Weight loss drugs are only a mouse click away

Mike Jarmula, who weighs 288 pounds and suffers from high blood pressure, has a sense of humor about his weight. What his doctor described as "increasing visceral adiposity," he said was "just a fancy term for 'beer gut.'" He also said that while he may look like a stereotypical American couch potato, he isn't. "I stopped eating fast food years ago; I can't remember the last time I watched TV; and I power-walk about 2 miles every day. The trouble is, I'm almost constantly hungry," he said.

Stomach surgery isn’t an option for him and weight loss medication has failed him in the past, but he’s excited about a new medicine awaiting approval from the Food and Drug Administration. He hopes the drug, Acomplia (also known as Rimonabant), will curb his appetite.

But others aren’t waiting for the drug to be approved. They’ve discovered online pharmacies in the United Kingdom that will fill Acomplia prescriptions. The pharmacies have been shipping the pills to eager U.S. buyers since the medication was approved for sale there last summer.

“Obese people are some of the most desperate people in the entire world,” said Dr. Richard Atkinson, director of the Obetech Obesity Research Center in Richmond, Va. “I can’t tell you how many times I’ve had people in my office break down and cry because I've told them that they have a disease and that I can help them."

Thin people, he added, are often unable to grasp the constant, insatiable hunger that many obese people experience. “Gnawing hunger is one of the most awful of human conditions,” he said.

When Sabrina Gardner, a mother of five from Fredrick, Md., weighed 291 pounds, she was familiar with the glaring eyes of passers-by. “In restaurants, people look at you like you shouldn’t be eating,” she said. “They cut their eyes at you like, ‘Stop eating, what are you doing here?’”

Acomplia was approved for sale in the European Union after trials showed the drug contributed to weight loss and improved blood pressure and cholesterol levels. The medication is called a CB1 blocker because it was designed to block the same receptors that give marijuana smokers “the munchies.” Studies also indicate that it can significantly curb the urge to smoke.

Britain released Acomplia in June, and according to Sanofi-Aventis of France, the maker of the drug, demand is already strong.

“There’s a lot of hype attached to the medication right now because there really hasn’t been anything new in the market for the past five to six years,” said Donny Wong, a pharmaceutical industry analyst for Decision Resources. Wong said the delay in getting FDA approval for the drug is somewhat surprising, but he acknowledged that the traditionally more cautious FDA may be worried about the drug’s long-term side effects.

Right now, there are questions about how safe Acomplia may be for pregnant woman and concerns that the drug may cause depression. It “remains to be seen how severe its depression symptoms are,” Wong said.

Other side effects include nausea, dizziness, anxiety and mood swings. But these drawbacks have been described as minimal when compared with other FDA approved weight loss medications that increase heart rate and blood pressure and cause unpleasant symptoms like “rectal leakage.”

In general, new diet medications have faced increased scrutiny since 1997, when researchers discovered heart valve damage in patients taking fenfluramine, an FDA approved weight loss medication.

People who are interested in weight loss are turning to the Internet to find out what their options are. Thirty-nine percent of people researching weight loss indicated that the Internet spurred them to learn more about a particular drug, according to a study by comScore Pharmaceutical Solutions.

And Internet users seeking information on weight loss are bombarded with banner-advertisements that flash: “Buy Cheap Acomplia Online from Europe's Prescription Pharmacy” or “Start Losing Weight Today! Buy Rimonabant Acomplia to Treat Obesity.”

But there are risks when purchasing drugs online. The European Commission issued a warning that counterfeit versions of Acomplia are being distributed over the Internet. According to the World Health Organization, more than 10 percent of the global medicines market is currently counterfeit. And while far more deaths from counterfeit medicines have been reported in developing countries, counterfeit drugs in wealthier markets have become a growing concern for doctors and public health officials.

Diet blogs and message boards are buzzing with comments on Acomplia--good and bad. Contributors from Britain wrote glowing reports about how well the drug worked and how easy it was to use. Others share stories about intense waves of depression, which they link to Acomplia. One woman wrote that her doctor immediately took her off the medication after she expressed dark, suicidal thoughts and an overwhelming urge to harm herself.

“Patients who are taking these drugs need to be followed extremely carefully,” Atkinson said. “This drug will work extremely well for some and not at all for others.”

Despite the dangers, Internet pharmacies seem to operate with impunity. Buying Acomplia online requires little more than filling out an in-house doctor’s health questionnaire, paying the fee (between $230 and $285 for a month’s supply) and waiting for the postal worker to arrive.

The law states that patients must have a relationship with the doctors who write their prescriptions. According to the Drug Enforcement Agency, “Completing a questionnaire that is then reviewed by a doctor hired by the Internet pharmacy could not be considered the basis for a doctor/patient relationship.”

Still, the laws surrounding online pharmacy regulation are unsettled, said Lawrence G. Walters, an Internet lawyer who advises online pharmacies around the world. “The federal government is not going to waste its time prosecuting a drug user or patient seeking medicine,” he said.

Jarmula says he has thought about ordering Acomplia online but has thus far resisted the temptation. He is hopeful that it will be released in America soon. “If Acomplia can correct a problem where my brain isn't receiving accurate hunger signals, maybe by taking it I’ll actually experience the feeling of satisfaction,” he said.

E-mail: brk2101@columbia.edu