Peter Moore: Wonder drugs said to cure obesity not all they seem

I was called out to a woman in her 30s. She had severe chest pain, and the ECG confirmed she was having a heart attack.

What worried me was her medication. She was seeing a private doctor in London for weight loss. He had prescribed both an amphetamine, known on the streets as “speed”, and thyroxine. Thyroxine is used to treat people with an underactive thyroid gland. Her thyroid had always been normal. This combination may be effective for weight loss but is very dangerous and directly led to her heart attack. 

She survived, but I felt that we could not leave it there. I spoke to the cardiologist, and we wrote a joint letter to the General Medical Council, the doctor’s governing body. We were not alone. We heard later that her private doctor had been struck off the medical register.

This was clearly the right decision. Any qualified doctor would know that this treatment was not only inappropriate but dangerous. For many of his patients, it was also an effective way to lose weight. He had probably made a small fortune until we ruined his unethical and dangerous business model. 

There are many much safer ways to lose weight, although eating less and exercising is also helpful.

The latest drugs are the injectable GLP-1 group, or glucagon-like peptides. Glucagon is a natural hormone. A peptide is a protein. GLP-1 is released by the gut when anyone eats food, reducing their appetite. They were originally developed as a treatment for diabetes but are now being used for weight loss. Obesity is dangerous, leading to high blood pressure, heart disease, arthritis and cancer, amongst other problems.

These new drugs appear to be safe and effective, but in the UK, they can only be given by a qualified doctor on prescription. It is possible to get a private prescription online, but these must still be overseen by a doctor. The NHS advises that, if people are getting private prescriptions, they should go to authorised sources such as a registered online pharmacy. Some of the online drugs from unregistered prescribers might be fakes or not properly manufactured. Anyone on these drugs should also follow advice from a qualified dietician.

They appear to be a massive improvement on previous weight loss drugs and could save many lives. There is now evidence they offer more than weight loss. They appear to reduce cancer and dementia as well as improve fertility and mental health. This is not just because of the weight loss. If a woman is trying for a baby, she needs advice, as some of these drugs may affect the unborn baby. 

Without undermining the amazing new drugs, years of working in medicine have taught me to be careful of “breakthroughs”. In my student days one pharmacology book started off with a graph. It showed the reputation of a new drug against time. When released, the reputation is very high, “the greatest new drug since penicillin”.

As side effects and other problems are discovered, the reputation falls with the comment “I wouldn’t give it to a dog”. Finally, it rises again with the comment, “a very useful new drug in some situations, but it needs careful monitoring”. This is where all drugs should be.

A journalist once told me that he only knew two types of drugs: a miracle cure or a lethal drug. A column arguing that a new drug is a useful addition to treatment in certain circumstances but there might be occasional drawbacks does not make good headlines.

This is an even bigger problem in the age of the Internet. Who’s going to click on a post which says that this new drug possibly has some advantages, but we cannot be sure yet? Unfortunately, a measured “sitting on the fence” is the most accurate description of any medical “breakthrough”. 

So far it looks as though these new injectable weight loss drugs will prove to have incredible benefits. As a cynical old, retired doctor, I am often dubious, but I hope I am wrong. I hope they are the greatest new drug since penicillin. If they had been around 30 years ago, our overweight holidaymaker would not have had a heart attack, and her doctor would not have been struck off.