A Little Transparency for Larger Persons, Please Dr. Makary

“If HHS Secretary Robert F. Kennedy Jr. and FDA Commissioner Marty Makary want to bring radical transparency to U.S. healthcare, they can start by updating drug labels that lack good information for persons with larger bodies. ”

In RealClearHealth yesterday, an editorial by Caroline Apovian and Ted Kyle called for policymakers at FDA to deliver on their promise of transparency in regulating drugs with disclosures about drugs that act differently in persons living with obesity.

A Simple Case in Point

It’s a simple request. The prime example is posaconazole. This is a antifungal drug that hangs around longer in larger bodies than it does in the bodies of smaller persons. A single sentence in the label could disclose it. The half-life of posaconazole is longer, 58 hours, in people with BMI greater than 35.

Doctors want this information. Everyone in this discussion agrees it’s a matter of fact that this drug lingers in the bodies of larger people. Because it interacts with other drugs, it’s important for doctors to know it. People needing an antifungal typically have complicated conditions (like cancer), requiring many different drugs with potential for interactions. In this situation, information is power that can serve to protect a patient.

Industry Stonewalling

But this simple request is one that that a pharmaceutical giant, Merck, is stonewalling. The company doesn’t make a lot money on posaconazole and doesn’t want to update the label. They say it doesn’t matter.

FDA’s new Commissioner, Marty Makary, says the agency will not be captive to a “cozy relationship” with the pharmaceutical industry. Requiring industry to update drug labels when research tells us a drug acts differently in larger persons is a good opportunity to deliver on this promise. The agency can start with posaconazole.

It’s a small step in the right direction.

Click here for the new editorial by Apovian and Kyle.

Glass Cube in Mannheim at Night, photograph by Hubert Berberich, licensed under CC BY 3.0

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July 3, 2025