“He who sups with the Devil should have a long spoon”. English proverbial saying, 14th century.
In our medical office, Thursday is drug lunch day, when a pharmaceutical company rep buys the whole office lunch and in return, gets the undivided attention of the physicians for one hour to promote whatever the product du jour happens to be. In biological terms it’s a bit like a host-parasite relationship where the pharmaceutical company is the host, the physicians are the parasites, and the reception and nursing staff are the commensals (they get to eat the food but don’t have to stay for the talk).
Today was a bit different because the drug rep was accompanied by Dr X (not his real name), a professional colleague from a nearby town who gave us a talk about the benefits of orlistat (Xenical) and liraglutide (Saxenda) in the treatment of obesity. The drug rep was from Novo Nordisk who, coincidentally, just happen to manufacture Saxenda.
I sat through the talk with a mounting but ill defined sense of unease. Of course, I agreed with Dr X that obesity is a big problem in industrialized societies (in the US, 35% of the adult population is obese). Naturally, I agreed with him that it is associated with many medical conditions including heart disease and stroke, high blood pressure, diabetes, cancer, gallbladder disease and gallstones, osteoarthritis, gout, sleep apnea and asthma. And it goes without saying that I agreed with him that Xenical and Saxenda could produce (in the short term anyway) a reduction in obesity and the associated medical conditions. So prescribing Xenical and Saxenda seemed like a no-brainer.
And yet…something still troubled me which I found it difficult to put my finger on. I suppose it boils down to this: where has the sense of personal responsibility gone? The principle of losing weight is very simple: you weigh yourself once a week, you keep cutting down your calorie intake until it’s below the level of your calorie requirements, and at that point your body starts burning your excess fat and you lose weight. That’s it really. I’ve done it myself, it’s not all that difficult, and it works 100% of the time. Eat less and you lose weight. Look at the photos of the liberation of the Nazi concentration camps: you don’t see any fat people.
So why is it my job, as a physician, to do for people what they won’t do for themselves: curb their appetites? It seems to be part of the trend towards hyper-professionalization in modern society. Low self esteem? The psychologist will fix it. Want entertainment? Don’t bother learning to play a musical instrument, just download some professional entertainment from the cable TV or internet. Car or household appliance broken down? Have a repairman fix it or buy a new one. Worried about the economy? The economists will take care of it. Too fat? The doctor will fix it. But for Heaven’s sake, don’t try to fix these things for yourself. Let the professionals do it for you.