen or dexfen-phen and did not have symptoms of heart disease. Of 291 asymptomatic patients screened, about 30 percent had abnormal valve findings, primarily aortic regurgitation.

What this means is that none of these 291 patients had symptoms of any kind of heart disease, yet 30 percent of them had evidence of abnormal heart valve function. Since these people had no symptoms of heart disease, it’s unlikely that they had ever had a previous echocardiogram. Since there was no previous study done, how did these doctors know that the 30 percent who demonstrated signs of valvular dysfunction didn’t have it all along? All kinds of people have heart murmurs, which are evidence of valvular dysfunction, yet they are entirely without symptoms. In this case, however, since the patients had taken fen-phen, the assumption was made that fen-phen was the cause.

Then the lawyers got involved. They began putting out the call to anyone and everyone who had ever taken fen-phen to come see them. They sent these folks to doctors to get echocardiograms, and it they were found to have any evidence of their valves not working–whether they had symptoms or not–they were taken on as clients. As the group of clients mounted, the legal machine began to move.

MD and I were impacted by all this in an extremely limited way. When all the positive press was going on about fen-phen and doctors everywhere were giving it out like candy, we decided not to join in. We felt that our patients should learn to eat correctly, not just rely on an appetite suppressant to help them lose weight. We lost some patients over our refusal to write prescriptions for the regimen, but most understood and agreed with us. In the time that fen-phen was flying high, we may have written between us a dozen or so prescriptions, but that’s about it. We wrote a few prescriptions for phentermine, a part of the fen-phen regimen, but again, not many. We wrote these on an individual basis for the very few patients we felt had particular situations requiring a little more than simply a change in diet. Even these patients we never let stay on the medication for very long.

When the word got out that there was going to be a settlement, we got a four or five requests for medical records from the maybe 30 or 40 people that we had put on fen-phen or phentermine. Plus, we got letters from people asking if they had been on fen-phen when they were at our clinic; they didn’t know if they had taken the drugs or not, but if they had, they wanted to get part of the payout. I can’t imagine what a nightmare it was for the physicians who had been prescription mills, writing hundreds of fen-phen prescriptions every week. They must have had to send out thousands and thousands of copies of medical records.

All the people having these medical records sent to their lawyers then got their echocardiograms, and if there were any abnormalities in valvular function found, they had hit the jackpot. They were going to get paid. We had one patient who had gotten her echocardiogram before she contacted us to send her medical records. At the time, we were one place and our medical records were somewhere else, so we were unable to send them off the day we got her request. She waited a bit, then wrote us again, telling us that she was in line for hundreds of thousands of dollars and the only thing standing in her way was our delay in sending her medical records. We dug out her records and sent them as soon as we could, but I fear she lost out, because when we reviewed them, she had been on only one part of the fen-phen, and that for only a short period of time. (I’m not familiar with the terms of the settlement, but I think in order to qualify, you have to have been on the drug for a certain length of time.) Since she was on it for just a couple of weeks, I’m fairly certain that whatever valvular dysfunction she had probably wasn’t caused by the phentermine. (She was lucky we even had her records. By the time some of these requests came in we had already shredded our records since they were beyond the age we were required to keep them.)
As you can probably tell, I think that most of the ‘problems’ caused by fen-phen are hogwash. There are no doubt some serious problems, but nothing of a magnitude anywhere near the number of people making claims. It’s been over ten years since fen-phen was prescribed in any large amounts, and if there were truly problems as a consequence, we would be hearing about them. But we aren’t.

Don’t get me wrong. If I think that a patient is harmed by a drug or a procedure I’ll bend over backwards to help out. In fact, I’m loving it that the makers of several NSAIDS are getting pounded because they didn’t disclose the problems they were fully aware of caused by the drugs they so heavily promoted. I would be the first to testify against any of the makers of statins. But in this case, I was in the middle of the whole fen-phen shebang and I know what went on. It wasn’t really the drug company’s fault, and there weren’t all that many people harmed. And most of those harmed were probably warned that there could be side effects, but insisted that they wanted the prescriptions anyway.

The company that made the fen-phen regimen, American Home Products (now Wyeth), crumbled under the onslaught of so many lawsuits and negotiated a multi billion dollar settlement with all the lawyers suing them. The money was paid out on a pro rata basis, and here’s where our story from the New York Times starts.

It is typical when lawyers represent clients on a contingency basis for the lawyers to withhold their percentage from any settlement and send the rest on to their clients. The usual contingency fee is about a third of whatever is collected.

The lawyers in this case received about $200 million for their 440 clients. Had the lawyers taken their third, the clients would be left with about $135 million.

But the clients received only $74 million. An additional $20 million went to a questionable “charitable fund.” The rest — $106 million — went to lawyers. Though amounts of the individual settlements remain sealed, court papers suggest they were from $100,000 to $5 million. On average, plaintiffs received less than 40 percent of what the settlement agreement specified, instead of the roughly 70 percent to which they were entitled.

How come the lawyers got so much? They applied to the court to give them a larger percentage of the fees since they had spent so much time and effort on the case, which the court did. The judge in this court was one Joseph Bamberger, who then left the bench and took a job for $5000 per month administering a $20 million ‘charitable trust’ set up with a portion of the extra money he, as the judge, awarded these lawyers. Very nice.

The 440 clients who were in store to get anywhere from $100,000 to $5 million, ended up getting less. When they tried to find out why they weren’t getting all the money they ‘deserved,’ they were threatened by the lawyers.

I would suspect that based on the statistics involved the vast majority of these people didn’t deserve a dime, yet they perceive themselves as horrendously wronged. Nowhere in this Times article does it mention any sort of disability or medical problems any of these people have–only their anger at not getting the money they ‘deserved.’ Their anguish isn’t over not being able to pay for their huge medical expenses incurred because they took fen-phen, but over not getting the money for other things.

Says one:

I was hoping to get enough money to pay the farm off, a farm that’s been in the family since 1857. I’ve asked the Lord to help me see and try to understand why they [the lawyers] did it. The greed got the best of them. They thought they needed it more than I did. [My bold]

So, we’ve got a situation where several things happened:

Greedy people got screwed. Not totally, but to a limited extent.
The lawyers doing the screwing got screwed themselves.
And the judge who facilitated the lawyers screwing the greedy people got screwed.

As I say, it was a heartwarming story.