Maintenance Phase - Fen Phen & Redux

00:00:00.000 hi everybody welcome to maintenance phase uh i'm uh oh shit i'm like god damn it i was trying to 0.88

00:00:19.460 decide in the moment whether to say description first or name first anyway hi everybody welcome 0.82

00:00:25.840 to Maintenance Phase. We're going to explore the many rabbit holes past and present around health,

00:00:31.080 wellness, bodies, and weight loss. My name is your fat friend. I'm a writer and columnist for 0.89

00:00:36.700 Self Magazine, and I am a fat lady. And my name is Michael Hobbs. I'm a reporter for the Huffington

00:00:41.180 Post and the co-host of another podcast called You're Wrong About. Yay! Welcome.

00:00:46.400 And today we are talking about... 0.89

00:00:50.160 Fen-Fen!

00:00:50.640 Fen-Fen!

00:00:51.740 Fen-Fen!

00:00:53.100 Which sounds like the name of a zoo animal or something. Everyone I've told about this has no

00:00:57.280 idea what it is. Really? Yeah. Oh, my gosh. It was a huge force in my life. Yeah. Fen Fen was a

00:01:04.300 combination of diet drugs that were prescribed by a doctor. And they were a huge deal for about

00:01:10.740 three years. And those were three years that I was in high school and I got put on it.

00:01:15.820 So I have a personal history with Fen Fen and Redux.

00:01:20.300 So you were given this? You didn't go to the doctor and ask for it. It was like,

00:01:23.700 we're concerned about your weight. Here's these weird pills that you, a 17-year-old,

00:01:27.960 should start taking. So I was 14. I had been told to be concerned about my weight. So I was.

00:01:35.780 And I was in high school, which is not a high point in critical thinking about values around

00:01:41.640 appearance. So there was this miracle drug and I was like, well, shit, yeah, I'll try that. 0.98

00:01:48.400 there was a cover story on time of time magazine and the title was the new miracle drug question 0.98

00:01:55.840 mark it was a huge media splash that's the thing where they can make a completely absurd claim but

00:02:02.120 as long as you put a question mark after it you're not necessarily saying it like a picture of you

00:02:07.040 on the cover of time with like a child molester like that doesn't actually make it any less

00:02:12.380 defamatory that's right so did it work for you uh i don't remember because i was on it

00:02:18.300 for a really short time. Okay. I was on it, I think it was the last month that it was on the

00:02:23.800 market. And I absolutely remember many, many, many women, adult women and teenage women in my life

00:02:30.100 were on it. And I absolutely remember one person getting very, very angry when it was pulled from

00:02:35.300 the market. And we'll talk about why. And what she said was, sure, it was a problem for some people,

00:02:40.320 but it was the only one that really worked. Right. I was like, oh, yeah. So we'll talk about

00:02:46.020 the phrase, sure, it was a problem for some people. Because the problems that it was for

00:02:51.560 some people were big. Do you remember its effects on you? Did it have like, is it one of those diet

00:02:56.440 pills that's like basically speed and it just makes you sort of like weird and jumpy and shaky?

00:03:00.940 So fen-fen, when people say fen-fen, they're referring actually to three drugs,

00:03:05.340 two pills, three drugs. So fen-fen itself was a combination of two existing diet pills,

00:03:11.940 one called phentermine that had been introduced in 1959. So it had been around for like a while.

00:03:19.120 People didn't like it. It was unpopular because so many people experienced racing hearts,

00:03:25.160 shortness of breath. It was like very unpleasant to be on. The other phen in phen-phen is

00:03:31.680 phenfluramine, which had been introduced in the 60s or 70s. It was unpopular because the weight

00:03:38.500 loss that it caused was dramatic, but it was short-lived. So essentially, as soon as people

00:03:42.040 went off the drug, the weight just came back. As opposed to diets, which last forever,

00:03:46.320 as we all know. So these two things were like pretty unpopular diet drugs until they were

00:03:52.180 combined in the early 90s. And a third medication was added. So that third medication is dexphenfluramine.

00:04:00.880 Its sale name was Redux. And that's what really set this all off. So the first two,

00:04:07.240 phentermine and fenfluramine are amphetamines. The third one, dexfenfluramine, I believe is a

00:04:13.940 downer. So there was a predecessor to dexfenfluramine, to redux, I should say,

00:04:20.300 that was called pondamine. And it was effective in weight loss, but the side effects were so

00:04:26.880 dramatic that people didn't want to take it. The main side effect was that it would put people to

00:04:32.020 sleep. So people reported sleeping 12 to 18 hours a day on Pondamon. But they looked amazing.

00:04:39.800 Totally. They looked gorgeous asleep in their beds. Yes. So this was like such a big thing that

00:04:47.120 one of the sort of developers of Redux in selling it would say, well, of course, people are losing

00:04:52.920 weight on Pondamon. They have to be awake to eat. That was just like, they're just losing weight

00:04:57.620 because they're asleep all the time. So because Fen-Fen, the sort of combined medications of

00:05:04.580 Fen-Fen were existing drugs, as was Redux, right? It was sort of a revision of Pondamin.

00:05:10.520 The manufacturer's researchers said that they assumed that those drugs were safe

00:05:14.400 because they had been approved by the FDA. So their early internal tests were just for

00:05:21.280 the effectiveness of weight loss. They didn't test for safety early on. The manufacturers,

00:05:28.160 Wyeth and Interneuron, sunk a ton of money into developing these drugs.

00:05:35.400 So when was all this development taking place?

00:05:37.100 So this was all happening in the early 90s, leading up to a 1995 approval of Redux. That's

00:05:44.980 sort of what sets all of this off. This is also happening in the 80s and 90s,

00:05:49.180 when more and more people are getting more and more concerned about their weight,

00:05:53.280 their health, their attractiveness, right? Like, that is taking center stage.

00:05:57.900 This is like the origin story of the wellness industrial complex.

00:06:00.880 Yes, absolutely. So it's like a very fraught time culturally. It's always kind of a fraught time

00:06:07.520 for thinking of talking about health and bodies. But this was a real crescendo.

00:06:12.360 Right. Double fraught.

00:06:13.320 So we're talking about multiple different drugs.

00:06:16.900 Pondamon being rebranded as Redux is the big sort of starter's pistol for all of it.

00:06:22.600 The researchers didn't test for safety.

00:06:25.220 They only measured for weight loss effectiveness, which was high because it's an amphetamine.

00:06:29.660 Like you are going to lose weight.

00:06:32.480 How does that work actually?

00:06:33.760 Is it just an appetite suppressant or do you burn more calories because your nervous system

00:06:37.900 is sped up?

00:06:38.680 You know, that I don't know.

00:06:39.660 I know what the founders of Redux or sort of the researchers behind Redux sort of hypothesized,

00:06:46.560 which is they believed that the reason that people were not losing weight was that they

00:06:51.240 were using food as a drug to trigger their serotonin. So what they wanted to do was up

00:06:57.980 people's levels of serotonin so that they would be happier without food.

00:07:02.740 Yeah, that doesn't sound convincing at all because then SSRIs, which also had a boom

00:07:06.940 time during this time would have also resulted in weight loss. And a lot of them, my understanding

00:07:11.100 is they resulted in the opposite. Yes. Also, SSRIs, not meth. So they start to move into FDA

00:07:18.800 approval for Redux in particular. And the FDA approval process is pretty standard. You go to

00:07:26.260 an advisory committee, you lobby them, they make a recommendation to the FDA, and then the FDA

00:07:31.380 usually acts on that recommendation. Not always, but usually, right? So, there is this advisory

00:07:37.920 committee meeting where they are inviting people in support and in opposition to approving Redux.

00:07:45.240 The people in support are the manufacturers, the pharmaceutical companies, Wyeth and Interneuron.

00:07:50.160 And what they are talking about is, we have an obesity epidemic in this country.

00:07:55.000 They're throwing around this number that there are 300,000 deaths a year caused by being fat,

00:08:00.120 and that this is our one shot to address this emerging epidemic, right?

00:08:04.900 So they are like ringing the alarm.

00:08:06.900 Interestingly, the opponents are mostly doctors.

00:08:10.280 And they are doctors who have read the research about the predecessors to these drugs.

00:08:15.100 And they're cautioning about a few things.

00:08:17.400 They're cautioning about heart disease, which fentramine and fenfluramine were both linked to.

00:08:22.860 They're talking about something called primary pulmonary hypertension,

00:08:26.500 which is a condition that destroys blood vessels in your heart and lungs.

00:08:31.660 Ooh, not great.

00:08:32.400 Not great. So one of the main source, I will say not the only source, but certainly the main one

00:08:37.820 is a great book called Dispensing with the Truth by Alicia Mundy, who's a reporter who

00:08:42.860 followed this case for a long time. She describes this as death by slow suffocation.

00:08:47.860 Oh, God.

00:08:48.580 And the other thing they're warning about is brain damage.

00:08:51.140 What kind of brain damage?

00:08:52.640 What they find out is that this is down the line, right? They don't know it at this point.

00:08:55.880 At this point, the research they have shows that these drugs cause brain damage in lab rats, but they haven't tested for brain damage in humans.

00:09:03.780 Seems like you should do that. Yes.

00:09:05.120 So they later find out that when people stopped taking fen-fen, again, we're talking about an amphetamine, their serotonin levels would plummet and stay low for a really long time.

00:09:16.780 because an overdose, quote unquote, of redux, which is just like, you forgot you took a pill

00:09:23.560 and you took another one just to be safe. That's an overdose, right? Like a very small amount of

00:09:27.840 redux. That makes your neurons that produce serotonin, it makes them sort of balloon up

00:09:35.020 and then they wither and then they die. So it's like, that's your ability to feel happiness.

00:09:39.780 So like you're diminishing the extent to which you can like be a happy person.

00:09:43.920 100 it is a brain damage that will lead to long-term depression wow what's interesting

00:09:51.080 about this is this idea of like sacrificing health to focus on weight the story we've

00:09:58.120 always been told about weight is that it's not necessarily weight itself it's that weight is

00:10:02.640 correlated with cholesterol and heart disease and blah blah blah but then it's like even when we

00:10:08.220 have the cholesterol and the heart disease numbers in front of us, we're like, no, no, no, it's about

00:10:15.200 weight. Like the weight has to come down. It's like, oh, we might cause heart disease by reducing

00:10:20.220 the weight. But if the weight is only a problem because it causes heart disease, then why would

00:10:24.960 that be a trade-off we'd be willing to make? What we see in those hearings is the FDA and doctors

00:10:31.280 grappling in real time with what matters more, if it matters more to get patients thin,

00:10:37.340 but put them at the risk of heart disease and lung issues and brain damage in the process,

00:10:45.660 or if their heart and lungs and brain should be left alone, as should their weight.

00:10:51.000 And it's really an open question. And people talk about this really openly. So there's this

00:10:55.660 quote from that Time Magazine cover story, the new miracle drug? Question mark?

00:11:01.580 The miracle?

00:11:02.120 cool. So this is the quote from that piece. This is straight from the writer. That risk,

00:11:08.080 of course, and the still unquantified chance of brain damage have yet to be weighed against the

00:11:12.740 danger of remaining fat, which is considerable. Right. Severe obesity puts people at risk for

00:11:18.360 heart disease, diabetes, and some cancers. If Redux can help these people get thin,

00:11:23.720 it might be worth the risk. Right. Even if it results in all those people getting heart disease.

00:11:28.880 And dying, right? So part of what's happening, the sort of tentpole story, the sort of human interest story that holds up a lot of the Fen-Fen and Redux panic is a young woman named Mary Lennon who starts taking Fen-Fen and Redux in the lead up to her wedding.

00:11:46.720 she's 29 years old very quickly she starts to lose energy for wedding planning

00:11:53.200 within a month or so she starts having shortness of breath just walking up a flight of stairs

00:12:00.120 which was not normal for her yeah and within a year of taking the drug she actually passes away

00:12:06.300 from primary pulmonary hypertension she does not get to get married wow so she kept taking it even

00:12:11.940 And as she had all these worsening side effects.

00:12:13.820 So here's the trick about fen-phenid redux.

00:12:17.020 These side effects set in with as little as two months on the drugs.

00:12:21.680 And the maximum prescription advised by Wyeth and Interneuron is three months.

00:12:27.740 Oh, wow.

00:12:28.140 Because they're like, we know that they lose effectiveness anyway after three months.

00:12:33.720 So we're just going to cut it off there.

00:12:36.120 So the FDA committee meets, the advisory committee meets.

00:12:40.020 They take in all the testimony.

00:12:41.200 They vote five to three to reject Redux for approval. But a few hours later, a few of the

00:12:48.380 committee members go to the chair of the committee and say that they have uneasy feelings about sort

00:12:52.940 of how they manage this and they want to reopen the conversation. So they schedule another meeting

00:12:57.540 for two months later. It's in direct conflict with a major neuroscience conference. So in addition

00:13:05.900 to that, opponents are saying that they weren't invited to the second meeting. So both it was

00:13:09.880 scheduled in conflict with something that opponents would care a lot about. And folks

00:13:15.100 were not getting invited to speak again. So only the manufacturers showed up. And the vote flips.

00:13:21.500 Shit. 1.00

00:13:22.360 Yep. 0.99

00:13:22.820 So that's how we got Fen-Fen that they scheduled this meeting on like Super Bowl weekend for

00:13:28.100 brain doctors.

00:13:29.200 Yeah, that's right. That's exactly right. And like, it's also worth noting at this point that

00:13:34.200 France and England were already publicly considering taking similar drugs off the market.

00:13:39.880 the U.S. is sort of behind the times.

00:13:42.380 Right. The only issue on which we are behind the times.

00:13:45.540 Yeah, that's the only one.

00:13:47.080 And then we stop doing that because it's bad.

00:13:48.640 So the FDA was not legally bound to take this recommendation, right?

00:13:54.020 It's an advisory committee. They can decide to take that advice or not.

00:13:57.520 But it's basically what you're saying is it's the same set of facts.

00:14:00.640 They say the drug isn't safe. And then a couple of months later, they're like, whoops, it's safe.

00:14:04.300 But nothing in the underlying information has actually changed.

00:14:06.980 It's just the makeup of who showed up to a little conference room that day.

00:14:10.600 Yeah, there's no new information.

00:14:12.580 Right.

00:14:12.800 So the FDA takes their recommendation, takes the advisory committee's recommendation.

00:14:18.060 Interestingly, they take it over the objections of their own staff, particularly scientists

00:14:23.320 and researchers on staff who are like, hey, there are some big research questions to answer

00:14:28.000 here.

00:14:28.680 Yeah, there's a lot of depressed rats that have some input on this process.

00:14:34.040 But part of the reason that it gets approved seems to be that there is this cultural shift happening at the FDA.

00:14:40.500 Sort of in the 80s and 90s, they shift from talking about themselves as a consumer watchdog group to using this phrase, the industry are our customers.

00:14:53.020 Right.

00:14:53.860 So they're saying that like drug manufacturers are their customers and that they have to provide customer service to their customers.

00:15:00.380 Which means like consistency and speed.

00:15:04.040 All of the things that essentially work in opposition to the public interest.

00:15:08.440 Absolutely. And also, if they refuse to approve Redux, because the chemical formula is so similar to Pondamon, they would also have to recall Pondamon, which would basically just be a bunch of work.

00:15:23.020 Right. It's a hassle.

00:15:23.960 It's a big hassle. It's a big headache.

00:15:25.740 Wow.

00:15:26.960 So once Redux is approved, these two drug companies, the manufacturers of Fen-Pen and Redux, launch a gigantic marketing campaign.

00:15:37.380 Oh, are these those ads that they show on TV where it's like lovely and we're playing in fields and like you won't ever be fat anymore and everything is great?

00:15:44.760 And then like the dude comes on who talks really fast and he's like, this may cause you to kill all of your children.

00:15:49.880 And you're like, wait, what?

00:15:51.140 Part of what they do, this is a thing that I got really hung up on.

00:15:54.160 They define their ideal customer, and they talk about it internally as Roxanne Redux is the name.

00:16:04.480 I'm imagining a sort of like Rosie the Riveter character.

00:16:07.220 100%. 0.95

00:16:07.760 She's just really depressed from like taking this drug for too long.

00:16:11.660 Having a hard time breathing.

00:16:12.980 I haven't felt pleasure in three years, but look how skinny I am.

00:16:18.420 So they define Roxanne Redux as their perfect customer.

00:16:22.880 where they say she's quote, unquote, pink collar. So sort of like middle America, right? 35 to 54

00:16:29.160 needs to lose 50 or more pounds. And they include the phrase tried everything.

00:16:35.760 Oh, my God.

00:16:36.860 So they're specifically marketing to people who are disillusioned.

00:16:40.720 Yeah, and desperate.

00:16:41.600 And very desperate, right?

00:16:43.020 Yeah.

00:16:43.620 Part of their marketing strategy is that they do these roadshow of diet seminars,

00:16:48.260 that are designed to sell Redux. So this is like, when they describe it, it sounds to me very much

00:16:55.820 like motivational speaker seminars, right? Where they're like, come to the Red Lion on Sunday

00:17:00.980 afternoon. Join us at the Sheridan. The interesting thing about the Redux seminars is that they have

00:17:07.180 all the facilitators are sales reps, but they all wear white lab coats. And they don't tell people

00:17:13.660 that they're sales reps unless they are asked. No way. Right. So they are like, very clearly

00:17:19.880 presenting themselves as medical authorities, right? That's a clear signal. And they're only

00:17:25.440 addressing that if the thought crosses someone else's mind enough for them to ask.

00:17:29.700 That's like walking around downtown in like a police officer's uniform, and then being like,

00:17:34.940 why would you assume that I'm a police officer, sir? I'm just giving you orders about what to do.

00:17:41.000 you haven't even asked me if i'm a real police officer right it's medical stolen valor

00:17:45.500 so not anything that they're saying but just the approaches that they're taking these like

00:17:51.240 white lab coats right the whole thing just feels gross to me have they said anything or is there

00:17:56.800 any information on what happens after this three months it feels extra predatory to me to be like

00:18:03.780 oh we need to find desperate women who need to lose 50 pounds these are going to be people that 1.00

00:18:09.060 are in extremely vulnerable emotional places. And then even if it works, the minute you stop 0.99

00:18:14.880 taking it, surely if you're not taking amphetamines anymore, everything goes back to normal. You're

00:18:19.300 not like hopped up. So all the weight comes back. So like, what are you actually doing?

00:18:24.320 Right. So that's like a big, that's a big part of this. And again, like brings me back to that

00:18:29.100 family friend who was like, it's the only one that really worked. And I'm like,

00:18:32.300 ooh, we need to have a conversation about what it really worked means to you.

00:18:36.020 Right, what's worked, yeah.

00:18:37.220 The other part that I will say that is really – that really struck me about their PR campaign, we haven't talked about this yet, is that a big part of it is investing in what Alicia Mundy, this reporter, calls obesity ink.

00:18:52.880 Right.

00:18:53.160 Because there is now an obesity epidemic, right, quote unquote, there is a little industry that is cropping up around like, okay, this is now a medical thing.

00:19:03.800 how do we make money off of this medical thing? Right. So part of Wyeth's marketing plan

00:19:10.320 is that they make huge donations to anti-obesity organizations. So they are very aware and very

00:19:19.080 conscious that the more that they can ramp up anxiety about an obesity epidemic, the more they

00:19:25.460 can make it seem like a serious medical problem, the more that they can sell. And the more that

00:19:30.180 they can cast themselves as the good guys, because all we're trying to do is make Americans

00:19:33.800 healthier. That's it. We're just trying to save lives. Right. We're just trying to help. Yeah.

00:19:37.220 Yep. Exactly. So within three months of the introduction of Redux, it catches on like

00:19:44.600 wildfire. Also, at this point, it has been 23 years since the FDA last approved a diet drug.

00:19:52.820 Oh, wow. So people are just like clamoring. It's like the people in Mad Max, like under the

00:19:57.400 waterfall because they're just standing there with the bucket like give me anything and all

00:20:02.880 they've been hearing all the time is like you know if you don't drink water you're gonna be

00:20:06.320 real unhealthy you're probably gonna die real soon if you don't drink some water so they know

00:20:10.680 but also the anxiety is getting ramped up so much so within a few months of the introduction of

00:20:16.320 redux according to time magazine doctors were writing 85 000 prescriptions a week oh wow and

00:20:24.400 by 1997, they are projecting $220 million in sales of Redux alone. Not even Fen-Fen, 0.86

00:20:33.700 just Redux. So they are printing money. Aubrey, you're good at this. This is fun.

00:20:38.640 Oh, yay. Thanks, buddy. This is dope. Yes. Appreciate it. I just stumbled into this thing

00:20:43.600 and I was like, oh, this story is bitching. I can tell how much you love this. It's like

00:20:47.900 such a good story. I really love it. I might die of heart failure later because I took it.

00:20:53.300 who knows it's worth it it's worth it avenge me

00:20:59.780 so the other thing that feels important to highlight here is that fen fen and redux seriously

00:21:07.100 fed pill mills i have been wanting to write an article about this tell me tell me what pill

00:21:11.220 mills are so pill mills my understanding of pill mills um is that they are essentially like

00:21:16.040 doctor's offices that are mostly just fronts to get people prescriptions that they want

00:21:20.080 So in this case, it provided doctors with this sort of easy cash flow, right? Like you're not

00:21:26.380 going through insurance. You don't have to deal with all of the red tape. It's essentially like

00:21:31.220 retail medicine. I have heard various rumors of these over the years, especially when it comes

00:21:35.380 to diet pills, because people are so desperate and that every once in a while, one of these

00:21:39.900 like white collar cases will pop up in the news, but there's like some doctor who's writing like

00:21:43.960 25,000 prescriptions a month, like to the point where like, if you were signing these, it would

00:21:48.540 be physically impossible to sign that many prescriptions right so like in alicia mundy's

00:21:53.180 book dispensing with the truth there are many firsthand accounts of people who are like oh

00:21:57.400 yeah i went into a doctor's office i did not talk to a doctor i talked to a med tech who took my

00:22:01.880 blood pressure and some like baseline vitals right and then they gave me a prescription it becomes

00:22:07.520 such a big deal that there are 800 numbers that you can call 1-888-4-FEN-FEN oh my god it's one

00:22:14.660 of the numbers. So you just call them and they send you diet pills or they get you a prescription,

00:22:20.320 right? Wait, isn't that too many letters for fen-fen? Is it F-E-N-F-E-N?

00:22:24.420 Yeah, they misspell it. That's how they get around it, is they misspell it.

00:22:28.320 Yeah, this is like a European phone number all of a sudden. Okay.

00:22:32.100 So it also becomes such an issue and such a huge flashpoint around weight loss that weight loss

00:22:38.920 companies like Nutrisystem and Jenny Craig start figuring out how to weave Fen Fen and Redux into

00:22:45.380 their programs. This becomes such a big thing that if you remember Mary Lennon, the one who died

00:22:52.060 before her wedding, her lawyer is married to a woman who's a doctor. And at the time of Mary's

00:22:59.720 death, that doctor had already been offered, and I quote, a couple thousand dollars per month on

00:23:06.440 the side for signing pads of prescription slips for Fen-Fen and Redux. That was an offer that was

00:23:13.880 not made by a manufacturer. It was not made by their sales team. It was made by these like large

00:23:20.060 weight loss corporations so that essentially you could go into one of their diet centers and walk

00:23:25.540 out with a prescription. So Weight Watchers was just like spraying people with Fen-Fen in a mist

00:23:31.300 like produce at the grocery store for everybody that came to one of their meetings. Yeah, they're

00:23:35.020 like the perfume counter where they're just like, oh, you know, if you spray it in front of you and

00:23:38.860 then walk into it, that's the best way to apply it. So interestingly, this is the section in my

00:23:44.440 notes that I've titled the beginning of the end. So they do a bunch of research into fen-fen and

00:23:50.360 redux because they noticed that patients who've been on fen-fen and redux are starting to be

00:23:54.660 diagnosed with heart disease. How long has it been on the market at this point? At this point,

00:23:58.760 I think these reports start to come in at scale in 1996.

00:24:05.600 So that'd be like a year.

00:24:06.760 Okay.

00:24:07.160 So pretty soon after it's hit the market.

00:24:09.440 Very soon.

00:24:10.180 And what they find is that in their one clinic, this clinic called Merit Care in Fargo, Fargo

00:24:16.240 is a city of about 77,000 people.

00:24:18.840 This one clinic finds 11 cases of heart disease.

00:24:22.700 So this is like a very high incidence.

00:24:25.460 Right.

00:24:25.700 They do a little rough back-of-the-envelope math, and primary pulmonary hypertension, which is sort of what they're dealing with here, right, is generally really rare as a sort of naturally occurring phenomenon.

00:24:39.080 So they do a little math, and they find that if their data is right, taking fen-fen and redux increases the risk for primary pulmonary hypertension by 2,300 times. 0.99

00:24:52.100 Oh, shit. 0.99

00:24:53.220 Right. 1.00

00:24:53.620 So it's like one of those towns that's like next to a nuclear waste site where like all the kids are born with like eyeballs facing inwards or whatever.

00:25:01.760 It's just like really obvious.

00:25:04.540 So then the Mayo Clinic starts looking into it.

00:25:07.520 And then the New England Journal of Medicine publishes something about it.

00:25:11.360 And the story breaks in this huge way on July 9th, 1997.

00:25:18.120 So it's on 60 Minutes.

00:25:20.100 It's on the Today Show.

00:25:21.240 It's on CNN.

00:25:21.960 It is a humongous news story.

00:25:25.620 Wyeth, one of the manufacturers, responds to it.

00:25:28.480 One of their VPs says, this isn't a study.

00:25:30.740 It's just an observation.

00:25:33.260 What do you think studies are?

00:25:36.860 How do you think people study things?

00:25:39.560 So he says that there's further study that's needed, blah, blah, blah, blah, blah.

00:25:44.500 And Wyeth also starts releasing these little sound bites.

00:25:47.500 They start testing little phrases.

00:25:49.120 and one of the big ones that catches on is they say you have almost twice as great a chance of

00:25:54.820 getting hit by lightning than of getting primary pulmonary hypertension from a weight loss

00:25:59.100 medication i mean that might be true but still like you're not supposed to increase people like

00:26:04.260 you can't just compare the risk of your drugs to like some other thing that's going to kill them

00:26:09.920 like look we're killing you but an axe murder might also kill you so i don't see what the

00:26:15.340 problem is. Like, that's not how morality or medicine or anything works. 0.97

00:26:19.240 Totally. No, I will tell you, this is like, as an aside, my dad, when he and my mom were

00:26:25.940 splitting up and she would like, ask him to do things differently and sort of the lead up to

00:26:30.520 their divorce, right? He would be like, I don't know why you're on my case. You could have married

00:26:35.020 Charles Manson. And she was like, that's not the bar.

00:26:39.140 there are some men in between you and charles manson there are more than one man on that

00:26:46.600 spectrum i felt like you would appreciate that so within 16 days of this story breaking

00:26:54.080 the fda essentially instructs wyeth to add a warning to their label because there's not a

00:27:00.660 warning on the label oh god don't go too hard fda really cracking down like sorry this might kill

00:27:05.980 but proceed. So Wyeth does that because they don't really have a choice. They add a warning

00:27:12.500 to their label. And they also have their PR firm write what they call a dear doctor's letter,

00:27:20.120 which is update to doctors about sort of the status of this medication is changing. Here's

00:27:24.380 what you need to know. So they're sort of explaining the label change, right? And one

00:27:28.360 of the phrases that they include is that the evidence is inconclusive, which technically true.

00:27:34.840 But the whole letter is sort of designed to downplay concerns, right?

00:27:40.320 This is the tobacco company playbook that one of the things that you learn when you

00:27:44.760 look into the big fights, decade-long fights over tobacco, is that what the tobacco companies

00:27:48.320 have always said is that the evidence that cigarettes cause cancer is unclear, and it

00:27:53.840 actually is, that scientists still do not know exactly why cigarettes cause cancer.

00:28:00.860 What they know is that people who smoke are more likely to get cancer.

00:28:03.700 people who smoke more are more likely to get cancer states which have more smokers have higher

00:28:08.140 cancer rates etc like there's a million of these correlations and there's always something that

00:28:13.520 we don't know but what companies always do is they latch on to these like ordinary things in

00:28:19.260 the scientific process that like we literally can never know everything yeah and they pick those

00:28:23.700 like areas where there is still debate and areas where there's still uncertainty and they're like

00:28:28.260 we couldn't possibly make a decision until we get clarity on this. And it's like,

00:28:33.480 no, guys, if people who are taking your drug are like dying a lot, like that's probably enough for

00:28:39.180 us to like pull back. Just like, let's start over. So at the same time that they are, you know,

00:28:45.400 sort of releasing this Dear Doctor's letter, their lobbyists are also lobbying Congress to get

00:28:51.560 Pondamon and Redux descheduled by the DEA. Wait, what does that mean?

00:28:55.860 That means it would no longer be a controlled substance.

00:28:59.180 Meaning what, you could buy it over the counter?

00:29:00.900 Meaning that they could extend prescription timelines past those three months. 1.00

00:29:06.860 Oh, shit. 0.99

00:29:07.860 Right. So their internal math that's later found in sort of trial discovery 0.99

00:29:13.900 shows that getting the drugs descheduled could increase their sales by 25%.

00:29:19.920 So what you're saying is they basically got FDA approval by being like,

00:29:23.540 don't worry about the side effects. People are only going to be taking this for three months.

00:29:27.120 It might be bad in the long term, but people are only taking the short term. Don't freak out.

00:29:31.140 And then once it's approved, being like, oh, yeah, we're just going to let people take this

00:29:34.140 forever. Yeah, that's right. That's right. So they also train their sales staff very,

00:29:40.900 very briefly. It's about five minutes of training that they get. It's essentially training on how

00:29:45.960 to redirect concerned questions and how to reassure doctors and customers.

00:29:51.300 dude yes when i sold frozen steaks over the phone as a college student they had like a literal script

00:29:58.760 for like every objection that people would make like i don't think i could make this decision

00:30:02.520 without consulting my wife and we were supposed to say like well i think your wife would want you

00:30:06.360 to buy steaks because steaks are good like we would have this little flow chart of all of their

00:30:10.160 objections i guess it's the same thing side note at some point i would like to hear many stories

00:30:14.880 about selling frozen steaks over the phone.

00:30:18.520 I did it for one night.

00:30:19.780 I laughed in one night.

00:30:21.500 And I was like, this is gross.

00:30:23.780 And then I stopped.

00:30:25.620 So there is this big media story now.

00:30:29.000 Wyeth, of course, they have more money than God at this point.

00:30:32.500 They swipe back. 0.98

00:30:34.280 They build a $100,000 counterattack plan.

00:30:39.560 They are paying for media blitzes about the dangers of obesity.

00:30:43.560 They are making those sort of splashy high dollar contributions. And over the years ahead,

00:30:51.520 lawsuit after lawsuit after lawsuit is filed from people who've gotten PPH and heart disease.

00:30:58.420 It becomes so big that they essentially pull together a conference of 500 attorneys from

00:31:03.580 around the country who are all managing fen-fen and redux cases.

00:31:07.780 So there's like, it's so big that there's like a summer camp of people that are fighting against

00:31:12.220 this one pill 100 so they have like doctors there to present they have researchers they're like

00:31:17.660 gathering everyone together there are breakout sessions right like it's a whole big thing no way

00:31:22.040 they do all of this and you can actually see if you look up the adverse drug reports adverse drug

00:31:27.900 experience reports you can see this massive crescendo of like as soon as the media coverage

00:31:34.860 hits that same year, the adverse drug experience reports skyrocket. They go up to 10,000 because

00:31:45.300 now people know what to look for, right? A lot of the symptoms of primary pulmonary hypertension

00:31:50.360 are just like fatigue and shortness of breath and things that don't necessarily strike people as

00:31:57.540 emergency conditions. But if you don't address it, I mean, it will kill you potentially.

00:32:03.120 So everybody, these stories come out, everybody starts putting two and two together of like, this is why I feel like this.

00:32:08.260 Yes. So as these stories start to come out, and as these cases start to move forward, trial discovery starts happening.

00:32:18.380 And in trial discovery, it becomes clear that Wyeth and Interneuron both have known about this since before even advocating for the approval of the drug.

00:32:28.500 oh my god i want to like gasp or something but this is like this is like such not a twist

00:32:33.720 i feel like every time we have these things of like corporate malfeasance it's never like

00:32:39.280 and in the discovery phase it turned out the company had no idea and they were acting in

00:32:43.760 good faith the whole time it's always just like kill them it's like it's these emails from like 0.97

00:32:49.580 palpatine of just like fuck these lives like this happens every time it's 100 the case and actually 0.98

00:32:57.780 like one of the things that shows up in the files, I will say, and this is something we should talk 0.99

00:33:01.720 about on like a full episode, their attorneys and researchers both checked them on the use of this

00:33:07.800 300,000 deaths a year number. And everyone says this is unsubstantiated. So even their basis for

00:33:14.600 like the obesity epidemic is killing so many people, like there's actually not a clear number

00:33:18.420 for that. There's not good data. They advise them to say obesity contributes to X number of the top

00:33:24.380 10 causes of death which you can say right potentially but this is like straight up

00:33:30.660 inaccurate and people internally were like this isn't accurate we shouldn't be saying it my two

00:33:35.300 rules for this are anytime you see a statistic with contributes to or at risk of you should like

00:33:42.000 run in the opposite direction totally and miracle drug yes we're just creating a list of like watch

00:33:47.440 words. So here are the things that Wyeth knew. We'll just run through it real fast because

00:33:54.660 you're exactly right. Like no one's clutching their pearls being like, can you believe this

00:33:58.280 giant pharmaceutical company didn't have their patients in mind?

00:34:02.000 Acting bad. How dare you?

00:34:03.900 So they knew that the drugs lost effectiveness after three months. They knew that most people

00:34:08.560 who took it regained the weight that they lost. They internally acknowledged that while PPH might

00:34:13.700 be a health concern. They haven't researched it and they will push back publicly against any

00:34:20.900 label warnings. They will push back publicly against any, basically any restriction on

00:34:27.280 distribution of this drug. Whoa. So we don't know, but we're going to fight this accusation

00:34:32.060 in the press. 100%. So like that written out all in one memo. It's not like, oh, here's one

00:34:39.260 document. And then a couple of years later, here's another. It's like, no, here it is. Like

00:34:42.600 the vice president of this department wrote this memo, right?

00:34:46.080 It's like those summary mails you write after conference calls. You're like,

00:34:49.000 hey, guys, I just want to put all of the evil stuff we're doing in one place.

00:34:52.380 We can refer to it later. I don't see why this would be a problem at all.

00:34:55.300 So here's one of the things that genuinely shocked me. You might be unshocked. I am super

00:35:02.240 shocked by this. Part of their budget, and this is like very clear in discovery documents,

00:35:08.720 is that they hired an outside PR firm to hire medical experts to write papers in praise of

00:35:18.220 Fen-Fen and Redux and get them published in journals.

00:35:22.060 Oh, that's rough.

00:35:24.620 Yeah. The ethics chair at the AMA, the American Medical Association,

00:35:28.680 publicly freaks out and like kind of loses it on Wyeth and Interneuron. And they say,

00:35:35.300 these are advertisements that are being couched as valid scientific papers, which is super

00:35:41.940 dangerous. Extremely bad. Yeah. And they're paying like 20 grand per paper, which is both

00:35:47.100 more and less than I would anticipate, right? I will say a bunch of these came up in the research

00:35:53.920 for this record. Oh, yeah. You know, when you're reading scientific research, the titles are

00:35:58.880 incredibly dry. It's not they're not making big, bold statements. They're like, this might be true

00:36:04.280 under these conditions. We still need to study more in these ways. These are two actual titles

00:36:09.340 of papers about fen-fen and redux. One of them was called rushing to judgment on fen-fen. And

00:36:15.420 the other one says, the fen-fen diet drug combination is not associated with valvular

00:36:20.740 heart disease. Nice. Which is like, again, like you and I have talked to enough researchers to

00:36:26.160 know that is not researcher language. That's PR language. It's like you're wrong about fen-fen

00:36:32.080 basically. Totally. You're wrong about our products. So buy it. Yeah. So all of this

00:36:37.980 happens. Fen Fen is finally Fen Fen and Redux are both finally pulled from the market. And from

00:36:44.320 start to finish from approval of the drug to being pulled from the market, the whole thing is about

00:36:50.020 three years, which is so fast for these processes, right? I mean, this is my cynical take on it. But

00:36:57.400 I'm imagining that the company made more money in those three years than they ended up paying in

00:37:03.180 like lawsuits and stuff. Do we know? I do know. Because and we'll like, skip ahead. They essentially

00:37:10.300 have to shutter their operation over this settlement. Like there is a massive class 1.00

00:37:17.780 action lawsuit. Okay. So they in 2000, a federal judge approves a settlement for this huge class

00:37:26.180 action lawsuit. The settlement is $3.75 billion. And according to Reuters, it is the third largest

00:37:35.620 pharmaceutical settlement in the nation's history. It's funny that it's not the first because it's

00:37:41.420 like pharmaceutical companies are so fucking bad. This is barely in the top five. Great job, guys. 0.97

00:37:47.640 So ultimately, they find that 45,000 people who took fen-fen and redux developed

00:37:56.240 either primary pulmonary hypertension or heart valve damage. 0.99

00:38:01.500 Holy shit. 0.98

00:38:02.840 45,000 people end up with heart conditions as a result of this. 0.99

00:38:07.620 Yes, but how many people were struck by lightning?

00:38:11.620 And how many of those people are now thin and depressed?

00:38:15.140 You know, how many – how do those people look now, huh?

00:38:18.880 Sure, sure.

00:38:20.800 And like many people also died.

00:38:23.020 These are heart conditions and brain conditions, right?

00:38:25.680 Yes.

00:38:26.180 You could sort of make an argument about like liver or pancreas or whatever that these are sort of like at least manageable things.

00:38:33.220 If you are messing with your heart and your brain, those are some real baseline functions, right?

00:38:38.480 Although what's also interesting about this is that, you know, we always focus on these sort of extreme side effects, harmful side effects of pharmaceutical drugs.

00:38:45.600 But there's also the basic question of like, this didn't do what it said it was going to do, right?

00:38:50.920 And that if people were taking it, even if they lost weight for three months, presumably the vast majority of them would have gained it back anyway.

00:38:59.100 So like, even by their own standard, I'm assuming it didn't even do what it said on the bottle.

00:39:04.040 Right. This feels like sort of the dirty little secret of the diet industry or the thing that they're like trying to distract people from. We're all dieting all the time. We're all taking part in cleanses and detoxes and diets and weight loss efforts and whatever. And none of us are actually losing weight in the long term, but we're still buying in. So they're still taking advantage of that.

00:39:24.540 I mean, this is like partly why we're naming this show this is because the maintenance phase of any

00:39:30.820 diet is the diet, that there's no such thing as like jumpstarting your weight loss or like

00:39:36.480 kickstarting a diet plan. It's like, no, the minute your habits go back to a default,

00:39:41.580 your weight is going to default. So again, if you're taking a pill for three months and then

00:39:46.560 you go off the pill, there's no reason to believe that you wouldn't just rebound to your previous

00:39:51.760 weight because that's how bodies work. Totally. Yeah, it sucks. This was also a major systems

00:39:56.700 failure on the part of the FDA. Dude, yes. Part of this is that Wyeth didn't tell people. But

00:40:01.200 again, like shocking, a manufacturer didn't tell someone about their product not working

00:40:07.120 or having harmful consequences, right? Right. The bigger challenge here is like,

00:40:11.540 how do 45,000 people end up with heart disease as a result of a drug that they've taken and the FDA

00:40:17.440 doesn't catch it. That's more than half the population of Fargo, North Dakota, I have

00:40:22.760 learned. So it highlighted some major sort of shortcomings in the ways that drug reactions

00:40:31.120 were reported, that they were analyzed, they were sort of circulated internally, right?

00:40:35.300 Some of these reports came in and didn't actually make it back to the advisory committee staffing

00:40:41.560 person, right? The person who's in charge of regulating this particular drug, right? So

00:40:46.640 So there's just like failure on failure on failure inside the FDA.

00:40:50.400 Right.

00:40:50.580 Because there's the central question is like if their internal data was showing that people

00:40:55.500 weren't, for example, keeping the weight off after they stopped using the drug, why wasn't

00:41:00.560 that part of like the packet of information that they were forced to turn over to the

00:41:04.480 FDA?

00:41:05.060 Right.

00:41:05.260 Why did it take a class action lawsuit after all of this damage has happened to catch that

00:41:11.580 this was not only possible, but in this case, likely, right?

00:41:15.220 Send us your Palpatine memos at the beginning of the process.

00:41:20.800 So again, like Wyeth gets this huge judgment. But like the bottom line here, and this is the part

00:41:27.260 that is really sort of haunting to me. The FDA is still approving diet drugs. They approve one

00:41:34.340 for the life of me. I can't remember the name. It was marketed as Ally was the name of it.

00:41:39.680 Yeah, this came up a lot when I was doing reporting on my article. I also forget the

00:41:43.520 name, but it's like it's one of those pills that basically it can help you lose 10% of your body

00:41:47.600 weight. And again, like once you stop taking it, you gain all the weight back. It's this it has

00:41:51.960 the same structural limitations as venfen, although it's probably not just like straight up crack

00:41:56.500 cocaine in your system, I hope. Right, totally. It's not going to murder you immediately. Yes.

00:42:01.080 But it's most it's Orlistat. That's the name of it. Orlistat. Yes. So in 2012, the FDA approved

00:42:08.240 Qsymia, which is another phentermine-based weight loss drug. So it's the same sort of

00:42:13.200 amphetamine-based. Phentermine is half of fenfen, right? There's this ongoing string of research

00:42:19.920 about whether or not fenfen could be used in treatment of addiction, especially to alcohol

00:42:24.740 and cocaine. So there have been studies in the last 10 or 20 years about could it be effective

00:42:29.480 here. And actually, this year in France, there is a huge trial happening about another weight loss

00:42:37.940 drug called Mediator, which was pulled from the market in 2010 after causing – the numbers vary,

00:42:44.740 but it's up to 2,100 deaths in France. In a real fun twist, the defendant is Servier International,

00:42:53.260 which is like a big drug company based in France. They were Interneuron's partner in buying and

00:42:59.380 selling Redux. So it's truly the same people doing it all again.

00:43:04.360 Like the literal same people.

00:43:05.700 Right.

00:43:06.000 Like, hey, Steve, I know you from the last one of these.

00:43:09.320 Today, Phentermine is number 210 on the list of the most prescribed medications in the US.

00:43:14.780 Wait, so it's still around?

00:43:16.000 Uh-huh. Phentermine is, which is not all of Fen-Fen, right? It's part of the drug cocktail.

00:43:21.280 The holy trinity that we were, yes.

00:43:23.340 That's right. And I did a Google search of Fen-Fen as part of this because I was like,

00:43:27.840 I wonder what comes up. Two of the suggested search terms in Google are,

00:43:32.540 is Fen-Fen still available? And where can I get Fen-Fen?

00:43:35.600 Dude, yes. I actually looked into this when I was working on my article, and I also found

00:43:39.680 a lot of demand for fen-fen and places selling it or pretending to sell it. I mean, I don't know

00:43:46.480 if they're just selling sawdust pills or whatever, but you can go online and buy

00:43:51.200 quote-unquote fen-fen. I have no idea what you're going to get in the bottle that you get.

00:43:54.780 So there you go. I mean, that's the whole story. It got smacked down in a really public way,

00:44:01.920 but it's still around. I feel like history is always a nice corrective to this idea that it's

00:44:06.540 like we made a mistake as a society and then we learned and we never did it again. In most of

00:44:13.080 these stories, you're like, oh, no, we're still doing literally the exact same thing. Right.

00:44:16.840 Nothing has changed. Right. Like many things, we get outraged about it in a cyclical way and then

00:44:23.380 decide to stop paying attention or get some kind of like, you know, satisfying climax to the story.

00:44:31.600 And so we assume that all the sort of underlying issues are solved. And in this case,

00:44:35.540 they are very much not.

00:44:37.160 Does this make you think any differently about your own experience? Like, are you more mad

00:44:41.100 that this was prescribed to you as a 14-year-old now than you were a couple weeks ago?

00:44:45.080 Oh, I'm more freaked out.

00:44:46.900 Yeah.

00:44:47.820 Because essentially, so like, the effects of primary pulmonary hypertension can

00:44:53.140 have an onset that is long after the first time you take the drug. 1.00

00:44:57.200 Oh, shit. 0.90

00:44:57.840 In 2012, Wyeth, which is now owned by Pfizer, asked a federal judge to bar any fen-fen cases from going to trial if they had developed any symptoms more than nine years after taking the medication. 0.99

00:45:13.380 Oh, interesting.

00:45:14.200 Right. So they're trying to get anything sort of like barred that feels too far out to them, which I can sort of understand, right?

00:45:21.100 On the one hand, you can be like, listen, they took this drug. It's a really high risk.

00:45:25.100 Right.

00:45:25.820 But on the other hand, you kind of can't know.

00:45:28.380 Yeah, it would be difficult to make a strong case for that.

00:45:30.680 Yeah.

00:45:30.980 It would be very difficult to prove a causal relationship in an individual.

00:45:34.900 Right.

00:45:35.120 So like, I sort of get it. 0.98

00:45:36.720 And also, I'm like, but listen, every single thing Wyeth has done so far has been garbage. 0.98

00:45:41.300 So I'm willing to consider that this is also garbage, right? 0.97

00:45:45.360 Every decision that companies make is profit maximization. 0.90

00:45:48.240 So we should just that's, they're not doing this for public health.

00:45:51.240 They're not doing this for fairness, or accuracy, or like legal purity.

00:45:54.840 they're doing it to preserve their profits. And so however you feel about that morally,

00:45:59.600 like that is what they are doing. And so we should always come into it with that

00:46:02.460 assumption in mind. 100%. So how about you? You came into this sort of like,

00:46:07.680 you're like, everybody I talked to didn't know what it was, which is mind blowing to me.

00:46:13.080 Well, it's also because most of the people I've been asking are men. I mean, I think the gendered

00:46:16.760 aspects of this are so interesting. Because if you know, the obesity epidemic is like this

00:46:20.840 biological thing that is really concerning, et cetera, 300,000 deaths, then like there's no

00:46:26.160 reason why women would be prescribed diet pills more than men. But the fact that this was marketed

00:46:31.780 toward women implies that there's clearly like an element of like looks like women are judged on

00:46:36.740 their looks to an extent that men are not. Right. And so you're clearly appealing to that in your

00:46:41.560 marketing while pretending that all you're appealing to is health. Absolutely. And that's

00:46:45.620 also like borne out by the data around bias facing fat people, right? That like, women who are 0.99

00:46:52.280 considered, quote unquote, overweight by even a small amount, make significantly less money in 1.00

00:46:57.920 the same job. Right. And for men, it takes getting very, very fat before that shows up in their

00:47:04.780 paycheck, right? And in this case, we're seeing like a conscious effort to focus on women.

00:47:09.800 Which is just like revealing of the exercise, because it's basically a pill that's going to

00:47:12.840 make people look better. And you're selling it as a weight loss pill, because like, that's what

00:47:16.340 you need to tell the FDA, like it's public health, blah, blah, blah. But what you're actually

00:47:19.780 promising people is look better in this pill form. Absolutely. And again, like, this also feels

00:47:25.620 to me, like very clearly racialized, right? The sort of income levels that they're talking about,

00:47:30.900 like the folks who are sort of primary plaintiffs in this are overwhelmingly white women. 1.00

00:47:36.280 They're overwhelmingly educated white women. One of them is a PhD candidate, right? Like, 0.98

00:47:41.980 there's like all of these stories of like very promising young white women in the way that we

00:47:47.260 like to talk about promising young white people right being sort of cut down in their prime

00:47:51.540 right we're talking about a drug that causes hypertension and we're not actually exploring

00:47:55.680 the stories of black people of latino people right like people who are already at higher risk

00:48:01.120 for hypertension and heart disease the dangers to people of color taking this drug are different

00:48:07.540 and probably much worse. Like there's not really data around that, that I've found at least,

00:48:13.440 but it seems not great. I mean, so much of this would come back also to like insurance status.

00:48:19.280 First of all, insurance of like who's having access to doctors. But then also, I mean,

00:48:24.560 what you come across in the literature over and over again is that fat people, especially fat

00:48:28.520 people of color at doctors are often sort of punished. Like I'm not going to give you this

00:48:33.820 diabetes medication, you refuse to lose weight on your own. So I'm not going to help you. I do

00:48:38.640 wonder if there is an element of like, well, I'm not going to give you the diet pill because I'm

00:48:43.920 holding you to the standard that like you should be able to do it yourself. I'm not going to give

00:48:47.600 you the quote unquote easy way out. Whereas like if a wealthy white housewife comes in, it's like, 0.92

00:48:53.240 oh, she's busy. She's on a bunch of charity boards. She's doing the gardening. I have to help her. 1.00

00:48:58.460 Yes, totally agreed. It feels very paternalistic to me too. It definitely feels like the medical

00:49:03.800 version of like you can have a puppy when you've proven that you can take care of it, right? Like

00:49:08.340 it's just like really a gross way of dealing with like major health issues.

00:49:13.820 Yeah. I just think there's like there's this wind at the back of any weight loss drug or anything

00:49:20.600 that is going to promise a easy solution to this much more complicated problem. From, you know,

00:49:26.800 the people who sit on these advisory boards to the people who work in medical journals to marketers

00:49:31.720 to doctors themselves. It's like everybody just wants something quick and easy for this. And so

00:49:38.140 in a million like little ways, I think people reduce their critical thinking to be like,

00:49:45.420 yeah, that sounds good. Like let's push this through a little bit faster. Let's subject it

00:49:49.260 to a little bit less scrutiny. And it's like you add up all those little tiny decisions and it

00:49:54.700 results in this just like greased water slide of this pill getting onto the market that like really

00:50:00.380 had no place being given to large numbers of people. Absolutely. And like the fact that there

00:50:06.160 was so little testing of the drugs in combination is fully bananas to me. Again, like pharmaceutical

00:50:15.380 companies acting badly, the FDA not requiring more of them is very troubling. Just the idea

00:50:22.640 that like, well, driving is fine and wearing sunglasses is fine. So driving while wearing

00:50:29.120 sunglasses i don't see what the problem is right it's like it's very obvious that drugs have

00:50:35.040 effects in combination with each other that are not predicted by their individual effects and

00:50:39.240 like this is not like an exotic concept to scientists but for some reason it seems like

00:50:43.420 everybody was like whoops guess it's fine yeah that's right anyway it's a it's a real bummer

00:50:50.300 it's a real bummer of a story it's the only bummer of an episode we're gonna have absolutely

00:50:54.780 everything else is sunshine and roses. After this, it's just gonna be how to get 10,000 steps

00:50:59.660 and how to lose 10 pounds for your wedding. Step one, get engaged. Step two, lose 10 pounds.

00:51:24.780 You

Maintenance Phase - October 27, 2020

Fen Phen & Redux

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