Thursday, May 13, 2010

The "hCG Diet"

This is something I've been meaning to post about for some time now, but just haven't gotten around to it.  A while back, my mom told me about this diet someone in my family had started on.  She referred me to this website and asked what I thought about it.

I'm now 25% doctor after completing my 1st year of medical school, so hCG (human chorionic gonadotropin) is something I've actually learned a bit about in class.  hCG is what some people think of as the "pregnancy hormone."  It's a hormone that doesn't show up in a woman's body until she becomes pregnant (it's what at-home pregnancy tests detect) at which point it acts to maintain other hormone levels at high enough levels for the developing fetus.  hCG is also responsible for morning sickness, which disappears by the end of the first trimester because at that point the placenta can maintain hormone levels for the fetus all on its own.  Such a wonderfully useful structure, that placenta!

So, when I first read about this, I thought, "So he's basically just giving himself morning sickness.  I should tell him to take a pregnancy test too just to freak him out!"  The website itself is downright awful too, even going so far as to say that their "product is a professional grade homeopathic hCG weight loss product that is made in the USA."  A professional grade homeopathic product... so does that mean they use filtered water or spring water instead of just plain old water?  And it's made in the USA, so it has to be good, right?

All kidding aside, I figured I'd look at some of the research behind this magical weight loss cure.  With weight loss plans like this, it often turns out that there was one (usually significantly flawed) study that showed a very small benefit, but that the effects couldn't be reproduced in larger, better-conducted studies. 

The study that started all of the hubbub about hCG assisting weight loss was conducted in 1956 by A.T.W. Simeons: "The action of chorionic gonadotropin in the obese. Lancet 2: 946-947, 1954."  I'd have loved to read this damned article but the only site that has it available is behind a pay wall (at $31.50), and I can't even get access via my university account.  They only allow access via a few US universities, and mine is not one of them.  If anyone has access to the article, I would greatly appreciate the chance to read it.  Not even The Lancet has it available on their site; they just link to ScienceDirect.  And I absolutely refuse to spend $31.50 to read a single article from 56 years ago.  Sorry!

So while I can't talk specifically about the results Dr. Simeons observed, I can refer you to a site that discusses the attempts to reproduce his supposed success with hCG.  For additional information, you can always go here, here, or here.  It sure is strange how the websites/people who claim hCG is a miracle weight loss cure are the same websites/people who are selling hCG.  All the other sites that point out how useless hCG is just keep using all that pesky "scientific evidence" and whatnot.

But onto the part of this story that irked me more than just the lack of scientific support for this hCG diet.  This family member was referred to this diet by his cardiologist (who is also receiving $900-$1000 for the injections and patient visits).  Let me say right now that this is not some medical student trying to say he knows more than a cardiologist.  I would like to point out very emphatically that I do NOT know anywhere near as much as a cardiologist!  But what I do know is how to think critically and scientifically, and how to use Google and PubMed to try to find studies that objectively measure the effectiveness of various treatments.  I have no doubt that this cardiologist has several patients who have experienced success with this diet, but guess what, if you go from 2,500+ calories per day to 500 calories per day, you're going to lose some serious weight no matter what!  Too many people, even some physicians, think that anecdotes qualify as sufficient evidence.  Science doesn't work that way, and neither does physiology.

I find it very troubling that this cardiologist is recommending such a scientifically unsound, clinically useless treatment like hCG.  The American Society of Bariatric Physicians has some doctors that have tried some really silly stuff, but even the ASBP has acknowledged that hCG is useless for weight loss.  I especially like the part where it says, "Physicians employing either the HCG or the diet recommended by Simeons may expose themselves to criticism from other physicians, from insurers, or from government bodies."

Situations like this worry me as a future physician.  You can't throw a shoe without hitting someone who's extremely distrustful of the pharmaceutical industry.  But if doctors promote pseudoscience like this, I fear it won't be long before people have that same distrust of their doctors, especially when there is such an obvious profit motive!  Losing weight and adopting a healthier lifestyle is a wonderful change to make, but don't be fooled by people promising you a pill or injection that will do it all for you.  Being healthy can be hard work in today's society, which makes it very easy for someone to make money spreading misinformation about how to get healthier using some shortcut or another.  I'm sure this physician is an excellent cardiologist, and I say again that I in no way assume that I know more than him, but in today's ever-changing medical landscape, we need to be mindful -- as physicians and as patients -- of the newest medical developments and learn how to differentiate between legitimate treatment and pseudoscience fad.

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