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Doctors, angry dieters, scramble to replace obesity drugs

September 18, 1997

With two weeks left on his ``fen-phen″ prescription, Christopher Burns has shed 60 pounds, bringing his weight under 200 pounds for the first time since he was 15.

Burns just hopes to keep the weight off when his last prescription runs out.

The 28-year-old Californian was one of more than 200 exasperated patients to call Dr. Dennis Tison within 24 hours after the drugs Redux and fenfluramine _ the ``fen″ in fen-phen _ were pulled off the market Monday at the Food and Drug Administration’s request.

Doctors like Tison and the diet centers that have made a business of prescribing the obesity drugs are scrambling for alternatives in a frenzy of hastily arranged appointments.

As the $40 billion diet industry regroups, furious patients feel doubly wounded _ first by the recall of nostrums that have done what diets often couldn’t and second by the news that those drugs may cause potentially fatal ailments.

``If the FDA is pulling the drug now, did they not test the drug right the first time? And if that’s true, we’re going to have to question the approval of other drugs,″ said Burns, a state legislative aide in Sacramento. ``Where were they when these drugs were introduced before?″

Burns was drawn to fen-phen after watching Verna King, who works a few offices away in the California Capitol, trim from 235 pounds to 180 on the drugs. After quitting last month, she has gained three pounds and is struggling to hold her current weight.

``This is a combination of drugs that can directly help people who have been yo-yo dieting all of their life,″ said Ms. King, 56. ``The easy work is done: I lost the weight. The hard work is ahead of me: keeping it off.″

About 3,000 miles away in Lynn, Mass., Keith Van Gasken shares her fear. The 6-foot health care company manager dropped a third of his body weight, from 270 pounds to 180, after 18 months on fen-phen.

``Am I concerned about gaining the weight back? You bet I am,″ he said.

He was willing to keep taking the drugs even after hearing fen-phen and Redux were linked to a rare and potentially fatal heart and lung ailment called primary pulmonary hypertension, or PPH.

But he quit last month after hearing the diet combination was linked to serious damage of patients’ heart valves that could dangerously weaken the heart.

``The PPH thing concerned me. And then when I heard about the heart valve thing I said forget it,″ Van Gasken said. ``I’m really angry at the FDA.″

Some diet doctors say there may be danger as well in dropping the drugs.

``I just feel sorry for the patients who have no recourse,″ said Pietr Hitzig, a Timonium, Md., doctor. ``They’re going to gain weight. Their depression’s going to come back. We’re going to have a lot of sad and sick people.″

In some cases, he added, ``their alcoholism is going to come back, and we’re going to see people die.″

Tison and other doctors shrug off the recall’s disruption on dieters. Though widely used in diet combinations, fenfluramine isn’t an appetite suppressant. Doctors added it to phentermine _ the other half of fen-phen _ to counteract phentermine’s side-effects. A stimulant, phentermine can leave patients jittery, dry-mouthed and constipated. Tison is replacing fenfluramine with either the anti-depressants Prozac and Trazadone.

As the FDA move disrupts dieters’ regimens, it is also rattling the practices of doctors and diet centers that have built their businesses around the diet drugs.

Hitzig has prescribed fen-phen to more than 8,000 patients, some by telephone, for ailments ranging from obesity to the ill-defined Gulf War syndrome. Like Tison, Hitzig advertised the drugs to patients on his own World Wide Web page, www.fenphen.com. The drugs and diet treatment cost $1,154 for the first six months.

Some diet doctors, like ``The Redux Revolution″ author Sheldon Levine, have erected national platforms pitching the diet drugs. Levine, who practices in Mahwah, N.J., changed his mind last month and switched most of his patients from Redux to a combination of phentermine and either diethylpropion or phendimetrazine.

``Personally, I don’t think it shudda been taken off the market,″ said Beth, 41, a Levine patient who has tried both drugs and asked that her last name be withheld. ``If you’ve ever been heavy or overweight, you know it’s hard to lose weight. Cigarettes kill, but they don’t take them off the market.″