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ChangeWave Research: Alliance Obesity Survey

ChangeWave Research Report:Alliance Obesity ReportObesity Still on the Rise – Along With Increased Use of Medications, Treatments and Surgery Overview

During the week of February 9-14, 2005 we surveyed Alliance healthcare members to see how doctors, patients and the overall industry are dealing with Obesity. A total of 141 healthcare members knowledgeable about Obesity participated in the survey, including 84 doctors.

Increasing Numbers of Obese Patients. Three-in-four doctor respondents (75%) report they have seen an increase in the number of obese patients over the past year – with 27% calling it a “Significant” Increase” and 48% calling it “Moderate.”

Increase in Dangerously/Morbidly Obese Patients. Seventy-one percent (71%) of

doctors say they have seen an increase in the number of “Dangerously or Morbidly Obese” patients in the past year (19% “Significant Increase;” 52% “Moderate”).

More Obese Patients Receiving Medication/Treatment/Surgery. An overwhelming 86% of doctors say they have seen an increase in the past year in the number of obese patients receiving medications, treatments or surgery for the disease (24% “Significant Increase;” 62% “Moderate”).

Top Dietary Interventions for Obese Patients. A diet emphasizing a “Reduction in Calories” (70%) is the top dietary intervention doctors typically recommend to persons who are obese but not “Dangerously or Morbidly” obese – followed by a “Diet Program” (e. g. Weight Watchers; 29%) and a “Reduction in Carbohydrates” (25%).

Top Dietary Interventions for Dangerously or Morbidly Obese. A diet emphasizing a “Radical Reduction in Calories” (i.e., 1100-1200 Total Calories Per Day; 38%) is the top dietary intervention doctors typically recommend to “Dangerously or Morbidly” obese individuals.

Dietary Intervention Winners. When asked which dietary intervention will experience the largest increase in popularity among obese patients and recommending physicians over the next year, 44% of doctors chose “A Diet Emphasizing a Reduction in Calories” (44%) – followed by “A Diet Emphasizing a Reduction in Carbohydrates” (26%) and “A Diet Program” (e.g. Weight Watchers; 24%).

Top Weight Control Product. Weight Watchers (44%) is the top weight control product recommended by doctors to obese patients, followed by “Other Weight Loss Programs (e.g., Jenny Craig)” (26%) and Fat Absorption Blockers (17%).

Copyright ©2005 ChangeWave ResearchAll rights reserved.

March 21, 2005


Xenical and Meridia are Top Weight Control Drugs. Xenical (Roche; 29%) and Meridia (Abbott Labs; 19%) are the top drugs that doctors report their practice or clinic recommends to obese patients for weight control.

Optimism About Gastric Surgery Reimbursement. A majority (52%) of doctors believe payors are going to be more willing to reimburse for Gastric Bypass and Gastric Banding surgery over the next 12 months.

Gastric Bypass vs. Gastric Belt. While 29% of doctors see the market for gastric bypass surgery growing faster than the market for gastric banding (gastric belt) surgery, 24% see the opposite occurring. Similarly, doctors report that slightly higher percentages of their Morbidly Obese patients are considering undergoing gastric bypass surgery than gastric banding (gastric belt) surgery.

BiDil’s Prospects. Only 29% of doctors say they have heard of the heart failure drug BiDil. Yet when told that BiDil trials were stopped due to overwhelmingly positive results among African American patients, 37% of doctors said they were “Very” or “Somewhat” Likely to recommend it to their African American patients with heart failure, if the drug received FDA approval. Only 8% said they were “Unlikely” to recommend it.

Bottom Line: The survey results provide strong evidence that the overall number of obese patients is continuing to rise, including the number of “Dangerously or Morbidly” obese patients. Moreover, doctors overwhelmingly report an increase in the number of obese patients receiving medications, treatments and/or surgery for the disease.

Xenical (29%) and Meridia (19%) are the top drugs doctors report their practice/clinic recommends to obese patients for weight control. A majority (52%) of doctors also believe insurance payors are going to be more willing to reimburse for Gastric Bypass and Gastric Banding surgery over the next 12 months. In this regard, doctors report a slightly higher percentage of their morbidly obese patients are considering gastric bypass surgery than gastric banding (gastric belt) surgery.

Diets emphasizing a “Reduction in Calories” (70%) are the primary intervention doctors typically recommend to their obese patients. However, doctors also reported that their primary intervention for “Dangerously or Morbidly” obese patients is a “Radical Reduction in Calories” (38%).

The ChangeWave Alliance is a group of 5,000 highly qualified business, technology, and medical professionals in leading companies of select industries—credentialed professionals who spend their everyday lives working on the frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment research and intelligence topics, collects feedback from them electronically, and converts the information into proprietary quantitative and qualitative reports.

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Table of Contents

Summary of Key Findings.............................................................................................4

The Findings...................................................................................................................5

ChangeWave Research Methodology........................................................................19

About ChangeWave Research....................................................................................20


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I. Summary of Key Findings

Introduction

During the week of February 9-14, 2005 we surveyed Alliance healthcare members to see how doctors, patients and the overall industry are dealing with Obesity. A total of 141 healthcare members knowledgeable about Obesity participated in the survey, including 84 doctors.


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Number of Obese Patients Rises 75% of doctors say they

have seen an increase in the number of Obese patients over the past year

Number of Morbidly Obese Patients Rises Too 71% of doctors say they

have seen an increase in number of Dangerously or Morbidly Obese patients in the past year

Increase in Number With Non-Dietary Interventions 86% of doctors say they

have seen an increase in number of Obese patients receiving medications, treatments or surgery to treat Obesity

Top Interventions Recommended forObese Patients Dietary Interventions:Non-Morbidly Obese “Reduction in Calories” (70%) “A Diet Program” (29%) “Reduction in Carbs”(25%)

Morbidly Obese “Radical Reduction in

Calories” (38%) “Reduction in Calories” (35%) “A Diet Program” (35%)

Winners – Next Year “Reduction in Calories”

(44%) “Reduction in Carbs”(26%) “A Diet Program” (24%)

OTC Weight Control Products Weight Watchers (44%) Other Weight Loss Programs

(i.e Jenny Craig) (26%)

Weight Control Drugs Xenical (29%) Meridia (19%)

Gastric Surgery Market Prospects While 29% of doctors

see the market for gastric bypass surgery growing faster than the market for adjustable gastric banding surgery, 24% see it growing slower

Optimism About Surgery Reimbursements 52% of doctors believe

Payors will be more willing to reimburse for Gastric Bypass and Gastric Banding surgery over the next 12 months


II. The Findings

Total Respondents (n = 141)Doctor Respondents (n = 84)All Other Respondents (n=57)

(1) Question Asked: Within your practice or institution, have you seen an increase in the number of Obese patients, a decrease, or has the number of Obese patients remained the same over the past year?

Doctors All OtherRespondents

Significant Increase in Obese Patients (More Than 10% Increase)

27% 32%

Moderate Increase in Obese Patients (1%-10% Increase) 48% 40%Decrease in Obese Patients 2% 0%No Change in the Number of Obese Patients 19% 4%Don't Know 2% 5%Not Applicable 0% 16%No Answer 1% 4%

Increasing Numbers of Obese Patients. Three-in-four doctor respondents (75%) report they have seen an increase in the number of obese patients over the past year – with 27% calling it a “Significant” Increase” and 48% calling it “Moderate.” Only 2% say they have seen a decrease.

(2) Question Asked: Within your practice or institution, have you seen an increase in the number of Dangerously or Morbidly Obese patients, a decrease, or has the number of Dangerously or Morbidly Obese patients remained the same over the past year?

Doctors All Other Respondents

Significant Increase in Dangerously or Morbidly Obese Patients(More than 10% Increase)

19% 14%

Moderate Increase in Dangerously or Morbidly Obese Patients (1%-10% Increase)

52% 44%

Decrease in Dangerously or Morbidly Obese Patients 6% 0%No Change in the Number of Dangerously or Morbidly Obese Patients

19% 12%

Don't Know 4% 11%Not Applicable 0% 16%No Answer 0% 4%

Increase in Dangerously/Morbidly Obese Patients. Seventy-one percent (71%) of doctors say they have seen an increase in the number of “Dangerously or Morbidly Obese” patients in the past year (19% “Significant Increase;” 52% “Moderate”).


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(3) Question Asked: Above and beyond dietary interventions, have you seen an increase in the number of Obese patients receiving medications, treatments or surgery to treat Obesity, a decrease, or has the number of Obese patients receiving medications, treatments or surgery remained the same over the past year?


Significant Increase in Obese Patients Receiving Medications, Treatments or Surgery (More than 10% Increase)

24% 21%

Moderate Increase in Obese Patients Receiving Medications, Treatments or Surgery (1%-10% Increase)

62% 44%

Decrease in Obese Patients Receiving Medications, Treatments or Surgery

0% 2%

No Change in the Number of Obese Patients Receiving Medications, Treatments or Surgery

11% 5%

Don't Know 2% 11%Not Applicable 0% 14%No Answer 1% 4%

Patients Receiving Non-Dietary Medications, Treatments or Surgery Increased. Eighty-six percent (86%) of doctors say they have seen an increase in the number of Obese patients receiving medications, treatments or surgery to treat the disease, with 24% saying “Significant” and 62% saying “Moderate.”

(4) Question Asked: What percentage of your practice or clinic's Obese patient population would you estimate are currently receiving medications and/or other treatments for Obesity, or have undergone surgery for Obesity?


1-10% 42% 16%11%-25% 24% 19%26%-50% 7% 11%Greater than 50% 6% 5%Don't Know 14% 19%Not Applicable 7% 26%No Answer 0% 4%

Percentage of Obese Patients Receiving Medications, Treatments or Surgery. Forty-two percent (42%) of doctors report that 1-10% of their practice or clinic’s Obese patients are currently receiving medications, treatment, or have had surgery for Obesity. Another 37% report that more than 10% of their Obese patients are receiving Medications/Treatments or have had surgery.


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(5) Question Asked: Which of the following dietary interventions would you most typically recommend to persons who are Obese but not Dangerously or Morbidly Obese (i.e., have a medical need to lose weight, but are not diabetic and do not suffer from coronary heart disease)? (Choose No More Than Two)


A Diet Emphasizing a Reduction in Calories 70% 49%A Diet Program (e.g. Weight Watchers) 29% 21%A Diet Emphasizing a Reduction in Carbohydrates 25% 19%Any Diet the Patient has Used Successfully in the Past 15% 14%A Diet Emphasizing a Reduction in Fat Intake 13% 23%A Diet Emphasizing a Radical Reduction in Calories (i.e., 1100-1200 Total Calories Per Day)

12% 14%

A Diet Emphasizing Supplements (Slimfast, Medifast) 4% 4%Don't Know 1% 9%Other 7% 12%

Top Dietary Interventions for Non-Morbidly Obese. “A Diet Emphasizing a Reduction in Calories” (70%) is the top dietary intervention doctors typically recommend to persons who are obese but not “Dangerously or Morbidly” obese – followed by a “Diet Program” (e. g. Weight Watchers; 29%) and a “Reduction in Carbohydrates” (25%).

While “A Diet Emphasizing a Reduction in Calories” (49%) is also the top response among all other respondents, “A Diet Emphasizing a Reduction in Fat Intake” (23%) is second, followed by “A Diet Program” (e. g. Weight Watchers; 21%) and “A Diet Emphasizing a Reduction in Carbohydrates” (19%).

(5A) Question Asked: Which of the following dietary interventions would you most typically recommend to persons who are Dangerously or Morbidly Obese? (Choose No More Than Two)


A Diet Emphasizing a Radical Reduction in Calories(i.e., 1100-1200 Total Calories Per Day)

38% 33%

A Diet Emphasizing a Reduction in Calories 35% 23%A Diet Program (e.g. Weight Watchers) 35% 33%A Diet Emphasizing a Reduction in Carbohydrates 20% 14%A Diet Emphasizing a Reduction in Fat Intake 10% 16%A Diet Emphasizing Supplements (Slimfast, Medifast) 7% 4%Any Diet the Patient has Used Successfully in the Past 6% 11%Don't Know 0% 9%Other 17% 18%

Top Dietary Interventions for Dangerously or Morbidly Obese. A diet emphasizing a “Radical Reduction in Calories” (i.e., 1100-1200 Total Calories Per Day; 38%) is the top dietary intervention doctors typically recommend to “Dangerously or Morbidly” obese


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individuals. “A Diet Emphasizing a Reduction in Calories” (35%) and “A Diet Program” (e.g., Weight Watchers; 35%) tied for second.Among All Other Respondents, “A Diet Program” (e.g. Weight Watchers; 33%) tied with “A Diet Emphasizing a Radical Reduction in Calories” (i.e., 1100-1200 Total Calories Per Day; 33%) as the top dietary intervention most typically recommended to persons who are Dangerously or Morbidly Obese.

(5B) Question Asked: Over the next year, which of the following dietary interventions do you think will experience the largest increase in popularity among Obese patients and recommending physicians? (Choose No More Than Two)


A Diet Emphasizing a Reduction in Calories 44% 40%A Diet Emphasizing a Reduction in Carbohydrates 26% 16%A Diet Program (e.g. Weight Watchers) 24% 28%A Diet Emphasizing a Reduction in Fat Intake 17% 12%A Diet Emphasizing Supplements (Slimfast, Medifast) 12% 12%Any Diet the Patient has Used Successfully in the Past 10% 9%A Diet Emphasizing a Radical Reduction in Calories (i.e., 1100-1200 Total Calories Per Day)

8% 16%

Don't Know 15% 14%Other 6% 4%

Dietary Intervention Winners – Next Year. When asked which dietary intervention will experience the largest increase in popularity among obese patients and recommending physicians over the next year, 44% of doctors chose “A Diet Emphasizing a Reduction in Calories” (44%) – followed by “A Diet Emphasizing a Reduction in Carbohydrates” (26%) and “A Diet Program” (e.g. Weight Watchers; 24%).

(6) Question Asked: Which of the following OTC supplements or weight control products does your practice or clinic recommend to obese patients? (Check All That Apply)


Weight Watchers 44% 35%Other Weight Loss Programs (i.e Jenny Craig) 26% 18%Fat Absorption Blockers 17% 14%Medifast 14% 4%SlimFast 13% 9%Appetite Suppressants (e.g., Xenadrine, Dexatrim) 8% 12%Other Diet Supplements (e.g. Cortisol, Acutrim Natural, Twinlab Diet Fuel)

4% 0%

Ephedrine Based Products 0% 4%Don't Know 14% 39%


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Other 15% 7%

Top Weight Control Product. Weight Watchers (44%) is the top weight control product recommended by doctors to obese patients, followed by “Other Weight Loss Programs (e.g., Jenny Craig)” (26%) and Fat Absorption Blockers (17%).

(6A) Question Asked: And which of the following pharmaceuticals for weight control does your practice or clinic recommend to obese patients? (Note: If you prescribe the generic form, please check the brand name). (Check All That Apply)


Xenical 29% 21%Meridia 19% 16%Adipex 6% 7%Phentermine 6% 12%Bontril 5% 0%Tenuate 5% 4%Fastin 4% 7%Ionamin 4% 2%Didrex 1% 2%Don't Know 30% 47%Other 18% 9%

Xenical and Meridia are Top Weight Control Drugs. Xenical (Roche; 29%) and Meridia (Abbott Labs; 19%) are the top drugs that doctors report their practice or clinic recommends to obese patients for weight control.

(7) Question Asked: Gastric Bypass surgery and Adjustable Gastric Banding (gastric belt) surgery are both used to reduce the ability of patients to consume food. Which of the following statements best reflects your opinion on the relative market growth of these two procedures?


The market for gastric bypass surgery is growing faster than the market for adjustable gastric banding (gastric belt) surgery

29% 25%

The market for gastric bypass surgery is growing slower than the market for adjustable gastric banding (gastric belt) surgery

24% 16%

The market for gastric bypass surgery is growing the same as the market for adjustable gastric banding (gastric belt) surgery

13% 16%

Don't Know 35% 35%No Answer 0% 9%

Gastric Bypass vs. Gastric Belt. While 29% of doctors see the market for gastric bypass surgery growing faster than the market for gastric banding (gastric belt)


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surgery, 24% see the opposite occurring. Another 13% see the two markets growing the same.(7A) Question Asked: New Medicare guidelines announced in July 2004 removed language that stated Obesity is not a disease. Yet the final decision has not yet been made on whether Medicare policies will be changed regarding coverage for Bariatric surgery - including Gastric Bypass and Gastric Banding surgery.

How would you characterize the willingness of payors to reimburse for Gastric Bypass and Gastric Banding (gastric belt) surgery over the next 12 months?


Payors Will Be Significantly More Willing to Reimburse 12% 11%Payors Will Be Somewhat More Willing to Reimburse 40% 40%There Will Be No Change in Payor Willingness to Reimburse 19% 18%Payors Will Be Less Willing to Reimburse 6% 2%Don't Know 21% 25%Other 1% 5%

Optimism About Gastric Surgery Reimbursement. A majority (52%) of doctors believe payors are going to be more willing to reimburse for Gastric Bypass and Gastric Banding surgery over the next 12 months (12% “Significantly More Willing” and 40% “Somewhat”). Only 6% say payors are going to be less willing to reimburse.

(7B) Question Asked: What percentage of your practice or clinic's patients that are Dangerously or Morbidly Obese would you estimate have already undergone Gastric Bypass or Gastric Banding (gastric belt) surgery?


1-5% 52% 30%6-10% 12% 5%11%-25% 4% 9%26%-50% 2% 4%Greater than 50% 0% 0%Don't Know/ No Answer 18% 30%Not Applicable 12% 23%

Morbidly Obese Patients and Gastric Surgery. Eighteen percent (18%) of doctors report that greater than 5% of their morbidly obese patients have already had gastric surgery. But a majority of doctors (52%) report that only 1-5% of their morbidly obese patients have had gastric surgery.


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(8) Question Asked: Currently, what percentage of your practice or clinic's patients that are Dangerously or Morbidly Obese would you estimate are considering undergoing Gastric Bypass surgery?


1-5% 26% 11%6-10% 25% 12%11%-25% 14% 9%26%-50% 2% 9%Greater than 50% 1% 2%Don't Know 22% 32%Not Applicable 8% 26% Four-in-ten doctors (41%) report that more than 5% of their practice or clinic's Dangerously or Morbidly Obese patients are considering undergoing Gastric Bypass surgery.

(8A) Question Asked: And currently, what percentage of your practice or clinic's patients that are Dangerously or Morbidly Obese would you estimate are considering undergoing Gastric Banding (gastric belt) surgery?


1-5% 33% 5%6-10% 10% 12%11%-25% 11% 5%26%-50% 4% 4%Greater than 50% 1% 2%Don't Know 33% 35%Not Applicable 8% 26%No Answer 0% 11%

One-in-four doctors (26%) report that more than 5% of their practice or clinic's Dangerously or Morbidly Obese patients are considering undergoing Gastric Banding surgery.

Gastric Bypass vs. Gastric Belt. In sum, doctors report that slightly higher percentages of their Morbidly Obese patients are considering undergoing gastric bypass surgery than gastric banding (gastric belt) surgery.


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These last few questions were on BiDil, a heart disease drug from Nitromed. (9) Question Asked: The drug BiDil, made by Nitromed, has shown positive results for treating African Americans with heart failure in late stage trials. Have you heard of BiDil?


Yes 29% 25%No 70% 68%No Answer 1% 7%

(9A) Question Asked: Recently (July 2004), BiDil trials were stopped due to overwhelmingly positive results in a sample of African Americans. The drug is now awaiting FDA approval. If this drug were to be approved, what is the likelihood you would recommend or prescribe it as a treatment for your African American patients with heart failure?


Very Likely 20% 9%Somewhat Likely 17% 14%Somewhat Unlikely 4% 2%Very Unlikely 4% 0%Don't Know 19% 28%Not Applicable 31% 35%No Answer 6% 12%

BiDil’s Prospects. Only 29% of doctors say they have heard of the heart failure drug BiDil. Yet when told that BiDil trials were stopped due to overwhelmingly positive results among African American patients, 37% of doctors said they were “Very” or “Somewhat” Likely to recommend it to their African American patients with heart failure, if the drug received FDA approval. Only 8% said they were “Unlikely” to recommend it.

(10) Question Asked: What percentage of patients served by your practice or clinic are African American?


1-5% 36% 9%6-10% 18% 5%11-25% 20% 16%26-50% 6% 7%51-75% 4% 4%Over 75% 1% 0%Not Applicable 12% 49%


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No Answer 4% 11%Percentage of Patients Who Are African American. Only 5% of doctors say that more than 50% of patients served by their practice or clinic are African American. A majority (54%) say that African Americans account for 1-10% of their patients, and another 26% say 11-50% of their patients are African Americans.

(11) Question Asked: In your opinion, what are the benefits and/or drawbacks to "Ethnocentric Drugs" such as BiDil, that are clinically more effective in treating disease within specific ethnic groups? (n=62)

Benefits and Drawbacks to ‘Ethnocentric Drugs’. When asked to name the benefits from ‘Ethnocentric Drugs’ such as BiDil, respondents cited targeted genetic therapy and the ability to optimize individual treatment. Among the drawbacks cited are tradeoffs in terms of time and costs, as well as putting medicine into the realm of political and discriminatory issues, rather than letting science dictate.

As Doctor JAM8235 writes, "…Ethnocentric drugs are precursors of drugs targeting individual genomic makeup for optimal individual treatment and that is very exciting in maximizing potential and minimizing side effects." And Doctor WLU8236 adds, "… therapy more tailored to individuals or the group to which they belong will be more effective, with generally better compliance and possibly lower cost to society..."

Citing the drawbacks, Doctor WLU8236 writes, "… testing a drug for specific subgroups often takes additional time (meaning additional delays before those patients can start enjoying the benefits), adds to development cost and may become such a hurdle that few want to take the risk." Doctor SSL1154 adds, "… The drawback of these labels is that it chances the polarization of medicine on ethnic or other issues. The only issue is whether a treatment is scientifically sound and beneficial to anyone."

The following are additional Alliance Member Responses:

(a) Benefits

Doctor JAM8235 writes, "Any additional treatment options available, especially in a combination format, is good for the patients. Ethnocentric drugs are precursors of drugs targeting individual genomic makeup for optimal individual treatment and that is very exciting in maximizing potential and minimizing side effects."

Doctor WLU8236 writes, "Benefits: therapy more tailored to individuals or the group to which they belong will be more effective, with generally better compliance and possibly lower cost to society..."

Doctor KER5863 writes, "The benefits are targeted therapy. This approach will have increasing application with genetic based therapies …"

Doctor MTA6607 writes, "Gene related diseases respond well to specificity."


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CHM7478 writes, "Highly desirable, since we know that diseases and disease processes are differentially distributed among ethnic groups."

ARD6888 writes, "Finally acknowledges that genetics and genomics play a role in human health issues. PC should not apply to health care."

Doctor HER4689 writes, "The bottom line is whether on not the patients take their meds, not who they are designed for. However, there is the distinct possibility that more patients would be likely to take their meds if they were ethnocentrically accepted."

Doctor ECR4086 writes, "There is likely significant benefit to ethnocentric therapies in general as the medical literature, esp. in heart disease, has revealed many differences in the response to therapies based on these differences, i.e., Hepatitis C and decreased response from African-Americans, African Americans better response to diuretics for BP control etc."

Doctor AVW4264 writes, "Bidil will probably prove to be effective not only in Afro-Americans."

Doctor SR10005 writes, "As long as they work, it should not matter what particular population will benefit. We all know genetics plays a great deal in disease onset and process, and if drugs are developed to be advantageous to one group over another - then so be it..."

DHA7570 writes, "Benefit: More arsenals in our hand…"

GHT7817 writes, "From a PhD (not MD) point of view -- I think ‘ethnocentric drugs’ are a very good idea. Clearly there are gender and ethnic differences -- use the best drug for the person."

Doctor GTG1086 writes, "No drawbacks, only benefits for the effected patients, e.g., Travatan, a glaucoma medication that works slightly better for blacks."

Doctor JGE3402 writes, "Patient tailored medicine is always better."

JAC7862 writes, "I can only think it is a benefit to narrow down a specific drug which works with a specific ethnic group."

JMA0132 writes, "The more we learn about specific (patient by patient & group by group) but subtle chemical differences in cell receptors, proteins, gene specific variations the more we will see programs that ultimately will be specific to individual patients."

P2P3810 writes, "ARBS like Cozzar and Hyzzar made by Merck has drawbacks on treating African Americans and this particular patient group tends to have a high morbidity and mortality percentage of having a cardiac event. So, in my opinion, ‘Ethnocentric drugs’ like Bidil in a drug category that has patient demand will bode well in its niche market."


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Doctor FSC4718 writes, "Must be aware of ethnic biodiversity, and prescribe accordingly."

OPT2917 writes, "Benefits: improved health ..."

FFR2565 writes, "Understanding the mechanisms that make such drugs more effective in specific ethnic populations and exploiting that knowledge.”

WIL1338 writes, "Benefits are that patients are treated taking their genetic reality into account. This also yields data that can help to determine underlying genetics, helping to explain what the mechanism could be leading to e.g. high blood pressure."

KVR1320 writes, "Benefit: Drugs are available to Rx diseases that are unique to the ethnic groups …"

FLO8176 writes, "Same as personalized medicine (prescriptions based on extensive diagnostic tests to identify likelihood of positive treatment responses and/or risk factors associated with particular treatment)."

SER5830 writes, "Very beneficial and the trend for the future including customized treatments based on genetic diversity."

Doctor SHA3031 writes, "This is the only drug accepted which has shown efficacy in an ethnic group only."

Doctor EBO5105 writes, "It is a matter of ethnicity. This group has specific phenotypic and genotypic characteristics that make this drug more beneficial for them. Other factor that could influence on this is the salt sensitivity of this people. Some of them have homodynamic changes like blood pressure increase when they eat food with more than 2 g of NaCl per day. Patients with heart failure are treated with low salt diet. The problem is that adherence to low salt diet is also low."

Doctor ABG4789 writes, "Clear pharmacogenetic benefits..."

Doctor AMO7582 writes, "Any time there is better focused drug it is an improvement."

Doctor VDS1474 writes, "BiDil has not been tested in white people; most likely it also works in other races."

BOL2762 writes, "There may be benefits for ethnocentric drugs, obviously if this can be unequivocally proven. It would be useful to determine why there are ethnic differences in effectiveness so that research on new drugs may benefit from this information."

Doctor GRA1199 writes, "They will be the 'future' of medicine."


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(b) Drawbacks

Doctor ABG4789 writes, "…Other drugs, not ethnicity-specific might offer greater benefit at lower cost."

Doctor WLU8236 writes, "…Drawbacks: testing a drug for specific subgroups often takes additional time (meaning additional delays before those patients can start enjoying the benefits), adds to development cost and may become such a hurdle that few want to take the risk."

Doctor SSL1154 writes, "There shouldn't even be mention of political correctness to medicine-only scientific facts. Even the word ‘Ethnocentric’ incites my anger. The drawback of these labels is that it chances the polarization of medicine on ethnic or other issues. The only issue is whether a treatment is scientifically sound and beneficial to anyone."

Doctor SR10005 writes, "…The only drawback would be if one group or another would cry foul that they do not have a drug for them - and thus insert the notion of racism into the development of drugs; which it would not be."

JAN7532 writes, "We have to be extremely careful not to prescribe ‘the new kid on the block’, despite FDA approval, until we are absolutely sure of its safety. Remember the horror show associated with Rotavirus vaccine a few years back?? Many healthcare providers simply do not trust the results of studies published by big Pharmaceutical any more."

MYR2599 writes, "There will be allegations that drug companies are not doing enough research to find other drugs of similar effectiveness for minority populations. Others will claim that there is a concerted movement to let minorities suffer more and face earlier deaths and hardships because the drug companies and the researchers are engaging in systemic discrimination. Hopefully, reputable clinicians will offer acceptable explanations on the hows and wherefores of such drugs."

DHA7570 writes, "…Draw back: Ethnic specificity."

OPT2917 writes, "…Drawbacks: Fuels discrimination by emphasizing racial differences that are biologically undesirable."

Doctor STE3218 writes, "May be statistical abnormality. I would like to see further studies. There is not that much difference in the biogenome."

Doctor 8486810 writes, "Less use because of ‘ethnocentric’ label."

Doctor KER5863 writes, "…The main drawback is having large enough and diverse enough study populations to tease out differences between various ethnic groups, men, women, children and eventually genetic differences."

Doctor GHM8270 writes, "We need more data before jumping headfirst into 100% prescribing of BiDil for all CHF Blacks. To treat hypertension, there is a difference in


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response to drugs used related to race and gender. Unfortunately, most of the patients that have come to me have been given the drug du jour, the latest samples left by the pharm rep, and often the wrong med for the specific patient. ‘Ethnocentric drugs’ will be used by the physician who takes the time to keep up with current treatment and will probably be underutilized."

Doctor DOC4023 writes, "Mostly a marketing ploy. In this case it's a common trade-off: cost vs. convenience and compliance."

KVR1320 writes, "…Drawback: No significant research carried out on this line because of low profits."

DRG8647 writes, "Let’s remove the race issue. Really what we are talking about is genetic profiling, drugs that work best with a specific genetic makeup, potentially the wave of the future for drug discovery. Potentially new drugs can fail in the clinic because of unacceptable adverse effects in a percentage of the patients, and genetics, rather than statistics may be the underlying factor. Genetic testing may be able to predict adverse effects in the future."

Doctor MAM7387 writes, "Most of the members of ethnic groups such as blacks in the US are really of mixed racial ethnicity and there is even great variation dependant on which part of Africa their relatives migrated from.”

Doctor LEO7024 writes, "It depends on the group. In the case at hand, there will be members who will complain that they are being discriminated against because they're black and will view these meds as a plot against them because the pharms are white owned and the scientists are white. Re: Aids in Africa."

Doctor DJA1158 writes, "Politics over science prevails."

(c) Other

Doctor BUC1834 writes, "The term is misleading-many drugs target various demographic groups. This is just another group shown to benefit from a particular drug."

Doctor H_H8615 writes, "Such a difficult problem that would utilize such drugs."

Doctor WJH7828 writes, "Whatever it takes.”

Doctor MIN9289 writes, "More definitive studies are needed."

Doctor ZSA8198 writes, "They have a place."

Doctor DOC7216 writes, "I would have to wait and see the 2 to 3 year statistics as to effect and side effects to give an opinion."

Doctor FER6743 writes, "The only guiding factor should be: Does it work?"


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CRA1451 writes, "Drugs have a place, but as with emotional problems, etc., most all approaches fail without lifestyle changes by sincerely motivated patients aided by clinicians who understand the culture and background of their patients. Some payers, like Humana in Northern California, are paying for wellness vs. drugs. The drug benefit, usually a carve out, must be integrated into total costs utilizing analysis programs like those provided by Hospital Analysis (Dimensional Insight) before truly effective patient outcomes will occur. Anyone who thinks the "take another $3.00 "pill" is the answer, especially in light of the $585BB price tag to add drug benefits to Medicare, is still smoking left handed cigs."

ALA0191 writes, "Yes, if they receive FDA clearance and more importantly show good results."

LON6196 writes, "Get them on the market fast."


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III. ChangeWave Research Methodology This report presents the findings of a recent ChangeWave Alliance survey on Obesity. The survey was conducted February 9 - 14, 2005 for all healthcare members who are knowledgeable about Obesity. A total of 141 Alliance members participated, including 84 doctors.

The Alliance’s proprietary research and business intelligence gathering system is based upon the systematic gathering of valuable business and investment information directly over the Internet from accredited members.

ChangeWave surveys its Alliance members on a range of business and investment research and intelligence topics, collects feedback from them electronically, interprets and reconciles the information in a cohesive manner and converts the information into valuable quantitative and qualitative reports. The Alliance has assembled its membership team from senior technology and business executives in leading companies of select industries. Nearly 3 out of every 5 members (58%) have advanced degrees (e.g., Master’s or Ph.D.) and 94% have at least a four-year bachelor’s degree.

The business and investment intelligence provided by the Alliance provides a real-time view of companies, technologies and business trends in key market sectors, along with an in-depth perspective of the macro economy – well in advance of other available sources.


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IV. About ChangeWave Research

ChangeWave Research, a subsidiary of Phillips Investment Resources, LLC, identifies and quantifies "change" in industries and companies through surveying a network of thousands of business executives and professionals working in more than 20 industries. ChangeWave has a very unique asset in its 5,000-member Alliance. We have assembled our membership team from a broad cross section of more than 20 vertical markets such as telecom, semiconductors, data storage, and biotechnology, along with a wide range of professional disciplines including CIOs, IT managers and programmers, executive management, scientists, engineers and sales personnel. The ChangeWave Alliance is composed of senior technology and business executives in leading companies - credentialed professionals who spend their everyday lives working on the frontline of technological change. This proprietary research and business intelligence gathering system provides a real-time view of companies, technologies and business trends in key market sectors along with an in-depth perspective of the macro economy - well in advance of other available sources. ChangeWave surveys its 5,000 Alliance members on a wide range of investment research topics and converts the findings into valuable investment and business intelligence reports. ChangeWave delivers its products and services on the Web at www.ChangeWave.com. ChangeWave Research does not make any warranties, express or implied, as to results to be obtained from using the information in this report. Investors should obtain individual financial advice based on their own particular circumstances before making any investment decisions based upon information in this report.

For More Information:

ChangeWave Research Telephone: 301-279-42009420 Key West Avenue Fax: 301-610-5206Rockville, MD 20850 www.ChangeWave.comUSA [email protected]

Helping You Profit From A Rapidly Changing World ™www.ChangeWave.com


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