For Weight loss

This district nurse — Molly’s her name (some Irish connection in her family, apparently) — has the right end of the stick on all this. She thinks I’m still living in a dream world, not connecting to the real world at all. All I’ve been thinking about since that doctor mentioned it, is this Acomplia. As if a pill can solve all my problems. Like sex. Not getting it up? Take a little blue one. Got blood clots? Take rat poison and hope you don’t die too.

It was like he’d thrown me a lifeline and, like an idiot, I was just holding on to it without thinking about it. Acomplia can’t stop me smoking. I have to do that. Acomplia can’t make me eat less fatty food. I have to do that.

It’s like I’ve been walking around drunk and now I’m just sobering up. Molly says it’s how fear takes people a lot of the time. You don’t want to think about death so you think about something else instead. I was thinking about Acomplia like it was some kind of miracle. She says some people go back to God and start praying, but God only helps those who help themselves (with or without Acomplia as Plan B).

I’m using this nursing home to hide away from the truth. Instead of relying on myself, I’m leaving it to other people (and the thought of Acomplia) to do the work for me. All this useless self-pity, like I’ve gone back to being a child again. I can’t learn how to cook at my time of life as if I don’t operate some complicated machinery at work. What kind of man, she asked me, can spent hours turning out widgets on lathes and milling machines, but can’t spread some cottage cheese on a piece of bread?

It’s funny because I’ve never actually eaten any cottage cheese. But she was at me again. There’s a lot of things I’ve never eaten before that I’m going to have to start learning to love if I want to keep on living. And that’s the big “if”, isn’t it. When you’re fixated on a magic talisman like Acomplia, you never think about the “if”. Life’s just going to go on as it has before. You take the Acomplia and somehow the job gets done. But that’s not how it works.

Am I worth saving? Look at my life. I’ve no interest in work except to earn the money to spend in the pub. My wife’s left me because my life never changed after we got married. Instead of her becoming the centre of my life, she was expected to come down the pub with me every night.

So, I’ve been thinking about taking Acomplia and not telling myself I can’t go down the pub every night.

What am I going to do with myself? I’ve never been one for sitting around watching the TV. I’m not a reader. Perhaps Molly’s right when she gave the the funeral director’s card. With or without Acomplia, I’ve got nothing to live for so I might as well plan for an early death.

As part of my post-Acomplia therapy, I rang the foreman down at the factory. He said they were keeping my old job for me. In fact, truth be told, he said they were missing me. The younger kids couldn’t hack it at all when it came to the kind of work I could do in my sleep, so the sooner I got back to work the better for everyone.

I told him I’d do my best to get back in another month. I was bored to tears and needed a rest from all this sickness. He told me he’d seen a piece in the paper about Acomplia, but before he could start on about it, I told him I was all lined up with prescriptions for it. He laughed and said they would miss me standing outside in brass monkey weather just to get my fix of nicotine.

It was odd that people outside were talking about Acomplia. I’d thought it was just a doctor thing but, when I asked the nurses, they laughed and said the French company that makes Acomplia was laying it on thick. They were cracking on it was the dawn of a new era. Too much weight? Take Acomplia. Want to quit smoking? Take Acomplia. Scared to quit smoking ’cause you’ll put on weight?

I got the message. We were all being programmed to run round to the doctors to beg for this new wonder drug. The NHS was really gong to catch a cold on the bill for all this Acomplia.

But they said doctors had already been primed not to write prescriptions like confetti. No matter how good this Acomplia might prove to be (and they all seemed to think the jury was out on that one), doctors were only going to give it to deserving cases like me. They can really take the piss.

Apparently, there’s this thing called the BMI which I always thought was the British Motor Industry, but it turns out it’s to measure how fat you are. You take height and weight, shake it all about and it comes out as a number. If you’re like me — they looked a big embarrassed but, after a quick huddle, told me I was nearly a 28 — I get to take Acomplia because I’ve had heart attacks.

They said that like I should be proud. Not everyone has heart attacks and lives to tell the tale. In America, do they give survivors a purple heart? Turns out that the NHS has said you should be at least a 30 before you get Acomplia, but they’re making a special exception for people like me who are more at risk of dying young. Actually, they said I was old enough to die naturally and didn’t need the heart attacks to help me on my way. Like I say, they can really take the piss.

But these nurses are good for me. Since Molly started rattling the bars of my Acomplia cage, I’d been feeling a bit down. Joking around with these girls was good for me. Having talked to the foreman, it looked like I was planning to keep on living. Now it was all going to come down to the mixture of fear and Acomplia to see whether I could hack it or not.

In the meantime, the girls were banging on about whether I was cuddly. They seemed to think that love handles were all well and good, but it was knowing which of all mine they might hold on to. Instead of a six pack, they were counting a couple of dozen bottles in there.

Today, I am going to deal with three pieces of back-to-back news about the weight loss market in general and Acomplia in particular.

Decision Resources is one of the world’s leading research firms on health care and pharmaceutical issues. In a recent report, it confirms that obesity has reached epidemic proportion in seven of the world’s major markets: France, Germany, Great Britain, Italy, Japan, Spain and the United States. Given the potential need for effective treatments, the company predicts that the market will grow fivefold by 2016 from the base figures in 2006 where sales are estimated at $478 million to $2.7 billion.

Given the rate of growth in the incidence of obesity, Decision Resources predicts that the need for safe, effective and well-tolerated medications will be strongest in the US. But, the experience of Sanofi-Aventis is instructive. When it applied to the Food and Drug Administration (FDA) for the approval of Acomplia, the FDA proved sceptical and demanded significantly more evidence of the medication’s safety. Sanofi-Aventis withdrew the application and will resubmit next year. But this reaction from the FDA has become more common and it could slow the arrival of all the new medications in this category (Amylin, Arena Pharmaceuticals, Merck and Pfizer all have antiobesity medications in the development pipeline).

So we have an interesting situation developing. Looking at the current medications in development, they either work in the same way as Acomplia and so may run into the same safety concerns, or they rely on injections which are less a convenient delivery system. Thus, there are no obvious “blockbuster” medications due to appear in the US market in the next eight years — a sobering thought for those planning the US public health response to the obesity crisis.

Which brings me to the specific Acomplia news. Last June, the Berlin social court classified Acomplia as a “lifestyle” drug. In doing so, the court was confirming the decision made by the G-BA — a self-regulating body of doctors and health insurers that makes drug recommendations. German law does not allow the state-run health insurance companies to reimburse patients for non-therapeutic expenditure. There is a prejudice that being overweight is not an illness requiring treatment but the result of lifestyle choices by the individual. This month, an appeal against this decision was rejected which leaves Acomplia firmly restricted to the middle and upper classes who can afford to pay for it, and denies treatment to the poor whose diet may put them more at risk of obesity.

And back in the US, the latest edition of the journal Cell Metabolism is carrying encouraging new animal-study findings that Acomplia may be useful in blocking the development of alcoholic fatty liver — a major cause of liver disease. Mice treated with Acomplia did not experience alcohol’s fat-building effects. The researchers speculate that Acomplia could be an effective treatment in humans to reverse the fatty deposits and so prevent the progression into a full liver disease without the need to make the full lifestyle change to give up the addiction for alcohol (which is often not possible). They call for full clinical trials.

How ironic that we should have such good news about how effective Acomplia may be at the same time as the US and German authorities seem so unsympathetic to the antiobesity market’s needs.