PhotoNut
04-02-2008, 06:42 PM
COMPETITIVE SQUEEZE (http://online.wsj.com/public/article/SB120692909065176045.html)
Industry Giants Push Obesity Surgery (http://online.wsj.com/public/article/SB120692909065176045.html)
By RHONDA L. RUNDLE
March 31, 2008; Page A1
Medical-device makers, venture capitalists and surgeons are racing to turn a once-controversial weight-loss procedure into the next big thing in elective surgery.
Once dismissed by some surgeons as a gimmick, gastric banding -- in which a silicone band is wrapped around the upper stomach to restrict food intake -- is now the focus of a fierce competition pitting consumer-products giant Johnson & Johnson (http://online.wsj.com/quotes/main.html?type=djn&symbol=JNJ) against Botox maker Allergan (http://online.wsj.com/quotes/main.html?type=djn&symbol=agn) Inc. Venture-capital-backed outpatient centers are popping up to implant the bands. Growing ranks of surgeons are touting the procedure at free public seminars. All see a vast market in a country where diet and exercise programs have failed to slow an obesity epidemic.
GASTRIC BANDWAGON
• What's New: Once dismissed as a gimmick, gastric banding is now seen by some in the medical industry as the next big thing in elective surgery.
• The Players: Industry giants Johnson & Johnson and Allergan, as well as venture-capital firms that are backing outpatient centers.
• Patient Concerns: The silicone device can shift after surgery, causing it to lose effectiveness. And patients may eventually need another surgery to replace or remove it.
Like any major surgery, gastric banding carries risks of infection and even death. The silicone device can shift after surgery, causing it to lose effectiveness. No one knows how long it will last inside the body, so patients may eventually need another surgery to replace or remove it. And some surgeons say the weight loss achieved through banding isn't as much as other weight-loss procedures. "There's no question that advertising and the commercialization of the band is what's driving it," says J.K. Champion, a bariatric surgeon in Atlanta. Bariatric is a medical term derived from the Greek word "baros" meaning "weight."
Weight-loss surgery remains rare, despite the fact that about a third of adult Americans are obese -- and despite evidence that the procedures improve overall health. Only an estimated 1% of the nation's 15 million morbidly obese people, typically those who are 100 pounds or more overweight, have undergone surgery. That may be partly due to the fact that the most popular weight-loss surgery to date has been gastric bypass, a more invasive procedure.
FOOD LIMITERS
Diagram: Gastric Banding vs. Gastric Bypass (http://s.wsj.net/public/resources/documents/info-enlargePic07.html)
A number of recent studies suggest that gastric banding is safer than gastric bypass, and some data suggest comparable, if slower, weight-loss results. Improvements in surgical techniques and follow-up care have helped gastric banding become the dominant weight-loss operation in Europe and Australia. Credit Suisse analyst Marc Goodman predicts that gastric banding will account for half of all weight-loss surgeries by 2010, up from about 30% today.
Treatment for Diabetes
And banding is emerging as a treatment for diabetes: It effectively cured the disease in 73% of treated adults who were lighter than people who typically undergo weight-loss surgery, according to an Australian study published in the Journal of the American Medical Association in January. Diabetes remission closely tracks weight loss.
Some parts of the country are already bombarded with gastric-banding ads. In one television spot airing in Texas for True Results, a Dallas-based chain of six outpatient centers, a young woman says, "I'm going to be around much longer for my family," after losing 178 pounds. Unlike the band makers, physicians and clinics can make advertising claims that aren't subject to the strict rules imposed by the Food and Drug Administration.
http://s.wsj.net/public/resources/images/P1-AL006A_FATBA_20080330212432.gif
"We see patients come into our office at the Cleveland Clinic who have heard about the band," says Philip Schauer, director of the Ohio-based Cleveland Clinic's bariatric and metabolic institute. He adds that the ads exert a powerful influence. "You don't see commercials for gastric bypass," he says.
In gastric bypass, the surgeon reroutes the gastrointestinal system. But gastric bands don't alter the body's basic plumbing. Tiny incisions are made in the abdomen, and a camera is passed through one of them so the surgeon can view the operation site on a video monitor. A band made of silicone is fastened around the upper stomach to create a small pouch that limits food intake.
Periodic Adjustments
After the band is installed, doctors make periodic adjustments depending on the patient's weight loss, food cravings and physical reactions to the band. Patients typically need four to six adjustments in the first year, and two or three in each of the next couple of years. If the band is removed, the patient may revert to old eating habits.
Not all surgeons have jumped on the bandwagon. Some believe gastric bypass is better for the super obese, who may be more than 200 pounds overweight. "We're finding patients have different demands," says Dr. Schauer.
What's more, the duration of weight loss for either procedure is still unknown. The possible complications of banding include slippage of the device or erosion into the stomach. Many health insurers are still reluctant to cover the procedures -- leaving patients to pay, or borrow, the $15,000 to $40,000 to finance the surgery.
But some patients are storming ahead anyway. "It's the best thing I've ever done for myself," says Patricia Zeolla, a 59-year-old teacher in New York City, who learned of the procedure via a Web site.
Concluding that gastric bypass is too "scary," Ms. Zeolla opted for gastric banding instead at New York's Lenox Hill Hospital; her insurer, initially resistant, eventually agreed to foot the bill after her surgeon intervened. In one year, Ms. Zeolla whittled her weight down to 166 pounds from 286 pounds.
The first adjustable gastric bands were implanted in Europe and Australia in the early 1990s. The procedure had many early detractors. A high rate of surgical complications made surgeons wary. Inamed Corp., the company pitching the Lap-Band, was better known for its breast implants and had a poor reputation with bariatric surgeons eager to distance themselves from cosmetic surgeons.
"There was a mind-set that gastric bypass was better," says Paul O'Brien, an author of the recent Australian diabetes study and director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia. Dr. O'Brien did his first Lap-Band surgery in 1994 in Australia. Since then, he and his colleagues have studied thousands of patients.
Gastric banding exploded after 2006, when Inamed was acquired by Allergan, best known for the antiwrinkle drug Botox. Allergan bought Inamed for its portfolio of cosmetic medical devices, but "we quickly realized the real jewel was Lap-Band," David E.I. Pyott, chief executive officer, said recently at Allergan's offices in Irvine, Calif.
In November 2006, Allergan began advertising the Lap-Band directly to consumers, an unusual tactic for a surgical device. The company aired a television commercial featuring a distressed woman trying to "tame" a roaring lion pulling her to the refrigerator.
The campaign was an immediate success: Within a week, visits to Allergan's Lap-Band Web site had increased nearly fivefold. Sales of Lap-Band and other obesity-intervention devices soared 50% last year to $270 million, making them Allergan's fastest-growing product line.
Enter Johnson & Johnson. Last September, J&J's Ethicon Endo-Surgical unit received FDA marketing approval to sell its band, dubbed Realize. In recent months, J&J has been bringing obesity surgeons to weekend training sessions to teach them how to implant the device. Bariatric surgeons such as Alan Wittgrove of La Jolla, Calif., who once pooh-poohed banding, say that J&J's efforts are validating banding as an option.
Industry Giants Push Obesity Surgery (http://online.wsj.com/public/article/SB120692909065176045.html)
By RHONDA L. RUNDLE
March 31, 2008; Page A1
Medical-device makers, venture capitalists and surgeons are racing to turn a once-controversial weight-loss procedure into the next big thing in elective surgery.
Once dismissed by some surgeons as a gimmick, gastric banding -- in which a silicone band is wrapped around the upper stomach to restrict food intake -- is now the focus of a fierce competition pitting consumer-products giant Johnson & Johnson (http://online.wsj.com/quotes/main.html?type=djn&symbol=JNJ) against Botox maker Allergan (http://online.wsj.com/quotes/main.html?type=djn&symbol=agn) Inc. Venture-capital-backed outpatient centers are popping up to implant the bands. Growing ranks of surgeons are touting the procedure at free public seminars. All see a vast market in a country where diet and exercise programs have failed to slow an obesity epidemic.
GASTRIC BANDWAGON
• What's New: Once dismissed as a gimmick, gastric banding is now seen by some in the medical industry as the next big thing in elective surgery.
• The Players: Industry giants Johnson & Johnson and Allergan, as well as venture-capital firms that are backing outpatient centers.
• Patient Concerns: The silicone device can shift after surgery, causing it to lose effectiveness. And patients may eventually need another surgery to replace or remove it.
Like any major surgery, gastric banding carries risks of infection and even death. The silicone device can shift after surgery, causing it to lose effectiveness. No one knows how long it will last inside the body, so patients may eventually need another surgery to replace or remove it. And some surgeons say the weight loss achieved through banding isn't as much as other weight-loss procedures. "There's no question that advertising and the commercialization of the band is what's driving it," says J.K. Champion, a bariatric surgeon in Atlanta. Bariatric is a medical term derived from the Greek word "baros" meaning "weight."
Weight-loss surgery remains rare, despite the fact that about a third of adult Americans are obese -- and despite evidence that the procedures improve overall health. Only an estimated 1% of the nation's 15 million morbidly obese people, typically those who are 100 pounds or more overweight, have undergone surgery. That may be partly due to the fact that the most popular weight-loss surgery to date has been gastric bypass, a more invasive procedure.
FOOD LIMITERS
Diagram: Gastric Banding vs. Gastric Bypass (http://s.wsj.net/public/resources/documents/info-enlargePic07.html)
A number of recent studies suggest that gastric banding is safer than gastric bypass, and some data suggest comparable, if slower, weight-loss results. Improvements in surgical techniques and follow-up care have helped gastric banding become the dominant weight-loss operation in Europe and Australia. Credit Suisse analyst Marc Goodman predicts that gastric banding will account for half of all weight-loss surgeries by 2010, up from about 30% today.
Treatment for Diabetes
And banding is emerging as a treatment for diabetes: It effectively cured the disease in 73% of treated adults who were lighter than people who typically undergo weight-loss surgery, according to an Australian study published in the Journal of the American Medical Association in January. Diabetes remission closely tracks weight loss.
Some parts of the country are already bombarded with gastric-banding ads. In one television spot airing in Texas for True Results, a Dallas-based chain of six outpatient centers, a young woman says, "I'm going to be around much longer for my family," after losing 178 pounds. Unlike the band makers, physicians and clinics can make advertising claims that aren't subject to the strict rules imposed by the Food and Drug Administration.
http://s.wsj.net/public/resources/images/P1-AL006A_FATBA_20080330212432.gif
"We see patients come into our office at the Cleveland Clinic who have heard about the band," says Philip Schauer, director of the Ohio-based Cleveland Clinic's bariatric and metabolic institute. He adds that the ads exert a powerful influence. "You don't see commercials for gastric bypass," he says.
In gastric bypass, the surgeon reroutes the gastrointestinal system. But gastric bands don't alter the body's basic plumbing. Tiny incisions are made in the abdomen, and a camera is passed through one of them so the surgeon can view the operation site on a video monitor. A band made of silicone is fastened around the upper stomach to create a small pouch that limits food intake.
Periodic Adjustments
After the band is installed, doctors make periodic adjustments depending on the patient's weight loss, food cravings and physical reactions to the band. Patients typically need four to six adjustments in the first year, and two or three in each of the next couple of years. If the band is removed, the patient may revert to old eating habits.
Not all surgeons have jumped on the bandwagon. Some believe gastric bypass is better for the super obese, who may be more than 200 pounds overweight. "We're finding patients have different demands," says Dr. Schauer.
What's more, the duration of weight loss for either procedure is still unknown. The possible complications of banding include slippage of the device or erosion into the stomach. Many health insurers are still reluctant to cover the procedures -- leaving patients to pay, or borrow, the $15,000 to $40,000 to finance the surgery.
But some patients are storming ahead anyway. "It's the best thing I've ever done for myself," says Patricia Zeolla, a 59-year-old teacher in New York City, who learned of the procedure via a Web site.
Concluding that gastric bypass is too "scary," Ms. Zeolla opted for gastric banding instead at New York's Lenox Hill Hospital; her insurer, initially resistant, eventually agreed to foot the bill after her surgeon intervened. In one year, Ms. Zeolla whittled her weight down to 166 pounds from 286 pounds.
The first adjustable gastric bands were implanted in Europe and Australia in the early 1990s. The procedure had many early detractors. A high rate of surgical complications made surgeons wary. Inamed Corp., the company pitching the Lap-Band, was better known for its breast implants and had a poor reputation with bariatric surgeons eager to distance themselves from cosmetic surgeons.
"There was a mind-set that gastric bypass was better," says Paul O'Brien, an author of the recent Australian diabetes study and director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia. Dr. O'Brien did his first Lap-Band surgery in 1994 in Australia. Since then, he and his colleagues have studied thousands of patients.
Gastric banding exploded after 2006, when Inamed was acquired by Allergan, best known for the antiwrinkle drug Botox. Allergan bought Inamed for its portfolio of cosmetic medical devices, but "we quickly realized the real jewel was Lap-Band," David E.I. Pyott, chief executive officer, said recently at Allergan's offices in Irvine, Calif.
In November 2006, Allergan began advertising the Lap-Band directly to consumers, an unusual tactic for a surgical device. The company aired a television commercial featuring a distressed woman trying to "tame" a roaring lion pulling her to the refrigerator.
The campaign was an immediate success: Within a week, visits to Allergan's Lap-Band Web site had increased nearly fivefold. Sales of Lap-Band and other obesity-intervention devices soared 50% last year to $270 million, making them Allergan's fastest-growing product line.
Enter Johnson & Johnson. Last September, J&J's Ethicon Endo-Surgical unit received FDA marketing approval to sell its band, dubbed Realize. In recent months, J&J has been bringing obesity surgeons to weekend training sessions to teach them how to implant the device. Bariatric surgeons such as Alan Wittgrove of La Jolla, Calif., who once pooh-poohed banding, say that J&J's efforts are validating banding as an option.