Is Fen-Phen Too Dangerous to Prescribe?
Two weight-control drugs--fenfluramine and phentermine, which separately have federal Food and Drug Administration approval--started being prescribed together in lower doses more than five years ago.
The combination, commonly known as fen-phen, has recently become the center of a debate following a report in the New England Journal of Medicine that 24 women using the drugs had developed heart valve disorders.
The Mayo Clinic study does not prove a direct causal link, but raises concern about the continued use of fen-phen, which in combination does not have FDA approval.
Should fen-phen, prescribed to 18 million Americans last year, be further controlled or banned?
Dr. Morton Maxwell, co-director of the UCLA Obesity Center, which has a branch in Sherman Oaks:
“Even the FDA says this is only an association, there’s no proof that the valve disorder and these drugs are connected. . . . If there is a relationship, it has to do with the large doses [of the medication]. At the UCLA Obesity Center . . . we give one-third of the usually prescribed amount. We have a thousand patient years of experience with [fen-phen] and we have never had a problem reported with it. . . . [Because of this report, however,] we are going to do a random sampling of patients. . . . I don’t think it should be banned.”
Dr. Calvin Ezrin of Tarzana, endocrinologist:
“I think it’s cause for concern. I believe that until we know more about its effects it should be more restricted than it is. . . . [Fen-phen] proved to us in the medical field that obesity was more than a lack of will-power, that there was something chemical about these patients’ needs. . . . The problem is you don’t know what the limitation is and because of that nobody on the medication is safe. . . . I think there should be some cautious control. . . . But there needs to be some kind of guidelines so that there would not be people suffering from a cold-turkey withdrawal.”
Dr. Adelaide Randak, family practitioner, Woodland Hills: “I have very mixed feelings about it. . . . I think education is the key, both for the public and physicians. . . . One of the problems here is . . . the class of appetite-suppressant drugs is getting the bad reputation. . . . It’s important because these people have significant weight problems where the danger is worse than the risk of side effects from the medication. . . . Therefore, banning it would be a mistake.”
Dr. Alan Heilpern, president of the Los Angeles County Medical Assn.:
“I don’t know [that] I would say it would be necessary to ban fen-phen. . . . It can’t be appropriated by patients without a prescription. . . . My personal feeling about fen-phen is that it can be a crutch, . . . because if it works you are reliant on having to take the drug to keep the weight off. . . . This is not to say a physician who prescribes it is a bad physician.”
Dr. Ron Lawrence, a neurologist in Agoura, former member of the President’s Council on Physical Fitness in the Reagan and Bush administrations:
“Any fat-reduction program that does not include exercise is doomed to failure. . . . I think we owe it to our patients to be honest with them and help them lose that weight, but not to do it with a drug that would be dangerous to them.”
