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wundayatta's avatar

Would you save a thousand lives at the cost of twenty?

Asked by wundayatta (58367 points ) June 21st, 2012

I saw my shrink yesterday. We were talking about weight, and obesity research. He’s a big time genetic researcher into bipolar, so I guess he knows a lot about other kinds of genetic research, as well.

As we all know, it’s hard to lose weight, but do you know how hard? He was telling me that the best treatment we have (diet and exercise) works a mere 7% of the time. That’s the best treatment. That shows you that we are going up against every defense that our bodies have—we are evolved to protect against starvation, not overeating.

Some of you may remember Fen-Phen, a diet supplement used in the 80s. It was pretty effective at helping people lose weight—a lot more effective than diet and exercise—but there were 20 (count them—20) cases where people’s arteries thickened, perhaps as a result of the Fen-Phen use (I don’t think the correlation was demonstrated, statistically).

So the FDA banned it. My shrink argues that obesity kills far more people than Fen-Phen thickens the arteries of. The risk is worth the reward. Society would be much better off. However, the FDA is so cautious, and law-suit averse, I guess, that it will not consider the benefits if there are any risks that could result in bad law suits.

If you were the FDA, would you allow Fen-Phen? How would you handle the law suits? Would you let companies be immune from them? Would an estimate of one thousand heart attacks prevented (a hypothetical number for purposes of discussion) be worth twenty cases of thickened arteries and possible deaths that might result from that?

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20 Answers

SavoirFaire's avatar

Given the hypothetical numbers, I don’t see the problem so long as people are fully informed of the risks. There are surgeries with a higher likelihood of death, but no one is banning them.

ragingloli's avatar

No, I would not.

SavoirFaire's avatar

@ragingloli Are you responding to the title or the details? Under some moral systems, after all, they might be interpreted as asking different questions. I understand why some people might hesitate to actively bring about the deaths of 20 people even to save 1,000 people people, but that seems much different than allowing 1,000 people to take a risk that only 20 will suffer. When my grandfather was diagnosed with an aneurysm, he was told that there was a 50% chance he would die on the table if he elected for a surgical treatment. Should he not have been allowed to make that decision for himself?

ragingloli's avatar

I was responding to the title.
If people want to poison themselves, let them.

nikipedia's avatar

I agree that if people give informed consent, this seems like a reasonable risk to take.

I am surprised at the 7% figure. Did your shrink say why he thinks that’s the case?

fundevogel's avatar

I wonder what the set of circumstances led to banning the drug. 20 deaths yes, but considering the list of side effects I hear listed for any number of approved drugs that doesn’t sound so extraordinary. Was it a matter of appeasing an outraged public or did the powers that be deem that obesity was not so serious an issue to permit such side effects in it’s treatment? I could see a fat bias playing a role if regulators saw the condition as a consequence of laziness rather than disease.

wundayatta's avatar

@nikipedia He didn’t say, but my impression was that we respond to the demands of our body. People who evolved to maximize caloric intake when calories are available, are the ones who survived.

The 7% figure, I would guess, is the result of the difficulty of making ourselves go against the demands of our bodies.

He said you have to remain a little hungry all the time in order to lose weight. Oh joy. I am hungry now.

mangeons's avatar

If they’re informed of the risks and still want to take it, then I’d say that it would be reasonable to allow the medication. People take risks like that for many other things, things that aren’t banned and really have no positive impact at all. So why shouldn’t it be allowed?

@wundayatta He said you have to remain a little hungry all the time in order to lose weight.

I don’t know where he got that idea from, because it’s certainly not true at all. There’s a difference between not being overfull and being hungry. I’ve lost about 25 pounds since January with good diet and exercise, and I eat when I’m hungry and don’t when I’m not. It’s more about what you put in your body than how much.

Coloma's avatar

Not for a weight loss drug, no. Now I’d gladly sacrifice 20 pedophiles to save 1000 children.
I have a tendency to out on weight and am a foodie all the way. A born hedonist and very orally fixated. Blame it on my mom and not enough sucking time at the breast. lol
I like to eat, drink, talk, smoke, eat happy brownies and I must curb my naturally expansive personality which includes my extreme attachment to my mouth. haha

I have dropped 15 lbs. in 4 months with little deprivation. My methodology is to stick to 1500 calories a day, drink lots of water, eat my biggest meal around 2–3 pm and have fruit or salad for dinner. I am addicted to Tootsie pops as a low cal sucking satiation tool and I allow myself to eat whatever I want weekends or random days, no more than 2, per week.

Last night was a cheat day, had dinner with a friend at one of my local tourist hubs that makes gourmet pizza and I had 2 Shocktop ales, a pear salad and a huge slice of tuscan pizza with enough cheese to clog the arteries of a Water Buffalo. lol
Then… another Shocktop when I got home to keep the momentum of my comedy writing in high gear for another hour or so.

Ya know what “they” say….” nothing good was ever written over a glass of ice water.” haha

flutherother's avatar

I don’t think drugs are the best response to the health problems caused by life style. Drugs always have side effects which differ from person to person and which might not even show up for decades. When I lived in the States I was shocked by how much people relied on their cars and combined with the proliferation of fast food places this is not conducive to good health. I don’t know what the answer to this is but I don’t think it is a drug. This ‘miracle’ drug is just an appetite suppressor combined with a type of amphetamine.

mangeons's avatar

@flutherother I agree that there are much better ways to lose weight than through medication, but I’d say that if an informed consumer wants to take that risk, then it’s their choice to do so.

YARNLADY's avatar

Given that people make a much more dangerous choice every single time they get in their car, I would say allow the informed user to decide.

wundayatta's avatar

All of you who say there are better ways, where are they? The best method works only on seven out of one hundred people. That sucks. It’s a horrible success rate. What methods are you talking about that are so good?

You all may have self control, although, if I were a betting man, I’d bet against you. You’ll have that weight back in a few years, if not sooner, chances are. It is very difficult to lose weight and keep it off. That’s why there is an obesity epidemic.

It isn’t as simple as eating what you want but eating healthier, either. You have to look at this over a lifetime. If you gain one pound a year, you’ll be thirty pounds overweight in thirty years. Two pounds a year and it’s sixty pounds to lose. Weight creeps up on you like that.

Losing fifteen pounds quickly is generally not the way to go. You don’t keep it off, usually. You need to lose the way you gain. A few pounds a year, if you want to keep it off. So my shrink says, anyway. If you lose a lot, you tend to yo-yo. That’s worse, I hear, than staying overweight.

Obesity kills. I don’t know how much it kills, but it seems to me that using a drug to control your weight, if it works, is far healthier and far more effective than the “self-control” methods.

roundsquare's avatar

Its not just 1 (or 20) vs 1000. Obesity kills, but not instantly. It brings about a faster death. Whereas (I assume) the pill kills instantly. So what are we talking about here? Giving 1000 people an average of 10 extra years of life? 20 years? And how old are the people who die? How much longer would they live?

So, if its 1000 people get 20 extra years and 20 people die 2 years early… I’d say its worth it. I’m not saying we should just do 1000 * 20 vs 20 * 2 but just saying <xyz> kills isn’t enough information.

As for people being informed… sure, but we need to be careful what we mean by informed. Above a certain risk level (not sure what that is) that needs to mean a sit down with a doctor who explains the risks in full and makes sure the consent is truly informed (as opposed to writing a warning on the box).

But, responding to just the title of the question: I would generally sacrifice x random people to save x + 1 random people. If its up to me to choose between two possible worlds, that’s the choice I’ll make.

chyna's avatar

Fen phen
Fen phen caused more than just 20 deaths. It caused a lot of heart valve problems. I knew a woman in my home town that had to have an operation on her heart caused by this drug. According to the article I have referenced, there are thousands that have been affected by heart issues and are suing the company. This side effect was not known when everyone was taking this drug, which was given out like candy back in the 80’s.

chyna's avatar

Correction: You didn’t say it caused 20 deaths, you said 20 cases of thickened arteries. Sorry for the misstatement.

SavoirFaire's avatar

@chyna Then again, there were about 25 million prescriptions written for the drug. The question asks about 1,000 versus 20; according to you, the reality is millions versus thousands. How many thousands, I wonder? If it’s around 20,000, then the question hasn’t really changed at all. If it’s fewer than 20,000, then the drug presents a smaller risk than the question assumes. And if it’s more than 20,000, it seems odd not to describe those affected as numbering in the tens of thousands rather than merely as numbering in the thousands. In any case, one of my best friends was on Fen-Phen when it was taken off the market. Her response? She just started taking speed instead.

nikipedia's avatar

@SavoirFaire, if speed stops working for her, she can switch to Adderall, since they’re basically the same thing…

wundayatta's avatar

I don’t want to get caught up in the exact details of the case, if possible. It’s the general principle of benefit vs risk in public health that I’d like to focus on. It is the attitude of the FDA which seems to be a kind of snake-bitten feeling. The alleged negative consequences of the drug get a lot of press, and the FDA bans it, regardless of the benefits it has. Why? Is it because the benefits are hard to see and hard to prove?

I don’t know if the harm of Fen-Phen was every scientifically proven, either. My shrink seemed to think it was mostly circumstantial, but that no rigorous studies were ever done to analyse the data. So he is skeptical. But even if it did cause harm, I want to know if there is a level of benefit to harm that is acceptable, and if so, what is it and how do we decide? Is there a fair way to decide given the way the media works—how sensationalistic everything is? Or does science inevitably get lost in the shuffle and that’s just the price we pay for being gullible people?

flutherother's avatar

There is a good article on the fen Phen phenomenon here.

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