Confessions of a Former Drug Rep

I was raised with the basic principles that we are placed on this earth to do good things for people and the planet during our lifetime. This basic desire led me to a very successful and lengthy career in the pharmaceutical industry, promoting products which addressed specific health care needs.

I was honored to be given the President's Club Award two years in a row as the No. 1 salesperson in America. As time progressed, the products I sold or managed fell into various therapeutic categories. I eventually became the vice president of sales and marketing with two different pharmaceutical companies.

Despite my tenure in the pharmaceutical industry, the evolution of drug treatments for pain and weight loss has left me devastated and disillusioned with the pharmaceutical business. The treatment of pain has led to the opioid crisis that exists today.

I'll discuss my thoughts on that topic in a later article. Today, my concern is the downright frightening pharmaceutical solutions to weight loss. The dynamic of "cash vs. care" is alive and well in America's health care system, with the risk/benefit scales severely tipped in the wrong direction.

The question medical doctors should be asking is, "Why am I putting an overweight patient on a drug that puts his or her cardiovascular system at risk when there are natural and safe alternatives? This is where you, the doctor of chiropractic, come in.

If your patients are like most of the population, two-thirds are overweight and one-third are obese. This is definitely impacting their musculoskeletal health, not to mention their general health. If they haven't already, these overweight patients will eventually seek some form of weight-loss program from someone. Many of the choices range from counterproductive to downright dangerous.

The least impacting are the weight-loss programs that incorporate purchased meals with empty calories, unnecessary additives and generally unhealthy ingredients. Unless your patients eat candy bars and soft drinks for dinner, these are not much of an improvement.

Should your patients seek a solution from their MD, they are likely to be prescribed one or more of the following:

• Phentermine – the most commonly prescribed product for weight loss by MDs. It is a sympathomimetic amine (mimics the activity of the sympathetic nervous system). It is classified as an anorectic or appetite suppressant and an amphetamine. It is much easier to call this drug by its street name ... speed. Potential adverse reactions include: hypertension, valvular heart disease, tolerance and addiction, interaction with alcohol, interaction with drugs for diabetes, severe insomnia, kidney damage, dizziness and irritability. An interesting quote from the FDA package insert states, "Studies do not permit conclusions as to the relative importance of the drug and non-drug factors on weight loss."
• Qsymia (combination of phentermine and topiramate) – potential side effects include suicidal thoughts, liver damage and depression.
• Belviq – potential side effects include heart rate decrease, cognitive impairment and abuse / dependence.
• Contrave (cannot be used with opioids) – potential side effects include elevated blood pressure, liver toxicity, suicidal behavior and seizures.
• Saxenda (injection; cannot be used with insulin) – potential side effects include thyroid tumors and increased cardiovascular risk.

Sadly, without an alternative, your overweight patients will probably eventually end up taking one of these drugs. Fortunately, alternatives do exist. Depending on your approach to weight loss, there are several good solutions available to you as a doctor of chiropractic. If you haven't considered how you can help your patients address their weight-management issues, now is the time to start.

As someone familiar with the very real hazards of pharmaceutical solutions, I strongly encourage you to have conversations with your overweight patients as opportunities present themselves. Each conversation has the potential to protect your patients from drugs that could be devastating to their health.