Maintenance Phase - Fen Phen & Redux

Episode Date: October 27, 2020

Fen-Phen & Redux were "the next miracle drugs" in the '90s, claiming to help people lose dramatic amounts of weight in just three months.  But within a few short years, they'd been pulled from the market.  They were just too effective! (Just kidding, they killed some people.)Support us: Subscribe on PatreonDonate on PayPal Get Maintenance Phase shirts, stickers and moreLinks! Dispensing with the Truth by Alicia MundyThe New Miracle Drug (Time Magazine)How Fen-Phen, A Diet 'Miracle,' Rose and Fell (the New York Times)Blowing the Whistle on Fen-Phen (Journal of Business Communication)Purdue OxyContin settlement would rank among largest in pharma history (Reuters)National Trends in Antiobesity Medication Use (JAMA Network)The Fen-Phen Finale: A Study of Weight Loss and Valvular Heart Disease (Obesity Research)Thanks to Doctor Dreamchip for our lovely theme song!Support the show

Hi everybody, welcome to Maintenance Phase. I'm a-oh shit. I'm like, goddammit. I was trying to decide in the moment whether to say description first or name first. Anyway, hi everybody, welcome to maintenance phase. We're going to explore the many rabbit holes passed in present around health, wellness, bodies, and weight loss. My name is your fat friend.

I'm a writer and columnist for Self Magazine, and I am a fat lady. And my name is Michael Hobbs. I'm a reporter for the Having and Post and the co-host of another podcast called You're Wrong About. Yay, welcome. And today we are talking about... Fenfen!

Fenfen! Fenfen! Which sounds like the name of a zoo animal or something. Everyone I've told about this has no idea what it is. Really? Yeah. Oh my gosh, it was a huge force in my life. Yeah.

Fenfen was a combination of diet drugs that were prescribed by a doctor, and they were a huge deal for about three years. And those were three years that I was in high school and I got put on it. So I have a personal history with FENFEN and Redux. So you were given this? You didn't go to the doctor and ask for it.

It was like, we're concerned about your weight. Here's these weird pills that you, a year old should start taking so I was 14 Oh wow I had been told to be concerned about my weight. So I was And I was in high school, which is not a high point in critical thinking about values around appearance So there was this miracle drug and I was like, well shit, yeah, I'll try that. There was a cover story on time of time magazine and the title was the new miracle drug question mark. Oh, no.

Huge media splash. That's the thing where they can make a completely absurd claim, but as long as you put a question mark after it, you're not necessarily saying it. Like a picture of you on the cover of time with like a child molester? That doesn't actually make it any less defamatory. That's right. So did it work for you? Uh, I don't remember, because I was on it for a really short time. Okay. I was on it. I think it was the last month that it was on the market. And I absolutely remember many, many, many women, adult women and teenage women in my life were on it.

And I absolutely remember one person getting very, very angry when it was pulled from the market and we'll talk about why. And what she said was sure it was a problem for some people, but it was the only one that really worked. And I was like, ugh. Yeah. So we'll talk about the phrase sure it was the only one that really worked. And I was like, ugh. Yeah. So we'll talk about the phrase,

sure it was a problem for some people. Oh, because the problems that it was for some people were big. Do you remember its effects on you? Did it have like, is it one of those diapills that's like basically speed and it just makes you sort of like weird and jumpy and shaky? So, Fenn Fenn, when people say Fenn Fenn,

they're referring actually to three drugs, two pills, three drugs. So, Fenn Fenn itself was a combination of two existing diet pills, one called fentermine, that had been introduced in 1959, so it had been around for like a while. People didn't like it, it was unpopular because so many people experienced racing hearts, shortness of breath. It was like very unpleasant to be on. The other fenn, in fenn fenn is fenn fluramine, which had been introduced in the 60s or 70s. It was unpopular because the weight loss that it caused was dramatic, but it was short lived. So essentially as soon as people went off the drug, the weight just came back.

I was supposed to die, it's which last forever. As we all know. So these two things were like pretty unpopular diet drugs until they were combined in the early 90s and a third medication was added. So that third medication is Dex-Fenfloremin. Its sale name was Redux. And that's what really set this all off. So the first two, Fentermine and Fentflermine are, M-Federmines, the third one, Dex Fentflermine. I believe it's a downer. So there was a predecessor to Dex Fentflermine, to Redux, I should say, that was called Pandemon.

And it was effective in weight loss, but the side effects were so dramatic that people didn't want to take it. The main side effect was that it would put people to sleep. So people reported sleeping 12 to 18 hours a day on Pandemon. But they looked Yes. So this was like such a big thing that the one of the sort of developers of Redux in selling it would say, well, of course, people are losing weight on Pandemon. They have to be awake to eat. That was just like, they're just losing weight

because they're asleep all the time. Yeah. So because Fen Fen, the sort of combined medications of Fen Fen were existing drugs as was Redux, right? So because FENFEN, the sort of combined medications of FENFEN, were existing drugs as was redux, right? It was sort of a revision of pondermen. The manufacturer's researchers said that they assumed that those drugs were safe because they had been approved by the FDA.

So their early internal tests were just for the effectiveness of weight loss. They didn't test for safety early on. The manufacturers, Wyeth and Interneuron, sunk a ton of money into developing these drugs. So when was all this development taking place? So this was all happening in the early 90s, leading up to a 1995 approval of Redux. That's sort of what sets all of this off. This is also happening in the 80s and 90s leading up to a 1995 approval of Redux. That's sort of what sets all of this off.

This is also happening in the 80s and 90s when more and more people are getting more and more concerned about their weight, their health, their attractiveness, right? Like that is taking center stage. This is like the origin story of the wellness industrial complex. Yes, absolutely. So it's like a very fraught time, culturally. I told him it's kind of a fraught time. Yes, I think I'm talking about health and bodies, but this was a real crescendo. Right. Double fraught.

So we're talking about multiple different drugs. Pandemon being rebranded as Redux is the big sort of starter's pistol for all of it. The researchers didn't test for safety, they only measured for weight loss effectiveness, which was high because it's an emphetamine. Really, like, you are gonna lose weight. How does that work actually? Does it just an appetite suppressant

or do you burn more calories because your nervous system is sped up? You know, that I don't know. I know what the founders of Redux or sort of the researchers behind redux sort of hypothesized, which they believed that the reason that people were not losing weight was that they were using food as a drug to trigger their serotonin. So what they wanted to do was up people's levels of serotonin so that they would be happier

without food. Yeah, that doesn't sound convincing at all because then SSRIs which also had a boom time during this time would have also resulted in weight loss and a lot of them my Understanding is they resulted in the opposite yes also SSRIs not math so They start to move into FDA approval for Redux in particular and the FDA approval process is Pretty standard you go to an advisory committee you lobby them Redux in particular. And the FDA approval process is pretty standard. You go to an advisory committee, you lobby them,

they make a recommendation to the FDA, and then the FDA usually acts on that recommendation, not always, but usually, right? So there is this advisory committee meeting where they are inviting people in support and in opposition to approving Redux. The people in support are the manufacturers, the pharmaceutical companies,

Wyeth and Interneuron. And what they are talking about is we have an obesity epidemic in this country. They're throwing around this number that there are 300,000 deaths a year caused by being fat and that this is our one shot to address this emerging epidemic, right?

So they are like ringing the alarm. Right. Interestingly, the opponents are mostly doctors, and they are doctors who have read the research about the predecessors to these drugs, and they're cautioning about a few things. They're cautioning about heart disease, which fentermine and fenthyluramine were both linked to. They're talking about something called primary pulmonary hypertension, which is a condition that destroys blood vessels

in your heart and lungs. Ooh, not great. Not great. So one of the main source, I will say, not the only source, but certainly the main one, is a great book called Dispensing with the Truth by Alicia Mundi, who's a reporter, who followed this case for a long time.

She describes this as death by slow suffocation. Oh, God. And the other thing they're warning about is brain damage. What kind of brain damage? What they find out is that this is down the line, right? They don't know it at this point. 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. Seems like you should do that. Yes. So they later should do that. Yes. So they later find out that when people stopped taking fenn-fenn, again, we're talking about an emphetamine, their serotonin levels would plummet and stay low for a really long time because an overdose quote unquote

of redux, which is just like, you forgot you took a pill and you took another one just to be safe. That's an overdose, right? Like a very small amount of redux, which is just like, you forgot you took a pill and you took another one, just to be safe, that's an overdose, right? Like a very small amount of redux. That makes your neurons that produce serotonin, it makes them sort of balloon up, and then they wither, and then they duck. So it's like, that's your ability to feel happiness. So like you're diminishing the extent to which

you can like be a happy person. 100%. It is a brain damage that will lead to long-term depression. Wow. What's interesting about this is this idea of like sacrificing health to focus on weight. The story we've always been told about weight is that it's not necessarily weight itself. It's that weight is correlated with cholesterol and heart disease and blah blah blah. But then it's like even when we have the cholesterol and the heart disease numbers in front of us were like no no no it's about weight. Like the weight has to come down. Yeah it's like oh we might cause

heart disease by reducing the weight. But if the weight is only a problem because it causes heart disease then why would that be a trade-off we'd be willing to make? What we see in those hearings is the FDA and doctors grappling in real time with what matters more, if it matters more to get patients thin, but put them at the risk of heart disease and lung issues and brain damage in the process, or if their heart and lungs and brain should be left alone, as should their weight. Right.

And it's really an open question and people talk about this really openly. So there's this quote from that time magazine cover story, the new miracle drug question mark. The miracle. And so this is the quote from that piece. This is straight from the writer. That risk, of course, and the still unquantified

chance of brain damage have yet to be weighed against the danger of remaining fat, which is considerable. Right. Severe obesity puts people at risk for heart disease, diabetes, and some cancers. If redux can help these people get thin, it might be worth the risk.

Even if it results in all those people getting heart disease. And die. Yeah. So part of what's happening, the sort of tent pole story, the sort of human interest story that holds up a lot of the Fenthen and Redux panic is a young woman named Mary Linnon who starts taking femphen and redux in the lead up to her wedding. She's 29 years old.

Very quickly, she starts to lose energy for wedding planning within a month or so. She starts having shortness of breath, just walking up a flight of stairs, which was not normal for her. And within a year of taking the drug, she actually passes away from primary pulmonary hypertension. which was not normal for her. Yeah. And within a year of taking the drug, she actually passes away from primary pulmonary hypertension.

She does not get to get married. Wow. So she kept taking it even as she had all these worsening side effects. So here's the trick about fenphenate redux. These side effects set in with as little as two months on the drugs. And the maximum prescription advised by Wyeth and Interneuron is three months. Oh wow. Because they're like, we know that they lose effectiveness anyway after three months. So we're just gonna cut it off there. So the FDA committee meets the advisory committee meets. They take in all

the testimony. They vote five to three to reject Redux for approval, but a few hours later, a few of the committee members go to the chair of the committee and say that they have uneasy feelings about sort of how they manage this and they want to reopen the conversation. So they schedule another meeting for two months later. It's in direct conflict with a major neuroscience conference. So in addition to that, opponents are saying that they weren't invited to the second meeting. conflict with a major neuroscience conference. So in addition to that, opponents are saying that they weren't invited to the second meeting. So both of the scheduled in conflict

with something that opponents would care a lot about and folks were not getting invited to speak again. So only the manufacturers showed up. And the vote flips shit. Yup. So that's how we got FENFEN that they scheduled this meeting on like Super Bowl weekend for brain doctors. Yeah, that's right.

That's exactly right. And like, it's also worth noting at this point that France and England were already publicly considering taking similar drugs off the market. The US is sort of behind the times. Right, the only issue on which we are behind the times That's the only one and then we stop doing that because it's bad so the FDA was not Legally bound to take this recommendation, right? It's an advisory committee

They can decide to take that advice or not, but it's basically what you're saying is it's the same set of facts They say the drug isn't safe and then a couple of months later. They're like whoops. It's safe But nothing in the underlying information has actually changed. It's just the makeup of who showed up to a little conference from that day. Yeah, there's no new information. Right. So the FDA takes their recommendation, takes the advisory committee's recommendation. Interestingly, they take it over the objections of their own staff, particularly scientists and researchers on staff who are like,

hey, there are some big research questions to answer here. of their own staff, particularly scientists and researchers on staff who are like, hey, there are some big research questions to answer here. Yeah, there's a lot of depressed rats that have some input on this process. But part of the reason that it gets approved seems to be that there is this cultural shift happening in the FDA. 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. Ooh.

Right. So they're saying that like drug manufacturers are their customers and that they have to provide customer service to their customers. Which means like consistency and speed. Mm-hmm. All of the things that essentially work in opposition to the public interest. Absolutely, and also, if they refuse to approve Redux

because the chemical formula is so similar to Pandemon, they would also have to recall Pandemon, which would basically just be a bunch of work. Right, it's a hassle. It's a big hassle, it's a big headache. Wow. So once Redux is approved, these two drug companies, the manufacturers of Fenn Fenn and Redux

launch a gigantic marketing campaign. 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. 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 Part of what they do this is a thing that I got really hung up on

They define their ideal customer and they talk about it internally as Roxanne Redux is the name I'm imagining us sort of like rosy the riveter character. 100%. She's just really depressed from like taking this drug for too long. Having a hard time breathing. Yeah. I haven't felt pleasure in three years, but look how skinny I am. So they define Roxanne Redux as their perfect customer.

They say she's quote, unquotequote pink collar, so sort of like middle America, right? 35 to 54, needs to lose 50 or more pounds, and they include the phrase tried everything. Oh my god. So they're specifically marketing to people who are dissolution. Yeah, desperate. And very desperate, right? Yeah. Part of their marketing strategy is that they do these roadshow of diet seminars, quote unquote, that are designed to sell Redux. So this is like, when they describe it, it sounds to me very much like motivational speaker.

Yes, seminars where they're like, come to the Red Lion on Sunday afternoon. Join us at the Sheridan. The interesting thing about the Redux seminars is that they have all the facilitators are sales reps, but they all wear white lab coats. And they don't tell people that they're sales reps unless they are asked.

No way. Right, so they are like very clearly presenting themselves as medical authorities, right? That's a clear signal. And they're only addressing that if the thought crosses someone else's mind enough for them to ask them. That's like walking around downtown

in like a police officer's uniform and then being like, why would you assume that I'm a police officer, sir? I'm just giving you orders about what to do. You haven't even asked me if I'm a real police officer. Right, it's medical stolen valor. So not anything that they're saying, but just the approaches that they're taking,

these like white lab coats, right? The whole thing just feels gross to me. Have they said anything? Or is there any information on what happens after this three months? It feels extra predatory to me to be like, oh, we need to find desperate women who need to lose 50 pounds. These are going to be people that are in extremely vulnerable,

emotional places. And then even if it works, the minute you stop taking it, surely if you're not taking amphetamines anymore, everything goes back to normal, you're not like hopped up. So all the way comes back. So like, what are you actually doing? Right. So that's like a big, that's a big part of this. And again, like, brings me back to that family friend who was like, it's the only one that really worked. And I'm like, oh, we need to

have a conversation about what it really worked means to you. Right. What's worked. Yeah. 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 Mundi, this reporter calls obesity ink, 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.

How do we make money off of this medical thing? Right. So part of YS marketing plan is that they make huge donations to anti-obesity organizations. Mm. So they are very aware and very conscious that the more that they can ramp up anxiety about an obesity epidemic,

the more they can make it seem like a serious medical problem, the more that they can ramp up anxiety about an obesity epidemic, the more they can make it seem like a serious medical problem, the more that they can sell. And the more that they can cast themselves as the good guys, because all we're trying to do is make Americans healthier. That's it. We're just trying to save lives. Right. We're just trying to help.

Yep. Exactly. So, within three months of the introduction of Redux, it catches on wildfire. Also, at this point, it has been 23 years since the FDA last approved a diet truck. Oh wow. So people are just clam, it's like, it's like the people in Mad Max, under the waterfall.

Because they're just standing there with a bucket, give me anything. And all they've been hearing all the time is, if you don't if you don't drink water, you're going to be real unhealthy. You're probably going to die real soon if you don't freeze water. They know, but also the anxiety is getting ramped up so much. So within a few months of the introduction of Redux, according to Time Magazine, doctors were writing 85,000 prescriptions a week. Oh, wow. And by 1997, they are projecting $220 million

in sales of Redux alone, not even Fenn Fenn, just Redux. Nice. So they are printing money. Aubrey, you're good at this. This is fun. Oh, yay, thanks. This is dope. Yes.

Appreciate it. I just stumbled into this thing and I was like, oh, this story is bitchin'. I can tell how much you love this. It's like such a good story. I really love it. I might die of heart failure later because I took it.

Who knows? It's worth it. It's worth it. It's worth it. Avenge me. So the other thing that feels important to highlight here is that Fenn Fenn and Redux seriously fed Pil Mills.

I have been wanting to write an article about this. Tell me what Pil Mills are. So Pil Mills, my understanding of Pil Mills, is that they are essentially like doctors offices that are mostly just fronts to get people prescriptions that they want. So in this case, it provided doctors with this sort of easy cash flow, right? Like you're not going through insurance. You don't have to deal with all of the red tape. It's essentially like retail medicine. I have heard various rumors of these over the years, especially when it comes to diet pills, because people are so desperate and that Every once in a while one of these like white-collar cases will pop up in the news

But there's like some doctor who's writing like 25,000 prescriptions a month, like to the point where like if you were signing these, it would be physically impossible to sign that many prescriptions. Right. So like in Alicia Mundi's book, dispensing with the truth, there are many first hand accounts of people who are like, oh yeah, I went into a doctor's office,

I did not talk to a doctor. I've talked to a med deck who took my blood pressure and some like baseline vitals, right? Mm-hmm. And then they gave me a prescription. It becomes such a big deal that there are 800 numbers that you can call 1-888-4-FEN-FEN. Oh my god. That's one of the numbers.

So you just call them and they send you diet pills or they get you a prescription, right? Wait, isn't that too many letters for FEN-FEN? Is it F-E-N, F-E-N? Yeah, they misspell this. Okay, but something get around it, is they misspell it? Yeah, this is like a European phone number, but I was like, okay. So it also becomes such an issue and such a huge flashpoint around weight loss that weight loss companies like Nutra System and Jenny Craig start figuring out how to weave FENFEN

and Redux into their programs. Oh. This becomes such a big thing that, if you remember Mary linen, the one who died before her wedding, her lawyer is married to a woman who's a doctor. And at the time of Mary's death, that doctor had already been offered, and I quote, a couple thousand dollars per month on the side for signing pads of prescription slips for Fenn Fenn and Redux.

That was an offer that was not made by a manufacturer. It was not made by their sales team. It was made by these large weight loss corporations so that essentially you could go into one of their diet centers and walk out with a prescription. So Weight Watchers was just like spraying people with fenfin in a mist like produce at the grocery store for everybody that came to one of their meetings. Yeah, they're like the perfume counter where they're just like, oh, if you spray in front

of you and then walk into it, that's the best way to do it. So interestingly, this is the section in my notes that I've titled the beginning of the end. Oh. So they do a bunch of research into fenphen and redux because they notice that patients who've been on fenphen and redux are starting to be diagnosed with heart disease. How long has it been on the market at this point?

At this point, I think these reports start to come in in like at scale in 1996. So that'd be like a year. Okay, so pretty soon after it's hit the market. Very soon. And what they find is that in their one clinic, this clinic called MeritCare in Fargo, Fargo's a city of about 77,000 people,

this one clinic finds 11 cases of heart disease. So this is like a very high incidence. Right. They do a little rough back at 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. So they do a little math and they find that if their data is right,

taking fen fen and redux increases the risk for pulmonary, primary pulmonary hypertension by 2300 times. Oh, shit. Right. 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. It's just like really obvious. So then the Mayo Clinic starts looking into it. And then the New England Journal of Medicine publishes something about it. And the story breaks in this huge way on July 9th, 1997.

So it's on 60 minutes, it's on the today show, it's on CNN, it is a humongous new story. Why is one of the manufacturers response to it? One of their VPs says, this isn't a study. It's just an observation. What do you think studies are? How do you think people study things? So he says that there's further study that's needed, blah, blah, blah, blah, blah. And why is also starts releasing these little sound bites. They start testing little phrases. And one of the big ones that catches on is they say, you have almost twice as great a chance

of getting hit by lightning than of getting primary pulmonary hypertension from a weight loss medication. I mean, that might be true, but still, you're not supposed to increase people. You can't just compare the risk of your drugs to some other thing that's going to kill them. Look, we're killing you, but an ax murder might also kill you. I don't see what the problem is.

That's not how morality or medicine or anything works. Totally. No, I will tell you, this is like, as of the side, my dad, when he and my mom were splitting up and she would like ask him to do things differently and sort of lead up to their divorce, right? He would be like, I don't know why you're on my case, you could have married Charles Manson

and she was like, that's not the bar. Like, there are some men in between you and Charles Manson. There are more than one man on that spectrum. I felt like you would appreciate that. So within 16 days of this story breaking, the FDA essentially instructs Wyeth to add a warning to their label because there's not a warning on the label. Oh God, don't go too hard, FDA, really cracking down. Sorry, this might kill you, but proceed.

So, why does that, because they don't really have a choice, they add a warning to their label, and they also have their PR firm, right, what they call a deer doctor's letter, which is update to doctors about sort of the status of this medication is changing, here's what you need to know. So they're sort of explaining the label change, right? And one of the phrases that they include is that the evidence is inconclusive,

which technically true. But the whole letter is sort of designed to downplay concerns, right? This is the tobacco company playbook that one of the things that you learn when you look into the big fights, decade-long fights over tobacco, is that what the tobacco company playbook that one of the things that you learn when you look into the big fights, decade-long fights over tobacco, is that what the tobacco companies have always said is that the evidence that cigarettes cause cancer is unclear, and it actually is, that scientists still do not know exactly why cigarettes cause cancer. What they know is that people who smoke are more likely to get cancer. People who smoke more are more likely to get cancer. What they know is that people who smoke are more likely to get cancer. People who smoke more are more likely to get cancer. States, which have more smokers, have higher

cancer rates, etc. Like, there's a million of these correlations and there's always something that we don't know. But what companies always do is they latch on to these like ordinary things in the scientific process that like we literally can never know everything. Yeah. And they pick those like areas where there is still debate and areas where there's still uncertainty. And they're like, we couldn't possibly make a decision until we get clarity on this. And it's like, no, guys, if people who are taking your drug

are dying a lot, that's probably enough for us to pull back and just let's start over. So at the same time that they are releasing you know, sort of releasing this deer doctor's letter, their lobbyists are also lobbying Congress to get condominant reducks de-scheduled by the DEA. Wait, what does that mean? That means it would no longer be a controlled substance. What meaning what you could bite over the counter? Meaning that they could extend prescription timelines past those three months.

Oh shit. Right. So their internal math that's later found in sort of trial discovery shows that getting the drugs de-scheduled could increase their sales by 25%. So what you're saying is they basically got FDA approval by being like, don't worry about the side effects. People are only going to be taking this for three months. It might be bad in the long term, but people are only taking the short term, don't freak out. And then once it's approved, being like, oh yeah, we're just going to let people take this forever.

Yeah, that's right. Okay. That's right. So they also train their sales staff very, very briefly. It's about five minutes of training. But they get nice. It's essentially training on of training, but they get nice. It's essentially training on how to redirect concerned questions and how to reassure

doctors and customers. Dude, yes. When I sold frozen steaks over the phone, as a college student, they had like a literal script for like every objection that people would make. Like, I don't think I could make this decision without consulting my wife. And we were supposed to say like, well, I think your wife would want you to buy steaks because steaks are good Like we would have this little flow chart of all of their objections I guess it's the same thing side note at some point I would like to hear many stories about Selling frozen steaks over the fire. I did it for one night. I lasted one night

That's like this is gross I said, one night, that's like, this is gross. And then I stopped. So. So there is this big media story now. Why, of course, they have more money than God at this point. They swipe back. They build a $100,000 counter-attack plan. Nice.

They are paying for media blitzes about the dangers of obesity. They are making those are splashy high dollar contributions. And over the years ahead, lawsuit after lawsuit after lawsuit is filed from people who've gotten PPH and heart disease, it becomes so big that they essentially pull together a conference of 500 attorneys from around the country who are all managing fenn-EN and REDUX cases. So there's like, it's so big that there's like a summer camp of people that are fighting

against this one pill. 100% so they have like doctors there to present, they have researchers, they're like gathering everyone together, they're a breakout sessions, right? Like it's a whole big thing. No way. They do all of this and you can actually see if you look up the adverse drug reports, adverse drug experience reports, you can see this massive crescendo of like as soon as the media coverage hits

that same year, the adverse drug experience reports skyrocket. They go up to 10,000. Because now people know what to look for. Right, a lot of the symptoms of primary pulmonary hypertension are just like fatigue and shortness of breath and things that don't necessarily strike people as emergency conditions. But if you don't address it,

I mean, it will kill you potentially. Right, so everybody, these stories come out, everybody starts putting two and two together. Right. This is why I feel like this. Yes. So as these stories start to come out and as these cases start to move forward, trial discovery starts happening.

And in trial discovery, it becomes clear that why if an internear on both have known about this since before even advocating for the approval of the truck. Oh my God, I wanna like gasp or something, but this is like such not a twist. I feel like, I feel like every time we have these things of like corporate malfeasance, it's never like, and in the discovery phase, it turned out,

the company had no idea, and they were acting in good faith the whole time. It's always just like kill them. It's like, these emails are like palpateen of just like fuck these lives. This happens every time. It's 100% the case. And actually like one of the things that shows up

in the files I will say, and this is something we should talk about on like a full episode, there are attorneys and researchers both checked them on the use of this 300,000 deaths a year number and Everyone says this is unsubstantiated. So even their basis for like the obesity epidemic is killing so many people like There's actually not a clear number for that. There's not good data Mm-hmm. They advise them to say obesity contributes to X number of the top 10 Causes of death which you can say, right? Potentially.

But this is like straight up inaccurate and people internally were like, this is an accurate, we shouldn't be saying it. My two rules for this are anytime you see a statistic with contributes to or at risk of you should like run in the opposite direction. Totally. And miracle drug. Yes, and miracle drug. Yes, also. We're just creating a list of watchwords.

Yeah. So here are the things that Wyeth knew. We'll just run through it real fast, because you're exactly right. Like no one's clutching their pearls being like, can you believe this giant pharmaceutical company that has to go down in the mine? Actically bad.

I dare you. So they knew that the drugs lost effectiveness after three months. They knew that most people who took it regained the way that they lost. They internally acknowledged that while PPH might be a health concern, they haven't researched it and they will push back publicly against any label warnings. They will push back publicly against any, basically any restriction on distribution of this drug. Whoa, so we don't know,

but we're gonna fight this accusation in the press. 100%. So like that written out all in one memo. Right? It's like all in one. It's not like, oh, here's one document, and then a couple of years later, here's another, it's like, no, here it is.

Like the vice president of this department wrote this memo, right? It's like the summary males you write after conference calls, you're like, hey guys, I just want to put all of the evil stuff we're doing in one place. We can refer to it later. I don't see why this would be a problem at all. So here's one of the things that genuinely shocked me. You might be unshocked. I am super shocked by this.

Part of their budget, and this is like very clear and discovery documents, is that they hired an outside PR firm to hire medical experts to write papers in praise of Fenn Fenn and Redux and get them published in journals. Ooh, that's rough. Yeah, the ethics chair at the AMA, the American Medical Association, publicly freaks out

and like kind of loses it, on why have they never near on? And they say these are advertisements that are being couched as valid scientific papers, which is super dangerous. Extremely bad, yeah. And they're paying like 20 grand per paper, which is both more and less than I would anticipate, right?

I will say a bunch of these came up in the research for this record. Oh, yeah. You know, when you're reading scientific research, the titles are incredibly dry. It's not, they're not making big bold statements. They're like, this might be true under these conditions. We still need to study more in these ways. It's not they're not making big bold statements. They're like this might be true under these conditions

We still need to study more in these ways These are two actual titles of papers about fennfen and redux One of them was called rushing to judgment on fennfen and the other one says the fennfen diet drug combination is not Associated with velvular heart disease nice Which is like again like you and I have talked to enough researchers to know, that is not researcher language. That's PR language. It's like you're wrong about FinFen basically.

I totally. You're wrong about our products, so buy it. Yeah. So all of this happens. FinFenFen is finally, FinFenFen and Redux are both finally pulled from the market. And from start to finish, from approval of the are both finally pulled from the market and from start to finish, from approval of the drug to being pulled from the market, the whole thing is about three years, which is so fast for these processes, right?

I mean, this is my cynical take on it, but I'm imagining that the company made more money in those three years than they ended up paying in lawsuits and stuff. Do we know? I do know. Because, and we'll like skip ahead, they essentially have to shudder their operation over this settlement. Like there is a massive class action lawsuit. Okay.

So they, in 2000, a federal judge approves a settlement for this huge class action lawsuit. The settlement is $3.75 billion, and according to Reuters, it is the third largest pharmaceutical settlement in the nation's history. It's funny that it's not the first, because it's like pharmaceutical companies are so fucking bad. This is barely in the top five. Great job, guys. So, ultimately, they find that 45,000 people who took Fenn Fenn and Redux developed either primary

pulmonary hypertension or heart valve damage. Holy shit. 45,000 people end up with heart conditions as a result of this. Yes, but how many people were struck by lightning? You know? And how many of those people are now thin and depressed? You know, how many, how do those people look now, huh? Sure, sure.

And like many people also died. These are heart conditions and brain conditions, right? Like, yes. You could sort of make an argument about like liver or pancreas or whatever, that these are sort of like at least manageable things. If you are messing with your heart and your brain, those are some real baseline functions, right?

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, but there effects, the pharmaceutical drugs. But there's also the basic question of like, this didn't do what it said it was going to do. 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. So even by their own standard, I'm assuming it didn't even do what it said on the bottle. 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 it. I mean, this is like partly why we're naming this show this,

is because the maintenance phase of any diet is the diet, that there's no such thing as like jump starting your weight loss or like kick starting a diet plan. It's like, no, the minute your habits go back to a default, your weight is going to default. Right. So again, if you're taking a pill for three months and then you go off the pill, there's no reason to believe that you wouldn't just rebound to your previous weight because that's

how bodies work. Totally. Yeah, it sucks. This was also a major systems failure on the part of the FDA. Dude, yes. Part of this is that YS didn't tell people, but again, like shocking, a manufacturer didn't tell someone about their product not working or having harmful consequences, right?

The bigger challenge here is like, how do 45,000 people end up with heart disease as a result of a drug that they've taken and the FDA doesn't catch it? That's more than half the population of Fargo, North Dakota, I have learned. Right. Right. So it highlighted some

major sort of shortcomings in the ways that drug reactions were reported that they were analyzed, they were sort of circulated internally, right? Some of these reports came in and didn't actually make it back to the advisory committee staffing person, right? The person who's in charge of regulating this particular drug, right? So there's just like failure on failure on failure inside the FDA. Right, because there's the central question is like, if their internal data was showing that people weren't, for example, keeping the weight off after they stopped using the drug,

why wasn't that part of like the packet of information that they were forced to turn over to the FDA? Right. Why did it take a class action lawsuit? why wasn't that part of the packet of information that they were forced to turn over to the FDA? Right, why did it take a class action lawsuit? After all of this damage has happened to catch that this was not only possible, but in this case, likely, right? Yes, send us your Palpatine memos

at the beginning of the process. So again, why is this huge judgment, but the bottom line here, and this is the part that is really sort of haunting to me, the FDA is still approving diet drugs. They approve one, for the life of me, I can't remember the name. It was marketed as Ally, was the name of it.

Yeah, this came up a lot when I was doing reporting on my article, I also forget the name, but it's like, it's one of those pills that basically it can help you lose 10% of your body weight. And again, once you stop taking it, you gain all the weight back. It has the same structural limitations as FENFIN, although it's probably not just straight up crack cocaine in your system, I hope.

Right, totally. It's not going to murder you immediately, but it's orlistat. That's the name of it. Orlistat. That's the name of it. Orlistat. Yes. So in 2012, the FDA approved Qsimia, which is another fentermine-based weight loss drug. So it's the same sort of emphetamine-based fentermine as half of fentphen, right? Right. There's this ongoing string of research about whether or not fentphen could be used in treatment of addiction, especially to alcohol and cocaine. So there have been studies in the last like 10 or 20 years about like, could it be effective here?

And actually this year in France, there is a huge trial happening about another weight loss drug called mediator, which was pulled from the market in 2010 after causing the numbers vary, but it's up to 2,100 deaths in France. In a real fun twist, the defendant is Servier International, which is like a big drug company, based in France. They were Interneuron's partner in buying and selling Redux. So it's truly the same people doing it all again. Like the literal same people. Right.

Hey Steve, I know you from the last one of these. Today, Fentermine is number 210 on the list of the most prescribed medications in the US. Wait, so it's still around? Uh-huh, Fentermine is, which is not all of Fent-Fent, right? It's part of the drug cocktail. The Holy Trinity that we were, yes. That's right.

And I did a little search of FENFEN as part of this because I was like, I wonder what comes up. Two of the suggested search terms in Google are, is FENFEN still available? And where can I get FENFEN? Dude, yes. I actually looked into this when I was working on my article and I also found a lot of demand for FENFEN

and places selling it or pretending to sell. I mean, I don't know if they're just selling sawdust pills or whatever, but like you can go online and buy quote unquote FENFEN. I have no idea what you're going to get in the bottle that you get. So there you go. I mean, like that's the whole story. It's like it got smacked down in a really public way, but it's still around. I feel like history is always a nice Corrective to this idea that it's like we made a mistake as a society and then we learned and we never did it again In most of these stories you're like, oh, no, we're still doing literally the exact same thing right?

Nothing has changed right like many things We get outraged about it in a cyclical way and then decide to stop paying attention or get some kind of like you know satisfying climax to the story, right, so we assume that all the sort of underlying issues are solved and in this case they are very much not. Does this make you think any differently about your own experience? Like are you more mad that this was prescribed you as a 14 year old now than you were a couple weeks ago? Oh, I'm more freaked out. Because essentially, so like the effects of primary pulmonary hypertension can have an onset that is long after the first time you take the drug.

Oh, shit. In 2012, Wyeth, which is now owned by Pfizer, asked a federal judge to bar any fenn-fenn cases from going to trial if they had developed any symptoms more than nine years after taking the medication. Oh, interesting. 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?

On the one hand, you can be like, listen, they took this drug, it's a really high risk. Right. But on the other hand, you can be like, listen, they took this drug, it's a really high risk. Right. But on the other hand, you kind of can't know. Yeah, it would be difficult to make a strong case for that. Yeah. It would be very difficult to prove a causal relationship

in an individual. Right. So like, I sort of get it and also I'm like, but listen, every single thing Wyeth has done so far has been garbage. So I'm willing to consider that this is also garbage, right? Every decision that companies make is profit maximization. So we should just, that's, they're not doing this for public health. They're not doing this for fairness or accuracy or like

legal purity. They're doing it to preserve their profits. And so however you feel about that morally, like that is what they are doing. And so we should always come into it with that assumption in mind. 100%. So how about you? You came into this sort of like, you're like, everybody I talked to didn't know what it was. Which is mind blowing to me. Well, it's also because most of the people I've been asking are men. I mean, I think the gendered aspects of this are so interesting because if, you know, the obesity epidemic is like this biological thing that is really concerning, et cetera, through 100,000 deaths, then like, there's no reason why women would be prescribed diet pills more than men.

But the fact that this was marketed toward women implies that there's clearly like an element of like, looks like women are judged on their looks to an extent that men are not. And so you're clearly appealing to that in your marketing while pretending that all you're appealing to is hell. Absolutely. And that's also like borne out by the data around bias facing fat people, right? That like women who are considered, quote unquote,

overweight by even a small amount make significantly less money in the same job. Right. And for men, it takes getting very, very fat before that shows up in their paycheck, right? And in this case, we're seeing like a conscious effort to focus on women. Which is just like revealing of the exercise because it's basically a pill that's going to make people look better.

And you're selling it as a weight loss pill because like that's what you need to tell the FDA, like it's public health blah, blah, blah. But what you're actually promising people is look better in this pill form. Absolutely. And again, like this also feels to to me very clearly racialized, right? The sort of income levels that they're talking about, the folks who are primary plaintiffs in this are overwhelmingly white women.

They're overwhelmingly educated white women. One of them is a PhD candidate. Right? There's all of these stories of like very promising young white women in the way that we like to talk about promising young white people, right? Being sort of cut down in their prime. We're talking about a drug that causes hypertension

and we're not actually exploring the stories of black people, of Latino people, right? Like people who are already at higher risk for hypertension and heart disease, the dangers to people of color taking this drug are different and probably much worse. Like there's not really data around that that I've found at least, but it seems not great.

I mean, so much of this would come back also to like insurance status. First of all, insurance of like who's having access to doctors, but then also, I mean, what you come across in the literature over and over again is that fat people, especially fat people of color at doctors are often sort of punished. Like, I'm not going to give you this diabetes medication. You refuse to lose weight on your own. So I'm not going to help you. I do wonder if there is an

element of like, well, I'm not going to give you the diet pill because I'm holding you to the standard that like you should be able to do it yourself. I'm not gonna give you the quote unquote easy way out. Whereas like if a wealthy white housewife comes in, it's like, oh, she's busy. She's on a bunch of charity boards. She's doing the gardening. I have to help her. Yes, totally agreed. It feels very paternalistic to me too. It definitely feels like the medical version of like you can have a puppy when you've proven that you can take care of it, right? Like it's just like really a gross way of dealing with like major health issues. Yeah.

I just think there's like, there's this wind at the back of any weight loss drug or anything that is going to promise a easy solution to this much more complicated problem. From the people who sit on these advisory boards, to the people who work in medical journals, to marketers, to doctors themselves, it's like everybody just wants something quick and easy for this. And so in a million little ways, I think people reduce their critical thinking. To be like, yeah, that sounds good. Like, let's push this through a little bit faster. Let's subject to a little bit less scrutiny.

And it's like you add up all those little tiny decisions. And it results in this just like greased water slide of this pill getting onto the market that like really had no place being given to large numbers of people. Absolutely. And the fact that there was so little testing of the drugs in combinations is fully bananas to me. Again, pharmaceutical companies acting badly. The FDA not requiring more of them is very troubling. Just the idea that driving is well, driving is fine,

and wearing sunglasses is fine. So driving while wearing sunglasses, I don't see what the problem is, right? It's like, it's very obvious that drugs have effects in combination with each other that are not predicted by their individual effects. And like, this is not like an exotic concept to scientists. But for some reason, it seems like everybody was like,

whoops, guess it's fine. Yeah, that's right. Anyway, it's a real bummer. A bummer of a story. It's the only bummer of an episode we're going to have. Absolutely. Everything else is sunshine and roses. After this, it's just going to be how to get 10,000 steps and how to lose 10 pounds for your wedding. Step one, get engaged. Step two, lose 10 pounds. So. So. Thank you.