How necessary is lap-banding?

Imagine for a moment that there was a medical benefit to penis enlargement. I can’t imagine what it might be. But you can bet that if there was the slightest chance of one, Big Pharma would be working the PR angles overtime.

There would be submissions to parliamentary enquiries on the virtues of large members. There would be intense lobbying for bigification to be added to the medicare schedules. Universities would be endowed with grants for studies showing that despite the huge costs involved, the community as a whole would be better off.

Successful recipients of the procedure would make regular appearances on current affairs shows. And even the occasional celebrity might become a posterboy for his newly enlarged and much more healthy lifestyle.

Normally this kind of cosmetic surgery misses out on the PR windfall of there being a remote possibility of medical benefit. But there is one kind of beautification which has managed to land smack bang in the middle of the biggest medical concern we have (no not hair regrowth, the other one).

Lap-band surgery promises to blow away years of eating the wrong thing with a simple slice of the scalpel (and large quantities of liquid food). But it’s not cosmetic surgery, oh no, this is about reversing Type II Diabetes.

You need look no further than our own Monash University’s Centre for Obesity Research and Education (CORE) for proof that lap-band surgery is a cost effective way to manage diabetes. I’m sure that the fact that CORE’s ‘principal sponsor’ is Allergan has very little to do with their decision to focus their efforts on the study of lap-band surgery.

Allergan is the little pharmaceutical company that gave the world Botox. It followed up that gift to mankind with the invention of the very first (and still the most popular) device for bariatric surgery. Years of marketing Botox for medical uses (really? It’s also used for cosmetic purposes? Well spank my bottom and call me Anna) has ensured that Allergan knows how to tread the cosmetic-surgery-that’s-healthy path with great skill.

CORE has been having a bit of success on the lobbying front. It submitted to the House of Reps inquiry into obesity that “the barriers to publicly funded access to this surgery need to be addressed as a matter of urgency”, (but forgot to mention that their principal sponsor was a maker of such devices). And voila out pops a key recommendation that governments need to work together to boost access to bariatric surgery.

One of the chaps who has run multiple studies for CORE is a GP by the name of Dr John Dixon. His latest study correctly discloses that he is affiliated with CORE and the Baker IDI Heart and Diabetes Institute, but doesn’t mention that he is also a consultant to Allergan and “the charter member of the board” of, and has an ‘ownership interest in’ Bariatric Advantage.

The recipients of lap-band surgery are put on an Optifast diet before and after surgery. It’s not the surgery that makes them thin, it’s being forced to stick to a very low calorie liquid diet. Optifast is one of those shake diets you can buy at the local pharmacy, but there is a special high end version for those undergoing lap-band surgery.

Bariatric Advantage makes its money flogging optifast liquid diets (and various other bibs and bobs) to lap-band patients, so it’s logical that Dr Dixon might want to have an ‘ownership interest’ in its operations. The primary ingredient in Optifast shakes (besides powdered milk) is fructose, a substance so dangerous to diabetics (remember diabetes is the disease we are ‘curing’ here), that the American Diabetes Association has pronounced “the use of added fructose as a sweetening agent in the diabetic diet is not recommended.”

CORE expects that 14,000 lap-band procedures will be done this year in Australia. But don’t worry, since Nestle make Optifast, they can probably get their hands on the industrial quantities of fructose required for the construction of that many ‘diet shakes’. And Nestle have no problems selling fructose to our kids as health food, so I guess this isn’t much of a leap to push it to diabetics either.

Bariatric surgery is not a simple piece of cosmetic beautification. One in five patients will suffer complications (but don’t worry less than 1 in 100 dies). And all for what? An average of just one decade’s remission from Type II Diabetes (for up to 40% of patients – the rest miss out).

Are we really going to seriously consider publicly funding surgery based on a submission from an outfit funded by the maker of the surgical device? Are we to seriously consider ‘research’ run by a GP who is a paid consultant to that manufacturer? And what are we to make of his side business flogging fructose (on behalf of Nestle) to the recipients of these devices? Is this really how public health policy is put together in this country?

Here’s an idea. How about instead of leaving a publicly funded first aid kit at the bottom of the slippery slide, we give some thought to telling people about the dangers before they climb the ladder? How about instead of blindly accepting that people are obese because they’re lazy or gluttonous (or both), we pay some attention to the more than 3,000 studies which suggest we’re fat because of a dangerous toxin (fructose) in our diet? How about we look a little deeper than the shiny surface that Big Pharma and Big Sugar want us to see?

Also published in Crikey

Image courtesy of artur84 / FreeDigitalPhotos.net