Better obesity drugs wanted.(LETTERS)(Letter to the editor)

I disagree with Dr. Helena Rodbard's statement that the anticannabinoid drugs have been "very promising" ("A Major Setback for Obesity Treatment," Guest Editorial, Nov. 15, 2008, p. 8).

I spend slightly more than half my time as a clinical investigator and have conducted many weight-loss studies including those involving drugs in this class.

By necessity, I am a professional skeptic: The drugs must prove themselves to be primarily safe as well as effective to warrant their entry into the marketplace. This drug class carries a risk of suicide and Dr. Rodbard omitted the reports of hostility, violence, and homicide. Furthermore, as we have seen repeatedly, once drugs come to market, the frequency of reported adverse effects increases--sometimes substantially--and new adverse reactions often emerge. I would not prescribe, nor would I personally take, a drug from the anticannabinoid class.

I also question the assertion that these drugs "induce a very effective sustained weight loss--better than most if not all other classes of drugs for the treatment of obesity. ..." These drugs appear to have a degree of effectiveness similar to that of sibutramine, which is not being touted as a miracle drug in obesity management. They also have a lack of sustained effect; many of the subjects in the studies start to regain their weight after 6-12 months, while still on the drugs. Several other drugs now being investigated appear to be substantially more effective, but they have not yet cleared all the safety and sustained efficacy hurdles necessary to reach the market.

For the benefit of my patients and myself, I am eager for a pharmacologic alternative to bariatric surgery for ...