The Thin Pill . . . . . . from Wired Magazine

75 million Americans may have something called metabolic syndrome. How
Big Pharma turned obesity into a disease – then invented the drugs to
cure it.

By Thomas GoetzPage 1 of 5 next »   [ LONG Article]
http://wired.com/wired/archive/14.10/thin.html

What is a disease?

FOR PATIENTS, disease puts a name to an affliction. It answers that
question we all face at one time or another: What's the matter with me?
If there is a clear and precise explanation for what's wrong, then
surely there is an equally clear way to get better.

At 228 pounds, Karen Cunningham knew she wasn't in great health. The
owner of a small transcribing business in Louisville, Kentucky,
Cunningham had gained 60 pounds during pregnancy in 1991 and just
couldn't shake the weight. She always felt fatigued, and her hands and
feet were often swollen. Doctors blamed it on her weight. "They said I
just needed to lose the excess and I'd be fine," she recalls.
Eventually, various specialists (rheumatologists, endocrinologists,
internists) offered various diagnoses (high blood pressure,
hypothyroidism, osteoarthritis) and prescribed various medications
(Synthroid, Celebrex). But nothing worked. "I was really at the end of
my rope, really thought whatever I had was going to kill me," she says.
"And it would have, had I not found out what the problem was. You can't
fight an enemy when you don't know who he is."

The breakthrough came last December when her new endocrinologist
diagnosed her with something called metabolic syndrome. She'd never
heard of it. As she Googled to learn more, her chronic ailments – the
weight, the high blood pressure, the lack of energy – started to make
sense. They even seemed treatable. She's now on Glucophage and Avandia
(which both regulate blood sugar) and has lost 20 pounds by cutting out
carbohydrates. "Getting a diagnosis was a relief," Cunningham says. "I
have hope now, whereas I didn't have any before."

Cunningham is among the first wave of Americans to be diagnosed with
metabolic syndrome, a condition that, though only concretely defined
five years ago, is now said to afflict as many as 75 million Americans –
whether they know it or not. We sit, indeed, amid an epidemic of
metabolic syndrome, a fact all the more remarkable because so few people
are familiar with it. For this is no virus on the loose, no plague that
has spread unchecked. Rather, metabolic syndrome is just a new way to
think about a cluster of well-known and increasingly prevalent
conditions. Metabolic syndrome is characterized by five risk factors:
high blood pressure, high blood sugar, high triglycerides (fatty acids
in the bloodstream), low HDL ("good") cholesterol, and obesity. Of the
five, obesity – which is itself often referred to as an epidemic – is
the most important, because the rise of the morbidly overweight is
directly driving the rise in the syndrome. Metabolic syndrome is, in
fact, almost indistinguishable from obesity – at least 85 percent of
those who have the syndrome are obese or overweight.

The tidiness of that correlation makes it tempting to view metabolic
syndrome not as an emerging fact of medicine, but as a fiction, wholly
devised and disseminated by the pharmaceutical industry. After all, drug
companies have long eyed obesity as the ultimate growth market – and
they just happen to have an arsenal of pills poised to target it. Such
cynicism isn't misplaced. The drug industry is among the most profitable
in the world; pharma's knack for generating money makes oil companies
look like lemonade stands. Drug firms owe their prodigious success to
doing one thing exceptionally well. R&D? No – marketing. And as perfect
an opportunity as obesity might be, it's also a legitimate health crisis
that's only getting bigger. The one snag is that most people don't
consider being fat a disease, they see it as a lifestyle problem. Which
explains the appeal of metabolic syndrome. It's a simple, compelling
concept that reframes the issue in scientific terms.

But is it real? In some ways, no. You can't see metabolic syndrome
through a microscope, or detect it through a single blood test. Since
it's a checklist of risk factors rather than symptoms, it stretches the
way we think of disease. It's very much a human invention, a "syndrome"
– that term researchers assign to things they don't quite understand.
But in other ways, it's absolutely real. Though championed by drug
companies, it's been defined and recognized by legitimate health
organizations. And it's definitely unhealthy. You can't die of metabolic
syndrome, but you can die of what it leads to: diabetes and heart disease.

And even if metabolic syndrome is just another term for obesity, it
wouldn't be the first condition of daily life to become a disease.
Alcoholism, clinical depression, and gastritis were all once considered
personal problems that are now recognized as legitimate medical
disorders, with all the trimmings of diagnosis, treatment, and
pharmaceuticals. Many of these new illnesses, like osteoporosis, are
widely accepted. Others, like fibromyalgia and female sexual
dysfunction, remain fuzzy quasi diseases with shaky standing in the
medical community.

The question now is whether metabolic syndrome will become accepted – or
whether it will be dismissed as bad medicine, the product of an
overeager illness industry. Proponents of the concept, including the
American Heart Association and the World Health Organization, say the
disease illustrates the cutting edge of diagnostics. It exists because
we're only now recognizing that some very bad conditions can cluster and
compound one another. Certainly metabolic syndrome is compelling to
researchers: In the past five years, it has been the subject of no fewer
than 15,000 studies, a number that puts it among the most researched
conditions in medicine.

................... End of Extracting .............
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speculation....

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