Oh, To Be a Koala: Battling Fat & Diets

This week has seen a lot of fat-loss-related news. Now I used to be infatuated with biology in high school and if I weren't going to school for finance, I would've happily done pre-med. So let me share a secret with you that I learned from my favorite teacher Mr. Fenoli. First day of class he hammered in something he hoped would save us girls (he wasn't sexist...it was an all-girls school) a lot of time with: to lose weight, burn more calories than you eat.

I've always wondered about fad diets. The above mantra is so simple and common sense, so what's wrong here? Funny how one of the things that saved us from death in our caveman days is now the sixth leading cause of death according to the Center for Disease Control's latest data (2006). But I guess people know smoking kills/causes sallow skin and acne/reduces sperm count and they do it anyway.

So this new cookie diet is one fad that's as ridiculous as the others and another testament to our national eating disorder (but it's not all our fault-our political leaders started a cheap food farm policy in the 70s and it worked too well: US farmers now can produce 500 more calories per person per day and logically a lot of that went into our guts). To follow this new diet, simply eat six cookies and one meal totaling 1,000 calories every day. How this is better or healthier than just counting calories but eating balanced meals (that's plural) is beyond me.

This week was also when we found a new weight-loss drug, liraglutide, to be more effective than the one we had- orlistat of Alli and Xenical. There's no mention of orlistat's pleasant side effects of leaking oils and suffering from stool incontinence. Rather, with this new wonder drug you might be more likely to vomit. And we all know that's a pretty effective weight loss method itself.

So liraglutide's already been approved in Europe and is being sold as Victoza by Denmark-based big pharma company Novo Nordisk. They seem to be doing pretty well since the drug was approved this April.


While there's no information on how many people used orlistat when they didn't need to (weren't obese nor were diabetes patients), I would guess there were a lot of people using it as a shortcut to get fit for summer. I doubt liraglutide will be any different.

Also consider that it seems plain vanilla diet supplements are not enough when we can get prescription drugs. We still like our diet replacement meals though, according to Euromonitor International. And Americans really like spending money to replace old fashioned self-control.

Why is it this hard? If you want the full answer, read Michael Pollan's The Omnivore's Dilemma. To illustrate the "dilemma" Pollan references a thirty-year-old paper written by UPenn researcher Paul Rozin titled "The Selection of Foods by Rats, Humans, and Other Animals," contrasting the koala's choiceless, thought-free approach to what's for dinner (nothing but eucalyptus leaves) with an omnivore's, where possibilities are endless and for which we need large brains to ponder about.

Because we aren't koalas, however, we'll always be tempted with that hot dog, that cheesecake, that steakburger. But because we are also gifted with modern technology that is the iPhone calorie-counting app, please don't turn yourself into a malnourished cookie monster. Just move more than you eat. And another tip: As Pollan puts it in the opening of his second book, In Defense of Food -

Eat Food. Not too much. Mostly plants.

Lashes to Maybe Literally Die For

This spring I visited Taiwan to see about resuscitating my Chinese by applying to Normal University's summer program (although I got in, I stayed in NYC for some entrepreneurship experience instead). This was about at least the tenth time I came, my parents hailing from Taiwan and taking me on trips to Asia EVERY year since I was three...no hyperbole here.

Two things struck me as most different from my previous trip last summer. The first was how much traffic increased (no doubt a sign of economic recovery after China somewhat unfroze relations by, for example, allowing direct flights between the two just last year in June of 2008-great help when there's such heavy trade on the line). The deterioration then was so apparent I thought there was some China-esque anti-pollution government mandate in effect when for an entire string of weekdays major roads were void of traffic even during rush hours.

But, and here comes the blog-related stuff, the second most visible change was how many girls were wearing eyelash extensions.

Now Asian obsession with longer eyelashes has been around for a long time, with Asians having characteristically (and being one myself, let me say frustratingly) short, straight and sparse fringes. I've even emailed Jared Diamond, the author of my favorite book Guns, Germs and Steel, on this subject about the origins of human societies. I'll let you know if he responds. Maybe Asia just wasn't as dusty back then so we didn't need as many eyelashes. Then again there is no race gene so it might be anyone's guess.

So from this we see that several innovations to enhance eyelashes have stemmed from Asia from the famously infallible $19 Shu Uemura eyelash curler and their insane false eyelashes (loved by the likes of Jennifer Lopez who had custom-designed fox or mink ones to wear to the Academy Awards in 2001 with a "Tokyo Lash Bar" that's been making waves in the industry) to Imju's Fiberwig, the first mascara that uses fibers and a formula to form individual tubes around each lash. I also saw heated eyelash curlers in the aisles of Watson's (aka Rite Aid of Asia) and had been bringing them back for friends a decade before beauty retailer Sephora had them here.

So plain mascara isn't good enough anymore, as about half of Taiwanese girls I saw there had obviously glued on a pair of fakes-a big change when I only noticed them on Sogo and Xin Guang San Yue department store salesgirls last year. When I asked a girl about her false set, she just said everyone else had them and saw it as no big deal.

(But they are if you consider these things are a couple bucks (to $20) a set, you've got to take the time and effort every morning to glue the lashes on and risk tearing out a few real ones, and they're as reuseable as fake nails.)

While I couldn't find specific numbers to find out exactly how much sales in these things have risen, there's a lot of news on this new focus on eyelashes not just in Taiwan but in the US.

In fact, there's been talk about a "mascara indicator" to replace the "lipstick indicator," which Estee Lauder Chairman Leonard Lauder coined when right after 9/11 deflated the economy he noticed lipstick sales were stronger than usual. But the indicator was debunked this year when it seemed lipstick was actually not impervious to the economy, tanking six percent earlier this spring. On the other hand, according to WWD, mascara sales jumped 6.68 percent which made some hail mascara as the new indicator (with a methodology about indicators which I have major beef against, but that's a whole other story). This mascara trend was noted as early as last October by the WSJ. Although no specific mascara data is available (NYU doesn't have access to NPD group unfortunately), Euromonitor International shows (big surprise) the US leads the pack with Japan in second when it comes to spending on lip and eye make-up products.

But now, it looks like the West is leading the craze for lusher lashes with our own way - tools and harmless inky black stuff, a method used for centuries, is no longer good enough. We need prescription drugs!

So in the last year, we've been seeing a lot of new lash-growers on the market.

Latisse was the first-a prescription drug for nothing but longer lashes brought to you by Allergan, the people that gave us Botox. Latisse is made from a prostaglandin (in this case, Bimatoprost), a chain of fats that's used to treat glaucoma. Actually, it was glaucoma patients who discovered this eyelash side effect in their battle against blindness. So now we've got perfectly healthy people like Latisse spokesperson Brooke Shields using drugs that glaucoma patients have no choice but to use.

Allergan's Latisse actually came out this year (and was slapped by the FDA for downplaying risks on its website last month) but it wasn't the first to discover prostaglandins' effect on lashes. Jan Marini Skin Research came out with their first lash booster back around 2005 but then the FDA had US marshalls seize $2 million worth of the stuff in 2007 when it turned out JMSR never applied for FDA approval (some say Allergan tipped them off) for including in the casual product a drug that could cause eye inflammation and BLINDNESS from nerve damage.


Of course JMSR had their own version of events saying they had discontinued sales in 2006, and then introduced a new version last year that now just vaguely lists among ingredients "proprietary peptides" and "other essential factors." Other similar products touting the same effect are Revitalash, Peter Thomas Roth's Lashes To Die For, Lilash (all of which use prostaglandins) and Talika's Lipocils (which has all natural ingredients and being a previous user, I can't say whether it works).

But here's the bad. Peter Thomas Roth warns its unsafe to use the product if you're pregnant or under 18. Latisse's possible side effects are darkened eyes (as in pupil color), itchy, dry or red eyes, red eyelids, darkened skin where the solution is applied. Allergan also cautions that contact lens wearers should remove their lens and wear them 15 minutes after application, and also for users to discontinue use if "visual acuity" is compromised (ie you turn blind).

I was turned off by the products when I read the "don't use if pregnant or under 18" warning. And anything that might compromise your eyesight is probably not the best-it might be depressing if you use what glaucoma patients use and turn into an eye-problem patient yourself. Until we see what happens after long term use (for me, that's around 50 years, at which time I probably won't care so much about the length of my lases), I think I'll stick with plain old mascara.

Speaking of NyQuil: Supplements and Multivitams

This NyQuil case was a good step toward closer scrutiny of supplements, and thinking about it again, there's another misconception I'd love to address:

Not all supplements are created equal.

Those cheap, one-tablet-a-day multivitamins? You might just consider them garbage when you're talking about whether you're even absorbing any of it, whether the manufacturer is lying about how much is in them, or worse if they contain poison.

While numbers are hard to come by when you're trying to figure out how much a human body is absorbing (called "bioavailability") from a specific source and the FDA says repeatedly that it's not their responsibility to regulate, you can be sure it's a business that needs regulating, especially when it's a $22.75 billion business from last year alone (Americans spent $7.54 billion) according to Euromonitor International.

ConsumerLabs actually found that taking whatever cheap multivitamin out there can be useless or dangerous: 52 percent of the multivitamins it examined were contaminated with lead, didn't disintegrate properly, or had more or less of certain ingredients than indicated on the label.

Such is the seriousness of this matter that there is a nonprofit organization called U.S. Pharmacopeia (USP) devoted to testing multivitamins and certifying ones that are safe and worth taking (this certification is displayed on the packaging).

Then, if you're thinking about taking multis even if they don't prevent the common cold because they might prevent long-term, more serious illnesses, it's no good there either. In 2006 scientists in the State of the Science Conference at the National Institutes of Health found after extensive trials that the "evidence is insufficient to prove the presence or absence of benefits from use of multivitamin or mineral supplements to prevent cancer and chronic disease."Obviously this wasn't such resounding news as year-on-year growth of multivitamin sales was higher from 2006-2007 than the year prior according to Euromonitor International. Or we didn't get the memo until the next year, which had a lower rate of YOY growth.


But if you're really bent on getting your vitamins and can't go the fruit and veggie route, get the USP certified stuff and stop drowning yourself in OJ once you're sick (not that oranges are even in the top five most Vitamin C-packed raw fruit list - Barbados cherries are first, then guavas, currants, kiwis, and longans, then lemons according to nutritiondata.com). Or more effectively, just invest in some all-natural hand-sanitizer. I would consider it more effective and safe than cultivating expensive pee and lead pills.

NyQuil, Vitamin C and Multivitamins

I can't talk enough about viral sicknesses after being completely enraptured by the infectious but unliving genetic structures in high school after reading stuff like The Great Influenza by John Barry and The Hot Zone by Richard Preston. That was the only type of terror I could happily handle, being so traumatized by movies like The Ring that I used to lie in bed in the middle of the night debating whether or not to get up and pee.

So here's a third post on the subject of fighting viruses in about a month...because it is very important:

You MUST know that gorging on massive quantities of Vitamin C when you're sick will not doing anything except maybe give you the runs. Vitamin C does not cure the flu.

This myth about Vitamin C curing common sicknesses is something I vehemently would love to eradicate with pleasure, so much that I used to troll Yahoo! Answers for the opportunity to warn people about this.

Well, we are one step closer to greater enlightenment, when today the FDA told Vicks to stop putting Vitamin C in NyQuil, since leads people to believe the FDA has evaluated the vitamin's efficacy when in fact (and big surprise) the agency's experts have found that Vitamin C does not cure the common cold. That this is clearly stated in the third line of the NYT article is even better.

I became aware of this pervasive misconception when in high school I read a small blurb on the subject in Newsweek's Periscope section (which ceased to exist this year), debunking both Vitamin C as well as Echinacea, saying that Zinc, instead, has been shown to slow growth of rhinoviruses (common cause of the cold) in recent studies at Wesleyan and as early as 1974. And then while Zinc hasn't exactly been completely debunked with several conflicting studies, there have been health concerns about taking too much of it, leading to the recall of Zicam earlier this year.

This is on top of last year's lawsuit in March against Airborne, which settled, paying $23.25 million to compensate for marketing itself as a cure of the common cold.


So where did the myth come from? Linus Pauling, a Nobel Prize-winning chemist (1901-1994) who wrote a book in 1970 exalting the benefits of Vitamin C without any scientific evidence. Even Pauling's biographer, Thomas Hager, said to Newsweek here that "he seemed to be prescribing a major change in dietary habits without much evidence."

I told my dad about this but old habits die hard with a fervent believer, so whenever he tells me to knock back a couple Airborne tablets when I'm feeling sick I just let him go on. After all, the placebo effect is undeniable, especially with major scientific proof to actually see it in action...so just forget about all this if you can't stand to see the light and you'd rather stay in Plato's cave.

Plastic Surgery Beauty Pageant

Plastic surgery is becoming as common as any other beauty routine, and it is far from a exclusively American trend, as I found out after a business school-sponsored trip to South Korea junior year. One of the first things they told us at orientation in Korea was 1. the country's lack of garbage cans despite the litter-free streets (clean and less wasteful culture?) and 2. EVERYONE's had plastic surgery done, with fourteen-year-olds getting their eyelids done. Well, everyone being 30 percent of all women. Which is as common as braces in the States.



So even though plastic surgery has been down in these economic times with surgeries in the states having fallen 15 percent from 2007 to 2008 (the same thing is happening in S. Korea too) while we Americans are still spending a ton on it (like $10 billion. See below), I guess with the ubiquitous nature of the trend it would be inevitable that one day we would have surgically-enhanced beauty pageants. Which is what happened Friday in Budapest, Hungary.

In the world's first plastic surgery beauty contest called Miss Plastic Hungary (winner Réka Urbán at left, who's a hostess and had only her breasts done just this year, won a new apartment...her surgeon won a prize also), the only requirements were to be female, at least 18 and to have undergone at least one cosmetic surgery. And organizer István Venyige asked that the surgeries not be too "extreme."

Of course the judging might not have been too level since contestants weren't grouped by what they had enhanced, but it's the world's first pageant of its kind so there's room for improvement. Or Venyige (not much information available on him unfortunately. I'd be very curious to know what his stake is in the biz) just wanted the publicity and didn't care.

But officially, why the pageant? Venyige says on his website that cosmetic surgeries in Hungary are not widely accepted. While there's not much reliable information on surgeries broken down by country, a Medical Treatment Abroad Survey said Hungary, along with India and Turkey, were the most popular cosmetic surgery destinations for UK patients.

But Venyige could also be comparing Hungary to the US, where we make everyone else look like puritans. According to the British Association of Aesthetic Plastic Surgeons (BAAPS), in 2006 there were 5,655 or 50 percent more breast augmentations (most popular in Europe and the States) compared to the prior year. Britons also apparently spent almost $1 billion (£497) total on surgeries in 2006.

Now compare that to the US, where in the same period we spent an estimated $10 billion on surgeries! But that's pretty easy to believe when as early as in 1997 we had 101,178 breast augmentations and last year we were up to 355,671. It might just be like the alarm clock thing where Americans are a lot more open to (sometimes shameless) self-improvement.

Anyway angry protesters aside, this is a small but interesting development toward acceptance that we have come a mind-blowingly far way from our caveman times. It sounds like science fiction when we're creating smarter, more (artificially) beautiful versions of ourselves. What about IQ tests on Adderall? Art contests on LSD?

Drug competitions might sound dangerous but it's comparable to plastic surgery. We're not just altering our minds but also bodies. And people seem to forget that plastic surgery is, well, surgery. The American Society of Plastic Surgeons (ASPS) say the plastic surgery fatality rate is 0.25%, comparable to the overall surgery fatality rate, and this is from the pro-plastic surgery folk. Then the FDA says that liposuction deaths could be higher than deaths from car crashes.

Whatever the rate I'm sure we can all agree it is a pretty unfortunate way to die when some out have no choice but to undergo surgery. So I hope people remember that before they opt for it that plastic's a pretty terrible way to die.

Allergan's Free-Speech Suit Against FDA

For the first time a drug maker, Allergan (NYSE:AGN), filed suit Thursday against the FDA and US government for violating the First Amendment of the right to free speech.

Currently, drug companies are prohibited from communicating anything related to uses of a drug that is unapproved by the FDA. But once a drug is approved, doctors can prescribe the drugs for uses other than what the drug was approved for. In this way the Botox-manufacturer wants to legally share with doctors what it calls "truthful and relevant" information concerning off-label uses of Botox such as dosing, patient selection criteria, and injection technique.

Allergan contends that 1 out of 5 drugs in the US are prescribed for off-label uses, and although the company won't disclose what that statistic is for Botox, it does say that half of Botox prescriptions are for medical, rather than cosmetic, reasons.

Regulatory authorities have approved botox not just for wrinkles but for 21 indications in 80 countries, including eyelid spasms, excessive sweating, crossed eyes and neck contortions. But doctors still prescribe Botox for unapproved uses such as facial spasms and headaches.

Whatever the ruling will be (NYT cites analysts who believe Allergan won't really pursue the lawsuit and is just using it as leverage for wiggle-room in providing off-label information), there's no doubt other drug companies are watching closely. But I doubt Allergan can win this one. After all, if drug companies are able to share such information with doctors, the FDA will have to investigate whether that information is true, so what's the point? The FDA might as well just approve it for that use anyway. Or will it be that the FDA-approved uses are more thoroughly approved than the non-approved uses because approving everything will take too long? Or if companies are just allowed to say whatever they say is "truthful" who will have the time to monitor those claims? It just doesn't seem viable either way.

And Allergan's investors seem to know it too. The company's shares fell 1.77 percent when the market closed Friday at $54.96.

Cephalon's Smart-Pill Sale Tactic

Biopharmaceutical company Cephalon (NASDAQ:CEPH) announced last week that the FDA will review its sleep disorder drug, Nuvigil, for treatment of jet lag. If it is approved (the decision is expected by December 29 this year), Nuvigil will be the only FDA-approved treatment for jet lag. However, Nuvigil is just a improved version of Cephalon's flagship alertness drug, Provigil (in the same "brain pill" class as Ritalin and Adderall), which was introduced in 1998. There are actually no head-to-head clinical efficacy trials comparing the two drugs, but Cephalon claims Nuvigil lasts longer in a 24-hour period.

Launched in the US markets in just June this year, Nuvigil is really Cephalon's answer to Provigil's potential generic drug competitors. And Provigil is worth protecting for the company, accounting for 54.9 percent of Cephalon's revenues in the US and 48.9 percent internationally in the first half of 2009. This is a 16 percent increase from the same period last year. However the increase was more due to a 10 percent price hike, offset by a 3 percent decline in prescription growth.

And let's look at this price hike, because you can be sure the company's focused on squeezing as much money out of this as quickly possible. But the tactic Cephalon has been using to protect sales quite clever...although described as shameful by some.

The company increased the price of Provigil by 28 percent last year in March according to WSJ, a 74 percent total increase from four years before that (this year, Provigil's about 10 bucks a pill), and has been offering Nuvigil at a 11 percent discount. And it's been working: in July Nuvigil had around 6,000 prescriptions a week, in a 50-50 split between new users and Provigil-to-Nuvigil users. 40 percent of new prescriptions were also supported largely by coupons, as CFO Kevin Buchi said in the 2Q earnings call in August.

Cephalon has also had run-ins with the Federal Trade Commission on antitrust and misleading marketing issues. In a case that is yet to be settled, the FTC alleges that the company broke antitrust laws by paying generic drug manufacturers $200 million not to flood the market with generics before 2011 or 2012. Then last year, Cephalon plead guilty to a criminal misdemeanor, paying at least $440 million for promoting three of its drugs, including Provigil for uses other than its FDA-approved treatment of sleep disorders.

This also comes at a time when, according to The Christian Science Monitor this May, 10 percent of American college students use prescription mind-enhancement drugs as study aids. The British science journal Nature also ran a survey in April 2008 of 1,400 people in 60 countries, finding that 20 percent had used such drugs for nonmedical reasons (only half had prescriptions for the drugs they were using), and even though half reported unpleasant side effects, 4 out of 5 "thought that healthy adults should be able to take the drugs if they want to." This view is shared by the editor of Nature as well.

The only largely publicized danger so far that the drugs may be habit-forming. Cephalon doesn't deny it, pointing out that Provigil has disclaimers warning exactly this. But this "danger" isn't saying much considering how everyone knows cigarettes are addictive but smokers love their cancer sticks regardless. Now imagine cigarettes that give you the effect of coffee on steroids. I doubt there will be much resistance to that, even if they are addictive. But given our inability to see long-term consequences, I wouldn't be surprised if we find 50 years from now that those who do use such drugs are more likely to suffer from brain disorders. After all, these users are trying fix what ain't broke.