Metabolically healthy but obese individuals

A subset of obese individuals seems to be protected against obesity-related metabolic complications. These individuals are described as metabolically healthy but obese, or as having uncomplicated obesity, or metabolically benign obesity. Despite having excessive body fat, people who are metabolically healthy but obese have favourable metabolic profi les, characterised by remarkably high insulin sensitivity, no sign of hypertension, and normal lipid, infl ammation, and hormonal profi les (low triglycerides and C-reactive protein concentrations and high HDL cholesterol and adiponectin concentrations). recommendation of developing quantitative measures of drug-induced harm and benchmarks for its recommended behavioural treatments, it does not take a similar approach to this necessary training proposal. The report is unclear about where the newly trained researchers will be deployed. Clinically approved drugs for substance abusers developed in academic settings have failed in multicentre trials for veterans in community settings. A lack of generalisable studies in academic settings underscores the need for some academic researchers to do studies in community settings rather than in academic clinics. There will need to be safeguards against adopting the non-academic benchmarks used in large hospitals, such as scope of clinical practice. Whereas in academia a major benchmark is the number and infl uence of publications, in hospitals the amount of clinical funding alone is often the major benchmark. We must be cautious that academic physicians are held to publication-based standards as opposed to gauging success merely by their ability to procure funding. But publication alone, while important for academic promotion, may not be suffi cient to jump-start translational drug-development. Since the report was written, several double-blind studies have shown that cognitive enhancers promote behavioural treatment of social anxiety and obsessive-compulsive disorders. Although these results are promising, they frustrate the clinician. The fi ndings are either insuffi cient to alter clinical practice or, as is often the case after small phase II academic trials, to satisfy sceptical reviewers. Clearly, industry needs to play the important role in fi lling this void between promising small academic phase II studies and larger phase III trials. That is why the recommendation of the Academy’s report to adopt a fl exible approach to drug pricing—taking account of the overall societal value of such drugs—is important. Orphan drug legislation in the USA has been uniquely successful in spurring industry to quickly develop old drugs for new uses, because time-consuming studies to establish safety have long since been completed. The sheer size of this success, by the type of academic clinical researcher that the report advocates training, begs the question: what if this approach to intellectual property, which (like the report’s recommendation) takes into account overall societal value, were extended to using old drugs for more common conditions. If policy makers embrace this report’s recommendation to expand the number of translational professionals and modernise antiquated intellectual property law. there is hope for at least doubling the rate of drug development.