From: dyer@spdcc.com (Steve Dyer)
Newsgroups: sci.med
Subject: Re: Adiposity 101
Date: 15 Dec 92 03:25:33 GMT
Article-I.D.: spdcc.1992Dec15.032533.28005
Organization: S.P. Dyer Computer Consulting, Cambridge MA

In article <1992Dec14.234410.11534@omen.UUCP> caf@omen.UUCP (Chuck Forsberg) writes:
>I wish I could try it.  Last month I suggested just that to Dr. Herson,
>my Kaiser Permanente endocrinologist.  I had brought with me some of
>the materials I've gathered showing the usefulness of this stuff in
>controlling obesity and insulin resistance.  He declined my offer to
>lend him these materials, stating that he was quite up to date on
>current research.  Herson stated none of this stuff was approved, and

Fenfluramine (the racemic mixture) is FDA approved, and has been for more
than 20 years.  Dexfenfluramine (the dextro isomer only) is not yet FDA
approved.

>that was that.  He put me on Verapamil 2x80mg and Micronase 5mg, which
>have lowered my glucose and BP readings.

Chuck, you should give him back a little bit of the feistiness you
display here! :-)  I would never let a doctor of mine get away with that.

>Gordon's biology/metabolism is rather different from mine, and
>the reaction to this stuff may also vary.  It's a rather
>academic question as it is not available to me.

No, it isn't available to you through your HMO.  That doesn't mean
that it isn't available elsewhere.  You'll just have to find a doctor
outside the system and pay out of pocket, not that that isn't enough
to discourage anyone.

In my case, it isn't available to me in Massachusetts, because the
Board of Registration in Medicine has prohibited M.D.'s from prescribing
any drug with sympathomimetic properties for the purpose of weight loss.
(That fenfluramine has few sympathomimetic properties is neither here
not there.)  I do not know if there is such a restriction in Oregon;
this is a very typical reaction for Massachusetts, IMHO.

>No unequivocal report of major health hazards has appeared with
>fenfluramine in spite of extensive worldwide prescription for
>decades, yet it is "not approved".  Can there be any question
>why the U.S. is Obesity Central?

There are reasons from primate studies to think it may be neurotoxic in
a fashion similar to MDMA.  However, neither MDMA users nor
fenfluramine users have exhibited any overt signs which would point to
any damage.  We're going to have to wait for autopsy results. :-)

I think you're observing the pendulum swing away from the use of drugs
in obesity in reaction to their wide use in the 60's and before.  People
who say otherwise are still voices in the wilderness.  Doctors also want
to cover their asses; there is a stigma associated with the prescription
of anorectic drugs which are controlled substances, even if they could be
considered medically indicated.  In a way, it's like the underprescribing
of opiates to control acute pain.

Now, having said that, I really doubt that fenfluramine is any kind
of magic bullet.  It might help some people follow a diet more easily.
It does have some beneficial effects on glucose tolerance, but so does
weight loss.  It's a shame that you haven't had the chance to try it,
because I suspect that such a trial would probably put it and other
related drugs into some sort of context and remove their magical
properties.

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer
Newsgroups: sci.med