An Interview with Dr. Arya Sharma (Continued)
Joseph: How do you think the approval of will change the way obese people are treated?
Dr. Sharma: Based on the experience of previous obesity drugs, there's usually a rush for new drugs, depending on how they're launched. Usually they launch with quite a bit of fanfare; even if the company is not generating the fanfare, the media is. Often lots of people will try the drug during the first year or so. Given the way it's going to be dispensed, it will be a prescription, they'll take it for a couple of weeks, and then some will realize that it's not working for them or it's not what they expected or they experience side effects or whatever, and then they'll stop using it. On the other hand, with the program that will be in place for Qnexa, even obtaining a first prescription may not be that easy, and this will certainly further limit uptake. Repeat prescriptions of obesity drugs have always been rather limited because most people look at obesity drugs as drugs that you take to help you lose weight. But you have to actually keep taking them to keep the weight off. Most people will think, "You know what, I'll just get the drug, and once I start losing weight I'll get more active and do what it takes to keep the weight off." That's where everybody kids themselves, because that's not how these drugs work. That's not how obesity treatments work in general.
Vincent Wu: At some point, people are going to plateau in terms of how much weight they lose. Given that most people will be paying out of pocket for this drug, what would make it compelling for patients to continue using Qsymia?
Dr. Sharma: Knowing that if they went off the drug the weight would come back. A lot of people become disappointed — whether this is a drug or having bariatric surgery or going on a diet — when they stop losing weight three to six months in. It's not that the diet has stopped working, it's that you've reached a new state of energy balance. What I can always tell people is that if you went back, and you stopped keeping your food diaries or you stopped your exercise plan or you stopped doing whatever it is you're doing right now — which in this case would include being on new medication — if you stopped any of this, all that weight that you lost is going to come back. If you lost ten pounds, well, you're getting those ten pounds back. If you lost twenty pounds, well those twenty pounds are coming back.
So your motivation for staying on the drug is to keep off whatever weight you've lost. You can actually think of this as an investment — once you've been taking the drug for three months, you've lost X amount of weight, but you've also invested whatever amount of dollars. When you stop the drug, all of that weight comes back and you're back to square one — you've essentially wasted all that money. This also happens with any diet program. One of the first things is to have a conversation with a patient and say, "This is long-term treatment. This is treatment for a condition that is not going to be cured by this medication. If the medication works, you're going to be on it for a long time."
Vincent: So it's not just about weight loss now, but maintaining weight loss over the long term.
Dr. Sharma: It's not a diet pill and it's not a weight loss pill — it's a treatment for obesity. That's an important distinction. Diets sound like they're something you do for a little while: people go on a seven-day diet, a six-week diet, or a twelve-week diet. Well, that doesn't work, and taking this treatment for just three months doesn't work either. Because you're going to have to continue treating it — that's why it's a chronic condition.
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There was a test strip that X used. There was blood on edge of the test strip that X used. The test strip that X used had sat on the desk. The desk is now tainted by the blood on the test strip that X used. There was work on the desk. The work is now tainted from the desk that held the test strip that X used. The work was picked up by Y. Y's hands are now contaminated by X's blood from the test strip that lie on his desk when Y's work was...