Debate over dexfenfluramine
CMAJ 1997;157:15
In response to: M. Deitel
Dr. Deitel is incorrect in asserting that Abenhaim and associates did not control for body mass in their study of appetite suppressant drugs and the risk of PPH. Unfamiliarity with logistic regression modelling may have led to this misunderstanding.
The authors clearly describe a logistic regression model that adjusts for weight-related confounding. Body mass index a (BMI) was dichotomized to a nominal independent variable representing BMI of less than 30 kg/m2 and of 30 kg/m2 or more. In their discussion, the authors did not consider whether the association between the use of appetite suppressants and PPH could be explained by the confounding effect of obesity. The possible interaction between BMI and appetite suppressants was tested and found not to be statistically significant; this led to the conclusion that "the effect of anorexic agents was the same whether patients had a high body mass index or not."
Before debating the risk of PPH with appetite suppressants, discussion should first focus on the health benefits of these drugs in reducing the long-term risks of obesity.
Dr. Gerald A. Faich, in his letter "Drug to treat obesity: editorial writer responds" (CMAJ 1997;156:978 [full text]), finds himself and Dr. Manson misrepresented in their relationship with the manufacturers of fenfluramine and dexfenfluramine in the controversy surrounding the editorial they coauthored,1 which accompanied the study by Abenhaim and associates. Faich states that he and Manson had served briefly as scientific consultants to Servier, but does not mention his association with WyethAyerst, the US distributor of dexfenfluramine. According to the editor of the New England Journal of Medicine: "We are aware that Dr. Manson's consultancy was not ongoing at the time the editorial was written, but Dr. Faich's consultancy with WyethAyerst was ongoing. He coauthored the editorial and his violation of our conflict-of-interest policy is unarguable."2
Sana R. Sukkari, BScPharm, MPhil
Joseph Brant Memorial Hospital
Burlington, Ont.
References
- Manson JE, Faich GA. Pharmacotherapy for obesity -- Do the benefits outweigh the risks? [editorial]. N Engl J Med 1996;335:659-60.
- Angel M, Kassirer JP. Editorial and conflicts of interest. N Engl J Med 1997;336:729.
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