Pharmaceutical interventions for obesity: a public health perspective.

The prevalence of obesity, a major risk factor for many chronic diseases, has risen in most developed countries over the past several decades. The economic burden for both public and private health care systems is substantial. Although certain non-pharmaceutical interventions have been proven efficacious in specific populations, the lack of scalability has caused many of these programmes to fail in sustainably decreasing the percent of patients who are overweight or obese. The benefits of other interventions, such as pharmaceutical agents, medical devices and surgery, should therefore be carefully considered: this article focuses on the first of these strategies. Various pharmaceutical products have been plagued with safety concerns or patient non-adherence because of unpleasant side effects. Therefore, the need for additional antiobesity drugs that are both safe and effective is considerable. This article discusses the regulatory landscape for the development of new antiobesity compounds in the United States and Europe and considers the ramifications of greater or lesser regulatory burdens.

Implications of patient selection and surgical technique for primary total knee arthroplasty.

Between 1983 and 1992, one surgeon at Wheeling Hospital in Wheeling, W.Va., performed 121 primary cruciate-sparing total knee arthroplasties on patients with degenerative joint disease. Rigorous preoperative screening criteria and surgical protocol were developed to improve the clinical lifespan of the joint replacements. The average range of motion increased from 99.8 degrees to 107.1 degrees during a mean clinical follow-up period of 40.5 months (range 12-144 months). Among the 86 patients with a preoperative fixed flexion contracture, the average improvement in flexion was 12.0 degrees. Twelve of the patients developed postoperative medical complications, including two revisions of plastic tibial trays. The relatively low revision and complication rates are attributed to the experience of one surgeon utilizing similar guidelines for deliberate patient selection, preoperative educational programs, standardized operative protocol and surgical technique, and prosthesis familiarity.