the rose has thorn into complex
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Every rose has it's thorn!
Ambika Gopalakrishnan Unnikrishnan, Sanjay Kalra, and Ganapathi Bantwal
Additional article information
In our fight against the epidemic of metabolic disease, researchers have provided us with an array of compounds. Drugs belonging to various classes, such as endocannabinoid receptor antagonists, serotonin–norepinephrine reuptake inhibitors, and PPAR-γ receptor antagonists, have been in use for the management of various aspects of metabolic syndrome.[1,2] All had been through rigorous preclinical and clinical trials, and were proposed to be answers to the global epidemic of metabolic disease.
Drugs such as fenfluramine, phentermine, and pioglitazone were a success, as they tried to meet a significant therapeutic gap. Many reviews quoted extensive research, which established the utility of these drugs in management and prevention of disease. At about the same time, suggestions were put forward by the scientific community, and later implemented; we refer to proposals for reducing the lower limits for diagnosis of hypertension, diabetes, dyslipidemia, and obesity. While this approach was driven by an increased understanding of the risks and morbidity associated with high blood pressure, hyperglycemia, deranged lipids, and overweight/obesity, it did lead to an increase in the number of patients being offered pharmacological therapy.
Aggressive management of all constituents of the metabolic syndrome, using these, and other, drugs, was hypothesized to be a means of preventing morbidity and mortality.[2]
Physicians and endocrinologists welcomed these drugs as helpful tools in the fight against disease. Many patients benefited from good glycemic control, blood pressure control, healthy lipid levels, and weight loss.
The list of beneficial pleiotropic effects expanded with new publications. Biochemical markers, physiological parameters, imaging techniques, and other surrogate investigations were used to assess and define the mechanism of action of these drugs. This helped complement the clinical effects of these molecules.