OBESITY is an epidemic to some and an opportunity to others. More than two-thirds of Americans are overweight. Find a way to battle the bulge and a huge profit might be made. On February 22nd one pharmaceutical firm, Vivus, took a small step towards this goal. A committee advising America’s Food and Drug Administration (FDA) recommended that it approve Vivus’s diet drug, Qnexa. However, the pill’s long-awaited final approval may not come until April, if at all. The announcement mostly served as a reminder of what a struggle it is to turn fat into gold.

　　在某些人群當(dāng)中，肥胖很普遍，而對其他人群來說，也依舊存在潛在肥胖的可能。在美國，超過三分之二的人體重遠遠大于標(biāo)準(zhǔn)體重。若能找到合適的方法可以消除肥胖，那么它所帶來的利益將不可估量。2月22日制藥公司Vivus在這方面有了小步突破，研制出了一種減肥藥。一家委員會建議美國FDA(食品和藥物管理局)批準(zhǔn)Vivus的減肥藥——Qnexa。但是心急吃不了熱豆腐，期待已久的Qnexa的最終核準(zhǔn)將在四月，或者更晚。這一宣布無疑暗示著從減肥中獲取收益相對比較艱辛。

　　Pharmaceutical and medical-device companies are quite good at treating the conditions that come with obesity. However, they are dismal at helping consumers lose weight. This is not for lack of trying. Take the curious case of the gastric band. Bariatric surgery can lead to weight loss in the long term. Hospitals can make money from all bariatric procedures, including gastric bypasses (in which the stomach is partitioned and the upper part connected directly to the small intestine), but the gastric band is a rare example of an opportunity for device-makers to profit from weight loss. Allergan, best known for selling Botox, has tried to use its Lap-Band to tap the obesity market. It is an inflatable loop which the surgeon fits near the top of the stomach, which helps the patient feel sated earlier.

　　對于這類問題，生物制藥公司在處理解決上往往非常在行�？墒�，對于切實幫助消費者減輕體重上卻并不那么給力。這并不是因為缺乏嘗試。以新型科技胃束帶①為例，在不遠的將來減肥手術(shù)或許可以成功幫助減肥者減輕體重。通常，醫(yī)院可以從肥胖治療中獲得不小的收益，包括胃繞道手術(shù)(通過將胃縫合，留出的上面部分小胃囊與小腸直接結(jié)合)。而減肥物品的制造商們想要從肥胖者減肥過程中獲得利益相對比較困難，胃束帶是個鮮見的例子。以銷售瘦臉針著名的Allergan公司，推出了胃束帶產(chǎn)品，試圖以此來抓住肥胖市場。所謂胃束帶，是一種可伸縮的硅膠制帶子，外科醫(yī)生通過手術(shù)將其束縛在胃的上部以幫助患者提前產(chǎn)生飽腹感。

　　Allergan has captured about 70% of the worldwide market for gastric bands and balloons, but sales are now shrinking. The recession has sapped consumers’ desire for expensive surgery. Some patients have had bands removed because they slipped or proved ineffective. Last year the FDA approved the Lap-Band’s use in patients who are only slightly overweight, but insurers have refused to pay. In January David Pyott, Allergan’s chief executive, said he would scrap an effort to market the band for teenagers. He is now trying to convince insurers of Lap-Band’s merits, arguing that the $20,000 surgery is recouped in saved medical costs within four years. There is some scepticism about his chances of success: “The fact that banding is not as good as bypass has been known by everybody except the PR firms for the band,” says Lee Kaplan, director of the Weight Centre at Massachusetts General Hospital.

　　Allergan公司已在世界市場上胃束帶的銷售上占了70%的份額，然而現(xiàn)在銷量卻開始下降。部分患者出現(xiàn)了束帶下滑的情況，或者無法有效減肥。去年FDA批準(zhǔn)了胃束帶可使用于苗條的人群，然而保險公司卻拒絕為此支付相應(yīng)的保險金額。Allergan的首席執(zhí)行官David Pyott在日本發(fā)表聲明，將放棄青少年胃束帶市場的挖掘。他現(xiàn)在正著力于讓保險公司認(rèn)識到胃束帶市場有利可圖，并堅持稱外科手術(shù)的2萬美金相當(dāng)于未來四年節(jié)約下來的藥物支出。對于他的成功，仍舊存在一些異議，“總所周知的是，束縛和分流并不一樣�！� 麻省總醫(yī)院體重管理中心主任Lee Kaplan說。

　　Drug companies have had even more trouble than device-makers. It has been 13 years since the FDA approved a prescription diet pill. That drug, Roche’s Xenical, has notoriousgastrointestinal side-effects. The FDA rejected Vivus’s Qnexa in 2010 over concerns for the safety of pregnant women and the quickening of patients’ heart rates. Vivus’s new data apparently satisfied the FDA’s advisory committee.

　　醫(yī)藥公司的取財之路，相對減肥器材制造商來說更加艱難。自FDA批準(zhǔn)處方膳食藥片以來已有13年時間。Roche公司推出的Xenical藥物，因其腸胃方面的副作用而并不被眾人看好。2010年FDA駁回Vivus公司的Qnexa減肥藥，其所受的關(guān)注程度不亞于孕婦的健康和病人心率的加快。Vivus公司的新資料顯然讓FDA咨詢委員會感到滿意。

　　However, the agency may yet reject the drug. Even if Qnexa is approved, it is unclear that patients will buy it. Qnexa combines two treatments that are already on the market. Both medicines are generic, which means that doctors may prescribe the existing drugs rather than Qnexa’s more expensive version. For now, it is more profitable to treat fat patients than to try to make them slim.

　　然而，該機構(gòu)也許依然會拒絕通過這類藥物的審批。即使Qnexa減肥藥通過了審批，肥胖病人是否會購買依舊是個未知數(shù)。Qnexa將市場上已有的兩種治療方式進行了結(jié)合。這兩種藥物都是一般藥物，這意味著相比Qnexa這個更昂貴的藥物，醫(yī)生倒不如開具現(xiàn)有的兩種藥物。就目前來講，治療肥胖病人比讓他們變得苗條更有利可圖。

　�、傥甘鴰В和ㄟ^外科手術(shù)植在胃部，縮減胃部容量，減少進食量。