Statement of Diana Zuckerman, PhD, at the APA Co-Sponsored Congressional Briefing

I was a psychologist for several years before coming to the hill. I've worked in the House and the Senate, and I see my job today to help you to figure out what you all can do using this information and the interests you have on this issue to really influence public policy. Public policy can obviously affect these issues in many different ways, but some are more likely to be successful than others. I love the idea of regulating the fashion industry. While I don't think that's going to happen by statute, Congress can be influential in bringing up issues in hearings, bringing publicity to issues, enlisting the help of movie stars, models and others. You do have that power that a lot of other people don't have.

I was glad Naomi brought up the issue of silicone breast implants. I was actually working in the House of Representatives for what's now the Government Oversight Reform Committee a few years ago and I started the investigation of the safety of silicone breast implants, and let me tell you that was a horrible experience. It was really a difficult experience to bring up an issue like that at a time when everybody thought that they were perfectly safe and really resented Congress getting involved. But, it can happen, and it can make a difference. And that is an example of how Congressional hearings can bring a lot of visibility to an issue that had not been considered in a serious way before. And it is the role of the FDA to make sure that the products that are sold in this country are safe and effective and so everything about diet pills and diet products that you've heard about today are relevant to that issue. The FDA is responsible for making sure that these products are safe and are effective and there's lot of ways to measure that. And it is the role of Congress to make sure that happens and that when they're looking at safety and effectiveness they're just not looking in the short term. That's one of the things we've found. When studies are done over a period of a few weeks or a few months, products may seem safe and effective. When they're studied over a long time that they're used, the results could be entirely different. I think Phen/Fen is a really good example of that. I first heard of some of the risks of Phen/Fen when I was working in the Senate a few years ago. And somebody on my staff spoke with a scientist at the FDA who was very concerned about the safety of this product and how it harmed humans, but in a year since that time it has gone on to be prescribed to thousands of women and one of the problems with that drug is that it's used in an off-label way. I'll talk about that a little bit later because it is a different kind of issue.

Is it the role of government to provide accurate information about health issues? Yes, that's the role of the Department of Health and Human Services and so the legislation that's been introduced by Nita Lowey and Louise Slaughter can help address that issue and we'll get into that.

Let me first focus on HHS. HHS can fund research preventing and treating eating disorders and it already does that. The question is do they do enough of it. Can they do more of it. Is that a decision that the Department of Health and Human Services makes on its own or is that a decision that can be influenced by Congress. Both those things are true. HHS can make those decisions, and Congress can influence those decisions about the amount of money that goes into them. HHS can hold a consensus conference. That's another thing that Congress can urge. The consensus conference can discuss some of the same issues we've discussed today, they can talk about dieting drugs and dieting products in a very detailed way over a period of a couple of days. They could bring in experts from all over the country. They could be discussing products like Phen/Fen, they could be discussing Slim Fast, they could be discussing different products and different programs. At the end of the consensus conference, they could make statements that would then get publicized all over the country about the effectiveness of certain products and the dangers. It's not a great cure-all but it does help get the information out. That the public really deserves. They could also hold a medical conference, a consensus conference at NIH to talk about the mechanisms by which weight is gained or lost, why long term weight loss is so rare. They could talk about the dangers of yo-yo dieting, those kinds of things. So again, those are experts talking to each other, but it can gain a lot of publicity, it can end up on evening news. It can influence what individuals do and the programs that become available across the country.

HHS can also work on a public education campaign they can fund one, they can fund a hotline as in this legislation that been introduced. That another way to get the information more long-term. The role of the FDA is also potentially essential. Since 1995 there have been food labels that tell you about calories. But that's only on food labels that you buy in the supermarket. You could still go to McDonald's any day and use up you entire week's supply of calories on one meal and you won't know it. I think the same is true of many other places. I got the shock of my life when I found out about Boston Market because it's chicken and you think it's healthy and when you actually count up the calories and it's very impressive. Now these, they do have to provide information to consumers if you ask for it. And I did go to Burger King yesterday and they do have a big thing on the wall that tell you what the calories are, but of course, if they had it right there on the wrapper, it might have more of an impact. But still that only tells you about certain products, and you'll still go to restaurants and won't know what the calories are. And of course, that doesn't really get to some of these other issues. It helps to be informed, it only helps you to make informed decisions but it doesn't help you with some of the other eating disorders issues we brought up earlier today.

I already talked about diet pills being proven safe and effective. In 1991 FDA actually banned 111 weight control ingredients. These were ingredients that had been in weight control products including things like caffeine and alcohol and a lot of other things you never heard of used in weight control products but had no use in those products. So they banned them. Obviously, they could do more looking at the long-term safety and effectiveness of these products. I'll talk very briefly about off-label uses... Medical products have to be approved for specific use. They have to be proven safe and effective for a specific use, but once they are marketed for that specific use, they can be prescribed for virtually any other use. That's the example of Phen-Fen. These are drugs that were approved for another use but they are being prescribed widely for something where they did not have to prove that they are safe and effective. That's the law. It's not against the law. That's not a law that's going to change. In fact a lot of effort has gone into, in the last couple of years, weakening that law. So that's something that you should be aware of.

Lastly, the FTC regulates advertising. They do in fact encourage consumers to bring false advertising to their attention. In February, for example, the FTC won a court order to halt accepted advertising by Slim America, which is one manufacturer of dieting products. Just last October, the FTC released a report talking about how Americans have been consuming less fat and cholesterol as a result of information that has become available since the late 80's. So obviously, information can be helpful, but the FTC could certainly do a lot more and that is something that those of you who work for Congressmen who are active in those kinds of issues where they could be encouraged to do more to really help consumers get the information they need. I just wanted to end up by saying that you really are in a position where much is possible. And it's possible on many different levels. A hotline isn't the answer, but it's one thing that can be helpful. A consensus conference isn't going to solve everything, but again it's something that can really help. Hearings that can publicize an issue that get attention can help. Money going to demonstration projects that are then evaluated to see how well they work. All of that can help. Research on prevention and treatment. that can help. And so even though this is a very big problem and very complex, and we're not going to change society this week probably, and we're probably not going to change all the stresses on girls and women to look a particular way. But you can make a difference when we start that process moving in a different direction. Thanks.

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