Clinic Doctors Downplay Dangers of Diet Drug

The pressure to be thin can be almost overwhelming. Everywhere you look, skinny models and actresses stare out at you, making it look easy in their skin-tight clothing. But being thin isn't easy. Unless you're one of the golden ones blessed with a high metabolism, shedding pounds means a strict diet and exercise regimen. So when doctors hold up some little pills and say that they are all it takes to lose weight, the temptation must be strong. And when there are doctors who specialize in prescribing that medication, is it any wonder that thousands of women are taking fen-phen? Many doctors and patients say that this "wonder drug" is the only way some people will lose weight because it keeps hunger away. But other doctors say that fen-phen's risks are being downplayed, and that it is overprescribed. Studies show the drug can raise cholesterol levels and cause pulmonary hypertension. Some people say it can even cause death. Fen-phen is actually a combination of two drugs - fenfluramine and phentermine. Both have been prescribed separately for years, but doctors only recently began using them together as a diet aid. Fenfluramine reduces appetite by stimulating serotonin levels in the brain. Phentermine also stimulates the brain. Using both drugs together enables a patient to take a smaller dose of each. Dr. Cheryle Hart, the physician at Women's Workshop, a Spokane diet clinic, says that fen-phen can be a good motivator for someone to lose weight. Because hunger is reduced and metabolism is increased, people see results fairly quickly and are thus encouraged to work on their eating and exercising habits. But Hart says that fen-phen should only be given to people where it is medically called for - "not for cosmetic reasons" - and then only as one part in a continuum of weight loss efforts, including stress reduction, nutritional instruction and exercise. At the Women's Workshop, one-on-one meetings with a fitness instructor, cooking classes and yoga are just a few of the services offered to support women and help them meet their weight loss goal. The crux of the controversy over fen-phen is that while the U.S. Food and Drug Administration has approved the two drugs' short-term (around three months) use in assisting weight loss for patients who are 20 percent or more overweight, some doctors are prescribing it for much longer periods of time, and to patients who only need to lose 10 or 15 pounds. Hart says that obesity has to be treated like other medical conditions. She likens it to someone with diabetes: "When their sugar levels are right, do you stop giving them insulin? No. Obesity is not a curable condition. It is only controllable. For that reason, we may have to manage their weight with medications," for as long as they have the problem, she says - potentially for the rest of that person's life. Hart adds that each person's medical case must be reviewed individually, and that sometimes she believes it is appropriate for a patient to permanently be on fen-phen.The use of both fenfluramine and phentermine together has never been studied by the FDA. The brand name drug Redux, a close cousin to fen-phen, has been approved to be marketed for use up to one year. "I think that for certain people, it can be of use. You have to weigh the dangers and the benefits of it," says Craig Hunt, a Spokane dietitian. "Say someone is so overweight they might drop dead of a heart attack any minute, or it is hampering their ability to live. Then those risks outweigh the risks of the drug.""Unfortunately it is being abused as a drug," he continues. "A lot of people are using it for quick weight loss, but they aren't taking the steps they need to keep the weight off." Hunt says that he is helping a woman who weighs 300 pounds with her diet. She is also taking fen-phen, which Hunt says is helping her lose weight. But while fen-phen may be appropriate in that case, he describes using fen-phen to lose 15 or 20 pounds as "risky." Despite the fact that many health care professionals say that fen-phen can be a dangerous way to lose weight, obtaining the drug is very easy. There are even doctors whose practices consist almost exclusively of prescribing fen-phen. Many weight loss centers also have physicians on staff to prescribe the drug. Insurance companies and HMOs like Blue Cross, Medical Service Corporation and Group Health Northwest do not provide benefits for weight loss medications like fen-phen. And buying the drugs can be costly - more than $100 each month. "It's a huge money maker," says Hunt. "You don't have to counsel these people. You just say, eat this and you'll drop the weight. It's capitalizing on short-term thinking." One Spokane center that doesn't offer fen-phen prescriptions is the Diet Center. Sandy Benson, a spokeswoman for Diet Center North, says that the program made a conscious decision not to prescribe fen-phen. "We don't feel that is the proper way to lose weight. It's just a quick fix," says Benson, adding that she also finds the health risks unacceptable. "I think people can have unknown health problems. They might never have a problem until they use a drug like this. Heaven forbid if someone died. I would not want someone I loved and cared about to be taking it." She says that many people - at least seven or eight each week - come to Diet Center North looking for a fen-phen prescription. When they find out the weight loss program there doesn't offer the drug, they look elsewhere. Hunt says fen-phen may just be "another yo-yo diet fad." He says that he would try to discourage most of the people who come to see him from taking fen-phen. But most people who take fen-phen say that the medicine is not the easy way out, but the only way out. Many have tried diet after diet and failed time after time. To these people, fen-phen is the answer to their prayers. One Spokane woman, who asked to remain anonymous, says that she took fen-phen to take off 20 pounds because she just couldn't do it alone. She adds that it gave her weight loss program a "jump start," and helped her get excited about eating properly and exercising because the first pounds came off so easily. She lost all of the weight in three months and says she experienced no adverse reactions to the fen-phen. She has since stopped taking the medication, but says she would consider taking it again if she gained the weight back.Doctors and nutritionists on all sides of the issue agree that people need to acquire proper eating and exercising habits if they are to have any hope of losing weight and keeping that lost weight off. A 1992 University of Rochester study found that the average weight loss while on fen-phen was 31 pounds in eight months. But while the pounds may fall off, they may also build right back up. Most people regain the weight in just a couple years after they stop taking fen-phen. And they also regain weight even if they continue taking the drug. The only long-term study of fen-phen's weight loss effects, by pharmacologist Michael Weintraub, found that after taking fen-phen for eight months, patients began to gain the weight back, although they were still taking the medicine. "I really understand it because dieting the proper way is a slow loss. They see an easy way out, and they take it," says Benson. "But the best way is to eat a low-fat diet, do portion control and exercise regularly. You'll lose weight and keep it off."Fen-phen Sidebarby Deborah FeldmanWhat price would you pay for the body of your dreams - a figure that turns heads at the beach or even in the boardroom? Hundreds of dollars? Maybe thousands? How about paying for it with your mind, or even your health? Fen-phen is one of the most popular diet plans around. With fen-phen, losing weight is as simple as swallowing. Linda Richardson, a nurse at a local weight loss clinic, is proud of the weight she's shed with fen-phen. "I've lost 55 pounds, and it really has not been hard," she says. "I feel so much better about myself. I bought jeans for the first time in 20 years." But not everyone is happy with their fen-phen experience. Roberta Rosario says she suffered a stroke after several months on the diet. Tears cloud her eyes as she describes side effects that progressed from mild to menacing. "After the dry mouth, after a couple of months of being on it, the mood swings started," she says. "And then the blurry vision and the excruciating headaches. I mean, worse than a migraine, and I've had migraines all my life." Rosario describes a week-long headache that culminated in a trip to the emergency room. She says she lost her ability to talk normally and dragged her leg for weeks. Months of physical and speech therapy have corrected her external problems, but she and her husband, Ed, say they're permanently affected by the experience. In particular, they're angry that fen-phen is being prescribed without full knowledge of the side and long-term effects. "They put the thing together. They hand it out there to these women who are after something that works and there's nothing," says Ed Rosario. "It's like they're guinea pigs." In another case, a Spokane woman died of heart failure after months on fen-phen. Shortly before her death, Gaylene Bontrager was diagnosed with pulmonary hypertension, a rare, often fatal, disease occasionally caused by fen-phen. One of her doctors says he doesn't think fen-phen is to blame in her death, but admits he doesn't know what caused her fatal condition. But Bontrager's widower, Steve, says his wife was healthy and had never been diagnosed with any heart or lung problems prior to taking fen-phen. "I think it was probably a combination of the fact that she dieted for years, and lost and gained an awful lot of weight," he says. "I don't think that was probably good on her heart." In Spokane, numerous doctors prescribe fen-phen. All it takes is an hour-long visit and, at many clinics, people walk out with drugs in hand. Some health care providers say that doctors who prescribe fen-phen risk public scrutiny for this practice since it creates a financial incentive to prescribe as much fen-phen as possible. Many health experts, from internists to emergency room doctors, say the risks and benefits of using fen-phen should be weighed with the same scrutiny as the high numbers on a bathroom scale. Emergency room doctor Dave McClellan says the drug can be useful for people whose obesity poses a significant health risk. But if only want to look good in a swimsuit, the risk probably isn't worth it. "Fifty, 60 pounds is probably when you should think about talking to your doctor," he says of fen-phen. "I think that everybody who goes on this should talk it over very carefully with their doctor and decide whether the risks are worth the benefits you can get from it."

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