Pooping Yourself Skinny: Today's Pharmaceutical Lifestyle

Recently, a friend sent me an Amazon.com link to a book called The alli Diet Plan. Written by Dr. Caroline Apovian, director of the Nutrition and Weight Loss Management Center at Boston University Medical Center, the book is full of helpful recipes specifically designed to "maximize your results from Alli(tm), the only FDA-approved over-the-counter weight loss aid." The link was clearly meant for nothing more than a cheap laugh -- one that I had. But as the thin sarcasm faded, I found myself considering the book's more serious implications.

For anyone who has been living under a rock for the past year, alli is the brand name for GlaxoSmithKline's diet-drug Orlistat. It offers a beguiling promise: a weight-loss regimen involving alli will help you shed pounds by inhibiting your body's ability to absorb fat. The newly excess fat exits your body by means of 'gas with oily spotting, loose stools, or more frequent stools that may be harder to control.' The drug's promotional materials suggest that you should, at least initially, wear dark pants and bring a change of clothes to work. In effect, alli lets you poop yourself skinny.

Granted, beyond the obligatory late-night talk-show jokes, alli is not as one-sided as its detractors would suggest. The pills are sold as part of an extensive kit, complete with a personalized website that helps you regulate your diet in such a way as to minimize or eliminate possible 'treatment effects' (as its side effects have been rebranded in a startlingly brilliant piece of pharmaceutical marketing). The messaging around the drug makes clear that it is no joke, no quick fix for yo-yo dieters; it is a serious commitment, requiring a regimen of dietary restrictions over an extended period of time. In fact, cautions of accidental soiling not withstanding, alli's communications are perhaps one of the best examples of a pharmaceutical manufacturer striving to achieve instructional compliance among its customers -- a problem that plagues most drugs, from the nonessential to the life-saving.

But The alli Diet Plan suggests a larger concern, of which alli itself is perhaps the tip of the iceberg. Adhering to the drug's stringent usage requirements is not easy. In fact, it requires lifestyle changes difficult for most people. As a result, the alli treatment experience becomes larger than the treatment itself. Beyond a book of easy-to-prepare, easy on the oily-discharge meals, the product add-ons are potentially limitless: an alli cross-branded set of clothing in dark colors, complete with a small absorbent replaceable pad; an alli branded wrist-watch, to keep track of the usual duration between your meal and your treatment effect; or alli-approved meal options at participating fast food chains. The list could go on indefinitely.

Alli, like many new drugs, blurs the distinction between treatment and lifestyle. In much the same way that Zoloft modifies your sex drive and your drinking habits, or that Lunesta affects your driving abilities, alli requires that to cure what ails you, you must accept new realities about what your life will be like. These drugs offer an increasingly common trade-off: the key to your health lies in conceding parts of your lifestyle -- whether your sleeping habits, your shopping habits or your eating habits -- to a pharmaceutical.

To be sure, this is not to suggest an easy blanket criticism of the pharmaceutical industry. Advanced medicine is now capable of curing and treating a historically unprecedented number of diseases and conditions. But, as typified by alli, the convergence of medical science and commerce is changing the types of choices we make about our health: whereas lifestyle trade-offs have always been de rigueur for lifesaving treatments, the pharmaceutical industry now offers us the opportunity to radically change our lives based on what is possible, no longer simply what is necessary.

From the four humors to the hysterectomy, history has proven that our commonly held concepts of wellbeing, illness, and treatment are nearly always supplanted by better information. In our modern race to find both a new drug for every disorder and a disorder for every new drug, it would be wise to consider that without an equal emphasis on advancing our understandings of illness, treatment, and health itself, our forward movement may actually be sideways. Adjusting our expectations of our lifestyles to meet the requirements of new drugs may prove to be very much like the historical practice of using mercury to treat syphilis: an effective solution for the present, but a dangerous precedent for the future.


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