Since GlaxoSmithKline's (GSK)
high profile launch of alli last summer, the first FDA-approved diet drug sold
over the counter, the only figures that have flattened are sales.
Two million starter packages sold in
the first few weeks at $49.99 for 60 pills and $69.99 for 120, thanks to a $150
million populist rollout that included displays in Targets, Wal-Marts and
warehouse clubs.
But in 2008 that revenue growth
"will be down a notch," Jean-Pierre Garnier, GSK's outgoing CEO, cautioned
financial analysts, "because you won't have as much growth coming out of alli,
although we have some."
Of course all diet products
generate dropouts who don't like the results they're getting or the dietary
restrictions.
And GSK admits alli results are
slow and close to placebo.
But not all diet products feature
the "oily bowels" and "anal leakage" that made alli an instant success on the
comic circuit.
Because the active ingredient in
alli, Orlistat, blocks the body's absorption of fat and ushers it out the
bowels, sometimes before a person is ready or warned, GSK originally cautioned
users to bring backup underwear with them or wear dark colors.
Users could even exchange
"accident support group" tips on alli's online message board.
"You lost a couple of pounds, and
you're on a date with that special girl," riffed Jay Leno, and then find
yourself saying, "Excuse me while I change my pants."
"With Allies Like This, Who Needs
Enemas?" asked Prescription Access Litigation.
"Maybe it should come with a
coupon for Depends," quipped Philadelphia-area pharmacist Maria Taylor.
"The Diarrhea Diet" and "Sh-t
Yourself Thin" spoofed bloggers.
GSK said the dreaded "treatment
effects" which occur when users exceed 15 grams of fat a day -- a fast-food
hamburger has 30 -- could teach people to avoid fatty foods through aversion
therapy, like Antabuse does with alcohol. (One specialist even suggested users
shouldn't get so upset about a little bowel incontinence.)
But critics said if eating right
is doing the heavy lifting, why do you need alli to begin with?
And Dr. Sidney M. Wolfe, director
of Public Citizen's Heath Research Group, observed that "alli doesn't block
carbohydrates," which for many overweight people is the real problem.
Even though Orlistat has been
available as the prescription drug Xenical, manufactured by Roche since 1998,
not everyone thinks it's safe.
Roche's own study raises
questions about precancerous colon polyps, says Public Citizen. And questions
about a higher incidence of breast cancer in early clinical trials actually
delayed FDA review of the drug.
Nor has Orlistat been successful
-- falling in sales from $135 million in 2002 to just $93 million in 2007, which
some say led to GSK's last ditch recasting of it as an over-the-counter
medication.
Of course it's no secret that GSK
is hurting.
Since the New England Journal
of Medicine outed its top-selling diabetes drug, Avandia, in 2007 for
raising the risk of heart attack by 43 percent, and the FDA subsequently
mandated a black box warning, the drug giant has lost $1 billion -- not to
mention its reputation and Wall Street luster.
"When you lose the most
profitable of your line, it has a disproportionate effect on the cost of goods
and the gross margin," conceded Garnier to reporters reviewing last year's bleak
performance.
GSK no doubt thought it could
churn alli -- maybe the lower case "a" was to disassociate it with Avandia --
like a bad movie or IPO. After all, even Merck's Vioxx made money after the
lawsuits were paid.
But you can't blame GSK for the
public's willingness to accept anal leakage and an eating disorder as the price
of being thin.
"Don't we consider people that
are using drugs to induce diarrhea as suffering from bulimia, and in need of
medical and psychological help?" asks a blogger writing about alli. "Maybe
someone should consider repackaging Ipecac into pill form and marketing it as
the newest diet plan."
Especially because the
traditional American tool kit of consumerism, impatience, and control doesn't
work with obesity -- as failed fat surgeries and liposuctions testify.
And you can't treat overeating
with a different kind of overeating.
In 1998, Frito Lay introduced a
brand new potato chip made with a fat that was chemically processed to make it
indigestible.
WOW potato chips boasted that
they had no fat calories because the recently approved sucrose polyester,
Olestra, passed right out of the body. Quickly.
But two years after its
introduction, Wow's sales tanked. Not only did it not make people thin, they
didn't like its "treatment effects." It wasn't the kind of "wow" they were
looking for.
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