Eli Reshef MD
What died in the 1950’s, revived by a charlatan, landed Manny Ramirez in hot water, and is currently prescribed by health care professionals all over the U.S. as the “hottest” treatment for obesity? Human Chorionic Gonadotropin (HCG), a fertlity medication, and the HCG diet. HCG is prescribed for infertility treatment in women to promote ovulation and in men with low pituitary hormones to increase testosterone and sperm counts. It is also used illegally for doping in sports to increase endogenous testosterone production to replace synthetic androgenic steroids detectable during urine drug testing. In 1954, Dr. ATW Simeons, a British enocrinologist, wrote an article which he later published as a book called “Pounds and Inches”, describing a semi-starvation 500 calories-a-day diet augmented by low-dose daily HCG injections. He claimed that the HCG helped specific fat tissue loss in the hips, abdomen, and thighs. Long after Simeons’ death, his pseudo-scientifc diet regimen became all the rage in the U.S., with at least 80 clinics in California alone treating thousands of patients. When reports that part-time doctors were offered as much as $100,000 to simply write HCG prescription, the medical profession finally took notice.
In 1974, the Journal of American Medical Association warned against the potential hazards and lack of effect of the Simeons diet. In 1974, the Food and Drug Administration imposed a warning label on HCG against its use in diet plans. Canada went even farther by warning that HCG use in diets “borders with malpractice.” In 1976, the FTC ordered clinics and promoters of the Simeons Diet and hCG to cease making false claims about the effectiveness of HCG for weight loss, after several research trials disproved any benefit for HCG over placebo. Later studies further refuted any benefit to HCG. Case closed? Not so fast…
Enter Kevin Trudeau, an author, salesman, self-proclaimed alternative medicine advocate, and a felon. He is known for his many television infomercials as well as several best-sellers, including “Natural Cures “They” Don’t Want You to Know About” and “The Weight Loss Cure “They” Don’t Want You to Know About.” Convicted for fraud and larceny in the early 1990’s and as late as 2007, and repeatedly sued and fined by the FTC, Trudeau nevertheless revived the Simeons diet until it became a current rage.
I contacted several physicians and compounding pharmacies in Oklahoma about prescribing and distributing HCG for weight loss. All were dispensing HCG and none were aware of the origin and history of the diet. The Web is replete with testimonials about the wonders of the HCG diet and advice about obtaining the drug on the Internet. For several months, patients undergoing legitimate HCG treatment for infertility could not obtain the medication because of a rush on pharmacies by patients and weight loss clinics. The price of HCG has increased substantially. Essentially, then, healthcare professionals who prescribe this diet indirectly (and unknowingly) harm other patients.
What harm can the diet itself cause? HCG in such sub-therapeutic doses is unlikely to be effective or harmful. A 500-calories diet, especially if unmonitored, is essentially a starvation diet that may cause protein depletion from vital organs. Weight loss occurs, as it does with any calorie-restriction diet, independent of HCG effect. Most patients are likely to gain weight back, as is the case with almost 90% of patients on any fad diet, unless they drastically alter their eating habits and physical activity. While patients have the right to hurt themselves, health care professionals must not collaborate, knowingly or not, in such efforts. If we, as physicians, fail to educate ourselves about the treatments we prescribe, we are likely to repeat the mistakes of the past and violate the First Do No Harm principle that is the central tenet of our mission. Hiding behind statements like “Well, it is worthwhile for patients to lose weight even if the HCG acts merely as a placebo” is not good medicine. To be complicit with an unproven, expensive, and potentially dangerous therapy constitutes a violation of clinical and ethical principles and moves the health care profession in a downwards spiral into Mr. Trudeau’s territory.