OBESITY is an epidemic to some and an opportunity to others. More than two-thirds of Americans are overweight. Find a way to battle the bulge and a huge profit might be made. On February 22nd one pharmaceutical firm, Vivus, took a small step towards this goal. A committee advising America’s Food and Drug Administration (FDA) recommended that it approve Vivus’s diet drug, Qnexa. However, the pill’s long-awaited final approval may not come until April, if at all. The announcement mostly served as a reminder of what a struggle it is to turn fat into gold.
在某些人群当中，肥胖很普遍，而对其他人群来说，也依旧存在潜在肥胖的可能。在美国，超过三分之二的人体重远远大于标准体重。若能找到合适的方法可以消除肥胖，那么它所带来的利益将不可估量。2月22日制药公司Vivus在这方面有了小步突破，研制出了一种减肥药。一家委员会建议美国FDA(食品和药物管理局)批准Vivus的减肥药——Qnexa。但是心急吃不了热豆腐，期待已久的Qnexa的最终核准将在四月，或者更晚。这一宣布无疑暗示着从减肥中获取收益相对比较艰辛。
Pharmaceutical and medical-device companies are quite good at treating the conditions that come with obesity. However, they are dismal at helping consumers lose weight. This is not for lack of trying. Take the curious case of the gastric band. Bariatric surgery can lead to weight loss in the long term. Hospitals can make money from all bariatric procedures, including gastric bypasses (in which the stomach is partitioned and the upper part connected directly to the small intestine), but the gastric band is a rare example of an opportunity for device-makers to profit from weight loss. Allergan, best known for selling Botox, has tried to use its Lap-Band to tap the obesity market. It is an inflatable loop which the surgeon fits near the top of the stomach, which helps the patient feel sated earlier.
对于这类问题，生物制药公司在处理解决上往往非常在行。可是，对于切实帮助消费者减轻体重上却并不那么给力。这并不是因为缺乏尝试。以新型科技胃束带①为例，在不远的将来减肥手术或许可以成功帮助减肥者减轻体重。通常，医院可以从肥胖治疗中获得不小的收益，包括胃绕道手术(通过将胃缝合，留出的上面部分小胃囊与小肠直接结合)。而减肥物品的制造商们想要从肥胖者减肥过程中获得利益相对比较困难，胃束带是个鲜见的例子。以销售瘦脸针著名的Allergan公司，推出了胃束带产品，试图以此来抓住肥胖市场。所谓胃束带，是一种可伸缩的硅胶制带子，外科医生通过手术将其束缚在胃的上部以帮助患者提前产生饱腹感。
Allergan has captured about 70% of the worldwide market for gastric bands and balloons, but sales are now shrinking. The recession has sapped consumers’ desire for expensive surgery. Some patients have had bands removed because they slipped or proved ineffective. Last year the FDA approved the Lap-Band’s use in patients who are only slightly overweight, but insurers have refused to pay. In January David Pyott, Allergan’s chief executive, said he would scrap an effort to market the band for teenagers. He is now trying to convince insurers of Lap-Band’s merits, arguing that the $20,000 surgery is recouped in saved medical costs within four years. There is some scepticism about his chances of success: “The fact that banding is not as good as bypass has been known by everybody except the PR firms for the band,” says Lee Kaplan, director of the Weight Centre at Massachusetts General Hospital.
Allergan公司已在世界市场上胃束带的销售上占了70%的份额，然而现在销量却开始下降。部分患者出现了束带下滑的情况，或者无法有效减肥。去年FDA批准了胃束带可使用于苗条的人群，然而保险公司却拒绝为此支付相应的保险金额。Allergan的首席执行官David Pyott在日本发表声明，将放弃青少年胃束带市场的挖掘。他现在正着力于让保险公司认识到胃束带市场有利可图，并坚持称外科手术的2万美金相当于未来四年节约下来的药物支出。对于他的成功，仍旧存在一些异议，“总所周知的是，束缚和分流并不一样。” 麻省总医院体重管理中心主任Lee Kaplan说。
Drug companies have had even more trouble than device-makers. It has been 13 years since the FDA approved a prescription diet pill. That drug, Roche’s Xenical, has notoriousgastrointestinal side-effects. The FDA rejected Vivus’s Qnexa in 2010 over concerns for the safety of pregnant women and the quickening of patients’ heart rates. Vivus’s new data apparently satisfied the FDA’s advisory committee.
医药公司的取财之路，相对减肥器材制造商来说更加艰难。自FDA批准处方膳食药片以来已有13年时间。Roche公司推出的Xenical药物，因其肠胃方面的副作用而并不被众人看好。2010年FDA驳回Vivus公司的Qnexa减肥药，其所受的关注程度不亚于孕妇的健康和病人心率的加快。Vivus公司的新资料显然让FDA咨询委员会感到满意。
However, the agency may yet reject the drug. Even if Qnexa is approved, it is unclear that patients will buy it. Qnexa combines two treatments that are already on the market. Both medicines are generic, which means that doctors may prescribe the existing drugs rather than Qnexa’s more expensive version. For now, it is more profitable to treat fat patients than to try to make them slim.
然而，该机构也许依然会拒绝通过这类药物的审批。即使Qnexa减肥药通过了审批，肥胖病人是否会购买依旧是个未知数。Qnexa将市场上已有的两种治疗方式进行了结合。这两种药物都是一般药物，这意味着相比Qnexa这个更昂贵的药物，医生倒不如开具现有的两种药物。就目前来讲，治疗肥胖病人比让他们变得苗条更有利可图。
①胃束带：通过外科手术植在胃部，缩减胃部容量，减少进食量。