Physician Pietr Hitzig angrily dismisses FDA warnings on 'fen-phen,' blaming bad doctors, not bad medicine, for the diet-drug cocktail's demise.


September 18, 1997

Dr. Pietr Hitzig adjusts his headphones as he readies for a radio interview. It's been one day since major drug companies pulled their diet pills off the market, citing patients who (x experienced heart damage, and Hitzig's Timonium office is on full alert.

On his desk is the Food and Drug Administration press release warning of the dangers associated with "fen-phen," the popular diet-pill combination he was instrumental in popularizing. On the phone is a national radio audience eager for his view on what to do next.

"Bring me the bullets," he calls out. His staff runs to produce his ammunition defending the pills.

Just as the interview begins, the fax machine in his office starts grinding, drowning him out. Hitzig's face turns red. He makes an obscene gesture at his office manager to get her attention.

With all the people trying to ruin his business, the usually entertaining Hitzig is understandably irritable. He wants to get the word out fast: He stands "ready to mend the damage" he says was caused by other doctors' indiscriminate use of the diet pill sensation.

The drug pulled from the market this week, fenfluramine and a variation sold under the name Redux, increases serotonin, the brain chemical associated with feeling full. Since 1992, it has been used with another drug, phentermine, to treat obesity and a variety of mood disorders. That was the year Hitzig coined the shorthand "fen-phen" to describe the drug combination, and began building a large international practice around it.

Other doctors have welcomed the FDA action, saying the drug is to blame for a rare but often fatal lung disorder, and may also be responsible for the damage to heart valves discovered in up to one-third of people taking the diet pill combination.

But Hitzig mourns the drug companies' decision to stop production, likening it to a voluntary recall by a meat manufacturer after the discovery of tainted hamburgers.

"Nobody died," he notes.

Meanwhile, the thousands of people who have shed various addictions with the aid of fen-phen are going to crash, he says. They will eat chocolate. They will bite their nails. Twist their hair.

Still, there's good news, he tells his radio audience: "We've got substitutes for it!"

The Ivy League physician is as well-known among patients for his charismatic, sometimes volatile personality as for his belief that doctoring has moved to a new paradigm -- and he is it.

Until the FDA intervened this week, Hitzig prescribed "fen-phen" for a multitude of chronic ailments -- obesity, AIDS, gulf war syndrome, bulimia, alcohol and drug addiction, chronic fatigue and depression among them. Today, even as he defends fen-phen employed under the right conditions, he uses a substitute regimen to treat a patient with Lou Gehrig's disease. The man attributes the improvement in his speech to the treatment he's received since becoming Hitzig's patient a few months ago.

Hitzig's new protocol uses naturally occurring substances, precursors to serotonin and dopamine -- the brain chemicals altered by fen-phen. He began using it two months ago, because naturally occurring substances, he says, are "always better."

He's named his new treatment "Nibbles-McBride." Nibbles because you don't swallow, you nibble, which permits the drug to send immediate signals to the brain, and McBride after one of his patients. Like fen-phen, this is a lifetime treatment. "You just have to change the dosage if you get PMS or mid-winter depression or allergies," he explains.

And like fen-phen, the new regimen elevates serotonin, and relies on the theory that the two brain chemicals can be balanced to achieve good health. But Hitzig believes the new regimen is effective and possibly safer.

Of course, he admits "people can find ways to do damage with Nibbles, too," if they don't follow prescribed dosages.

Hitzig says he's no Johnny-come-lately to the dangers of the drug that the Mayo Clinic of Rochester, Minn., said in July may cause valvular heart disease. A year ago, he points out, he sent a letter to a medical journal warning of its dangers in the hands of poorly trained doctors.

"Nibbles-McBride is fast becoming a replacement," he says.

At his desk, while he speaks to the radio show, he is busy pushing pills on a 61-year-old Clearwater, Fla., woman. Until today, Jamey Worthington, who suffers from depression and fibromyalgia, a painful arthritis-like condition, had been treated by Hitzig by phone. She's in town for two days to adjust her dose in his office.

"Are you still in pain?" he asks.


"Take more," he says.

"I'm cautious," she replies.

L "Very cautious," he says. "You are going to die of old age."

She laughs. Hitzig has diagnosed the problem as a deficit in one of her drug levels. Within a half hour, after she puts more of the powdered stuff on her tongue, and after her sweating is gone, Worthington relaxes.

"It feels very nice not to have the pain," she says simply.

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