Hi, everybody, welcome to Maintenance Phase, I'm oh, shit, my God, I was trying to decide in the moment whether to say a description first or came first anyway.

Hi, everybody.

Welcome to Maintenance Phase. We're going to explore the many rabbit holes past and 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 Huffington Post and the co-host of another podcast called You Were Wrong About Yay!

Welcome.

And today we are talking about Fanfan Fanfan, 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. Fanfan 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 personal history with Fanfan and 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 seventeen year old, should start taking.

So I was fourteen. 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 Questionmark. It was a 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? I don't remember because I was on it for really short time. OK, 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.

Right. I was like, oh, yeah. So we'll talk about the phrase.

Sure, it was a problem for some people cause 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 diet pills that's like basically speed and it just makes you sort of like weird and jumpy and shaky.

So Fanfan, when people say Fanfan, they're referring actually to three drugs, two pills, three drugs. So Fengjun itself was a combination of two existing diet pills, one called phentermine 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 fen invention is fenfluramine, 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, as opposed to diets which last forever, as we all know.

So these two things were like pretty unpopular diet drugs until they were combined in the early nineties and a third medication was added. So that third medication is Decs Fenfluramine. It's Sailele name was Redox, and that's what really set this all off. So the first two phentermine and fenfluramine are amphetamines. The third one decs fenfluramine, I believe, is a downer. So, oh, there was a predecessor to Decs Fenfluramine, to Redox, I should say, that was called bondman 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 Bonderman, but they looked amazing.

They looked gorgeous asleep in their beds.

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 Ponton and they have to be awake to eat.

It was just like they're just losing weight because they're asleep all the time. So because fen phen, the sort of combined medications of fenthion, were existing drugs, as was redox, right? It was sort of a revision of porn men, the manufacturers, 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 Neuron sunk a ton of money into developing these drugs.

So when was all this development taking place? So this is 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 when more and more people are getting more and more concerned about their weight, their health, their attractiveness rate 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. It's always kind of a fraught time.

Yes. Yes. Talking about both bodies. But this was a real crescendo. Right.

So these are we're talking about multiple different drugs. Bondman being rebranded as Redox 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 amphetamine like you are going to lose weight.

How does that work? Actually, does is 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 Redock are 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 SSRI, 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, SSRI is not meth, 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, 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 Iran. And what they are talking about is we have an obesity epidemic in this country. They're throwing around this number that there are 300000 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.

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 in about a few things. They're cautioning about heart disease, which phentermine and fenfluramine 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. Not great. Not great.

So one of the 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 Mundy, 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 what 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.

And he seems like you should do that. Yes. Mm hmm.

So they later find out that when people stopped taking fenthion again, we're talking about an amphetamine, 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 rate, like a very small amount of reduction that makes your neurons that produce serotonin. It makes them sort of balloon up and then they wither and then they die.

So it's like that's your ability to feel happiness. So like you're diminishing the extent to which you can be a happy person 100 percent.

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, we're 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 tradeoff 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 and 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 Questionmark A Miracle.

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, right?

Even if it result in all those people getting heart disease and dying.

Also part of what's happening, the sort of tentpole story, the sort of human interest story that holds up a lot of the Fanfan and redox panic is a young woman named Mary Lenine, who starts taking fenthion and redux in the lead up to her wedding. She's twenty 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.

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 Fanfan and Redux. These side effects set in with as little as two months on the drugs and the maximum prescription advised by Wyeth and Neron is three months. Oh, wow.

Because they're like we know that they lose effectiveness anyway after three months.

So we're just going to 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.

So both in schedule, 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 up.

So that's how we got fenthion that they scheduled this meeting, unlike Super Bowl weekend for brain doctors.

Yeah, that's right. That's exactly right. And it's also worth noting at this point that France and England were already publicly considering taking similar drugs off the market. The U.S. is sort of behind the times, right. The only issue on which we are behind the times.

Yeah, that's the only one. And then we stop doing that. So 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, well, it's safe, but nothing in the underlying information has actually changed. It's just the make up of who showed up to a little conference room that day.

Yeah, there's no new information. Right. So the FDA takes their recommendation, takes the advisory committees recommendation. Interestingly, they take it over the objections of their own staff, particularly scientists and researchers on staff who are like, hey, there is some big research questions to answer here.

Yeah, there's a lot of depressed rats that 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 at 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 customers who.

Right.

So they're saying that, like drug manufacturers are their customers and that they have to provide customer service. Their customers, which means like consistency and speed, 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 bondman, they would also have to recall Pandits in. Which would basically just be a bunch of work, right? It's a hassle, it's a big hassle begetting. Wow.

So once Redux is approved, these two drug companies, the manufacturers of Fanfan 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. What 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 Roxann Redux is the name I'm imagining a sort of like Rosie the Riveter character.

One hundred percent. She's just really depressed, 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 Roxio redux as their perfect customer. They say she's quote unquote pink collar. So sort of like middle America, right? Thirty five to fifty four needs to lose fifty or more pounds. And they include the phrase tried everything. Oh my God. So they're specifically marketing to people who are disillusioned and 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. Because they're like come to the Red Lion on Sunday afternoon, join us at the Sheraton.

The interesting thing about the Redux seminars is that they have all of all the facilitators are sales reps, but they all wear white lab coats and they don't tell people that their 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.

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 they're saying, but just the approaches that they're taking these like lab coats raid, 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. Right. All the weight 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 is 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 Mundy, the reporter, calls Obesity Inc. Right. Because there is now an obesity epidemic. Right. Quote unquote. There is a little industry that is cropping up around like, OK, this is now a medical thing. How do we make money off of this medical thing?

Right. So part of Wyeth's marketing plan is that they make huge donations to anti obesity organizations. 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 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. We're just trying to help.

Yeah. Yep, exactly. So within three months of the introduction of redux, it catches on like wildfire.

Also at this point, it has been twenty three years since the FDA last approved a diet drug.

Oh, wow. So people are just like Klamt. It's like it's like the people in Mad Max, like under the waterfall.

They're just standing there with the bucket, like, give me anything.

And all they've been hearing all the time is like, you know, if you don't drink water, you're going to be real unhealthy. You're probably going to die real soon if 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. 85000 prescriptions a week. Oh, wow. And by 1997, they are projecting 220 million dollars in sales of Redux alone, not even Fanfan, just Renai. So they are printing money. Aubrey, you're good at this.

This is fun. Oh, yeah, I think so. Yeah. Speciate I just stumbled into this thing and I was like, oh, this story is bitchin. I could 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 Aveng me.

So the other thing that feels important to highlight here is that Shenzen and Redox seriously fed pill mills.

I have been wanting to write an article about this. Tell me tell me what pill mills are so pill mills.

My understanding of pill mills is that they are essentially like doctors' offices that are mostly just fronts to get people prescriptions that they want. Yes.

So in this case, it provided doctors with this sort of easy cash flow rate, 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 25000 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 Mundy's book, Dispensing with the Truth, there are many firsthand accounts of people who are like, oh, yeah, I went to a doctor's office. I did not talk to a doctor. I talked to a medic who took my blood pressure and some like baseline vitals. Right. And then they gave me a prescription.

It becomes such a big deal that there are 800 numbers that you can call one 888 four Fanfan.

Oh, my God. What are 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 fenthion? Is it FSN Fien.

Yeah, they misspelled. Yes. OK, let me get around. It is the.

Yeah this is like a European phone number said OK, so it also becomes such an issue and such a huge flashpoint around weight loss that weight loss companies like Nutrisystem and Jenny Craig start figuring out how to weave fenthion 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 Fanfan and Redux.

It wasn't that was an offer that was not made by a manufacturer. It was not made by their sales team. It was made by these like 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 fenthion in a mist like produce at the grocery store, everybody.

They can run their meat in there, like the perfume counter where they're just like, oh, you know, if you spray it in front of you and then walk into it, that's the best way to do that.

So interestingly, this is the section in my notes that I've titled The Beginning of the End Through.

So they do a bunch of research into Fanfan and Redux because they notice that patients who've been on Fenthion and Redox 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 like nineteen ninety six. So that would be like a year.

OK, so pretty soon after it's hit the market very soon. And what they find is that in their one clinic, this clinic called Merrett Care in Fargo, Fargo's a city of about seventy seven thousand people. This one clinic finds eleven cases of heart disease. So this is like a very high incidence, right? They do a little rough back of 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. It's like next to a nuclear waste site. Toer, 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. Nineteen ninety seven. So it's on 60. And it's it's on The Today Show, it's on CNN, it is a humongous news 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 Wyeth 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, like you're not supposed to increase people like you can't just compare the risk of your drugs to, like, some other thing that's going to kill them, like, look, we're killing you, but an axe murderer might also kill you.

So what the problem is like, that's not how morality or medicine or anything works. Totally.

No, I will tell you, this is like, as an aside, my dad, when he and my mom were splitting up and she would like ask him to do things differently and sort of the lead up to their divorce rate, he would be like, I don't know why you're on my case.

You could have married Charles Manson. That's not the bar there.

There are some men in between you and Charles Manson. There are more than one man on that spectrum 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 like this might kill you, but proceed.

So Wyeth 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 dear 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 rate. 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 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.

States which have more smokers have higher cancer rates, et cetera. 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, oh, 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 like dying a lot, like, that's probably enough for us to, like, pull back, just like let's start over.

So at the same time that they are, you know, sort of releasing this dear doctor's letter, their lobbyists are also lobbying Congress to get Ponton and redux, these scheduled by the DEA. What is what does that mean? That means it would no longer be a controlled substance.

What meaning what you could buy 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 they scheduled could increase their sales by 25 percent. 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, I mean, like, oh, yeah, we're just going to let people take this forever.

Yeah, that's right. 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 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 stakes are good. Like we would have this little flowchart 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 phone.

I did it for one night. I lasted one night. Now it's like this is gross stuff, so so there is this big media story.

Now, Wyeth, of course, they have more money than God at this point. They swipe back. They build a hundred thousand dollar 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 gotten P.H. 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 Fanfan and Redox 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 percent.

So they have like doctors there to present. They have researchers. They're like gathering everyone together. There are breakout sessions. Right.

Like it's a whole big thing now why 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 10000 because now people know what to look for.

Right. 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.

Like, 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 Wyeth and inner Neron both have known about this since before, even advocating for the approval of the drug.

Oh, my God, I want to like, gasp or something. But this is like 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, though. It's always just like kill them. Like these emails from like Palpatine of just like fuck these lives.

This happens every time.

It's 100 percent 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, their attorneys and researchers both checked them on the use of this three hundred thousand 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.

They advise them to say obesity contributes to X number of the top ten causes of death, which you can say, right, potentially.

But this is like straight up inaccurate. And people internally were like, this isn't accurate. We shouldn't be saying it.

My two rules for this are any time you see a statistic with contributes to or at risk of, you should like run in the opposite direction. Totally.

And miracle drug. Yes. We're just creating a list of like watchwords.

So here are the things that Wyeth knew.

Well, 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 in my bad to you?

So they knew that the drugs lost effectiveness after three months. They knew that most people who took it regained the weight that they lost. They internally acknowledge that while they 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.

Well, so we don't know, but we're going to fight this accusation in the press.

One hundred percent. So like that written out all in one memo like, oh, well, 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.

It's like the summer emails you write after a conference, call us. 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 shocked. I am 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 Fanfan and Redux.

And get them published in journals. Oh, that's right. Yeah, the ethics chair at the AMA, the American Medical Association, publicly freaks out and like kind of loses it along with an inner neuron. And they say these are advertisements that are being couched as valid scientific papers, which is super dangerous. Extremely bad. Yes. And they're paying like 20 grand per paper, which is both more and less than I would like to say.

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 need to study more in these ways. These are two actual titles of papers about Fenton and Redux. One of them was called Rushing to Judgment on Fen Phen.

And the other one says the fence and diet drug combination is not associated with valvular 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 fenthion the second.

Totally. You're wrong about our product. So, yeah.

So all of this happens. Fanfan is finally unfounded. Redox 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 like lawsuits and stuff.

Do we know I do now because and will like, skip ahead. They essentially have to shutter their operation o- over this settlement, like there is a massive class action lawsuit.

OK, so they in 2000, a federal judge approves a settlement for this huge class action lawsuit. The settlement is three point seventy five billion dollars. 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 45000 people who took Fanfan and Redox developed either primary pulmonary hypertension or heart valve damage.

Holy shit, 45000 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 die.

These are heart conditions and brain conditions. Yes.

You can 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 the way some real baseline functions.

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's also the basic question of like this didn't do what it said it was going to do. Right. And 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, like 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 that.

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 were totally.

Yeah, it sucks.

This was also a major systems failure on the part of the FDA, dude. Yes. Part of this is that Wyeth didn't tell people, but again, like shocking. A manufacturer didn't tell someone about their product not working or having harmful consequences. Right. Right. The bigger challenge here is like how do 45000 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 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.

So there's just like failure on failure, on failure inside the FDA, 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 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.

Send us your palpating memos at the beginning of the process.

So, again, like Wyeth gets this huge judgment. But like 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 approved one for the life of me. I can't remember the name. It was marketed as an 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 percent of your body weight. And again, like, once you stop taking it, you gain all the weight back. It's it has the same structural limitations as fenthion, although it's probably not just like straight up crack cocaine in your system, I hope.

Right. Totally. It's not going to murder you immediately. Yes, but it's most it's Orlistat, that's the name of it. Oral to say yes. So in 2012, the FDA approved Q SAMEA, which is another phentermine based weight loss drug. So it's the same sort of amphetamine based phentermine is half of fenthion, right? Right. There's this ongoing string of research about whether or not Fanfan could be used in treatment of addiction, especially to alcohol and cocaine.

So there have been studies in the last 10 or 20 years about 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 twenty one hundred deaths in France.

In a real fun twist, the defendant is Servia International, which is like a big drug company based in France.

They were interferons partner in buying and selling Redox. So it's truly the same people doing it all again, like the literal same people, right?

Like, hey, Steve, I know you from the last one of these today.

Phentermine is number two hundred and ten on the list of the most prescribed medications in the U.S. So it's still around phentermine is, which is not all of fenthion. Right.

It's part of the drug cocktail, the holy Trinity that we were. Yes, that's right.

And I did a Google search of Fanfan as part of this because I was like, I wonder what comes up. Two of the suggested search terms and Google are is fenthion still available and where can I get Fengjun, dude?

Yes.

I actually looked into this when I was working on my article, and I also found a lot of demand for fenthion 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 fenthion.

I have no idea what you're gonna get in the bottle that you get.

So there you go. I mean, like, that's the whole 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.

But 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. And 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 to you as a 14 year old now than you were a couple weeks ago?

Oh, I'm more freaked out now 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 Fanfan 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 Baade 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 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.

It's 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.

One hundred percent. 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. Yeah. 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, 300000 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 look like women are judged on their looks to an extent that men are not bright. And so you're clearly appealing to that in your marketing while pretending that all you're appealing to is health. 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 me like very clearly racialized. Right. Sort of income levels that they're talking about. Like the folks who are sort of primary plaintiffs in this are overwhelmingly white women. They're overwhelmingly educated white women. One of them is a PhD candidate. Like there's like 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.

Right. We're talking about a drug that causes hypertension. And we're not actually exploring the stories of black people, of Latino people, 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 is like who's having access to doctors? But then also, I mean, what you come across in 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 going to 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.

I totally agree. 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 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, you know, 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, like 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 subjected 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 on to the market that like really had no place being given to large numbers of people.

Absolutely. And like the fact that there was so little testing of the drugs in combination.

Yeah. Is fully bananas to me. Again, like pharmaceutical companies acting badly.

No, the FDA. Requiring more of them is very troubling, just the idea that, like, 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 is like, oops, guess it's fine.

Yeah, that's right. Anyway, it's a real bummer, sort of 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 is just going to be how to get 10000 steps and how to lose ten pounds for your wedding.

Step one, get engaged to lose ten pounds.