Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Binge eating disorder: Real or disease mongering?

Allen Frances, MD
Conditions
April 2, 2015
Share
Tweet
Share

A drug company recently received FDA approval to peddle its speed-like pill for “binge eating disorder” (the very same pill that is already widely overused for ADHD). And it is sparing no expense pushing the drug — a former world tennis champ is the shill and commercials are everywhere.

Five years ago, I predicted binge eating disorder (BED) would become a new fad diagnosis and a wonderful target for pharma disease mongering. I tried to convince the DSM-5 group to drop it, but failed.

Now we are off to the races. A drug company has gotten FDA approval to peddle its speed-like pill for BED (the very same pill that is already widely overused disease-mongered ADHD).

My prediction now is that, with a massive marketing campaign behind it, BED will become one of the most common of all diagnoses. Especially with a former world tennis champ as shill and with commercials.

Millions of people will be mislabeled as mentally ill and treated with unhelpful, and potentially harmful, diet pills.

The first suggestion to make BED an official diagnosis was made 25 years ago, by eating disorder experts working on DSM-IV.

They reported seeing patients who they felt needed help for binge eating, but who didn’t fulfill the full criteria for bulimia nervosa. BN required that eating binges be compensated for with dieting, vomiting, laxatives, or intense exercise. BED would be for those who binged without compensation and were, therefore, more likely to be overweight or obese.

We had a high threshold for including new disorders in DSM-IV and BED didn’t come close to making the cut. There was virtually no research to back it up.

Three things have changed in the ensuing years to turn BED from clear reject to bright star.

First, a few more studies were done. But they would not have satisfied the high DSM-IV standard for including a new diagnosis. Because creating a mental disorder often leads to unintended harmful consequences, we should always have substantial, supportive research on its risks and benefits. Instead, DSM-5 was flying mostly blind.

Second, DSM-5 had radically lowered the bar for including new diagnoses, giving its experts free rein to promote their pets. The few, largely uninformative studies that would have badly flunked the DSM-IV test breezed through DSM-5.

The head of the DSM-5 Eating Disorders Workgroup is a smart, honest, and decent man who had the same role in DSM-IV. When I repeatedly warned that he was creating a target for diet pill disease mongering, he replied that his job was just to judge the science. Any possible misuse of BED was an “educational issue.”

This didn’t make sense then, and the careless FDA approval has since given him buyer’s remorse. The science was weak. The risks as clear as the nose on your face. The education would mostly be done by drug companies to enhance profits, not help patients.

ADVERTISEMENT

Three, the FDA approved a BED indication and the marketing of the diet pill after an expedited review of two small, very inadequate, short-term treatment trials. The FDA is heavily funded by the drug industry it is supposed to regulate. It now works much more for the corporations than for the public. The foxes guard the henhouse.

The experts working on DSM-5 did not include BED because they wanted to help the drug companies. They were worried about missed patients and blinded by an intellectual conflict of interest. Experts always overvalue the research in their area and want to broaden its boundaries.

They need adult supervision by people who are more objective and less subject to diagnostic exuberance. DSM-5 failed to provide it.

The BED diagnosis and meds may be helpful for the few but will almost surely be misused to mislabel and overtreat the many.

In Greek myth, Cassandra was cursed with the gift of seeing the future without having any power to change it. I know the feeling. What a mess.

Allen Frances is a psychiatrist and professor emeritus, Duke University.  He blogs at the Huffington Post.

Prev

In medicine, we have murdered the story

April 2, 2015 Kevin 4
…
Next

ER physicians can help meet the triple aim

April 2, 2015 Kevin 1
…

Tagged as: Psychiatry

Post navigation

< Previous Post
In medicine, we have murdered the story
Next Post >
ER physicians can help meet the triple aim

ADVERTISEMENT

More by Allen Frances, MD

  • #MeToo shows why women must learn sexual self-defense

    Allen Frances, MD
  • The problem of polypharmacy in psychiatry

    Allen Frances, MD
  • Pay primary care doctors what they’re worth

    Allen Frances, MD

More in Conditions

  • Why your health is a portfolio to manage

    Larry Kaskel, MD
  • Pain control failures in fertility clinics

    Maire Daugharty, MD
  • Why what you do in midlife matters most

    Michael Pessman
  • Was Viagra the best heart drug we never had?

    Bharat Desai, MD
  • How to stay safe from back-to-school illnesses

    Kevin King, PhD
  • The infectious hypothesis of heart disease revisited

    Larry Kaskel, MD
  • Most Popular

  • Past Week

    • A doctor’s letter from a federal prison

      L. Joseph Parker, MD | Physician
    • When language barriers become a medical emergency

      Monzur Morshed, MD and Kaysan Morshed | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Why doctors are losing the health care culture war

      Rusha Modi, MD, MPH | Policy
    • The hypocrisy of insurance referral mandates

      Ryan Nadelson, MD | Physician
    • A cancer doctor’s warning about the future of medicine

      Banu Symington, MD | Physician
  • Past 6 Months

    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • I passed my medical boards at 63. And no, I was not having a midlife crisis.

      Rajeev Khanna, MD | Physician
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
  • Recent Posts

    • How Gen Z is reshaping health care through DIY approaches and digital tools [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love and loss in the oncology ward

      Dr. Damane Zehra | Physician
    • The weight of genetic testing in a family

      Rebecca Thompson, MD | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Meeting transgender patients with compassion and equity in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why your health is a portfolio to manage

      Larry Kaskel, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • A doctor’s letter from a federal prison

      L. Joseph Parker, MD | Physician
    • When language barriers become a medical emergency

      Monzur Morshed, MD and Kaysan Morshed | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Why doctors are losing the health care culture war

      Rusha Modi, MD, MPH | Policy
    • The hypocrisy of insurance referral mandates

      Ryan Nadelson, MD | Physician
    • A cancer doctor’s warning about the future of medicine

      Banu Symington, MD | Physician
  • Past 6 Months

    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • I passed my medical boards at 63. And no, I was not having a midlife crisis.

      Rajeev Khanna, MD | Physician
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
  • Recent Posts

    • How Gen Z is reshaping health care through DIY approaches and digital tools [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love and loss in the oncology ward

      Dr. Damane Zehra | Physician
    • The weight of genetic testing in a family

      Rebecca Thompson, MD | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Meeting transgender patients with compassion and equity in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why your health is a portfolio to manage

      Larry Kaskel, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Binge eating disorder: Real or disease mongering?
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...