Concerns Over Participant Suicides Prematurely Abort a Clinical Trial of Potentially Significant Impact on Public Health: How Will We Make Progress in Timid Times?
Obesity, among the most common “preventable” causes of morbidity and premature mortality in developed societies, fundamentally arises from a mismatch between calories consumed (ie, feeding behavior, which in the rich world occurs in the setting of essentially unlimited availability of high-calorie foods) and calories expended (largely a function of how much or little a person uses weight-bearing musculature [ie, exercise behavior]). Thus, it is useful to view obesity and its adverse cardiovascular sequelae as behavioral disorders. The psychopharmacology of obesity is an important topic from the point of view of pharmacologic treatments aimed at influencing feeding behavior [1], as well as the myriad antipsychotic and antidepressant medications associated with changes in body weight [2, 3]. 
 
Antagonists at endocannabinoid type-1 receptors (CR1) have shown promise as potential anorexic agents useful in managing obesity. The current report, documenting the abrupt cessation by the sponsor of a large, multinational trial of the CR1 antagonist rimonabant for prevention of cardiovascular sequelae of obesity, is important to the field of psychiatry from a variety of perspectives and raises troubling questions about the willingness of our leaders to take reasoned risks in the service of public health.