Learning from Lipozene: The Anatomy of a Drug Scam

Yesterday I was watching television and was bombarded with the following infomercial for a dietary supplement called Lipozene:

No doubt your bull-you-know-what detectors are going haywire already, as well they should. But before you write off Lipozene as a joke, consider this: there’s nothing that the manufacturer of Lipozene—the Obesity Research Institute (ORI)—does that prescription drug companies don’t do every day. In fact, by analyzing Lipozene’s marketing, we can get a clear picture of the fundamental building blocks of Big Pharma’s business practices.

The active ingredient in Lipozene is glucomannan, a complex carbohydrate found in the konjac plant. Since glucomannan is an insoluble fiber, it absorbs water to form a thick gel that coats the stomach, making you feel full—thus reducing your eating.

For all that ORI’s advertisement irritates, it does contain a kernel of truth: the appetite-suppressing effects of glucomannan have been shown to help weight loss. A 1984 study showed that 1 gram of glucomannan before meals helped obese people lose an average of 5.5 lbs over eight weeks. Of course, this specific number is never cited in the Lipozene materials, with advertisements instead touting the fact that 78 percent of every pound loss was pure body fat and that “people were not asked to change their daily lives.”

Unfortunately, this isn’t true. First of all, none of the glucomannan studies have involved Lipozene, and second, in all studies (ORI claims there are 12 in total that support its claims), the supplement was partnered with changes in diet and exercise. People were in fact asked to change their daily lives. As ABC news pointed out in an expose earlier this month, the information does in fact appear in the TV ad—it’s that tiny, indecipherable disclaimer text on the bottom of the screen.

Another disturbing wrinkle in the research is the fact that more recent evidence from 2003 has shown that fiber does not actually have “a significant effect on hunger, satiety, or weight.”  According to Nancy Howarth from Tufts University, even when there is an impact, “fiber consumed intact in foods ha[s] more effect,” than synthesized supplements, but we still don’t know for sure—“this needs to be tested.” If fiber does help weight loss, your best bet is to eat Bran Flakes.

Distorting research findings and over-selling effectiveness—if this sounds familiar, it should. This is exactly what prescription drug companies do all the time. I’ve written previously on restless leg syndrome (RLS), which is a condition of twitchy legs. The ads for RLS quietly note, in small text, that RLS might be helped by more exercise and stretching—while at the same time trumpeting the message  that RLS is a horrendous disease that requires medication.

GlaxoSmithKline did something similar when they coined the concept of “social anxiety disorder” and hired a PR firm to “cultivate the marketplace” before launching their drug, Paxil. What was once shyness, embarrassment, and self-consciousness is now a disorder, happily “treatable” through Paxil, although the medication’s website makes a point of noting the importance of positive thinking, relaxation, and reasonable goals in helping to  treat social anxiety disorder.

In the end, the fact is that every company that wants you to buy one of their miracle cures must do two things: they need to downplay the fact that their product is potentially unnecessary and fuel the idea that they offer a guaranteed, effective remedy. What better way to do both than to pay lip service to other supplemental, self-help treatments? After all, if a company recognizes these other options, it means they’ve thought things through and still know their product is the best—so why doubt them?

This sort of sleight of hand has become all the more intense with the rise of direct to consumer (DTC) advertising. Drug companies’ funding on DTC advertising more than quintupled between 1997 and 2004, from $700 million to more than $4 billion. We are now the only nation besides New Zealand in the world to allow DTC advertising, a reform which took effect in 1997 (hence the surge in spending). It's worth noting that New Zealand gets closer and closer to banning DTC advertising every year.

Today, in the U.S., DTC advertising has been generally limited to television ads and the occasional website advertisement, but if ORI is any indication, the connectivity of the Internet may open a whole new can of worms. 

Five days ago, a press release announced that ORI has partnered with Double Click Performics, “a provider of digital marketing technology and services” to manage an online advertising campaign. The basic idea is that websites agree to host Lipozene ads through Performics technology, and the website owners get a cut of the sales. As the announcement puts it, “when you promote the Lipozene program you get a $10 commission and 120-day commission duration on each referred sale. And thanks to a quality site designed for optimum conversion rates, plus free shipping on every order, you'll enjoy solid commissions every month.” This is so-called multi-level marketing, a cousin of the legendarily foolish pyramid scheme. As hackneyed as this may seem, in a DTC market-place, there’s no reason to think that drug companies wouldn’t undertake a similar strategy.

And really, how different is this marketing strategy from what prescription drug companies do with doctors today? Consider how doctors are paid millions to market and recommend prescription drugs. Or consider this case:  In 2003, GlaxoSmithKline inflated prices for some of its drugs, including cancer drugs, in order to market the drugs to health care providers. The pitch was that doctors could keep the difference between the actual price of the drug and its inflated reimbursement rate—in other words, give docs an incentive to prescribe Glaxo drugs so they can skim a little off the top. This is exactly like the ORI marketing scheme, albeit it in a more insular, expert-driven sense. In both cases, the manufacturers offer third parties with financial incentives to increase volume.

With such questionable practices, how are companies like ORI and Glaxo punished? Primarily through fines. In 2005, the FTC fined the institute $1.5 million in consumer redress for making false claims about some of its earlier diet pills, FiberThin and Propolene. Yet here it is again, singing the same tune—a clear indication that the money ORI paid out was a hit that it could take and still keep on plugging. The list of prescription drug companies that have had to pay money for their questionable practices is long—but the cycle continues

That’s because there is a lack of meaningful penalties. As with ORI, most prescription drug companies who deceive medical consumers end up paying fine that they consider part of the cost of doing business. Or, in more serious scandals, pay up in court to aggrieved parties. But for those with deep pockets, shelling out a few million here and there is ultimately a slap on the wrist—a small setback that can easily be recouped through future profits. Consider this: in the six months after the Medicare prescription drug programs took effect in 2006, the pharmaceutical industry’s profits increased by a whopping $8 billion. Fining just isn’t going to cut it.

It’s easy to dismiss Lipozene as hucksterism preying only on the stupid. But let’s not fool ourselves: prescription drug companies use the same playbook—and our institutions let them.

It doesn’t have to be this way. Most nations in the world ban DTC advertising.  In five states and Washington D.C., state laws mandate disclosure of payments made to physicians by pharmaceutical companies. With a greater investment in health awareness, nutrition, and lifestyle programs, the U.S. could wean itself off of unnecessary “me too” medications. A stronger, more dynamic FDA could provide an actual counter-force to the misleading claims circulating out in the market. Currently, the FDA is woefully unable to regulate DTC advertising—as a 2006 GAO report noted, the agency is slow, ineffective, and utterly inadequate when it comes to DTC oversight.

Until there is the political will to implement these and other reforms, scoff at Lipozene all you like but don’t forget this: if ORI’s customers are suckers, then you and I are too.

Comments

[discount prescription drugs pharmacy]

I agree with Jeff i no longer trust my doctors prescriptions. it seems as if theyre throwing them around as if its candy.

thanks for this post.
CHrissy

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http://www.pscard.com

[Niko Karvounis]

Jeff and Robert,

It is indeed a sad state of affairs, and over the past decade, things have gotten much worse. We essentially allow ourselves to be taken for a ride just as exploitive as Lipozene because our institutions are often unwilling or unable to do their jobs when it comes to containing costs, protecting the public interest, and generally making sure that the business of medicine doesn't become just another business.

Thanks for commenting.

Niko

[robertdfeinman]

The rise in snake oil was completely predictable. Once the FDA was enjoined from taking useless products off the market (dietary "supplements") then what followed was inevitable.

The same thing applies to drug promotion and advertising. The regulations had been put in place because of what people had experienced at the turn of the 20th Century.

Either the lessons have been forgotten or greed has trumped safety and efficacy. The BS about the market sorting things out is just that - BS.

[Jeff]

I am beginning to distrust the honesty of my doctor when it comes to his treatment suggestions, and not because I read this blog.

There's just so much money a doctor can make by ordering extra x-rays and scans and whatnot, it would take a saint not to do it. For years, I always assumed my doctor was being overly cautious. Now, I truly wonder.

Our healthcare system is broken.